Kangaroo care (KC) is the practice of skin-to-skin contact with a premature baby and parent. In low and middle-income countries, where there are fewer medical resources, Kangaroo Care has been shown to reduce mortality among premature babies and shorten the length of hospital stay.

Kangaroo Care is also very beneficial in high-income countries even in the midst of extremely high-tech care. Holding a premature baby skin-to-skin:

• Improves breast milk production and breastfeeding (when mothers do the KC). Remember, breast milk is the best medicine for preemies.
• Reorganizes the nervous system. A premature baby is meant to be in the warm, dark, dampened environment of a uterus filled with amniotic fluid. The stress of our noisy, harsh, cold environment can negatively affect a premature nervous system. KC promotes healthier sleep patterns for a premature baby and reduces stress on the nervous system. Premature babies who experience Kangaroo Care tend to have better neurological outcomes. My children were born at 26 weeks, which in 2003 meant a 85% chance of survival and, if they survived, a 25% risk of severe or moderate disability and a 25% risk of a minor disability. The more premature the baby, the greater the negative impact on the nervous system.
• Improves parent-child bonding. The universal first experience of a parent is touching and holding their baby. It is a primitive need and evolutionarily was probably essential for survival as a mother’s embrace at birth provides warmth, helps with bonding, and improves breastfeeding. Many parents of premature children don’t even get to touch their babies at birth, never mind hold them. My son Oliver was too sick for his resuscitation team to even stop for me to have a look. The neonatal intensive care unit is a very disorienting and traumatic experience for parents, and so the time when you can mentally step out of that environment and hold your baby helps the healing go both ways. I feel I got as much out of holding my boys as they did being held.
• Provides pain control for your baby. There is such a positive effect on the nervous system that a baby a young as 28 weeks can have a reduced pain response to a procedure with KC.

But what about all those tubes and wires? And some of the preemies are so small!

That’s what I thought. My children were 26 weeks and weighed 1 lb 11 ounces and 1 lb 13 ounces. They had breathing tubes, intravenous lines, oxygen monitors, and EKG electrodes. It seemed that almost every square inch of them (and there weren’t that many square inches) was covered with some kind of medical equipment. And they were so small. And fragile. I was terrified that I would either: A) dislodge some really, really important piece of medical equipment and/or B) break them.

But that’s where the neonatal intensive care nurses come into play. They are so used to handling the tiniest babies they make it look easy, and the thing is, once you do it a few times it’s not so hard. And you manage to get skin to skin, even with all those tubes and wires.

If a preemie is critically ill, and some are, it may take a few days or even longer until they are stable enough to be held. Sometimes even touching them is just too much for their nervous system and they will drop their heart rate or lower their oxygen levels in response. However, the nurses are trained to look for the subtle signs that means a baby is ready to try KC.

Getting to hold your baby the first time is an amazing thing. For me, it happened 8 days after my children were born. They were each able to tolerate about 30 minutes, but within another week they were up to an hour. I held them each for an hour twice a day until they came home. It is the most amazing thing to see your baby’s heart rate lower and oxygen levels rise in response to your touch.

Kangaroo Care is a simple, intuitive, and free therapy that has been proven effective by high quality medical research. What a wonderful thing indeed.

Plan B is one type of morning after pill. It is the hormone levonorgestrel. The brand is Plan B but there are generics as well. It does not cause abortion. It does not affect implantation. It works by inhibiting ovulation.

The American Congress of Obstetrics and Gynecology and The American Academy of Pediatrics feel that Plan B should be available over-the-counter to anyone who wants to buy it without a prescription or identification. This is because

• The sooner the product is taken, the more effective it is (i.e. if you have already ovulated, it won’t work)
• There is no known medical contraindication to taking levonorgestrel. And one could take it every day, but since the generic is $25 (at least) the chance that would actually happen is 0%.
• Levonorgestrel is very safe. Far safer than many drugs already available without a prescription of identification. Acetaminophen (Tylenol) is far more dangerous than levonorgestrel.
• Identification is a big barrier. Not everyone has their ID with them at all times and not everyone has a driver’s license. Especially young people.

Initially, the Obama administration stepped in and went against the Food and Drug Administration who voted in 2011 to make Plan B available to all ages without a prescription. We were left with the over-the-counter for ages 17 and up ruling.

Various groups sued the department of Health and Human Services about this decision, but in the meantime the FDA decided to to approve an application from Teva (the manufacturer of the brand name product, Plan B) to sell their Plan B product on the shelf to those ages 15 and up, albeit with identification.

