Good riddance to bad rubbish

One week ago, the FDA issued a warning regarding three Zicam products: Zicam Cold Remedy Nasal Gel; Zicam Cold Remedy Nasal Swabs; and Zicam Cold Remedy Swabs, kids size. The long overdue warning stems from the FDA receiving 130 reports of anosmia (loss of the sense of smell) since 1999. (You can count on that 130 number being the tip of the iceberg; our legal friends are interested in finding others who have been similarly affected.)

Because homeopathic products are regulated in a similar fashion to dietary supplements and not as drugs, prior FDA approval was not required for the Zicam “remedies.” But Zicam is more than a homeopathic treatment — it contains hefty amounts of zinc gluconate, which might be the culprit in these cases of anosmia.

While I’m not a huge fan of the FDA, I do think the loophole for dietary supplements and homeopathic products is ridiculous. These things get marketed as remedies, so they should be subjected to the same standard of proof as any other medication. Homeopathic agents have escaped this level of scrutiny because we docs tend to view them as placebos — sugar pills — which they often are. You see, the idea behind homeopathy is this: poisons which cause particular symptoms can, in diluted form, be used to treat diseases that have those same symptoms. The dilutions are usually so extreme that none of the poison’s molecules remain. No matter — that compound’s vibrations (or whatever) are still present. Spray this on lactose beads and you have yourself a cure.

Yup. Lactose. Milk sugar.

So, yes, we’ve winked at homeopathy all these years because we figured that snake oil salesmen will always be among us; better that our patients take a sugar pill than some tonic that might do them some harm. But this Zicam story makes me question that belief.

The AP story is worth reading, as is the excellent Quackwatch article, which includes the math demonstrating that not a single molecule of the original substance remains after a typical number of homeopathic dilutions.

What I learned on The Colbert Report tonight: Zicam is one of Rush Limbaugh’s big sponsors. Watch it here.

D.

Death by provincialism

I went to Grand Rounds today* at our nearby non-major-world-religion-affiliated hospital, where the speaker gave a talk on transgender medicine. Interesting stuff, especially the historical bits in the beginning.

It was a mixed crowd. At least one residency program rotates their docs-in-training through this hospital, so there were lots and lots of young faces. Neat! Have I mentioned how much I miss teaching and just being around residents? I do. Anyway, I spotted a few of the local docs, some young, some old. Some very old. Some docs when they retire, they hang up the stethoscope for good; some docs keep coming back to grand rounds because, well, I guess they love medicine and they like to keep up with new things. I can appreciate that.

One old guy must have been pushing ninety — tiny, hunched over, but with a briskness to his step. After the talk, he left the conference room with some of the other retirees, and said to one, “They never taught us about THAT in medical school.”

I felt like telling him, “I graduated in ’90, and they never told US about that, either!”

Add transgender to the list of Things Not Even Deserving One Hour of Lecture Time, along with nutrition and . . . well, sex. Did we get any talks at all on sex? I remember one of my female friends asking a lecturer about dyspareunia, eliciting titters from some of the students and sidelong glances at her blushing boyfriend. But that wasn’t even a lecture on sex; I think it was a lecture on genital anatomy. And NO, that does NOT count as a lecture on sex.

Sometimes I think we’re still a very provincial, puritanical nation, even in our institutions.

One lecturer even saw fit to warn us of the dangers of provincialism. Here’s the story he told the class:

This was some years ago, when most gay men outside of San Francisco remained closeted. A fellow from one of the suburbs an hour away used to come into town on the weekends, do his thing, then on Sunday evening return home, where he worked the usual Monday-through-Friday nine-to-five job. One Monday evening he developed severe abdominal pain and drove himself down to the local hospital’s ER.

The man’s abdomen was tender but not yet rigid. Who knows what the ER doc was contemplating — perhaps a general surgery consultation to evaluate the patient for appendicitis. That, at least, would have made some sense. But the patient made the mistake of telling the doctor the truth. “We were fisting,” he said.

After explaining to the doctor what this meant, the doctor decided his patient was delusional and gave him a fat shot of thorazine, which knocked the patient out. They kept him on thorazine for the next day or two . . . however long it took for the supervising physician to note that his patient had gone into septic shock. By the time anyone realized what had happened to the man, it was too late.

I took this story to heart as a cautionary tale. A doctor’s ignorance could be deadly to his patients.

Which is why, of course, I try to keep informed on all of the newest paraphilias 🙂

D.
*The idea being to shmooze the local docs . . . but they were all far more interested in the speaker than in me, a new face in the room. Oh, well. I’ll try again in a couple of weeks.