Ed’s corner of the web

The scales of justice nudged a little closer towards balance last Monday when the British General Medical Council struck Andrew Wakefield – the idiot who launched a thousand anti-vaccine ships – off of the medical register.  It’s a largely symbolic victory, but I’ll take it.  At the very least, this illustrates just how wacko the medical and scientific establishment think this guy is.  Barring someone from practicing medicine is neither a simple nor quick affair.  BBC.

I’ve heard of taking timed exposures as long as several hours, and even I myself have done exposures as long as several minutes, but this guy takes the cake with his six month exposure tracking the sun’s path from June to December.  He didn’t need no stinkin’ fancy SLR, either.  This was done using a tin can and a sheet of photographic paper.  Super cool.  (Help My Physics via Gizmodo)

Today was my first ever session at Bikram Yoga.  For the uninitiated, Bikram Yoga distinguishes itself from other forms of yoga by being higher in intensity (just as ashtanga is higher intensity than hatha) and taking place in a room heated to 105 degrees.  Yeah – wow.  I went at the behest of a good friend, who is an enthusiastic participant and big believer in Bikram Yoga.

I’ll ignore, for the moment, some of the more ridiculous claims that came up during the course of the session – detoxifying through sweating, “massaging your pancreas” with certain poses, and savasana “corpse” pose being more restful than eight hours of sleep.  These are laughably woo-tastic (I’m sure those yoga instructors still sleep in their beds at night), and I don’ t think any reasonable person – my yoga friend included – lends them any significant degree of credence.  I would’ve given at least a dubious huff when these ridiculous claims were aired, but I was too busy lying on my back trying to get my heart rate to come down while keeping the sweat out of my eyes.

This brings me to a more interesting claim of Bikram Yoga proponents.  Apparently the heat and the accompanying elevated heart rate allow one to burn an incredible number of calories during a typical 90 minute session.  One Bikram website calculates my personal expenditure to be 1100-1200 calories for 90 minutes.  A brief look around the web revealed similar claims – anywhere from 600-1000 calories per session.  This was simply too good to be true, but lacking the means to immediately falsify this claim, I had to do some digging.

Lacking access to a physiology lab and experimental volunteers, I had to turn to Google.  I expected the usual minefield of misinformed, baseless claims, and the web did not disappoint.  A large number of pages (usually devoted to quick weight loss secrets) tried to address the question of whether merely being in a hot environment causes you to burn more calories.  On the surface, this is not an unreasonable idea.  When you get hot, your body has to expend energy trying to cool itself.  Your sweat glands excrete sweat, and your heart rate elevates as it pumps more blood to your skin and periphery where it can be cooled.  The effect, however, is not anything to write home about.  The  L.A. Times reports that sitting on your butt in front of the TV for 20 minutes burns 23 calories.  Plop that butt into a jacuzzi, though, and the number rises to – wait for it – 34 calories.

“But wait!” some say, “I’ve worn my heart rate monitor during my Bikram Yoga class, and it says I burn a gazillion calories!”  Unfortunately, what these people don’t know is that heart rate monitors calculate calorie expenditure using formulas based on weight and heart rate (some better ones use height, gender, and age).  They assume that if your heart rate is up, it’s up because of exercise.  If your ticker is pounding away just because of that triple espresso, it’ll think you’re running on a treadmill and give you credit for calories you didn’t really burn.  So a heart rate monitor worn during Bikram yoga is giving you unearned credit just for being in a hot room with your heart having to work harder to keep you cool.

Carisa believes that the propagation of misinformation on Bikram Yoga can be partially attributed to the failure of science education, and I’m inclined to agree.  Perusing a Bikram Yoga thread on a fitness message board only serves to reinforce this notion, as misinformed, woo-filled posts drown out the attempts at reasoned, fact-based argument.  And this is one of the better threads out there.  Don’t get me wrong; I think there are a lot of benefits to be had from yoga – flexibility and improved balance to name a couple.  I personally hope to do more yoga in the future.  But I think that bogus claims like these don’t help anyone (save for those who profit from the falsehood) and ultimately only discredit any of the real benefits yoga might have.

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.