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.
Before this theme gets too old, I want to reserve a special shout-out for Wired Magazine. Thank you, Wired, for having the bravery and integrity to do what the rest of mainstream media was unwilling to do: put “Vaccines don’t cause autism” on your cover, highlighted in fluorescent green, for the whole world to see. And not only that, you backed that statement with a well-crafted, reasoned, non-hysterical article inside. It makes me want to go out, buy extra copies, and put them in my hospital waiting rooms. Bravo. The rationality is very, very refreshing.
My little corner of the pediatric world seems to be rather occupied of late with a recent study published in the BMJ. The study looked at a group of 240 kids in the Netherlands who were given either amoxicillin (an antibiotic) or placebo for treatment of otitis media (ear infection). Looking back 3.5 years later, the researchers discovered that those kids who were randomized to receive amoxicillin had a 2.5 times higher risk of recurrent ear infection.
The trend in recent years has been for less and less antibiotic treatment of ear infection, opting instead for a “wait and see” approach for uncomplicated cases. This has been a reflection of data that shows that most ear infections are caused by viruses (not helped by antibiotics), and that it doesn’t seem to make much difference whether one treats simple ear infections with antibiotics or not.
So you would think that docs would be receptive to this additional data further reinforcing the lack of need for antibiotics in many, if not most, ear infections. You would think that, but you would be wrong. Pediatricians and family medicine physicians have spent a lot of time on the intertubes resisting reduction of their antibiotic usage in ear infections, citing personal experience and anecdotal evidence (“back in my day…”) while giving wild exhortations in CAPITAL LETTERS.
The one thing that these docs don’t use to make their point is data – real data. By that I mean large, randomized, well-controlled studies that seek to eliminate confounding variables and answer a specific clinical question. At what point does personal experience become real data? Never. How long does one have to practice before their anecdotes become a valid basis for policy? Let’s just say longer than anyone is willing to wait.
I pause here to realize that even doctors, for all their education, for all the trust placed in them by their patients, are just as prone as anyone to having “blind spots” – areas of thought that refuse to accept evidence contrary to their beliefs. For some doctors, it’s vaccines and autism. For others it’s herbal medicine. For these docs, it just happens to be antibiotics and ear infections.
So what will it take to shed enough light on the issue to get these docs to change? A large part of it, I think, is getting people to take their blinders off. But this, unfortunately, is something you can’t do for them. It’s not easy to self-criticize, but I firmly believe that opening your own practice and knowledge to critique can only help you become more knowledgeable, more humble, and a better doctor. Failing to do so might preserve a frail ego, but it does disservice to everyone else.
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.
Carisa brought to my attention a recent paper in the journal Environmental Health that details an inquiry into the mercury content of high fructose corn syrup, a ubiquitous food additive (fervently disliked by this blogger). As the story goes, an Environmental Health Officer (EHO) at the FDA was trying to track down some missing mercury in the chlor-alkali industry starting in 2003. During this process, the EHO learned that two products created by the chlor-alkali industry, sodium hydroxide and hydrochloric acid, could contain small amounts of mercury depending on the processes used in their manufacture. The EHO then went on to discover that these two products were used mainly in the production of high fructose corn syrup (HFCS). It wasn’t a huge leap of insight from there to surmise that mercury might, as a result, end up in HFCS and thus the country’s food supply. Sure enough, government labs, followed subsequently by an independent lab, found mercury in HFCS samples. The paper mentions that out of twenty samples from three production facilities tested by the independent lab, nine contained detectable amounts of mercury. Of course, being smart people, your next question is how much? The dose makes the poison, after all. Well the range was 0.012 to 0.570 micrograms mecury per gram of HFCS, with an average of 0.252 micrograms Hg/gram HFCS.
Still need more info? That’s the spirit. The average American consumes about 50 grams of HFCS per day. Revolting, isn’t it? Taking the worst case scenario of 0.570 micrograms Hg/gram HFCS, that means 28.5 micrograms Hg per day just from HFCS. The FDA lists 0.1 micrograms Hg/kilogram as a “no effect” amount of intake (note that this is a very controversial number, with different values almost everywhere you look). So for a 70 kg person (high unlikely if you’re really consuming 50 grams of HFCS per day), that means you can safely shoot for 7 micrograms of mercury a day, or about a quarter of what you just consumed in all that HFCS. Oops. Just for reference, that six-ounce can of albacore tuna you just ate? The stuff that you’re not supposed to have too often? That’s roughly twice the amount of mercury from your HFCS.
Is there room for tighter standards and regulation here? I think so. For sodium hydroxide intended for food use, there is an international cap of 1 microgram mercury per gram of sodium hydroxide. Unfortunately there is no such limit for hydrochloric acid. At the other end of the food production chain, the FDA checks a lot of the food we eat for mercury, but unfortunately carbonated sodas – a huge source of HFCS – aren’t included on the list.
Now avoiding tuna and other yummy, high-mercury fish is difficult, especially since fish is generally good for you. But luckily, avoiding this newly-recognized source of dietary mercury is not particularly challenging, at least from the culinary or health standpoints. Avoiding HFCS means avoiding sugary sodas, over-sweetened breakfast cereals, and a lot of the highly processed, crappy excuses for food you find out there. You’re not missing out on anything by cutting HFCS from your diet, and you’re probably doing yourself a great deal of good. As if you needed another reason.
