Ed Friedlander, M.D., Pathologist
scalpel_blade@yahoo.com
Cyberfriends: The help you're looking for is probably here.
Welcome to Ed's Pathology Notes, placed here primarily for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com Your confidentiality is completely respected.
DoctorGeorge.com is a larger, full-time service Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again.
Numbers in {curly braces} are from the magnificent Slice of Life videodisk. No medical student should be without access to this wonderful resource. Someday you may be able to access these pictures directly from this page.
I am presently adding clickable links to
images in these notes. Let me know about good online
sources in addition to these:
I am presently seeking one or more individual or corporate sponsors for my work as "the internet pathologist." My site receives an enormous amount of traffic, and I'm handling about 200 requests for information weekly, all as a public service.
Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with peoples' health, reasonable freedom, and happiness. I talk and write straight, and without apology.
Throughout these notes, I am speaking only for myself, and not for any employer, organization, or associate.
Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.
If you're a private individual who's enjoyed this site, and want to say, "Thank you, Ed!", then what I'd like best is a contribution to the Episcopalian home for abandoned, neglected, and abused kids in Nevada:
My home page
More of my notes
My medical students
Especially if you're looking for
information on a disease with a name
that you know, here are a couple of
great places for you to go right now
and use Medline, which will
allow you to find every relevant
current scientific publication.
You owe it to yourself to learn to
use this invaluable internet resource.
Not only will you find some information
immediately, but you'll have references
to journal articles that you can obtain
by interlibrary loan, plus the names of
the world's foremost experts and their
institutions.
HealthWorld
Yahoo! Medline lists other sites that may work well for you
During the ten years my site has been online, it's proved to be one of the most popular of all internet sites for undergraduate physician and allied-health education. It is so well-known that I'm not worried about borrowers. I never refuse requests from colleagues for permission to adapt or duplicate it for their own courses... and many do. So, fellow-teachers, help yourselves. Don't sell it for a profit, don't use it for a bad purpose, and at some time in your course, mention me as author and KCUMB as my institution. Drop me a note about your successes. And special thanks to everyone who's helped and encouraged me, and especially the people at KCUMB for making it possible, and my teaching assistants over the years.
Whatever you're looking for on the web, I hope you find it, here or elsewhere. Health and friendship!
The word Quack is supposedly derived from quacksalver, a variant spelling of "quicksilver".
Mercury was used in the past in certain "remedies" that the public came to recognize as harmful. "Quack" may also recall the sound made by a duck.
More recently, I've been assured by none other than the president of the National Council Against Health Fraud, for that I've done some work in the past, that the real origin is from the Dutch "kwakzalver", or purveyor of salves rubbed quickly into the skin.
Modern quackery has several other names.
Scientific physicians describe "medical sects", "therapeutic cults", and "unproven remedies". Consumer advocates describe "health frauds".
Quacks themselves use other terms.
"Alternative Medicine" (notice the implication....)
"Natural Medicine" (for systems not using machines)
"Holistic Medicine" (the commonest term in the 1980's, and a perversion of a movement within scientific medicine)
Today, most popular systems calling themselves "holistic" are quackery. There are exceptions. See below.
Quackery may reasonably by defined as the making of health claims without an honest effort to validate them by the usual methods of science.
The technique of science (the "scientific method") is always the same:
1.State a hypothesis
2.
Design a study to test it, using appropriate controls
3.
Do the study
4.
Analyze the results
5.
Share the results with everyone
This method has never been used by the practitioners of any system of quackery.
NOTE: This is in glaring contrast to such "holistic" procedures as scientific acupuncture, biofeedback, hypnosis, and meditation, whose proponents have never hesitated to use the methods of science, and have been proud of doing so.
It is of no consequence that a quack practitioner may be "sincere".
Quacks are easy to recognize.
Quackery invests its efforts in propaganda directed at the public rather than in controlled research directed toward other professionals.
This is true of all types of quackery, from mouthwash to Laetrile.
The technique of quackery is usually the same regardless of the system.
1.
Present false health claims confusingly.
2.
Present bogus models of health, mankind, and even the universe.
3.
Create fear of everything except quackery.
4.
Pretend to love the victim and to share his or her values.
5.
Offer false hope without making specific promises.
6.
Operate as a bogus organization.
I.
Presenting false health claims confusingly:
The technique is to tell a series of obvious truths followed by one lie.
The true statements in the series are often trivial.
The series usually includes commonplaces of preventive medicine.
(Curiously, quacks usually ignore or oppose immunizations, breast self-examination, cervical cytology, and vision and hearing screening. See Pediatrics 68: 407, 1983.)
The lie is phrased as a true statement with an obvious insinuation.
II.
Presenting bogus models:
Quackery invariably opposes the understanding of disease provided by empirical science.
"Holistic medicine" (as the emphasis is perverted by quackery) implies:
All disease has the same cause and may be treated in the same way.
(Quackery is indifferent to the fact that its many systems present many different explanations for the "whole" of suffering.)
All disease may be diagnosed and treated by examining and doing things to one part of the body.
All disease indicates that the "whole person" is in need of remediation.
Disease and therapy, because they affect individual "whole persons", cannot be studied by examining a series.
(All quack claims are based on selected anecdotes.)
Disease being absent, therapy may still be instituted to promote "wellness".
Many quack systems present alternative systems of physiology (and even cosmology) based on traditional ceremonial magic.
III.