Judge Edward Korman of the 2nd U.S. Court of Appeals called bullshit on everyone. The Obama administration, the FDA, and Teva and sided with (gasp) science. Korman agreed that the science says that Plan B is safe and not an abortifacent, but rather contraception (remembers, it interferes with ovulation) just like a condom, so it should not have an age restriction nor an ID requirement.

From a science perspective this should have been the end of the story. But it’s America and the government is cowardly and science is often viewed as witchcraft.

There has never been a levonorgestrel related death, but almost 200 children under the age of 12 die every year in the United States from gun violence, but I don’t see any federal legislation banning children from touching firearms. Every day in the United State 7 people between the ages of 1 and 19 die from gun violence, but the government is concerned about Plan B affecting the safety of the youth of America?!

Mr. President and Ms. Sebelius if you really cared about protecting young people you wouldn’t be wasting tax dollars appealing Plan B.

No one aged 19 and under will die today from Plan B, but 7 will die from gun violence.

While I applaud the lowering the age limit and putting it on the shelves, there really should be no age limit at all. Here’s why:

1) No one asks for ID when you buy a condom. Plan B is just another form of contraception. There is a multitude of scientific data proving Plan B is not an abortifacient and the idea that levonorgestrel could cause abortion isn’t even biologically plausible.

2) Requiring ID is another barrier. No everyone has their ID with them at all times, not even 46 year-old gynecologists. Also, not every 15-year-old has a driver’s license and even if they do, they might not have it on them.

3) There are no medical contraindications, so why have an age limit at all? You don’t need to be 15 to buy Tylenol or Aspirin, both of which are deadly when taken incorrectly. There are actually all kinds of toxins one can buy at the age of 10.

4) You don’t need ID to deliver a baby.  

5) Privacy. It’s hard enough to muster up the courage to buy condoms etc, why should the person ringing up your purchase get to know your name? What if they tell someone? Paying with cash and remaining anonymous should always be an option.

6) You don’t need ID to take it. My boyfriend bought Plan B when I didn’t have my ID.

And for the bonus round….What about parental notification? There’s no tracking device on condoms, so again, why should parents know about Plan B? One hopes that parents talk about sex and pregnancy prevention with their kids, but it doesn’t always happen (if it did happen, we wouldn’t have so many unplanned pregnancies in this country).

And for those who think this will leads to scores of young women buying Plan B? Well, I hope so because it’s better to be 15 and taking Plan B than 15 and pregnant. Given the fact that the generic starts at around $25 it’s hard to see how putting Plan B on the shelves is going to help too many 15 year olds, however, putting it at eye level may make someone more likely to buy it and that’s a step in the right direction.

Now some people wonder why this is needed. After all, genital warts are benign. And it is true, a genital wart will not progress to cancer, but in addition to being irritating they cause a high degree of personal distress.  While some will remit spontaneously or respond to treatment (which can be painful), recurrences are common. I have seen many women over the years who are plagued by warts that recur and recur. It can be devastating.

However, a new study (Ali et al BMJ 2013;346) suggests that the quadrivalent HPV vaccine could all but eliminate the treatment of genital warts from my practice. To this I say, “Wonderful!”

The study is from Australia which has a nationally funded program for the quadrivalent HPV vaccine for girls and women between the ages of 12 and 26. At least 83% of girls ages 12-18 have received one dose of the vaccine and 73% in this age range have received all three doses. In Australia, vaccination rates are lowest (52% receiving at least one dose) among women ages 20-26.

The Australians have been far better at HPV vaccination than we have in the Unites States where only 32% of girls ages 13-17 have been vaccinated (even more dismal, the rates of HPV vaccination is 14% for  uninsured girls).

Early data from the Australian HPV vaccination experience indicated a drop in genital warts of 59% among women ages 12-26 years (and 39% among young men, who were typically unvaccinated) just two years after the national vaccine program was implemented. This new study provides 5 year follow-up data and the results are amazing.

Prior to starting the vaccination program 11.5% of women under the age of 21 had at some point been

Diagnosis of genital warts in Australian women before and after a national program of HPV vaccination (Ali et al)

diagnosed with genital warts, 5 years later that rate plummeted by 92% to 0.85%. Genital warts were all but eliminated in women 20 years of age and younger. Among the under 21 years age group the vaccination rate (3 doses) was 71%. The rate of genital warts also dropped significantly for women ages 21-30, from 11.3% to 3.1% (an almost 73% reduction).

