Bad Medicine Research Articles

Quantifying seasonal variations in space use within the home range of Burbot

AbstractObjectiveAdvances in acoustic telemetry have assisted biologists in understanding migration patterns, space use, survival, and the effects of human influences on aquatic species. Using fine‐scale positioning, fisheries managers can quantify home range size fluctuations throughout the year and even identify spawning areas. Burbot Lota lota population dynamics have been studied across their range, while movement dynamics have been briefly investigated. Our objective was to assess seasonal variations of Burbot space use using estimations of home range size with an attempt to infer spawn timing.MethodsThirty‐two acoustic‐tagged Burbot were used to study home range size in Bad Medicine Lake, Minnesota, from April 2019 to June 2020.ResultFemale estimated home range size was significantly larger than that of males. Estimated home range size increased following ice formation in December and continued through March. Average home range estimates were largest in the middle of March and smallest in April, assumed to be caused by spawning and postspawn behaviors, respectively.ConclusionThe results suggest that Burbot movement increased during the winter months, which may cause potential increases in vulnerability during spawning. High exploitation rates are possible in situations where spawning and feeding Burbot encounter elevated angling pressure. Future research should continue to assess the movement dynamics and potential site fidelity of Burbot populations by monitoring spawning grounds and if the same areas are used year after year. The results of this study improve the knowledge of areas used by Burbot in lakes, which can assist with management of Burbot in Bad Medicine Lake. Furthermore, we highlighted how Burbot movement increased during spawn timing, which could contribute to increased encounters with anglers.

Bad Medicine Is What I Need?

This narrative suggests that a proper recognition of “bad medicine” may need to take into consideration the needs of the patient.

Bad medicine: Litigation, competition, and the marketing of prescription opioids

AbstractResearch AbstractHow do competitors respond when a firm experiences an increased threat of penalties for questionable business activities? While conventional wisdom suggests that competitors will attempt to avoid similar activities, we draw attention to a countervailing incentive. If an increased threat of penalties induces one firm to reduce its engagement in an activity, competitors in an industry may see an opportunity to profit by increasing their engagement in the activity. We explain how this is theoretically possible even if competitors also experience an increased threat of penalties. As an empirical example, we show that following a lawsuit against Purdue Pharma, Purdue significantly decreased its spending to promote OxyContin, but other prescription opioid firms significantly increased their spending to promote competing opioids to the same physicians.Managerial AbstractCompetitive dynamics can make questionable business activities in an industry difficult to stamp out on a case‐by‐case basis. Forcing one firm to decrease its engagement in a questionable activity may result in competitors stepping in to fill the void by increasing their engagement in similar activities. We find that this occurred in the prescription opioid industry. Following a lawsuit against Purdue Pharma, Purdue significantly decreased its spending to promote its controversial OxyContin product. But rather than attempt to distance themselves from association with Purdue, other prescription opioid firms significantly increased their spending to promote competing opioids to physicians previously targeted by Purdue, including in counties where the opioid epidemic was known to be severe.

The Pitfalls of the Ethical Continuum and its Application to Medical Aid in Dying

The Pitfalls of the Ethical Continuum and its Application to Medical Aid in Dying

The undergraduate ‘corridor of uncertainty’: teaching core concepts for managing clinical uncertainty as the ‘special technique’ of general practice

ABSTRACT McWhinney’s first principle of family medicine states that GPs ‘are committed to the person rather than to a particular body of knowledge, group of diseases, or special technique’. While indeed committed to the person, we propose that the ‘special technique’ of general practice exists in the form of core clinical concepts for managing uncertainty (e.g. time as a tool, therapeutic examination, safety netting and doctor as drug). Managing clinical uncertainty calls for GPs (and trainees) to operate in a ‘corridor of uncertainty’, a cricketing analogy where the batter is unsure whether to play a defensive or attacking shot. For students to recognise and value these concepts requires longitudinal learning and simulation. Here we describe a GP module at Brighton medical school where core concepts are ‘drip fed’ through small group sessions across year 4. Formative simulated surgeries constitute a ‘corridor of uncertainty’ where simulated patients drive students into using concepts in practice (e.g. through shared management plans). Although recognised in postgraduate training, these concepts should be taught formally within the undergraduate curriculum. Doing so helps students distinguish general practice from hospital generalism and prepares them for clinical placements in general practice. These concepts are inherently ‘soft’ and founded upon the GP paradigm of understanding medicine. In the eyes of the specialist, they risk being unacknowledged, misinterpreted as ignoring guidelines or, worse still, as bad medicine. Soft core concepts constitute the tools to prepare students for managing clinical uncertainty and serve to inscribe the art of medicine within the undergraduate curriculum.