Creating fear of everything except quackery:
Quacks create fear of familiar things (flour, sugar, tap water, etc., etc.)
Quacks capitalize on and expand fear of unfamiliar things....
Disease (quacks of course claim to detect and treat it sooner than anyone else can...)
Scientific medicine ("The Medical Establishment"... expense, impersonality, uncertainty, hazards, and the alleged malice of physicians)
Spiritual forces: the appeal is powerful....
Quackery gets free publicity through many different churches, both "conservative" and "liberal".
People who are not active church members are presented with "spirituality" in the form of astrology, magic, occultism, spiritualism, etc.
All target groups are told to have "faith" in quackery, and made to feel guilty about their own lack of faith.
IV.
Pretending to love the victim and to share his or her values
Quacks invariably appear "caring", "considerate", "helpful", "loving", "personally concerned", "unhurried".
Quackery varies its appeal for different target groups....
conventional lifestyles: "family"
alternative lifestyles: "alternative"
minority groups: "cultural tradition"
all lifestyles: "altruism", "fun", "independence", "love"
Quackery makes indoctrination and treatment enjoyable.
Quack propaganda uses humor as often as possible.
Quack therapies are usually pleasant.
(People like health food, apricots, colored lights, dancing, enemas, massages, music, individual attention.)
Quacks never get tired of telling their patient how much they "love" them.
Quackery, having nothing to gain by objective discussion, urges victims to "keep an open mind", "think for themselves", exercise "freedom of choice".
Quackery presents itself as "self-help".
Quackery victims are urged to help their neighbors by introducing them to quackery.
This takes advantage of the natural human tendency to like to proselytize and appear to be an expert.
(NOTE: The health problems most typical of the poor are never addressed by organized quackery.)
V.
Offering false hope without making specific promises
This is best illustrated by examples.
Federal law allowed almost any sort of false health claims to be made so long as they do not appear on the label of a medicine bottle.
VI.
Operating as a bogus organization
Names: "Alternative", "Balanced", "Church", "Foundation", "Harmony", "Holistic", "Institute", "Life", "Preventive", "Research", "Science", "Wellness", etc.
Recently-founded organizations have frequent address changes, generally short life expectancies.
Established organizations lobby and advertise.
Quacks claim to be persecuted and misunderstood.
They are fond of comparing themselves to Galileo and occasionally to Michael Servetus and Charles Darwin.
(NOTE: Galileo, Servetus, and Darwin were all attacked by organized religion, not by the scientific community.)
Quacks demand "equal time" for "alternative views".
Acceptable research to justify extravagant claims is sometimes promised, never produced.
Quacks instead demand that public money be spent to investigate their claims (no matter how silly).
Ultimately, quackery states that its claims cannot be investigated freely and scientifically:
"The techniques are private knowledge."
"The processes are intuitive."
"The effective principles are spiritual."
"The methods of scientific inquiry are themselves invalid."
"Scientific hypotheses have been refuted."
"Modern views of the world (i.e., relativity, quantum mechanics, the Heisenberg Uncertainty Principle) teach that empirical observations cannot enable us to arrive at real knowledge." (This is crazy.)
Quack advertising relies on anecdotes, innuendoes, and appeals to various authorities.
Anecdotes of cures may be solicited or counterfeit.
Rhetorical questions (rare in science) and slogans are typical.
Authorities acceptable to the target group are cited when possible.
Legitimate experts are quoted out of context.
Sometimes experts from other fields will offer testimonials.
Some quacks are not beneath citing studies that do not exist.
Quackery blends at one end into traditional folk medicine, sometimes protected as such by law (Soc. Sci. Med. 143: 15, 1983; Indian J. Med. Res. 68: 368, 1983).
First, we must understand quackery.
Do not confuse quackery with avant-garde techniques that have been extensively and objectively studied by scientific medicine (biofeedback, hypnosis, etc.)
Do not confuse quackery with the techniques every clinician uses to try to understand and help his patient as a "whole person".
Recognize that quackery is present when, and only when, health claims are made with no honest attempt to verify or refute them by the scientific method.
Recognize that a quack's standards of practice and a quack's personal integrity fall far below your own. (Most quacks richly deserve your hatred.)
Second, we must be able to answer our patients' questions, and those of the general public.
Information is available from the American Medical Association, from your own state and local medical associations, and from such organizations as the American Cancer Society, the Arthritis Foundation, and the California Council Against Health Fraud.
Third, we must use the quack's main technique....
Have a genuine concern for your patient. If you are in medical school, you have already proved you want to do a doctor's work. If you lose some illusions about people, never feel you have been deprived of your compassion or goodness.
Genuinely try to understand how your patient's attitudes, habits, and life-situation affect his or her health. Sometimes this is easy, sometimes difficult. Often there is nothing you can do.
Explain things to people. Let the patient know what you are doing. Teach people how to do things for themselves. Give someone your undivided attention and notice how much he or she likes it.
When you both feel comfortable about it, touch your patient. Touch need not always be limited to examinations and procedures.
Always try to be kind to everyone, even when this is most difficult.
-- Edward R. Friedlander, M.D.
November 23, 1983 Prayer Request
| Visitors to www.pathguy.com reset Jan. 30, 2005: |
Ed says, "This world would be a sorry place if people like me who call ourselves Christians didn't try to act as good as other good people ."
PathMax -- Shawn E. Cowper MD's
pathology education links
Ed's Pathology Review for USMLE I
Translate this page automatically
