I’m a Doctor Now and I’m Upgrading to a New Blogging Site

October 16, 2015
Reinventing Primary Care

               Reinventing Primary Care

I still get a lot of daily views on this shabby old blog site from my medical school days. This site was what laid the foundations to a future in online content marketing. Lessons were learned. Don’t invest TOO much time in research and writing. Now I’ll be quicker and swifter, making more videos personally. Focus will be on medical topics. In particular, my specialization in medical marijuana, which I hinted at my early interest in this field years ago by writing about it. 

So join me over at Nature’s Way Medicine. It’s a company devoted to integrating primary care medicine with medical marijuana for patients who need it. Between updates and posts, patients will be getting treated in my Wilmington, Delaware office, where I will provide medical marijuana consultations alongside their primary care.

That last marijuana post didn’t make the cut at Science-Based Medicine the way my CAM in Obamacare article did, but who knows, maybe in the future I’ll have the chance to share my impressions, research, and personal opinions on a topic I know back then was discussed without much optimism.

For additional updates, check out our Facebook Page, Twitter account, and Youtube channel.

Thanks for reading everyone. Now let me bring you to a new era of blogging by DOCTOR Roman, MD.

See ya’ll there!

The American Need to Invest in Science and Technology

May 31, 2010

Right now, the American people are experiencing the worst natural disaster in the history of their country. A kilometer deep in the Gulf of Mexico is an entire natural reserve of oil leaking into the ocean. Over the past decade, America’s lead in producing scientists, engineers, and novel research has been declining compared to asian countries like China. The BP oil spill has exposed this achilles-heel by leaving the American government helpless. If anyone can stop this oil leak, it is the private companies who spend the most money on scientific research. During Obama’s most recent press conference, he said,

“What is true is that when it comes to stopping the leak down below, the federal government does not possess superior technology to BP.”

Maybe America’s obsession with terrorism and wars has caused its politicians to forget that America’s position in the world is due not only to its power and strength but also to its brains and scientific knowledge. This is certainly the case when it comes to public education, where children are taught hardly any science anymore, leading to the scientifically most embarrassingly  ignorant population in the Western world. As a previous elementary school science teacher, I will say that the quality of our elementary science education is pitiful. This leads most americans to learn the majority of their scientific knowledge outside of school! However it usually takes some time before such lag in education begins to affect the actual production of gadgets and research and so far we haven’t felt the  inevitable effects of this scientifically-illiterate population maturing.

Thankfully, a recent bill has been approved by the House of Representatives that is awaiting Senate approval and will grant $84 billion dollars to scientific research and technology. This bill has been derailed twice already by the Republican party (A.K.A. the party of ‘No’) but has finally been approved. It is a good start to overcoming the recent decline in the U.S.A.’s role as the world’s leader in technological research.

In the New York Times, David Brooks discusses how this recent oil spill is one of many areas in the fields of science and technology that is becoming too complex for people to handle. Steven Novella writes in his blog that one possible solution to this problem is creating robots to help combat situations where humans are inadequate to stop disasters. This is already being done with the Deepwater Horizon oil leak by using BP’s underwater robots to fix the leaking pipe. It is such robots that are missing in the governments arsenal for stopping the growing slick. If they had pumped more funding into research in this area, perhaps they would have some of their own robots to use. For now, the American people and America’s ecosystems are in the hands of BP because they are the only ones with appropriate robots at their disposal.

I hope that this environmental disaster proves to the government how important scientific research and technology is for us. If we want to help prevent this sort of occurrence in the future, we should be producing more engineers and scientists and we should do so from an early age, rather than attempting to fill our textbooks with lies and unscientific religious beliefs. That way the next time something like this happens we will not only have more scientists and engineers we can rely on, but also better tools for the job.