AAP Perspective: Race-Based Medicine.

Race is not a biological category that produces health disparities due to genetic differences; rather, it is a social category that can have devastating biological consequences. Social inequality impacts people’s physical and mental health. In other words, race should not be viewed as a risk factor that predicts disease, disease severity, and disability but as a risk marker of bias, discrimination, and vulnerability.In 2019, the American Academy of Pediatrics (AAP) cautioned against false notions of racial biology in its policy statement “The Impact of Racism on Child and Adolescent Health,” naming racism as a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families.1The policy denounces race-based medicine as “flawed science…used to solidify the permanence of race, reinforce the notions of racial superiority, and justify differential treatment on the basis of phenotypic differences as people from different parts of the world came in contact with each other.” The policy reminds us that just because there is no such thing as biological race, it does not mean there is no racism, cautioning that “failure to address racism will continue to undermine health equity.”In viewpoint published in the October 2020 issue of The Lancet,2 Cerdena et al describe race-based medicine as a “system by which research characterising race as an essential, biological variable, translates into clinical practice, leading to inequitable care” and names racism, rather than race, as a key determinant of health. They propose introducing “race-conscious” medicine as an alternative.Last summer, the AAP Annual Leadership Forum passed a resolution, “Prohibit the Use of Race-Based Medicine,”3 which states that “the Academy shall end the practice of using race as a proxy for biology or genetics in all their educational events and literature, and…require [that] race be explicitly characterized as a social construct when describing risk factors for disease with all presentations at AAP-sponsored conferences.”The AAP Equity Agenda,4 which sets forth explicit and intentional actions to support and implement the Academy’s commitment to equity, diversity, and inclusion, also lists eliminating race-based medicine and other forms of bias in all CME/MOC activities as a key objective.In addition, the AAP “Words Matter” guidance5 on the use of antibiased, inclusive language specifically states that “race should be acknowledged as a social construct and should not be used as a biological or genetic descriptor…[nor] used as a biological proxy for disparities.”Following these principles and direction, the AAP Board of Directors in May 2021 voted unanimously to immediately retire the guidance “Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months” because of improper use of race as a factor in disease risk.First published in 2011 and reaffirmed in 2016, the Academy’s urinary tract infection clinical practice guideline6 came into question when Kowalsky et al7 expressed concerns in a commentary published in the January 2020 issue of JAMA Pediatrics, stating that this guideline “systematically indicates differential care for black or non-white children based on a theoretical lower risk of UTI.”Given the clear evidence and overwhelming consensus that action was needed, the AAP Board of Directors took this firm stance against the use of race-based medicine in our current and future policies and is continuing its efforts to address previous harms and promote equity and transparency throughout all AAP core activities and functions, including education, programs, policy, and research.Despite the evidence, unfortunately, the use of race as a proxy for biology persists. The fact remains, however, that even when practiced in good faith, race-based medicine is bad medicine that leads to inequitable medical care and hurts the health and well-being of people of color.AAP members have been asked to systematically apply an equity lens to all core activities and functions. To realize these ideals and make this goal a reality, all AAP authors are now required to consider health inequities and the conditions needed to achieve equitable health outcomes when developing policy.All AAP authors are now asked to do the following: As AAP Immediate Past President Sally Goza, MD, FAAP, acknowledged, “Like other institutions in our society, medicine has much work to do to right the wrongs of the past and ensure that current systems are equitable. Only through honest introspection can we truly begin to disentangle the thread of racism sewn through the fabric of society and move forward toward a brighter future for all children and families.”8

The "Medical Plot Thickens": Bad Medicine and Good Health in the Contagious Diseases Acts Repeal Campaign.

Britain's Contagious Diseases Acts (1864, 1866, 1869) mandated the use of medical detention and speculum exams to manage the bodies of "common prostitutes" and thereby reduce sexually transmitted diseases among enlisted men. Repeal advocates challenged the gendered power structure of the Acts but also used melodramatic frameworks to produce a broader critique of nineteenth-century Britain's centralizing medical orthodoxy and to argue for unregulated traditional approaches to medicine. Across a variety of repeal speeches and documents, advocates idealized alternative health practices in order to challenge institutionalized modern medicine and the governmental interests that extended its authority. J. J. Garth Wilkinson's Forcible Introspection of Women for the Army and Navy by the Oligarchy, Considered Physically (1870) exemplifies the multivocal and intertextual medicolegal plots of repeal melodrama as it cast professionalized modern medicine as corrupt, villainous, and in collusion with the state while presenting alternative medicine as authentically preventative, curative, and democratic.

