Harm Reduction

Humans, it seems, are susceptible to DSS -- "do something syndrome."

Described by economist John Maynard Keynes as a desire for action over inaction, it partially explains why politicians insist on passing thousands of new laws every single year. It even explains why goalkeepers dive left or right during a soccer penalty kick, when remaining in the middle of the goal is a better decision. Doing something is preferable to not doing something.

That human urge also applies to our healthcare. A sick patient expects the doctor to do something, even if nothing useful can be done. This point has been underscored by new research scheduled to be published in the Journal of...

The “opioid epidemic” consistently addressed in the news, by politicians and throughout social media conflates many aspects of the issue, often speaking interchangeably about prescription medications and illicit drugs. When the narrative and identifying of the problems get so confused and blurred or legal and political grandstanding becomes more about virtue signaling than honest analysis of multifactorial causal agents and helpful action, the solutions get further and further out of reach. As does the suffering.

The mere existence of an opioid pill is not why there is a crisis.

Myths abound in the public forum surrounding who caused it, what “it” actually is, how we got here, what it will take to fix it and who we can blame for the totality of a truly complex situation....

Everyone agrees smoking is bad these days but how to end it has become its own cultural war, and the warring sides have come down along predictable lines. Some believe in abstinence only, some only think there should be products that are for quitting (cessation) while some believe smokers should have options for that which can also help with harm reduction while they quit. Like other cultural wars related to science and health, the sides can now be predicted politically.

It's also no surprise that one side of the culture war has flipped the narrative and declared that smoking cessation and harm reduction using e-cigarettes ("vaping") don't do anything of the kind, they instead create nicotine addiction - just like cigarettes. Even if there is no nicotine. ...

We always knew when our PhD advisor was applying for a grant. He would pace the hallways, then go outside and smoke. A lot. (Thankfully, he's quit since then.)

Why do smokers find such solace in cigarettes? It may be the nicotine. Several years ago, a (very) small experiment suggested that people who were intentionally provoked into becoming angry were less likely to retaliate if they were wearing a nicotine patch.

That's an interesting finding because, as the original study explains, "Deficits in anger management may be a risk factor for smoking initiation and...

Nowadays, some folks are raising alarm about "third-hand" smoke—residual chemicals, essentially particulate matter, left on indoor surfaces by tobacco smoke. The claim is that residues from smoking can be absorbed through the skin, ingested and inhaled months and even years after the smoke has dissipated. The alarmists say that just because you're in a non-smoking environment, it doesn't mean you aren't exposed to harmful tobacco products. (1)

No one is in favor of smoking and the real worry is that by constantly ratcheting up the hype, people will assume studies on smoking itself are also exaggerated. And that is the real problem with third-hand smoke, which isn't smoke at all. As Sandy Szwarc said, “The healthiest thing for all of us might be a helpful dose of common sense and...

The Europeanesthesia Conference had a poster/abstract [1] addressing a phenomenon “barely known by health workers,” being the second victim. The first victim is the patient who suffers an adverse outcome, for which presumably the second victim, the doctor, was in part or totally responsible. I always thought of those feelings as regret or even guilt, but I am not sure victimhood came to mind.

The Study

This was a simple survey of 34 Spanish anesthesiologists, predominantly working in tertiary referral hospitals, so no need to worry about statistics, this is just a set of quantified observations.

  • 91% felt responsible for medical errors [2] - 26% of those errors resulting in severe injury
  • Emotional responses were the most common - 84%...

Medical training involves both the learning of information and skills and because the practice of medicine can unintentionally harm individuals, supervision, and oversight. But as with riding a bike, to be truly autonomous, at some point, one has the remove the training wheels and act on their own. A study in JAMA Internal Medicine looks at the effect of closer supervision on medical error and autonomy. When residents care for hospitalized patients they participate in two team meetings, the first with supervising “attending” physicians who discuss patients and treatment plans; the second, without those supervisors, where the work of patient care is allocated, discussed and advanced – work rounds.

The study carried out at Massachusetts General Hospital internal medicine program...

When you mention infrastructure maintenance what comes to mind; roads, bridges, a political football, as exciting as watching paint dry, job creation? Have you considered the possibility that a form of infrastructure maintenance can change whether you are considered an “at risk patient” in need of aspirin or statins? That question and its answer is the subject of a new paper in the Annals of Internal Medicine.

Because we have been collecting medical data for some time, we can create mathematical models of a patient’s risk of developing complications from a variety of diseases, especially cardiovascular disease. The classic complications, heart attack, death from coronary disease and strokes have been extensively modeled, taking a large dataset on patients followed over time and...

It’s been a while since I wrote about foreign bodies in the body; but, given a recent published case report describes a 20-cm eggplant transanally positioned and stuck in the rectum of a patient, there seemed to be no better time than the present. As my series Inanimate Objects in Orifices worked its way down from the eyes, ears, nose and throat to vagina, ...

"There’s no pill or capsule that can replace your sunscreen."

And with that straightforward comment, part of a written statement from Commissioner Scott Gottlieb, the Food and Drug Administration is warning consumers not to purchase alleged sun-protection supplements from four companies because they do not work.

In addition, the public needs to be warned that taking these products misleads consumers and delivers a "false sense of security," which puts "people at risk." 

At the same time, the FDA has put these "unscrupulous" manufacturers on notice Tuesday, sending "warning letters to companies illegally marketing pills and capsules labeled as dietary supplements that make unproven drug claims about protecting consumers from the harms that come from sun exposure...