Humans Create Synthetic Life

May 23, 2010

Science is undergoing the equivalent of the Cambrian explosion right now both metaphorically and literally. The summation of advances in different fields of science has created an exponential growth curve of our understanding and abilities so steep that we are propelled practically vertically into the skies above. With all the expanses in computer processing and medicine it is easy to overlook the speed at which the field of biology is expanding. This week, an article published in the journal Science has reminded many of us how advanced we are becoming in molecular biology.

Venter's Process

Craig Venter and his colleagues at the J. Craig Venter Institute have succeeded in synthesizing an entire genome that was implanted into a bacterial husk and lead to the creation of a small colony of man-made protozoans. The inserted DNA was from a different species of bacteria than the rest of the microbe yet caused the organism to transform into the species encoded by the DNA.  This marks the first time that a member of a species was created without ancestors. If you think genetically-modified food or organisms are a big deal, think about the implications of organisms with entirely synthesized genomes.

It’s very difficult to predict the implications and repercussions of new technologies but the potential benefits of this particular technique is massive. The scientists involved want to create an especially simplified template genome that has all the metabolic processes necessary to sustain life, so that they can later add whichever genes they choose for a multitude of purposes. This was the first step demonstrating that they can use a DNA sequence edited with computer software, synthesize it, and transform a bacteria into a different species with the digitally edited genome.

Some of the future implications for this include adding a gene for the metabolism of carbon dioxide. This would lead to bacteria capable of devouring carbon emissions from factories and power plants (maybe even the atmosphere). Other ideas include genes for creating pharmaceuticals or oil. Combine that with a gene to excrete the product and we could be using Craig Venter-patented bacteria to convert our landfills into gasoline (Exxon Mobile has invested $700 million with Venter already). Or, a modified bacteria with the opposite purpose could be used to devour oil slicks like the one in the Gulf before it bedaubs the coast.

"GloFish" are genetically modified pets already sold in pet stores.

This is only the start of what looks to be a new field in biology. Once we can apply this to eukaryotes, we will be able to synthesize new animals and plants. Forget about breeding dogs into new species (that is soo 20th century). Who’s to say we won’t be able to create our own dog with the characteristics of our choice instantly on our laptop? Send the DNA sequence code to the nearest laboratory and they’ll have your shitzdoodle delivered in no time.

Better yet, here’s to hoping I can have my children completely specialized to my own likings. Let’s add a couple inches to their height, eliminate any unnecessary  silent mutations or recessive diseases, brown hair, green eyes, +50 IQ points and **presto** little Robert Roman will have an expected life span of 130 years, good looks and a good brain to match. First stop, GATTACA!

Of course, there are those pesky ethical concerns that keep cropping up. Just like when people protested genetically-modified foods, which doubled our crop yields, now people are protesting against this. Ignoring the tremendous potential benefits, they point to religion and claim we are ‘playing God’ or worry that an evil scientist will create a superbug to destroy humanity. Their lack of evidence separates them from those actually conducting the research and is based solely on fear mongering.

The Human Genome

Craig Venter, the man in charge of much of this, has quite a repertoire for biological research. In the 90’s he criticized the Human Genome Project, a worldwide effort to map the human genome, for being too slow and instead started his own company that mapped it 3 years ahead of time. In 2007, with a team of researchers he mapped the first genome of an individual person: his own. He has been named one of Time magazine’s 100 most influential people in the world twice. It’s my opinion that he will be remembered as one of the greatest minds of our generation.

Here’s a video of him talking about his research in 2008:

After this new accomplishment, it is suspected that he will synthesize a genome completely devised by human beings and unlike any species known to date. This new species is already patented and will possibly be named Mycoplasma laboratorium, although why one would need to establish a genus and species to an organism devised by man is beyond me. I assume that when we begin creating our own organisms, a new form of taxonomy will need to be devised and cladistics won’t be pertinent. M. laboratorium will probably be the aforementioned ‘simplest’ bacteria possible, and will serve as a blank slate to add other useful genes into.