US executive heart screening programmes violate "do not harm" rule, say medics.

US “executive screening programmes” offer expensive cardiovascular testing even though the tests are not justified and often not covered by insurance, according to a report published in JAMA Internal Medicine .1 Leading US medical centres offer “executive screening” at prices ranging from $995 (£760; €901) to $25 000 to wealthy people who can pay out of pocket for tests not covered by insurance. Professional organisations usually do not recommend the tests for asymptomatic people and there is no evidence they reduce deaths from heart disease. Not only is this bad medicine but …

Bad Medicine? Federal Debt and Deficits after COVID-19

The government’s response to stem the pandemic has resulted in an erosion in public finances.

Bad Medicine: Nofreelunch.

I am a nobody. A bang average medical student who found a home working in the inner city of Glasgow. I also felt like a square peg in a round hole but I tried hard to fit in with my chosen profession. Twenty years ago drug reps were omnipresent in general practice, providing lunch and restaurant nights out, paying for Christmas parties, and offering international trips and endless freebies. I accepted the status quo because it was all I knew, for the hospitals had been just the same. Doctors were entitled. And when I became the local prescribing lead this largess escalated with offers of a lot more hospitality and highly paid ‘teaching’ opportunities. In the late nineties during the statin wars, a rep cupped my ear and simply …

Defensive Medicine and the Imposition of a More Demanding Standard of Care

“Defensive medicine” refers to the practice of medicine guided by the intention to avoid litigation, either by excluding scenarios with potential risks (negative defensive medicine) or by providing additional health care (positive defensive medicine). Positive defensive medicine is the topic of this article.Despite the criticism surrounding it, positive defensive medicine is increasing because doctors feel that they will be better protected from litigation if they provide more medical care. Courts, patients, and the community in general never seem to have enough medical care and are even willing to accept some negative outcomes if they feel that the doctor is doing a lot.There are, however, several negative consequences engendered by positive defensive medicine. This article focuses on a particularly pernicious one: the consolidation of an extremely demanding standard of care. If a significant number of doctors starts acting as imposed by defensive medicine, the rest will feel pressured to follow that behavior. Customary conduct will prevail over reasonable conduct.This article demonstrates that this new standard of care leads to bad medicine and eventually to medical malpractice, because it postpones necessary treatments, exposes patients to unnecessary risks, and results in ineffective medical care.

Bad Medicine: Men matter too.

Female genital mutilation (FGM) is wrong and we have rightly legislated against this as an obvious contravention of a child’s human rights. However, very large numbers of male children still undergo a form of genital mutilation: it’s called circumcision. Virtually all circumcisions are for religious and cultural reasons, and are not medically indicated.1 I have avoided certain topics such as this over the years, too afraid of the anger lying in my email inbox. But even upsetting truths need to be said. We legally allow the continued mutilation of …

Bad Medicine: From the cradle to the grave.

Born on 4 June 1985. Two parents, a big house, and lots of expectations. Brought up the proper way: sent off to boarding school, rugby, cars, golf, Ralph Lauren polo shirts, pinkie rings, pink trousers, and wine. A man’s man. Rugby made him feel he belonged and was his only acceptable emotional outlet. Married in his twenties to a woman he thought he should marry. Working in a career that made money but had no value. Up to his neck in debt, school fees to pay, and cars to maintain. Work and more work and not too much to say. Friends lived far away. Keep it all inside. Even the sexual abuse he experienced at school, which no one expected or suspected. He tried …

Counselling and psychotherapy: Hierarchies, epistemicide and bad medicine

Counselling and psychotherapy: Hierarchies, epistemicide and bad medicine

Bad Medicine: It's time for 15-minute appointments.

When I first started work as a doctor 30 years ago, 7-and-a-half-minute appointments were the norm. But this very much depended on where you worked. For a few years I worked at 6-minute intervals. People ask: how did you do it? The answer is, we just did. We also took our own bloods, did house calls in the middle of the day, referrals, acutes, and all the rest. We didn’t write much and the history and examination structure I had been taught at university was binned. Most of my undergraduate education was just plain wrong because illness never seemed to present in the …

Bad Medicine: Advanced practitioners versus doctors.

