Ed’s corner of the web

This story and its close cousins have already been followed extensively in the blogosphere, skeptical and otherwise (see here and here for examples), but I’m glad to see CNN picking it up, even if it underplays the huge negative consequences.

What it boils down to is that governments around the world - including Thailand, Mexico, and Iraq -  have been duped into purchasing glorified dowsing rods as bomb detectors.  Apparently, since dowsing for oil, gold, and buried hoards of cash wasn’t proving profitable for the manufacturers of these devices (gee – I wonder why), they have chosen instead to defraud national governments.  I guess it was just easier.

As sad as it is that some malicious groups out there are trying to profit off of people’s gullibility (and don’t get me wrong – these people should absolutely go to jail), it’s just as disheartening that there are national governments falling for this crap.  If you’re Iraq, for example, not only are you tens of millions of dollars poorer from purchasing these carnival gadgets, but you’ve failed to prevent an unknowable number of deaths.  All from placing your faith in a woo-toy to sniff out bombs.  This is the true cost of pseudoscience and stupidity.

This is great news.  It’s a little late in coming – well, actually a lot.  But truth and the self-correcting nature of scientific inquiry have finally won a little victory.  There has still been irreparable harm done to autism research and treatment as a whole, not to mention the fight against vaccine-preventable illness, but hopefully this is a reflection of the turning tide.

Great gutsy opinion piece from Barbara Ehrenreich of the LA Times.

Choice quote:

What we really need is a new women’s health movement, one that’s sharp and skeptical enough to ask all the hard questions: What are the environmental (or possibly lifestyle) causes of the breast cancer epidemic? Why are existing treatments such as chemotherapy so toxic and heavy-handed? And, if the old narrative of cancer’s progression from “early” to “late” stages no longer holds, what is the course of this disease (or diseases)?

What we don’t need, no matter how pretty and pink, is a ladies’ auxiliary to the cancer-industrial complex.

Regardless of how you feel about Bart Stupak’s amendment to the health care bill, I think Ehrenreich makes a very valid point about the need for skepticism and reason.

We’re going to continue today’s theme of thanks by sending some gratitude towards Minnesota.  Just like every other state in the nation, Minnesota is faced with a shortage of primary care physicians.  It doesn’t take a rocket scientist to figure out one of the big reasons: a graduating medical student has little reason to become a family physician if he or she can make two, three, or even more times as much money by choosing a more lucrative specialty, like dermatology or radiology.  This financial disincentive comes even more into play when considering the staggering six-figure debt that most medical school graduates are faced with today.  Part of the solution, Senator Franken realizes, is to provide loan forgiveness to those graduates who choose to enter primary care or work in underserved areas.  It’s a no-brainer that unfortunately hasn’t caught on very well in the power circles.  Here’s some hope that it gains some traction.

The hard drive on my laptop met an untimely end about three weeks ago.  There were no warning signs, no ominous clicks.  Instead, the machine refused to finish booting into Windows one day.  I tried rebooting a few times, and each time the machine would get less and less far into the booting process.  Not good.  I chilled the drive and tried getting into safe mode, which only was stable for about 15 seconds.  Still not good.  Finally I got into a command prompt and got all my data out on a thumb drive.  Whew!

The real circus began when I called up Lenovo support.  Ostensibly it’s in Atlanta, Georgia, but I ran into just as many hard-to-decipher accents as I do when I call tech support in Mumbai.  But that was just the beginning.  Turns out my warranty had expired a mere six days earlier.  I shook my little fist at Shiva and was transferred to warranty sales, where I was offered a $149 extended warranty.  It was more than I would have liked, but I bit, figuring that purchasing a new hard drive and going through the reinstall process would be at least as costly in terms of time and money.

The warranty dude said that I should be able to use my warranty to get service on my laptop in 24 hours.  I called back the next day, only to find that the warranty wasn’t invoiced yet.  I had been misinformed, the new rep told me; warranties don’t invoice for 2-3 business days.  I called back again 4 business days later – still no dice.  This time I was told that it takes 10-14 business days for a warranty to become active.  Flustered, I requested that the extended warranty be canceled.  I couldn’t wait that long to get service on my laptop.  The rep apologized and said that he would expedite the warranty invoice process so I could get warranty service within 2 business days.  I hesitated (why couldn’t they have done this in the first place?!?) but eventually said ok, asking for some sort of email confirmation of the warranty being ready.  Of course, I never got that email confirmation.  I called back a few days later, thoroughly peeved, ready to cancel my warranty order for sure this time.  Guess what?  My warranty order had been canceled already, back at the time of my last phone call!  Gah!  It’s enough to make a guy go Mac…

So after a couple purchases at Newegg and an afternoon of installing software, I’m back to blogging on my laptop.  I’ve got a blacklog of stuff I wanted to write about but probably won’t have a chance to get to.  Fortunately, one topic has continued to be current enough for me to comment on: the “birther” movement.