In case you’re beginning to think we are reaching the limits of human technology, I posit that this is only the beginning. Imagine future synthetic life forms with genomes made of non-nucleotide molecules translating into structural components besides protein (carbon nanotubes would be nice). Perhaps people will devise inorganic life forms based on molecules other than carbon. Where will this research lead us a thousand years from now? Will humans use biology to better themselves, or will we integrate ourselves with computer systems and become silica-based “artificial life”? OK, that’s enough for now. These questions can be addressed in future blog posts.


The Current Legalization of Marijuana is Unethical

May 15, 2010

Marijuana has been both steadily decriminalized and legalized for medical purposes in the United States since the Compassionate Use Act of 1996, where Californians voted to allow the use of marijuana with the guidance of a physician for the alleviation of symptoms for various medical diagnoses. Since that time there has existed a battle between the federal and State governments stemming from the federal governments blunt opposition towards the substance. Nevertheless, other States have since followed California’s lead and have also legalized its use for medical purposes.

Whether or not marijuana has therapeutic effects is becoming more evident with the coming years. Clearly, it has physiologic effects on both the mind and the body. Its active ingredient, tetrahydrocannabinol (THC), is a cannabinoid that exerts its effects on the brain through its binding to cannabinoid receptors. Cannabinoids are neurotransmitters, and like other neurotransmitters can be used for therapeutic effects. For example, the neurotransmitter dopamine  is used to treat Parkinson’s disease (in the form of L-Dopa), which is caused by a deficiency of dopamine within the brain, and opiods, such as morphine, are used for analgesic properties. THC’s neurotransmitter effects show potential for future therapies and the molecule could help create similar drugs with different properties.

Tetrahydrocanabinnol (THC)

Although there exists this potential for marijuana to be used pharmacologically, we still do not know enough about it for it to be ethically made legal. All FDA-approved drugs that go on the market are tested through Phase I, II and III clinical trials before they are approved for release. These phases are extremely important as they help determine not only side effects but also dosages and other vital information required for optimum benefits and minimum risks. Without this sort of knowledge, patients can be harmed from over or under-usage, unexposed side effects, or potential adverse combinations with other pharmaceuticals.

These sorts of clinical trials, and large long-term studies have never been performed for marijuana. Ultimately, the federal government is to blame for this. As I write this, marijuana is a Schedule I substance according to the Controlled Substance Act that came into effect in 1970, along with heroin, cocaine, peyote and a multitude of extremely detrimental substances. Schedule I substances are defined to have “no current medical use.” If the United States government is to remain consistent with their legislature, they should surely drop marijuana to a Schedule II drug because research has shown it to have a multitude of potential health benefits, as well as side-effects.

The problem with marijuana being a Schedule I substance is that drugs of this legal caliber have a much stricter set of rules and circumstances for clinical testing. It is much more difficult for a research institution to study the effects of a Schedule I drug than it is for it to study a completely new drug synthesized in the laboratory. By definition, the same laws for researching heroin apply to researching marijuana, but researching a cholesterol-lowering drug or an anti-depressant is legally much easier. What this ultimately leads to is an inability for academia to research marijuana and study its effectiveness and proper dosages.

To counter the federal governments rigid stance on marijuana, 14 States have broken accordance with federal laws and allowed marijuana to be legal for medicinal uses anyway. This has created a sticky situation where the federal government is inconsistent with its own laws by refusing to reclassify drugs as new evidence deems them therapeutic, and individual States counteract this with their own inconsistency by allowing drugs with inadequate research confirming their efficacy to be medicinally legalized. Two wrongs don’t make a right. On top of all of this is the indecency of physicians who prescribe marijuana with inadequate clinical evidence to do so.

The lack of proper research on medical marijuana is evident through the completely different dosages that individual States recommend for their patients. A recent New England Journal of Medicine article about this very same subject has detailed information about the inconsistencies of marijuana dosing between different States. For example, Alaska allows patients a maximum of 1 ounce per month but Washington State allows 24 ounces and as high as 15 personal plants. Furthermore, the potency and quality of the plants themselves are undetermined and unregulated. Obviously, such guidelines are not based on any resounding proof or evidence of efficacy but rather politics alone. This exemplifies a completely unscientific approach that is necessary in modern medicine.

