Screening Tests and Primum non nocere

Primum non nocere is a Latin phrase meaning “first do no harm.” It is commonly attributed to Hippocrates, but if he ever said any such thing, he certainly didn’t say it in Latin. He lived in ancient Greece from 430 BC to 370 BC and presumably spoke Greek. The phrase, in English and in Latin,

Breast Milk Testing: Scaremongering, Not Science

New mothers, especially first-time mothers, tend to worry about whether they are doing what is best for their babies. A new service, Happy Vitals, will only add to those worries. We know that breast is best, but these folks make women question whether their breast milk is good enough. They say: Happy Vitals provides families with

“Hands On Learning Solutions”: Untested Solutions for Problems That May Not Even Exist

Get started…for as little as $14,000! Hands On Learning Solutions, a business in Gig Harbor, Washington, evaluates and treats children for learning disabilities and claims to identify the underlying causes and help eliminate the symptoms. Much of what they do is questionable, and at least one of their methods is clearly bogus. Their program is

“Finally. . . The Low Back Pain Solution”: A Chiropractor Makes Questionable Claims

Pictured: Railgun patient launcher Magnetic resonance imaging machine, not a useful tool in identifying the cause of back pain The ads in my local newspaper are a never-ending source of questionable health claims, most often from diet supplement manufacturers and chiropractors. There’s no single spokesman like Dr. Oz, but as a group they remind me of Oz’s unending series of weight

Incidentalomas: Too Much Information Can Hurt You

Incidenta-what? An incidentaloma is an unexpected abnormality accidentally found on medical imaging studies done for an unrelated reason. It typically leads to further diagnostic tests, sometimes invasive ones like biopsies and surgery, and it almost always turns out to be something harmless. It would have been better not to know it was there. Sometimes ignorance

Recent Developments and Recurring Dilemmas in Cancer Screening: Colon, Lung, Thyroid

Screen detection and tumor growth rates. Cancers have different growth rates, which determine their potential to be detected by screening. Tumor A remains microscopic and undetectable by current technology (although more sensitive tests in the future might render it detectable). Tumor Beventually becomes detectable by screening (*), but its growth rate is so slow that it will not

An Egregious Example of Ordering Unnecessary Tests 

Last week I wrote about doctors who order unnecessary tests, and the excuses they give. Then I ran across an example that positively flabbered my gaster. A friend’s 21-year-old son went to a board-certified family physician for a routine physical. This young man is healthy, has no complaints, has no past history of any significant health

Why Doctors Order Too Many Tests

While cleaning out some old files, I was delighted to find an article I had clipped and saved 35 years ago: a “Sounding Boards” article from the January 25, 1979 issue of The New England Journal of Medicine. It was written by Joseph E. Hardison, MD, from the Emory University School of Medicine; it addresses the reasons doctors

Precision Medicine: The Coolest Part of Medicine

One size rarely fits all. Most medical knowledge is derived from studying groups of subjects, subjects who may be different in some way from the individual who walks into the doctor’s office. Basing medicine only on randomized controlled studies can lead to over-simplified “cookbook” medicine. A good clinician interprets study results and puts them into

Point-of-Care Ultrasound: The Best Thing Since Stethoscopes?

A bit of good news for a change: a “Perspective” article in the New England Journal of Medicine describes how point-of-care ultrasound devices are being integrated into medical education. The wonders of modern medical technology are akin to science fiction. We don’t yet have a tricorder like “Bones” McCoy uses on Star Trek, but we are heading in