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.
I can get a little moody and punchy when I’m short on sleep, so my reaction was not particularly favorable a few mornings ago when I opened up the AMA Morning News in my inbox and read the first headline:”Study indicates MMR vaccine may not be linked to autism.” I think I nearly had a stroke. I may have yelled, “Gee – you think?” out loud to the empty room, but I can’t fully recall.
For background, AMA Morning News is a daily digest of medically relevant news that’s compiled and sent out by the people at the American Medical Association. The idea is to keep the busy doc apprised of what’s going on in the world of medicine and medical science.
The article attached to this particular headline referenced a newly-published study on PLoS ONE (the online journal for the Public Library of Science) that shot down the contention, made 10 years ago in a much-derided study by Dr. Andrew Wakefield, that measles virus – obtained through MMR immunization – persisted in the guts of kids with autism and possibly was involved in autism’s pathogenesis. What followed from Dr. Wakefield’s study was heightened vaccine fear-mongering and strengthening of antivaccination movements in the the US and UK, the unfortunate results of which can been seen now in the recently reported outbreaks of measles in the UK and the US (without – it should be noted – any change in the incidence of autism).
In the last few years, the idea of a link between vaccination and autism has been thoroughly debunked by several large, rigorous scientific studies. Unfortunately, the public has been a little slow to catch up with the data (which is actually one of my big gripes with the American Academy of Pediatrics), and a lot of unwarranted, even counterproductive, fears regarding vaccines still remain. This headline, instead of reflecting the consensus state of the medical scientific community (minus a few whackjobs), played more to those unfounded fears of vaccines. The likelihood of vaccines being linked to autism is vanishingly small, well beyond what any reasonable person would require for convincing. But a headline that says “MMR vaccine may not be linked to autism” gives a very different impression. To someone who has been fighting against those fears and misinformation for years, it was not a welcome sight – and especially upsetting coming from the AMA.
So I wrote a letter.
To Whom It May Concern,
I was greatly dismayed when I opened up my inbox this morning to see this headline in today’s edition of AMA Morning Rounds: “Study indicates MMR vaccine may not be linked to autism.” I’m not sure how this headline made it past your editors, but the implication it gives is that there is still significant doubt as to whether MMR is linked to autism, when in fact there is none. This lack of association has been established and reestablished by study after stronger study, and for the AMA – of all organizations – to imply that there is still doubt is a reflection of either base ignorance or refusal to accept the data. I’m not sure which is worse. A more appropriate headline would have been, “Study reaffirms lack of link between MMR vaccine and autism,” which is a much better reflection of the article’s actual contents. If the AMA is going to continue to be a trusted source of news and information for doctors as well as patients, it needs to work harder to avoid the irresponsible, obfuscating language that I read today.
Sincerely,
Edward Chung, MD
In my irate, sleep-deprived state, I wrote a complaint letter to the feedback email address at AMA Morning News. I didn’t really expect to get a response; I just felt better having aired my opinion. And a little part of me thought that maybe somewhere, somehow, someone would read it and realize that what they had pulled was not cool.
You can imagine my surprise, then, when a couple days later I got this:
Dr. Chung,
Thanks for writing. You’re right…that headline could most certainly have been written better. In fact, you already wrote what would have been a more appropriate headline for that news item. I’ll discuss this with the editors at U.S. News Custom Briefings, which the AMA partners with to produce Morning Rounds, in hopes of not repeating this in future issues.
Thanks again for writing, and thank you so much for your membership with the AMA.
Sincerely,
(name redacted)
Manager, member communications
American Medical Association
Not bad! It wasn’t defensive, back-pedaling, or falsely apologetic (ie. “We’re sorry if you were offended by what we wrote.”). It was, “Our bad, you’re right, we’ll fix it.” Kudos to member communications at the AMA. Now they’ve gotta be careful. If I continue to get positive feedback for airing my opinion, I just might have to do it more.
A tip of my hat goes out to David Campbell, a biology teacher at Ridgeview High School in Orange Park, FL. The NYT recently published an article detailing his difficulties in teaching evolution to his Biology I class. I thank my Dad for pointing the article out to me. The battle of evolution versus creationism (or Intelligent Design or whatever else they’re trying to disguise it as these days) has been particularly heated in the past several years, and public schools and their school boards have been the front lines in this debate. The fact that there’s a battle at all is somewhat of a sad indictment of the status of science education in this country, but that’s a topic for a whole other series of posts. Beyond all the posturing and rhetoric in the blogosphere is this single human trying his darndest to make a difference in an steeply uphill struggle. It’s easy to sit at the keyboard and say, science teachers should do such and such, evolution should absolutely be taught in the classroom, etc. But the details of how to do that in a real school with real kids is a much more complex issue. Here is a dude who is actually there, walking the walk, pursuing not only the noble goal of teaching science, but also promoting the concepts of evolution. In Florida. Hard core, man. Keep fighting the good fight, sir.