Denialism Blog

Month: April 2008

  • Democracy at work

    Despite my usual cynical nature, I had a favorable brush with politics last night. I was up in my kid’s bedroom, getting her bathed and ready for bed, when the phone rang. When my hands are full of soaking wet toddler I don’t usually answer the phone, but for some reason I picked it up. To my surprise it was my Congressman—he was holding a phone conference with his constituents. I did not vote for this guy, and I’m pretty certain I never would, but he is my representative, so I joined the conference (by failing to hang up).

    The district I live in is quite mixed. Economically it runs from moderately wealthy to not-doing-so-great. There are a huge number of home foreclosures, and people are losing auto industry-related jobs. Within a square mile of my house there is a Korean market, two Indian markets, a Halal butcher, a Kosher butcher, an Israeli restaurant, a Lebanese restaurant, a Chaldean market, a Jain Temple, two Synagogues—you get the idea.

    The calls that came in were a mix. One of the things that politicians are usually good at is responding to individuals when given the opportunity. I’ve written to representatives on behalf of patients and gotten wonderful responses. Many calls were from people about to lose their homes, and the rep gave them contact numbers, etc. A few calls complained about illegal immigration, although I’m not sure why—Michigan had a hard time bringing in the crops last year, a folks from my area weren’t heading Up North to do field and orchard work.

    Most of the calls were handled without the usual political lip service (most—not all). Some callers were clearly disturbed, and he handled them very well.

    All in all, I was very impressed with the job my Congressman did communicating his ideas, even the ones I think are idiotic. I was even more impressed with the way he dealt with his constituents. He seemed to be in politics for all the right reasons (and, no, I don’t think I’m being credulous).

    So, despite my dislike of this individual’s politics, I felt a renewed sense of optimism about American democracy. Plus, I got two loads of laundry folded and one poopy diaper changed while participating in my government. Woo-hoo!

  • Denialist comments—a brief analysis

    My recent post on a local “holistic” doctor brought a number of considered and interesting comments (all of whom are quite polite and patient, even when I disagree with them).

    Some of the issues deserve fleshing out.

    Heart disease is a major killer. Hypertension is one of the strongest risk factors for heart disease. In some people, salt contributes to hypertension, and reduction of salt intake reduces bad outcomes. In people with congestive heart failure, salt-restriction is crucial.

    The statement of this idea led to some interesting objections, with a good helping of goalpost-shifting.

    The objections raise some important points, but also engage in some typical denialist tactics.

    I’ve just been looking for basic information, and coming up empty-handed, so I hope you can understand my frustration. I’m not one to hold on to bad ideas in the face of evidence, but I’d like to see a prima facie case made first.

    and

    I’ve also seen a study in the news in the last few months that was reported to show a significant increase in mortality among high-risk patients over a 10-year period for those who maintained a high salt intake. That raises questions that weren’t answered in the news article, such as: How did the diets compare otherwise? It’s reasonable to assume that someone who reduces their salt intake because of blood pressure is going to make other dietary changes as well, and vice versa. If other variables were controlled, then by what mechanism does salt increase mortality? What do those results mean for individuals with normal blood pressure?

    and

    The correlation between sodium intake and heart disease doesn’t prove anything. This is a classic example of correlation not equalling (sic) causation. Processed and fast food, the biggest sodium offenders, also tend to be loaded with saturated fat and cholesterol. Could these not also be the cause of the artery disease, and the salt just be a relatively innocent bystander?
    I am not saying that there is no place for a low-sodium diet, I’m just saying that I’ve yet to see any evidence for one in general. (emphasis mine –PalMD)

    This is simply an argumentum ad ignorantiam. The fact that the commenter doesn’t know the answers does not affect the validity of the conclusions stated. Does he think that researchers have never asked these questions?

    How about a plausible method by which salt causes ateriosclerosis?

    and

    We have no convincing evidence that blood pressure increases resulting from salt intake contribute substantially to heart disease or stroke. You, and the medical profession in general, are taking a giant illogical leap.

    Actually, I gave references. If he can’t be bothered to check them, it’s hardly my fault, or the fault of the medical profession.

    High salt intake may raise blood pressure in some groups, but it does not necessarily lead to chronic or dangerous hypertension. And chronic hypertension might be an effect, rather than cause, in many cases. We don’t really know.

    I already said that there is great variability to patients’ susceptibility to salt, so objection noted. Actually, we do know that hypertension is a cause rather than an effect of heart disease.