What is even more interesting (and shows the widespread implications of the HPV vaccine) is the drop in the incidence of genital warts among men in the same age range as the men were largely unvaccinated. There was an 81% reduction in genital warts diagnoses among heterosexual sexually active men under the age of 21 and a 51% reduction for heterosexual men ages 21-30 years. The reducing in genital warts for men is likely the result of herd immunity.

What this study tells us is that genital warts could be all but eliminated for young women, although further follow-up is needed to make sure that the immunity of the vaccine doesn’t wane over time and there is simply a spike in genital warts 5 or more years down the road.

Currently, the Australian program has been expanded for universal vaccination for boys as well. With these kind of results the target of eliminating HPV from teenagers and young adults may well be achievable. Well, in Australia anyway.

Getting Americans to accept that the HPV vaccine doesn’t affect promiscuity, understand that the HPV vaccine is very safe, and invest in the concept that eliminating the burden of HPV is a worthy goal is another thing entirely.

Ms. Halappanavar needed her uterus evacuated before Wednesday (preferably on the Monday), but under current Irish law a woman apparently has be waiting in death’s antechamber to get a termination. To evacuate a uterus so a women doesn’t get gravely ill is simply not an option. 

The coroner and jury recommended that the Irish Medical Council lay out guidelines to decide when exactly a doctor can intervene to save the life of the mother. What has apparently been proposed is a panel of six doctors to review each case. 

Canada used to have a panel of 3 doctors although that was never for medical necessary terminations, it was for elective cases. Women had to prostrate themselves, begging for mercy. This was deemed unconstitutional along with all abortion laws, and so now in Canada abortion is not legal or illegal, it is simply a medical procedure.

An abortion panel, especially one where the procedure is part of the medical care, is ludicrous and, as Dr. Anthony McCarthy an Irish psychiatrist has so eloquently stated, is “abusive to women.” Panels are a terrible idea. The concept is degrading. Women shouldn’t have to beg for health care (and if you are gravely ill, do you leave your hospital bed to petition for your life or does the panel come to you?). And what if the panel members disagree? If 2 say, “Yes, abortion is needed,” and 4 say, “Well, no it isn’t,” does the minority report not count for anything? If 1/3 of the doctors think you have a real and substantial risk of death, wouldn’t that count for something? And how will personal neutrality of the physicians be assured? 

A woman shouldn’t have to prove that she is sick enough or suicidal enough or whatever enough, there should just be recommended treatment options for medical conditions.  

The Irish medical council needs to put on their big boy and girl panties and recommend the following: 

A) List conditions where termination is an accepted part of the medical therapy. For example, they could state (like the American Congress of OB/GYN) that the treatment for chorioamnionitis is delivery, regardless of gestational age. 

B) State that abortion should be allowed when an OB/GYN or appropriate specialist considers that there is medical evidence to suggest that continuing the pregnancy either  increases a woman’s risk of death above the Irish baseline of 8/100,000 live births OR when continuation of the pregnancy could reasonably be considered to have a serious and deleterious effect on the health. While not dying is a worthy goal, we must not forget women whose medical conditions get worse during pregnancy often with permanent consequences. An example might be a diabetic with renal disease that is progressing during pregnancy. Renal failure can be treated with dialysis, but the better option is to prevent that situation rom occurring. Abortion must be allowed for both the life and health of a woman. 

The big “fear” is that if abortion were allowed in Ireland for medical reasons that women would flock to their doctors and claim that they will commit suicide if they don’t get a termination, but that whole construct is insulting to women. That isn’t what happens. Women don’t feign or claim mental illness to get abortion. 

The best answer, of course, is to simply leave the decision for a termination for medical reasons to be a private one between a woman and her physician, which is of course the statement that I’d really like to see from the Irish Medical Council.   

One of the experts at the inquest, Dr. Susan Knowles, a microbiologist at the National Maternity Hospital in Dublin is reported in the Irish Times as saying there wasn’t a substantial risk to Ms. Halappanavar’s life before Wednesday at 6:30 am. While she admits to what she calls “subtle indicators” of sepsis and chorioamnionitis (infection of the fetal membranes), she asserts these findings were just not enough to warrant a termination.

She is wrong.

By the Monday morning, less than 24 hours after admission, Savita had a white blood cell count of 16.9 and ruptured membranes. She also had pain. This would be enough to prompt every OB/GYN I know in the United States and Canada to discuss evacuating the uterus, or at least gather more evidence to say it is safe not to hold off and watch and wait. The standard of care in North America is “expeditious delivery” and antibiotics when chorioamnionitis is diagnosed, not wait until this get worse.