Unfortunately, you’ve probably heard about these yahoos already.  The internet allows for the creation of an infinite number of echo chambers in which fringe lunatics can congregate and convince themselves that their ideas aren’t pure drivel.  The internet also allows for easy dissemination of these ideas, with the end result being that whackjob claims that would’ve been completely unheard in the pre-information age now have the capability of amassing a larger audience.  The birther crowd – those who believe that Barack Obama was born in Kenya and thus not qualified to be president – is just one sad, deluded poster child of this trend.

Two weeks ago I listened in on an NPR show in which Tom Ashbrook, the moderator, tried to host a discussion with Orly Taitz, one of the leaders of the birther movement.  I’m not the biggest fan of Tom Ashbrook’s style, but if anything he’s a very capable, experienced moderator.  I don’t think I ever heard Tom Ashbrook as not-in-control as he was that night.  Since Tom typically has very reasonable, intelligent people on his show, I think he may have made the mistake of assuming that his usual conversation-control tools would work on Taitz.  Then again, I don’t think anything short of a Tazer and injectable tranquilizers would have worked on Taitz that day.  Her careening, shrieking, disjointed commentary made my brain hurt, and any shred of credibility I might have afforded her (admittedly, not much to begin with) vanished instantly.

People like Taitz don’t go away, though.  And now, with the release of an image of a document purported to be Barack Obama’s Kenyan birth certificate, she continues to dig a deeper hole for herself.  This (pretty clear forgery) is now the smoking gun, the unassailable proof that Obama is the centerpiece of a vast left-wing, Communist, Zionist conspiracy designed to take over the world.  I’ll let snarkier minds lay out the details for you.

I could despair that such a ridiculous issue has wasted so much time and energy, that such rabid lunatics can steal the nation’s attention for such a long time.  And I do, admittedly – just  a little bit.  But outwardly, at least, I’m laughing.  I’m laughing in mockery of the stupidity, close-mindedness, and downright lunacy of these whackjobs.  I can at least get a little entertainment out of them.

It’s been one heck of a month.  Turkey was great – more to follow – but I already feel like I need another vacation.  Too much work, too much long-distance driving, a GI bug, a ten-day course of Tamiflu for an H1N1 exposure, and a death in the family on top of all of that.  I’m beat.

But then two of my readers tell me personally (the other three couldn’t be bothered, I guess) that they noticed I hadn’t updated in a while, so here I am, dragging myself back in front of the keyboard.  Must…post…

Actually, today’s subject of posting is too interesting to pass up.  I hold a special place in my heart for Zicam.  It’s the non-homeopathic homeopathic remedy.  Unlike “conventional” homeopathic remedies, which are diluted so much that you’d be lucky to get a single molecule of active ingredient in a dose, Zicam actually contains biologically active amounts of zinc.  The product manages to squeak by FDA regulation, though, because the product makers finagled a “homeopathic” designation.  (More on this subject from Steven Novella here.)  As if it wasn’t enough to have homeopathic remedies masquerading as medicine, now you have not-so-homeopathic remedies masquerading as masquerade medicine.  All yours for the low low price of $10.  Oh how far we’ve fallen.

Now, as you’ve probably heard, the FDA put the kibosh down on Zicam today.  Seems it could make you lose your sense of smell, permanently.  Not good.  Can you smell what Matrixx Initiatives (the two “x”’s mean they’re extra extra cool) is cooking next?

You guessed it!  Denial!  Matrixx asserts that, “There is no reliable scientific evidence that Zicam causes anosmia.”  In other words, “We didn’t want to have to do that science stuff to prove safety or efficacy when we brought this junk to market, but we demand that you peform rigorous science-y experiments to take us down.  Neener neener.”  How’s that for a double standard?  In all seriousness, this sort of post-market surveillance for adverse events is the FDA’s job.  If they suspect that there are unreported side effects or adverse events cropping up, then their responsibility is to consumer safety first.

Am I passing early judgment on this?  Yes.  I’d be lying if I denied it.  All the data should be laid out on the table, and Zicam should be given the chance to make its case.  But I’d also be lying if I said I wasn’t getting a great deal of schadenfreude out of today’s news.  It’s very satisfying when a company that tries to get by on disingenuous practices finally gets its comeuppance.