    We do know that the major causes of artery disease leading to heart attacks and strokes are cigarette smoking and type 2 diabetes. So we do not have any clear connection between a high salt diet and artery disease. And you have admitted that.

    In addition to cigs and diabetes is hypertension. As cited, in many patients, high salt intake leads to hypertension. Hypertension leads to heart disease. To require the most proximate cause is an absurd argument. Medical science looks for correlations, and tries to explain them. Much of the time we understand the specific mechanisms involved. To ask for more and more detailed explanations is simply moving the goalposts—if you don’t like the answer, just ask more detailed questions until everyone is tired of answering you.

    Unfortunately, I am not a member of the AMA, so I don’t have access to that article. I did want to read it given the alarmist wording of the headline, but it wasn’t $15 of want, especially since I’d need to pay for the references, ad infinitum….

    If the commenter is unwilling to accept my expert status, that is quite reasonable. But then to be unwilling to dig up the data himself, well, that’s just silly. To gain information, you can either listen to an expert or try to interpret the data yourself. To be unwilling to do either is simply intentional ignorance. To then expect others to buy that as a legitimate argument is not just unfair, it’s asinine.

    The point here is not about individual commenters—it’s about strategy and errors in thinking. For complex information, we trust in experts—we have no choice. If we are curious about going deeper, we look up the primary sources.

    Salt may or may not be an important cause of heart disease, although evidence favors the connection; there are certainly more important causes. But in some people, salt very directly causes increased blood pressure, and high blood pressure most certainly does lead to heart disease. That fact does not negate other causative factors (which is another non sequitur brought up in some comments).

    Denialism involves, well, denial. If you don’t like a fact, then just keep looking for ways around the truth. Or plug your ears and go, “la la la la la.” Either has the same effect.

  • Answers Research Journal—HAHAHAHAHA!!!

    So, Answers in Genesis cranked out the first issue of its new journal, and with all deliberate speed! It’s remarkable. I’m guessing that creation research doesn’t take quite as long as, say, real science. The pilot issue is a true testament to the idiocy of the Creation Cult. I guess we have to actually look inside this waste of electrons to see what’s going on.

    While it is true that no scientist with an intact cerebral cortex will take the Answers Research Journal seriously, still, it’s hard to ignore. If this is the best shot the Creationist cults can do at making their point then I don’t think the NIH is going to be sending them a lot of money any time soon. Each article from the pilot edition has its own kind of stupid..

    Remember that “Answers” is supposed to be a “professional, peer-reviewed technical journal.” One article is called “Proceedings of the Microbe Forum”, but what this “forum” was is not clearly indicated. This doesn’t start well (nor does it end well). If fact, it ends so badly, that I’ll start with the footnotes:

    These are pseudonyms. The writers, who hold PhDs in fields related to the topics of their abstracts, are scientists at prominent research facilities in the eastern part of North America. They prefer to keep their creationist credentials hidden for the moment until they achieve more seniority.

    If you publish a scientific paper anonymously, it isn’t scientific. There is no way to verify anything. If what they publish is quality research, then they have nothing to fear. If it is crap, well, then academia can be very harsh on non-productive idiots (productive idiots, however…). Let’s go back to the top and see what has the authors so verschrecked.

    Introduction

    For many years the roles of microbes as part of God’s wonderful design have been neglected. Creationist literature is largely void of topics related to these tiniest creatures. Perhaps it is because many people associate microbes as the cause of death, disease, and suffering. This is true for only a fraction of microbes; the large majority are extremely vital for sustaining life on earth. Their roles range from recycling nutrients in soil and water to symbiotic relationships that provide necessary factors to their host. Their role in death and disease is a result of the Fall and the Curse on all living things.

    Ouch! That is a steaming pile of burning stupid. I can see why the authors are scared. A tenure committee would look pretty foolish if they promoted a microbiologist who believes that “the role [of microbes] in death and disease is a result of the Fall and the Curse”….

    (more…)

  • There is no such thing as alternative medicine

    What is alternative Medicine, anyway?

    That’s a great question. I know it is, because I asked it. I get this question almost daily. The secret answer is that there is no such thing as alternative medicine. You don’t believe me? Why not–I am a doctor.

    There are several ways to define alternative medicine, and sometimes it is contrasted with “complementary medicine”. CM refers to treatments that “complement” traditional medicine, while AM refers to treatments that stand in the stead of mainstream medicine. CAM is a broad category used to refer to both.

    So what’s my problem? How can I say that there is no such thing?