By Tuesday evening Savita had shaking chills and an elevated heart rate. This means the infection had now spread from the uterus to her blood stream. This is what happens when chorioamnionitis is inadequately treated. At this point my colleagues and I would be panicking about Ms. Halappanavar’s health. Not so in Galway. Dr. Knowles didn’t think things were bad enough until the next day.

If the diagnosis of chorioamnionitis is in doubt there are ways to be more certain, although keep in mind, Savita’s risk of infection was 30-40% the second her membranes ruptured early Monday morning so the burden of proof for infection in such a setting is low. Her white blood cell count (WBC, a marker of infection) was apparently 16.9, which is very suspicious, but looking at specifics of the white blood cell count (the neutrophil count and the presence of bands, which are immature neutrophils) could have provided more about the possibility of a bacterial infection. An elevated neutrophil count or a bandemia would all but confirm chorioamnionitis in this clinical setting. An amniocentesis could also be performed if the diagnosis of chorioamnionitis were in doubt.

One could argue that the diagnosis of chorioamnionitis wasn’t in doubt as the team started antibiotics on the Monday evening, although say, just for the sake of argument, that the antibiotics were started as prevention. In this case, as infection was obviously suspected why wasn’t more done to confirm the diagnosis or rule it out? Was the maternity ward at Galway that much of a fuck up that no one, from nursing student all the way up to senior staff, could possibly conceive of the idea that a woman with ruptured membranes at 17 weeks might actually have an infection? Or didn’t it matter, because Savita was pregnant with a 17 weeks fetus that had cardiac activity but a 0% chance of survival. If Savita had to be sick enough to have a termination why bother confirm a diagnosis that no one could do anything about? Did the staff feel the only treatment that they could legally give was antibiotics so there was no point in knowing more?

Dr. Knowles’ testimony confirms for me that the law played a role, because her statements indicate the standard of care for treatment of chorioamnionitis is less aggressive in Ireland. This can only be because of the law as there is no medical evidence to support delaying delivery when chorioamnionitis is diagnosed. Standard of care is not to wait until a woman is sick enough to need a termination, the idea is to treat her, you know, before she gets sick enough. An elevated white count and ruptured membranes at 17 weeks is typically enough to make the diagnosis, so Dr. Knowles needs to testify as to what in Savita’s medical record made it safe to not recommend a delivery.

By the way, I also disagree with Dr. Knowles about her interpretation of Savita’s medical record, the chart doesn’t have “subtle indicators” of infection, it screams chorioamnionitis long before Wednesday morning.

In North America the standard of care with chorioamnionitis is to recommend delivery as soon as the diagnosis is made, not wait until women enter the antechamber of death in the hopes that we can somehow snatch them back from the brink.

If Irish law, or the interpretation thereof, had nothing to do with Savita’s death no expert would be mentioning sick enough at all.

I can’t comment on what motivates journalists, but to say that the Gosnell case is an abortion horror story and it is being ignored by a supposedly pro-choice media completely misses the point. It’s a medical horror story.

State legislators like to boast that abortion laws protect women, but laws or even legal abortion for that matter don’t prevent the unscrupulous from preying upon the disadvantaged. TRAP (targeted regulation of abortion providers) laws drive up the cost of high-quality care forcing the desperate to turn to cheaper options and charlatans. I’ve seen women maimed by legal abortion, but not because the procedure is unsafe because untrained providers in unsafe settings maim patients. If you haven’t read my post, Anatomy of an Unsafe Abortion, read it. I’ve also seen women maimed by poorly done or unindicated hysterectomies, but I don’t see any hysterectomy legislation aimed at making the procedure safer for women.

When you have no money, are afraid to ask for advice, don’t speak the language, are a victim of domestic violence, or are afraid of immigration officials (to name a few reason why a pregnant woman seeking an abortion might be medically disadvantaged) a cheaper procedure from a clinic that is flexible about providing identification and doesn’t require a contact person might seem like the only option. Well-trained providers who have done residencies and comply with the ever growing number of bizarre state laws are too expensive for many women and also require more personal information that some are able to provide.

The desperate overlook or don’t know about obvious warning signs that scream, This does not look like a safe place. How many women do you think go to their abortion alone? Abortion is so marginalized in America that having a friend or family member looking out for you is a luxury. And not everyone has a friend or family member who knows what to look out for.