As of right now, medical marijuana is an alternative medicine that puts not only the patient and the doctor, but entire States, on thin ice legally. More importantly, however, if marijuana is to be used as a prescribed medicine it has to be researched as intensively as other drugs on the market. To do this requires a change in its classification from a Schedule I to a Schedule II drug by the federal government. Until then, its usage for medical purposes will continue to be unethical and potentially dangerous to patients.

Why Is Evolution Still Debated?

May 9, 2010

It always baffles me that to this day many people don’t believe in evolution. Even from my early days in grade school it seemed so obvious to me that human beings came from earlier species of animals. Other people don’t seem to grasp such fairly simple scientific concepts, especially in the U.S. where polls have shown that only 45% of Americans agreed with the statement, “Human beings, as we know them today, developed from earlier species of animals.” That’s significantly less than the figure in Europe, which was 65%. Still shabby.

Last year I had a knock on my door and when I answered it there was two Catholic’s awaiting me to preach the good word of the Bible. They asked me if I was willing to speak to them about Jesus and the Bible, and I replied that I would be very grateful to discuss with them but that I was an atheist. After hearing this response, the considerably older one of the two was shocked. “You don’t believe in a God!?”, he asked. “No. Not at all.” The other member of the Biblical task force was a young guy that looked eager to confront a challenge.

He said to me, “But you must know that the evolution of feathers has never been proven and this is a major obstacle for the theory of evolution!” Every now and again, someone will use an argument that is so demonstrably false that you worry that if there was even a hint of truth to it your beliefs about something would dissolve. The more you learn, the harder it is for this to happen, and that poor kid had no idea who he was dealing with. He was like a sheep outside of a lions den, trying to convince the lion himself to become a vegetarian. I debunked his claim in about 3 sentences. But could anyone who doesn’t read general science articles and listen to science podcasts have done the same? Definitely not.

We bid each other adieu and went on our merry way. Who knows how many people will be led to believe his moronic assumptions? The nonsense will just keep on spreading.

Of note is the detail of his argument. The evolution of feathers? Comeon! That’s just going to make you sound like you know what you’re talking about. More importantly, it’s going to decrease the amount of people able to argue against the claim.

As someone who supports evolution, I find it so easy to come up with much more common sense arguments. Yesterday I thought about how humans lactate after delivery to feed their young, and how mice do the same exact thing. Is that a coincidence? Is it a coincidence that salamanders have hearts in their chests and that bacteria use oxygen with the same molecular mechanisms as us? Or that viruses use DNA just like we do?

According to polls, less than half of Americans that read this post will agree with my views. At what point will the evidence be so overwhelming that those numbers will rise? I guess since evolution has already been proven in just about every way possible, and nothing has come close to challenging it, evidence alone will never change people’s opinions on the subject.

Long-term Evolution Depiction

About Science

April 18, 2010

This blog mostly covers scientific subjects. It is my understanding from my own experiences that most people don’t grasp what science is and why it is so important. For example, people don’t realize the differences between acupuncture, or herbal medicine or chiropractic as anything different from science-based medicine. The fundumental difference between these modalities of therapy and, say, aspirin is that they don’t use science to support their claims and, if they do, it is lacking, flawed and never corrected.

Let’s start off discussing how stupid we are. We see ourselves as these incredible beings much greater than other animals. We are more intelligent but not by much. Primates (and birds) use tools, just like us. They can speak with sign language and use spears to hunt. Our brains are better adapted to these skills but we broke off evolutionarily not that long ago. A new discovery shows that at one point,three species of humans coexisted with one another around 40,000 years ago and a fourth lived on an island in the phillipines. Only our species remains, but it is closely linked with others. We only began to use metal tools 6,000 years ago and we were hunter gatherers until 10,000 years ago. It took a long time for us to create a society vastly different from how animals live.