Had to take another little break there to wait for the comment spam to die down.  Sorry for the pause and thanks for your patience.

Got a little doozy of a story going on in Boston that has even caught the attention of the national news providers.  The “Craigslist killer” is allegedly a second year BU Medical School student.  This story really has it all – a dark murder; a young, smart, promising suspect engaged to be married; trips to casinos; possible related crimes in another state; potentially damning evidence.  The cherry on top?  A handgun hidden in a cut-out copy of Gray’s Anatomy.  Not to be crass, but you really can’t make this stuff up.

I think every med school class has those one or two students where you wonder, “Now how the heck did he/she get into med school.”  I know mine did.  This, of course, is a very extreme example.  For the record, I really like BU med students.  They’re bright, hardworking, and don’t have the sense of entitlement you can sometimes see from other schools.  My interactions with them have been almost entirely positive.  I hope that this episode doesn’t prove too difficult for the rest of the class and the rest of the school.

On Thursday, February 12th – Darwin Day, no less – I had just finished checking in on a patient in the ICU and decided to check the news.  I was greeted on the front page by this story.  I had to read the headline twice to make sure I read it right.

The vaccine court, a special court convened to determine whether petitioners were entitled to compensation from the Vaccine Injury Compensation Program, had ruled on three test cases wherein parents asserted that their children had acquired autism through a combination of MMR vaccine and thimerosal from other vaccines.   The ruling was that the evidence presented did not prove a link between autism and childhood vaccines.  In fact, the evidence presented was “overwhelmingly contrary to the petitioners’ contentions.”

Many in the medical and scientific community waited for these rulings with bated breath, all the more concerned because the vaccine court had a lower standard of evidence than a regular civil trial.  Because of this lower standard, even though the scientific evidence clearly showed no link between autism and vaccines, there still remained a small chance that the petitioners could have received an award.  If that happened, it would have been ugly.  I don’t even like to think about what it would have meant for child health in this country.  But fortunately, science and reason prevailed, and I breathed a heavy sigh of relief that morning followed by a triumphant fist-in-the-air.  Just as fortunately, none of the ICU nurses saw me.

On a more sordid note, the Andrew Wakefield saga also deepened this month.  If you recall, Wakefield was the doctor who published a paper in Lancet in February of 1998 purporting a link between the MMR vaccine and autism.  Despite involving only 12 children, the paper’s effects tipped off a MMR vaccination scare that was felt throughout the world, with sharp dropoffs in MMR vaccination rates over the subsequent years.  The sketchy stuff comes when, over the course of the next several years, 10 out of 12 coauthors on the Wakefield paper jointly publish a retraction of the original paper’s conclusions, independent researchers are unable to replicate any of Wakefield’s data, and we learn that Wakefield was massively conflicted in his research – having filed patents for an alternate vaccine to replace MMR and having received over four hundred thousand pounds in fees from lawyers seeking to sue MMR vaccine manufacturers.

Right – scary.  But wait, it gets better.  This month, the London Sunday Times revealed that Wakefield may very well have cooked up the data for his landmark 1998 paper (more details here).  The audacity boggles the mind.  It angers me greatly to think that this one doctor, acting so irresponsibly, selfishly, and unethically, has caused so much damage to child health.  I am, however, at least grateful that science (and a tenacious journalist named Brian Deer) has finally caught up with this guy a little.  Hopefully with the efforts of further inquiries, peer review, and reeducation, science will be able to correct this injustice.  (If you want to read more, Orac talks a lot more about this issue here.  Wikipedia even has a decent bio on Wakefield detailing all the latest controversies.)

So all in all, with just three days left in the month, we’ve had one solid victory for science and a big step towards correcting a past wrong.  Perhaps not as fast as I would like, but still not too shabby.  Charles Darwin would, I think, have approved.

We’ve already heard about measles outbreaks, both domestic and abroad, due to reduced to vaccination rates.  Now we have new case reports of another vaccine-preventable disease cropping back up: Haemophilus influenza type b (aka. Hib) infection.

Hib is one of those bugs from the bad old days.  Thanks to a vaccination program begun in the 90’s, I’ve never personally seen a case, and this is a very, very good thing.  Basically every pediatrician from the pre-Hib vaccine era has a horror story of some terribly sick kid with Hib meningitis or epigottitis*.