However, we must not forget that bad and unsafe medical care is not an abortion-exclusive phenomenon. Didn’t we just hear about a dental shop of horrors in Oklahoma where the instruments were not sterilized, exposing potentially thousands to HIV and hepatitis? Most of those patients were economically disadvantaged. Then there was the endoscopy clinic in Las Vegas that re-used medical vials exposing patients to hepatitis C. One man died from the hepatitis C he contracted (and by the way, the news coverage has been pretty scarce). If you read enough news stories you will find plenty of accounts of bad outcomes by suspect surgeons or less than reputable surgery centers. There is also case after case of counterfeit Botox, often with disastrous and deadly outcomes.

While lack of health insurance and other economic disadvantages clearly increase the risk of bad care, even those with money are not immune. Priscilla Presley had her face injected with industrial silicone instead of cosmetic grade by an unlicensed provider.

More laws won’t prevent the Gosnells of America from taking advantage of people, just like they won’t stop plastic surgeons from buying cheap, unsafe botulinum toxin from Mexico and passing it off as the more expensive Botox. Legal abortion doesn’t guarantee safe abortion any more than legal root canals guarantees safe root canals.

I agree that we need to focus more on the Gosnell case, but not because he provided abortions. We need to talk about this case because it highlights how despite regulations providers somehow manage to game the system in state after state and that this atrocious care disproportionately affects the desperate and disadvantaged. We should also not forget that in America women who seek abortion will almost always be the most disadvantaged of all.

Just walking through the door with ruptured membranes at 17 weeks Ms. Halappanavar baseline risk of chorioamnionitis was 30-40%. Her presentation should not have posed a diagnostic dilemma, not even for an intern. She was a perfect set up.

In Canada and the United States, once chorioamnionitis is diagnosed the treatment is antibiotics and delivery. An “expeditious delivery…regardless of gestational age,” according to the guidelines of the American Congress of Obstetrics and Gynecology (ACOG). If the fetus is not viable there is no waiting for the fetal lungs to mature or waiting for the fetus to succumb. The recommendation is delivery. This is because chorioamnionitis kills women and if a fetus is on the cusp of viability it has a far greater chance of survival without an infection than with one. The infection helps no one, neither the mother nor the fetus.

To not deliver a woman in such a high risk situation requires proof that she does not have an infection. This can only be accomplished with an amniocentesis, which is extracting amniotic fluid from around the fetus and testing it for signs of infection. The results take 1-2 hours.

Savita Halappanavar’s medical team tells a different story. The testimony of the consultant obstetrician was that Ms. Halappanavar was not sick enough to be allowed a termination on Tuesday according to the Irish legal position. However, there is clear evidence that she was rapidly deteriorating on the Tuesday evening. Ms. Halappanavar’s heart rate was 110 beats/minute and her widower reports that she was shivering and her teeth were “chattering.” Tachycardia (a rapid heart rate) and shaking chills and clear clinical signs that she was gravely ill.

To figure out how a woman could die from such an obvious diagnosis with clear treatment recommendations, the inquest into Savita Halappanavar’s death must answer these three questions:

1. When did the medical team make the diagnosis of chorioamnionitis?

If it wasn’t until Tuesday then that’s negligence. Ruptured membranes at 17 weeks, an open cervix, back pain, and an elevated white blood cell count means chorioamnionitis. The diagnosis was likely clear on Sunday evening, Monday at the absolute latest. By Tuesday evening she was beyond sick, she was gravely ill.

2. Considering there was a delay in delivering Ms. Halappanavar, what tests were done to support the safety of the “watch and wait” therapy? 

Say the team was on the fence about chorioamnionitis. Maybe there was reason to believe that her white cell count was elevated? In this scenario, an amniocentesis would be required to prove the amniotic fluid was not infected. In my opinion watching and waiting could only be supported with a negative amniocentesis. If an amniocentesis wasn’t done then either A) the team were certain she had an infection B) the team had no idea that she could have an infection C) the team was on the fence, but the results wouldn’t matter anyway because the fetus had cardiac activity.

3. What is the treatment for chorioamnionitis?

If the answer is delivery then the delay must be explained. One obvious explanation is the swiss cheese effect, where several things are missed culminating in a very bad outcome. It shouldn’t happen, but it does.  This problem can be fixed with better staffing, education, and specific protocols.