We continue to believe that we are something extra special and smart. The problem with this is that we fail to realize how much our minds affect our observed reality. Time and time again, studies show that our memories are terrible at remembering facts, we observe what we believe (rather than vice versa) and we have natural tendencies to believe certain things. Even our most basic choices and behaviors are affected by our surroundings and circumstances.

Such facts are a thorn in our methods of science. Experiments are bombarded with biases and confounders that we often fail to realize. One of the most obvious examples of this is the placebo effect. Take some ginkgo and go study. Surely you’ll think your memory is better when in fact it doesn’t do jack to help your thinking.

But the reason science is so great is that it incorporates this knowledge of our inherent biases and the ways that data can be affected through non objective influences and it controls for these factors. One of the greatest ways to help do this in drug experiments is by doing a double blinded study where neither the experimenter nor the subject knows whether he is receiving a true therapy or not. This prevents both sides from biasing the outcomes of the experiment.

Another way to help filter out bias is through the replication of experiments. There are many published experiments and studies that show benefits of medical therapies whose results have never been replicated by independent researchers. This implies that the experiments are flawed in some way. Supporters of sham therapies use these outlying studies to support their treatments. That’s why (and this is key) truth is based not on any single study but on the entire scientific literature.

Another important way of filtering out flawed studies is by subjecting them to a peer review before they are published. Anonymous experts on any specific topic are chosen to read and criticize every detail of a study before it is published. This makes it much more difficult for scientists with an agenda to publish a biased report after such rigorous inspection.

Furthermore, all published data is made available to the public, allowing for ongoing review and repeated experiments and observations by multiple researchers operating independently of one another. This is because science, unlike most everything else, is open to falsification if new evidence is presented. Want to know if something is based on proper science? Ask yourself this, “How much has this therapy changed over time?” If it is stagnant, like chiropractic or accupuncture, chances are it does not abide to science very rigorously and therefore doesn’t rely on actual proof of its benefit. Science-based medicine, on the other hand is always being re-examined and changed depending on proper objective data that has been acquired in ways that prevent bias and people’s beliefs from affecting it as best as possible.

One of my favorite ways of figuring out whether something is true is not by attempting to prove it but instead attempting to disprove it. There is a hypothesis and, more importantly, there is a null hypothesis that says something does not work. Before saying something has benefit, true science attempts to prove the null hypothesis (that it does not) as best as possible many times over. Only if experiments can not prove the null hypothesis is something considered to be valid. Homeopaths can cherry-pick some studies implying that homeopathy works but scientist sure as hell can prove that it doesn’t work more concretely. Thus it is labeled as pseudoscience.

Finally, I’d like to mention Occam’s razor as an important principle in science. Always expect the most simple reason for anything first. If there is a study that sounds too good to be true, like one that shows that accupuncture helps cure cancer, don’t believe it right away (like the media often does) but instead believe the more simple and obvious reason for this conclusion: the study was flawed! I recommend cutting away the nonsense and believing the more logical and scientifically-proven conclusions in life.

All of these things I am discussing can be shown in the general trends that pseudoscientific theories undergo in the published literature. Most adamantly-supported beliefs have small, poorly conducted studies demonstrating that they work early on. Then, as more proper and larger studies are conducted, the positive data starts to disappear. Finally, as the largest and most expensive studies are performed the pseudoscientific theories are shown to be false. Unfortunately, supporters of pseudoscience continue to cherry-pick the early studies to support their beliefs.

A current example of this is the anti-vaccination movement’s strong adherence to the principle that vaccines cause autism. Their hero, Andrew Wakefield, published a study showing that the MMR vaccine causes autism. Subsequent investigations showed no link and eventually the study itself was removed from the published literature because it was found that Wakefield was bribed by lawyers involved in vaccine-caused-autism lawsuits to change his data. Yet anti-vaxers continue to support him and refuse to change their stance on vaccines despite a mountain of evidence disproving their claims.

