Saurabh Jha is a radiologist and can be reached on Twitter @RogueRad. 

Masks are an effigy of American technocratic incompetence

Physician
August 20, 2020

Seven weeks before President Trump declared COVID-19 a federal emergency heralding the economic lockdown, Jesse’s customers began cutting their orders. Jesse sells garments and cotton, imported predominantly from India, to wholesalers and retailers, big and small, in malls across the North East corridor.  His business had a good January. December was like any December. But February was different.  His customers, reassuring him that it wasn’t personal, were predicting …

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Masks are an effigy of American technocratic incompetence

False negative: COVID-19 testing’s catch-22

Conditions
March 31, 2020

In a physician WhatsApp group, a doctor posted he had a fever of 101 degrees Fahrenheit and muscle ache, gently confessing that it felt like his typical “man flu” which heals with rest and scotch. He worried that he had coronavirus. When the reverse transcription-polymerase chain reaction (RT-PCR) for the virus on his nasal swab came back negative, he jubilantly announced his relief.

Like Twitter, in WhatsApp, emotions quickly outstrip facts. …

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False negative: COVID-19 testing’s catch-22

Why the Lancet’s editorial on Kashmir is unhelpful

Policy
August 29, 2019

If Rudolph Virchow’s observation that “medicine is a social science and politics is nothing but medicine writ large” is true, then medicine is bias writ large because politics is nothing but bias on steroids. Virchow’s maxim is now adopted by medical journals which freely mix medicine with politics. No journal has taken this mixology to greater depths than the Lancet. In its pages, you’ll find tomes on the efficacy of …

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Why the Lancet’s editorial on Kashmir is unhelpful

Becoming a doctor in India can be life-threatening

Education
August 12, 2019

Recently, my niece gingerly confided that she was going to study engineering rather than medicine. I was certain she’d become a doctor – so deep was her love for biology and her deference to our family tradition. But she calculated, as would anyone with common sense, that with an engineering degree and an MBA, she’d be working for a multinational company making a comfortable income by twenty-eight. If she stuck …

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Becoming a doctor in India can be life-threatening

Keeping the art of medical satire alive

Physician
March 12, 2019

Sequels generally disappoint. Jason couldn’t match the fear he generated in the original Friday the 13th. The sequel to the “Parachute,” a satirical piece canvassing PubMed for randomized controlled trials (RCTs) comparing parachutes to placebo, matched its brilliance — and even exceeded it, though the margin can’t be confirmed with statistical significance. The “Parachute,” published in BMJ’s Christmas edition, will go …

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Keeping the art of medical satire alive

The social determinants of a physician’s path

Physician
July 17, 2018

Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to their rural roots? The story of Prashant, a physician raised in rural Bihar, India, is …

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The social determinants of a physician’s path

To err is homicide in Britain

Physician
March 6, 2018

A single error oft inters the good that doctors do. The case of Dr. Hadiza Bawa-Garba, a trainee pediatrician in the NHS convicted for homicide for the death of a child from sepsis and hounded by the General Medical Council is every junior doctor’s primal fear.

A boy in shock

Friday, February 18th, 2011 was not a typically unusual day in a British hospital. Dr. Bawa-Garba had recently returned from a 13-month …

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To err is homicide in Britain

A reaction to ORBITA: Keep on stenting, judiciously

Conditions
December 10, 2017

Physicians’ reactions to ORBITA — a blinded, randomized controlled trial (RCT) from Britain with a sham arm comparing percutaneous coronary intervention (PCI) to placebo in patients with stable angina — are as fascinating as the cardiac cycle. There were murmurs, kicks and pulsating jugulars. Though many claimed to be surprised and many unsurprised by the null results of the trial, the responses were predictably predictable. Some basked in playful schadenfreude, …

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A reaction to ORBITA: Keep on stenting, judiciously

The real reason why the National Health Service survives

Policy
December 1, 2017

When Aneurin Bevan was asked how he convinced doctors to come on board the National Health Service (NHS) he allegedly replied, “I stuffed their mouths full of gold.” Bevan recognized that to conscript doctors to the largest socialist experiment in health care in the world he had to appeal not so much to their morals, but their pockets.

There is much piety about the NHS. It is the envy of the …

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The real reason why the National Health Service survives

Did doctors know best in the Charlie Gard case?

Physician
September 7, 2017

For American conservatives, Britain’s NHS is an antiquated Orwellian dystopia. For Brits, even those who don’t love the NHS, American conservatives are better suited to spaghetti westerns, such as Fistful of Dollars, than reality.