If the answer is, as the consultant obstetrician suggests, that Ms. Halappanavar was simply not sick enough to warrant delivery then it appears that the current “legal position” in Ireland is that a woman must be left brewing her infection until the stench is bad enough that Death himself gets a whiff and comes calling.

Washington, DC – The American Congress of Obstetricians and Gynecologists (ACOG) strongly opposes all three restrictive abortion laws recently enacted in North Dakota. ACOG opposes laws regulating medical care that are unsupported by scientific evidence and that are not necessary to achieve an important public-health objective. These laws hurt the women of North Dakota and their families and do not enhance women’s health or patient safety. These laws destroy the reproductive rights of women and impose unnecessary barriers that limit access to medical care. 

Legislators should not needlessly interfere in the patient-physician relationship or the practice of medicine. ACOG, as an organization, joins other women’s health advocates in supporting the legal right of women to obtain an abortion and opposing laws that are dangerous, unscientific, and criminalize medical care.      

Physicians, not legislators, should be making medical decisions with North Dakota women about their care.

Do we really want a society where we completely disregard science for religion and political fundraising? 

Who do you want in your examining room, your politician or your health care provider?

If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.

First of all, no one should believe any medical information on the Internet, whether anonymous or not, that isn’t sourced and dated. Without a source it’s opinion at best. Without a date, well, medicine is constantly evolving and if a post is more than 2 years old, look for something more recent. That’s why I tell my patients to go to .gov sites because they are curated and the post indicates when it was last updated. If a blog is written by an anonymous doctor, but everything is sourced to excellent sites, is that evil? Does it mislead the public? Not necessarily.

Good online data should also come from a source that has disclosed bias up front. If you are reading information about a drug written by a doctor who takes money from the manufacturer versus one from a doc who takes no drug company money it should make a difference as to how you consider what you’ve read. Without knowing who wrote the post, it is a little like taking candy from a stranger. However, I will always maintain that sourced data is better than knowing the name of the author, but yes, both are preferable.

The GMC also warns doctors that their anonymity can be easily unmasked! Yes, at anytime Sherlock Holmes and Dr. John Watson stand at the ready to tear down the veil and let the whole world know your true identify. In reality, it doesn’t take Scotland Yard to find out who’s who on the Internet, just someone with a rudimentary knowledge of computers and the Internet and a little extra time on their hands. Anyone who thinks they are truly anonymous is in for a shock. Perhaps it bears repeating, but it doesn’t warrant censure. Reminding doctors that anonymity is no guarantee is a little bit like reminding one not to play in traffic. There are risks. Take them at your own peril.

The GMC forgets that anonymous providers have the opportunity to whistle blow. What if a hospital is doing something terrible? Maybe there’s a problem in sterile processing that is being ignored potentially putting people at risk? Maybe a surgeon is doing unnecessary surgeries? Maybe a senior doctor is making unwanted sexual advances on a junior doctor? While it would be nice if everyone had the courage to speak up, not everyone does. However, SOME PEOPLE MIGHT FEEL THAT THEY COULD SPEAK UP IF THEY COULD DO IT ANONYMOUSLY. My understand of British libel laws is that it’s a lot harder for scientists to speak up about pharmaceuticals in the United Kingdom. The GMC wants to make this even harder?

But for me, the biggest error in the GMC requiring that doctors use their real name is the unmentioned but obviously incorrect assumption that only anonymous doctors post shitty information and ever doctor who tweets/posts/blogs under their own name is an honest, true, prophet of evidence based medicine. Has the GMC never visited Dr. Joe Mercola’s website? He sells tanning beds (among other things). You know. the ones the World Health Organization say are carcinogenic? And have they never heard of the good Dr. Oz? Promoter of cleanses and the homeopathy starter kit? Thousands of doctors in the United States sell snake oil via the Internet (the hCG diet is a great one) and they ALL DO IT UNDER THEIR OWN NAMES! I don’t know the purveyors of fine British snake oil, but I have to believe they exist.

While reminding physicians that no one is truly anonymous isn’t a bad thing (though a little nannyish if you ask me), banning anonymous posting is a bit like passing around the Victory Gin and forcing everyone to drink. Instead of restricting the way physicians use the Internet anonymously, the GMC should join the 21st Century and focus on patient education regarding Web 2.0 and how to search for accurate medical information. Teaching doctors how to post evidence based content isn’t a bad idea either. And hey, it would be nice if they censured doctors who peddle useless tinctures and other assorted crap as well, but that should happen whether they do it online or in the office.

I don’t post anonymously, but I will defend anyone else’s right to do so.