This sort of behavior is common in all aspects of society. Conspiracy theorists believe that the government caused 9/11, herbalists believe herbs can cure a plethora of diseases, politicians think Obama isn’t a US citizen, ghost hunters communicate with spirits, religious leaders claim their authority comes from a supernatural source, and so forth. What ties all these together is the lack of adherence to a scientific method before making their claims and forming their beliefs. That is why I love science so much: if conducted correctly, it is almost impenetrable to human bias.

Let’s Get Sirius!

April 14, 2010

Last week, Klara and I went for a nice walk around the Kazimierz district of Cracow and ate a delicious zapiekanka for 6 zloty (about 2 dollars). On our way home, we decided to stop by the Wisla river, which I live practically next to, and we took the remaining few bites of our meal while watching the last sliver of sun that remained disappear as we rotated away from it.

Obama will be here on Sunday!

It was at that very moment when I recalled a blog post by astronomer Phil Plait, in which he said that in the subsequent few days it would be possible to see both Venus and Mercury next to one another after sun set. This was a perfect opportunity for us to see if that was true and we stuck around for a little bit to see the nearby planets.

Low and behold, not long after sunset appeared a bright “star” in the sky above where the sun had just been. I figured that it had to be Venus, since Venus is almost twice as close to us as Mercury and a lot bigger. Interestingly, Mercury is only 0.055 earth masses and is actually smaller than the moon Ganymede, which revolves around Jupiter. We waited for Mercury to show its hot little self, but couldn’t see it.

Screen shot from Stellarium depicting exactly what we were looking at and location of Sirius, Venus and Mercury.

That’s when Klara pointed at another star in the southwest direction (we were looking west) and asked if that was it. I looked at the twinkling and bright star and told Klara I didn’t think that it was Mercury since I assumed that it would be closer to Venus in the sky. Realizing that I didn’t know much at all about astronomy, I decided to educate myself a bit about the stars I was looking at, especially this bright southwestern star because I recall always seeing it throughout my life as one of the brightest in the sky.

So the next day I downloaded a free program called Stellarium. It is basically a planetarium on your computer that allows you to manipulate visuals and settings at a whim. After plugging in your coordinates (find them on google maps) you can see which stars are visible from where you are, at any time you choose. It’s even possible to turn off the visibility of the ground to look ‘down’ through the earth and see what’s visible from the southern hemisphere.

Of course one of the first things I did using Stellarium was to see what the southwestern star was. It was Sirius, the brightest star in the sky. A quick wikipedia search (yes, I use wikipedia all the time for everything) explained that it is almost twice as bright as the next brightest star. It’s still not as bright as Venus and Jupiter, but they don’t count as stars.

There are other cool things about Sirius, besides it’s luminosity. For one, it’s a local neighbor of ours. It’s about 8.5 light years away making it the fifth closest star. There are no planets around Sirius, but that’s OK because it makes up for it by being a binary star system composed of two suns revolving close to one another.

Sirius A on left and Sirius B on right.

One of the suns, Sirius A, is a lot larger than the other and its surface is almost twice as hot as our own sun’s: a steamy 10,000 degrees Kelvin. That’s three times the temperature required to boil iron.

Sirius B, on the other hand, is a lot smaller but used to be even larger than its brother. Around 120 million years ago (the Cretaceous period), when dinosaurs walked the planet, it collapsed from a red giant into a white dwarf. That means that some dinosaurs would see Sirius as nearly twice as bright as we do. Nowadays, Sirius B is much smaller, with a volume of earth’s but a mass of our own sun’s (astronomy is so freakin’ cool!).  Its surface is 25,000 degrees Kelvin, yet its small volume makes it thousands of times less bright than its counterpart.

Next time you’re out, see if you can spot Sirius to the left of where the sun set (at least in the northern hemisphere). It’s visible from pretty much everywhere in the world and bright enough to be seen during the day from some places so it shouldn’t be hard to spot. It will stay near the horizon for most of the time and it sets after the sun and rises before it. I’m glad I know now at least one star by name and I hope some of my readers will as well.