We don’t have enough doctors. This is odd because we have plenty of applicants, good universities, and the money spent on training is a fraction of the cost incurred by a limited supply. For example, locum costs in primary care are £500 a day and, incredibly, some consultants are being paid £375 000 a year.1 Scarcity is highly profitable. Is this scarcity by intent? An attempt over generations by doctors to maintain high pay and the status of the profession with no care for the negative impact on patients? Consider also if the NHS had more doctors and shorter …

Bad Medicine: Men's health.

Children are infected by their parents’ musical tastes. I went to see The Streets with two of my sons recently. They headed to the front to throw some beer and to do some shouting. The last song was ‘Dry Your Eyes’, about a man being distressed by a break-up, and is much parodied. Society seems to be uncomfortable with men expressing their emotions. But interestingly, when Mike Skinner, the lead singer, acknowledged his own mental health issues, the audience of young men cheered. It is difficult to raise men’s health issues as society seems obsessed with the notion of …

Solubility as well as Bioavailability Enhancement Techniques

Solubility is a solvent property. The word ‘solubility ’is a defined as the maximum number of disruptions possible. It can also be quantitatively defined as well as qualitatively. Quantitatively, it is defined as the ratio of solute to saturated solutions at a particular temperature. In qualitative condition, consistency can be defined as random interactions between two or more substances, which create uniform molecular dispersal. Solubilization involves the breaking of inter-ionic or intermolecular Solvent molecules, Solution between soluble molecules or ions, Space for spatial interaction. Drug, temperature, Pressure and pH Solubility is an important component get the desired concentration of medicines to systemic circulation, This is a bioavailability. Most medicines are weak acidic or weak fundamental with poor aqueous solubility. This review highlights various techniques of dissolving medicines or increase solubility of medicines. These techniques include Physical and chemical changes like particle size reduction, micronization, density, Dispersion, complexity, self-emulsification, including complex, prodrug and salt Creation. The larger the surface, the higher the dissolution rate. Since surface area is reduced due to particle size, conventional method can be accomplished through methods such as grinding, ball milling, fluid energy micronization, salt formation and control promenade. Therefore, formulization methods are being invented to increase the biological availability of bad density medicine.

321. Role of Diagnostic Reference Levels (DRLs) in Nuclear Medicine: The experience of INT Pascale in Naples

Purpose DRLs provide guidance regarding appropriate or conventional levels of radiation dose to be delivered to patients. DRLs should be used to supplement, not replace, professional judgment and do not provide a dividing line between good and bad medicine but they offer a tool to educate imaging clinics on best practices. We assert that national DRLs have a limited role to promoting optimal practice, that is sufficient image quality at the minimum dose. In contrast, each clinic can set local DRLs based on local resources (imaging equipment, time for examinations). This study was focus precisely on local reference levels as guidance to ensure that certain radiation doses not exceed and to optimize quality images with to improve patient care. Methods The data of all diagnostic examinations were collected from 2012 and 2016. The 75th percentile of the distribution and the average administrated activity were calculated and the average effective dose per examination were estimated using dose conversion factors. Results For each examination the average administered activity was lower than national DRLs, except for 99mTc-MAA pulmonary perfusion imaging which was larger for the need of tomographic acquisition. Furthermore, during last five years the average administered activity decreased with improvements in imaging equipment and the review regularly of local reference levels. For the 2 common examinations, 18F-FDG whole body and 99mTc-MDP bone planar, the radiation dose estimated according to models recommended in ICRP106 were 5,1 mSv and 4,2 mSv, respectively. Conclusions The main outcome of this internal survey is that local reference levels should continuously reconsidered to optimize protocols, to ensure best practices and to reduce dosimetry to patient and workers.

Bad medicine: The future is video consulting.

The problem with all research is commissioning bias. Researchers set out to prove their own hypothesis and come hell or high water that is what they do. After choosing more than 20 potential data outcomes, bingo, you get a statistically significant outcome purely by chance; mess around with some exclusions and the chances of proving aspects of a predetermined hypothesis become a certainty. This is why so much data are conflicting — it’s biased right from the go. I think if something truly works, then it is self-evident. No one did an RCT into penicillin or, for that matter, if planes can fly! Here is another truism: the more complicated the research and the data …