But now, it seems, thanks to well-intentioned but misinformed parents refusing vaccination for their children, Hib infection is making a comeback.  In 2008, five kids in Minnesota – aged 5 months to 3 years – contracted invasive Hib disease.  Three of these kids were unvaccinated due to parental refusal.  One of these – a 7 month old – died.  Of the other two to contract the disease, one was too young to have completed the intial 3 vaccine series, and the other one had an immunodeficiency.

I’ve said before, and I’ll say it again.  As this trend of refusing vaccines continues, herd immunity will continue to drop to dangerous levels, and we will continue to see increasing numbers of “breakthrough” cases of vaccine-preventable illnesses.  And the tragedy is, there’s really no reason for this happen.

The antivaccine crowd justifies some of their vaccine avoidance like this: why should we provide protection against simple childhood illnesses like measles and chicken pox?  Let kids get immunity the old fashioned way, by contracting the disease.  If I have the choice between autism and a self-limited viral illness, I’ll take the viral illness any day.

Of course, this choice is a false dichotomy.  And there are very good reasons for preventing measles and chicken pox (which I won’t get into here for the sake of brevity).  This argument for avoiding vaccines sucks.  But in this case, the antivaccine case sucks even more.  Measles or chicken pox might not be a huge deal for most kids, but get this: about 1 in 20 kids who get invasive Hib die.  Of those who survive, many are afflicted with deafness, developmental delay, seizure, or other neurocognitive ailments.  In this day and age, with a safe, effective vaccine, there is no reason for any child in this country to suffer from invasive Hib disease.  And it is for this reason that every case like this is a tragedy.  Unfortunately, it looks like we will have many more tragedies like this to deal with before the tide of irresponsible antivaccination is (hopefully) turned.

* The epiglottis is the cover to your windpipe that swings down into place whenever you swallow.  It keeps food and drink from going down the wrong tube.  Epiglottitis is inflammation/infection of the epiglottis, which can lead to swelling severe enough to cause complete airway obstruction.  Yeah – bad.

This has lit up the blogosphere already, but I just felt I had to post it here.  Courthouse News and RH Reality Check have reported on the story of a New Mexico woman, Ashley Van Patten, who went to Presbyterian Health Services Rio Rancho Family Health Center to have her IUD strings shortened.  No big deal, you would think.  Just a quick snip and all done – something any reasonably competent medical professional could handle.  Unfortunately for Ms. Van Patten, she ran into nurse practicioner Sylvia Olona and ended up leaving the clinic without an IUD at all.  As the court complaint states:

As Defendant Olona began the procedure, Ms. Van Patten felt Olona pull on the strings of the IUD. Ms. Van Patten felt a distinct pulling on the strings followed by a sharp pain in her uterus similar to a very strong menstrual cramp.

As that happened, Defendant Olona stated “Uh oh, I accidentally pulled out your IUD. I gently tugged and out it came.” She then explained, “I cut the string than (sic) went back and gently pulled and out it came. It must have not been in properly.”

Doesn’t sound too sinister yet, right?  Simple mistake, happens all the time.  Wait for it…

Olona then stated, “having the IUD come out was a good thing.” She asked Ms. Van Patten if she wanted to hear her “take” on the situation. Without receiving a response, Defendant Olona stated, “I personally do not like IUDs. I feel they are a type of abortion. I don’t know how you feel about abortion, but I am against them. What the IUD does is take the fertilized egg and pushes it out of the uterus.”

Defendant Olona stated, “Everyone in the office always laughs and tells me I pull these out on purpose because I am against them, but it’s not true, they accidentally come out when I tug.”

…

Defendant Olona told Ms. Van Patten that is was better that she did not have the IUD because she could now use a “non-abortion” form of contraception. Defendant Olona suggested the deprovera (depo) shot or the pill, and made clear that she would not insert a new IUD.

It was at about this point that I had to pick my jaw up off the floor.  Not only did this show some sad ignorance and misinformation on the part of Olona, but it also constituted highly unprofessional behavior and borderline assault.  The full facts of the case have yet to appear, and Sylvia Olona is entitled to give her side of the story, but if this ends up being anywhere close to true, it’s a very poor reflection on Olona and a sad indictment of the state of women’s health.

If you’ve been keeping up with health news at all, you know that there’s a lot of people holding their breath over the Bush administration’s new 11th hour “conscience clause” regulation that allows a wide swath of health workers to refuse to participate in treatment that conflicts with their values.  I could’ve sworn I blogged on this topic already, but I can’t find the post for the life of me.  Maybe I hallucinated it.  At any rate, more of the above sort of nonsense is what many – including myself – fear will be one of the outcomes.  We’ll see what happens…