Appendicitis: Surgical vs. Medical Treatment

Surgery or antibiotics for appendicitis? This new study can help with the decision. The standard treatment for appendicitis has long been appendectomy, the removal of the appendix. The successful use of antibiotics instead of surgery was first reported in 1956 by Dr. Coldrey in the British Medical Journal, and since then there have been several randomized trials of

When Doctors Refuse to Believe Evidence

Paul Offit’s new book covers the evidence for many surgeries, medications, and screening tests that have been proven ineffective and harmful yet are still being used by doctors who refuse to follow the science. Science-based medicine is all about testing medical ideas against reality. If there is abundant evidence from well-designed controlled clinical trials that

Ian Harris on “Surgery, the Ultimate Placebo”

Ian Harris explains that more than half of commonly performed surgical operations may be placebos. Adequate studies using a blinded control group are essential. Ian Harris, a Professor of Orthopaedic Surgery at the University of New South Wales in Sydney, Australia, wrote a book titled Surgery, The Ultimate Placebo. I haven’t read the book, but I

Carotid Artery Stenosis: Surgery, Stent, or Nonsurgical Stroke Prevention?

One treatment for carotid artery stenosis: stent placement The carotid artery in the neck is a common site of atherosclerosis. As plaque builds up, it leaves less room for blood flow and can cause strokes through clotting or embolization. Carotid stenosis is defined as a greater than 70% narrowing of the lumen (the space through which the blood

An Alternative to Appendectomy: Antibiotics

My title doesn’t refer to alternative medicine, it refers to an alternative within medicine: treating appendicitis with antibiotics instead of surgery. You may be surprised to learn that patients with appendicitis don’t always automatically need an appendectomy. A recent randomized controlled trial in Finland compared surgery to medical treatment. History of appendicitis treatment There is an excellent,

The Marvelous Dr. Mütter

The Mütter Museum in Philadelphia has a marvelous collection of human bones, surgical specimens, monsters in jars, and medical memorabilia. It holds attractions for everyone, from the jaded medical professionals who thought they’d seen it all to the coveys of youngsters who compete to point out the grossest items to their friends, from the student of

Knee Osteoarthritis: Thumbs Down for Acupuncture and Glucosamine

Osteoarthritis is the “wear and tear” kind of arthritis that many of us develop as we get older.  Cartilage becomes less resilient with age, collagen can degenerate, and inflammation and new bone outgrowths (osteophytes) can occur.  This leads to pain, crepitus (Rice Krispie type crackling noises with movement), swelling and fluid accumulation in the joints

New AAP Policy on Circumcision

Back in 2008, I tried to look objectively at the scientific evidence for and against circumcision.  I got a lot of flak from commenters who focused on the ethical issues rather than the scientific evidence. I concluded that the evidence showed small benefits and small risks, and I didn’t advocate either for or against the procedure.

RISUG: Birth Control for Men

According to an enthusiastic article on the Internet, “The Best Birth Control In the World Is For Men.” It’s called RISUG: Reversible Inhibition of Sperm Under Guidance. It involves a minor surgical procedure in which the vas deferens is exposed and pulled outside the scrotum by the same techniques used for a vasectomy. A copolymer, powdered styrene

Halsted: The Father of Science-Based Surgery

One (dark and stormy?) night in 1882, a critically ill 70 year old woman was at the verge of death at her daughter’s home, suffering from fever, crippling pain, nausea, and an inflamed abdominal mass. At 2 AM, a courageous surgeon put her on the kitchen table and performed the first known operation to remove

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