The twain are unlikely to meet after the recent press surrounding Charlie Gard, the infant, now deceased, with a rare, fatal mitochondrial disorder in which mitochondrial DNA is depleted — mitochondrial depletion disorder (MDD). In this condition, …

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Did doctors know best in the Charlie Gard case?

Are CTE headlines overblown? A radiologist investigates.

Conditions
September 6, 2017

A study published in JAMA looking at the brains of former football players donated to a brain bank, a highly selective sample, found signs of chronic traumatic encephalopathy (CTE) — a degenerative neurological disease — in nearly all deceased players examined.

The mainstream media converged towards numerical consensus.

  • Fox News reported players in a study had CTE.”
  • CNN reframed the headline, “CTE found …

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Are CTE headlines overblown? A radiologist investigates.

The chargemaster is health care’s most evil component

Policy
July 26, 2017

Any backpacker traveling on a shoestring in Thailand knows not to blow their entire budget on premium whiskey in a premium hotel on the first night in Bangkok. Rather, you need to skip the occasional meal, stay in a cheap dorm with random strangers and drink cheap beer on Khao San Road if you wish to see the country and return home without having to wash dishes in a restaurant …

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The chargemaster is health care’s most evil component

The obsession with diagnosing President Trump

Physician
July 7, 2017

When I first read about neurosyphilis in medical school, I became convinced that Mrs. Thatcher, who I detested intensely because it was fashionable detesting her, had general paralysis of the insane. The condition, marked by episodic bouts of temporary insanity, which indicated that the spirochetes were feasting on expensive real estate in the brain, seemed a plausible explanation why she had introduced the poll tax.

A little bit of medical knowledge …

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The obsession with diagnosing President Trump

Science has been hijacked by puritans and needs rescuing by heretics

Physician
June 17, 2017

In college, I once marched for the plight of Tibetans. Forty of us marched in Hyde Park, London; after an hour, half retreated to the nearest pub to discuss global injustices. Recently, over a million, including five penguins, marched for science. There were no penguins at our march for Tibetans but our goal, though naïve and unrealistic, was clear — we wanted Tibetan independence from Chinese rule. The goals of …

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Science has been hijacked by puritans and needs rescuing by heretics

When science ceases to be value-neutral, science ceases to be science

Physician
May 22, 2017

Recently, the Harvard Chan School of Public Health reported on the effect of surgical checklists in South Carolina. The press release was titled, “South Carolina hospitals see major drop in post-surgical deaths with nation’s first proven statewide Surgical Safety Checklist Program.”

The Health News Review, for which I review, grades coverage of research in the media. Based on their objective criteria, the Harvard press release would not score highly.

The title exudes …

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When science ceases to be value-neutral, science ceases to be science

How useful is a cardiac calcium CT scan?

Conditions
April 19, 2017

Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium …

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How useful is a cardiac calcium CT scan?

Should we treat anti-vaxxers with more respect?

Physician
February 7, 2017

Years ago, when I was less flexible, I took up Pilates. My instructor, Jim, a charming chap with an infectious laughter, was a 9/11 truther. I’d egg him on to hear about his conspiracy theories. Jim believed that 9/11 was concocted by Bush and Halliburton so that the U.S. could invade Iraq to capture their oil. He thought that United Flight 93 never took off. Whatever happened after 9/11 became …

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Should we treat anti-vaxxers with more respect?

The deadly risk of being treated by a male physician

Physician
January 13, 2017

Halfway through the “Bell Curve,” which is an analysis of differences in intelligence between races, I realized what had been bothering me about Charles Murray’s thesis. It wasn’t the accuracy of his analysis, which concerned me too. It was what he analyzed. The truth, I used to believe, was always beautiful, whether it was what happened in the multiverse at T equals zero or the historical …

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The deadly risk of being treated by a male physician

Does lead-time bias have a place in court?

Physician
January 3, 2017

In 2014, a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47 for a missed cancer on a chest X-ray. The verdict reminds me of the words of John Bradford, a heretic who was burned at the stake: “There, but for the grace of God, go I.” Many radiologists will sympathize with both the patient …

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Does lead-time bias have a place in court?

Let’s stop being skeptical about statins

Meds
December 6, 2016

If you’re going to indulge in anticipatory medicine, it is best to anticipate those at highest risk. An elegant study by Wald et al in the NEJM shows how precision primary prevention can be done. The researchers screened toddlers, who presented routinely to their general practitioners for vaccinations, for an uncommon, but not rare, familial predisposition to high cholesterol known as heterozygous familial hypercholesterolemia (FH), in which premature …

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Let’s stop being skeptical about statins

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