Ed’s corner of the web

So there I was, drowning in comment spam, my poor little blog neglected out of an ill-informed, futile attempt to reduce the tide of spam coming from all the pharmacies of ill-repute out on the interwebs.  Desperate, I turned to my colleague Eliot Gelwan for help.  A prolific blogger himself, I knew I could turn to him for advice.  I was not disappointed, for Dr. Gelwan pointed me in the direction of Wordpress’s own anti-spam plugin, a feature I had not noticed in my helplessness and n00bishness.  Now girded in the armor of Akismet, I feel rejuvenated.  I no longer have to login to my blog in fear.

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.

This is just too cool for words…

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.

Another speed post from Turkey – this time from the super-cute town of ??rince.  I´m using a Turkish keyboard with some extra characters (stuff like ?, ?, Ü, é, and €) and alternate key placements (ö instead of a comma, ç ?nstead of a period), so typing is a bit of a challenge.  I´ve even got a secondary Alt key to handle the extra stuff.  I´m not even sure this is go?ng to display anyth?ng but gibberish, but I thought it would be a fun experiment to try out.

Here’s a little international post for you.  I’m writing to you now from Esbelli Evi, a cute little hotel in the cute little town of Urgup (there should be little dots over the u’s – I can’t figure out how to do it right now) in the Cappadocia region of Turkey.  We’ve been  in this great country for several days now and have been having a great time.  Today we traveled from Istanbul, a city of over 15 million, to this little town of 15 thousand.  In doing so we crossed from Europe to Asia, which would’ve been more cool had we not already crossed from Europe to Asia and back again just for dinner the other night.  If I could post a couple pictures, I would, but I didn’t want to drag my laptop with me this time around.  Rest assured that there will be a full assault of photos once we return.  And in case you’re wondering, we haven’t run into any swine flu over here.  With any luck, things will burn out stateside before we come back.  I’ve got my N95 respirators packed just in case.

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.

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.

As a Darwin Day “gift,” a friend of mine presented me with a copy of The Reason for God, by Timothy Keller.  The subtitle reads, “Belief in an Age of Skepticism.”  I guess I’m letting my skeptical nature show a little bit, huh?  At any rate, I love this friend dearly, and I know the gift was well meant, so I felt obliged to read the book, even if it wasn’t the sort of thing I would usually pick to curl up with.  As I made my way through the book, I began to think that it would be an interesting exercise to blog about the book as I went along.  This post, then, is an introduction to that very exercise – hopefully a series of posts about my impressions of the arguments put forth by Keller as he tries to poke holes in the common arguments against Christian belief and support the strongest reasons he sees for faith.

And just so you know how serious I am about this, I’m actually taking notes in the margins.  Close friends of mine know that I never write in books.  Even my medical school textbooks have nary a highlight or underline.  I’ve always had a hard time “defiling” a perfect printed page, and it’s still against my instinct to put pencil to the paper, even for this cause.  The things I do for you people…

As a preamble, I feel it’s necessary to give my initial impressions of the book, so that you can better know my state of mind going into this exercise.  According to the dust jacket, Keller is trying to reach out to “atheists, agnostics, and skeptics” in an attempt to make an “intellectually compelling case for God.”  Ostensibly, Keller seeks to connect with these nonbelievers, to speak in their own language and argue using their own tools – a high goal, to be sure.  But then you look at the back cover, where the first two jacket quotes come from Rick Warren and Billy Graham, with another quote further down from Christianity Today magazine – not exactly ringing endorsements from the nonbeliever crowd.  I’m not crazy enough to expect a Sam Harris or Richard Dawkins, but maybe a Francis Collins?  Ken Miller?  Maybe Keller really makes some reasonable logical arguments for faith or against skepticism, but from first impressions I am – frankly – skeptical.