    Because “mainstream” medicine is medicine that works. It has been studied, tested, deployed, followed, and it is proven to do what it says. Alternative medicine is any treatment that is not yet, or may never be, mainstream. If it is found to work, it becomes mainstream very rapidly. If it is not proven to work, it remains “alternative”.

    So, I guess there is, after all, such a thing as alternative medicine. It is any treatment that doesn’t work. Why would anyone want that?

    There’s lots of answers to that question. There are also several incorrect answers. The most common incorrect answer describes a conspiracy of doctors and Big Pharma. Others include the myth that patients are dissatisfied with their physicians and the care they provide. In fact, most people like their doctors. But they like their friends even more, and if a friend testifies about a great new potion, well, why not try it?

    Why not, indeed. Your doctor knows quite a bit about the medications being prescribed, and the problems being treated. Your friend, alas, does not.

    When someone offers you an “alternative therapy”, ask them what it is an alternative to. Does it work better that something else? Is it safer? How do you know? Why should I believe you?

    Those questions apply to your doctor as well, but hopefully, you have already decided whether or not you trust your doctor and modern medicine. Try applying this simple test–when you have crushing chest pain and shortness of breath, who do you want to call: the GNC guy or an ambulance?

    Maybe further explanation is needed to tease out the difference between “real” medicine and “alternative” medicine.

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  • More stupid from the Huffington Post

    In a new apologia for Jenny McCarthy and the mercury militia, Alison Levy, writing for HuffPo, wonders what all the fuss is about.

    When I watch Jenny McCarthy on CNN or when I read the blogs (and comments) on autism, I keep wondering: What is this debate about? Yes, the parents of autistic kids are more “emotional” than the aloof doctors before them. But why are they met with anger, rather than compassion? If their concerns are heard, how does that harm other citizens? As a health journalist, and recent newcomer to this issue, I’m trying to understand the passion on the “pro-vaccination” side.

    She wonders what the debate is about? After all that reading? How dense is she?

    The underlying fear and anger towards these parents suggests that it’s somehow heretical to question any proffering of scientific “proof” even when it squares off with experience–in this case, parents’ tragic and oft repeated experience of watching hundreds of thousands of children immediately deteriorate upon vaccination.

    There are several logical fallacies here…
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  • More from a local "alternatician"

    I recently posted an article on a particular “holistic” doctor’s take on salt–the bottom line is the bottom line; more expensive is better. You’d think I’d call it a day.

    However, if someone is going to advertise widely, he’s leaving himself open for criticism. How can one family physician have so many answers? He sells books and DVDs purporting to cure and treat a remarkable number of diseases from arthritis to thyroid disorders to fibromyalgia. These works are not available for free, so I can’t evaluate their validity. They may contain harmful advice, helpful advice, or none at all. The hype, though, is pretty remarkable.

    For example, he sells a book called “Overcoming Thyroid Disorders”. This book:

    provides information on safe and effective natural therapies to help the body heal itself. Dr. Brownstein provides over 30 actual case studies of his success in treating thyroid disorders.

    I’m not sure what the big deal is. Medical science has been successfully treating thyroid disease for decades. It’s offering a service that, well, isn’t really needed. I’m also not so sure what is so exciting about offering “30 actual case studies” except that the rest of the sentence says “of his success in treating” these problems. He seems to be saying that, at least in 30 of his patients, he’s done a decent job treating thyroid disease.

    My God! I hope so! Treating thyroid disease is basic to the practice of primary care medicine, and when it gets too complicated, endocrinologists can help out. I have also successfully treated dozens (more, really) of people with thyroid disease. I don’t brag about it because it’s part of my job (and I’m not selling anything).

    People have every right to write books, sell them, and profit from them. People should just be aware of what they are buying.

    Richard Dawkins said, ” If you are in possession of this revolutionary secret of science, why not prove it and be hailed as the new Newton? Of course, we know the answer. You can’t do it. You are a fake.” This was meant to make the point that those who offer up miracles are usually unable to deliver. If this guy knows so may remarkable things about medicine that no one else does, why isn’t he more widely known? Why hasn’t he published his results in peer-reviewed journals? I doubt he’s “a fake”. But what makes him think he has a special insight that the rest of the medical community missed out on?

    The answer is probably that his books bring comfort and control to people dealing with frustrating health problems. A person buys a book like this because they feel bad, and they want to feel better. Some books on health contain useful advice, some don’t. Perhaps the advertised tomes give good advice…I don’t know. But hyping a problem (the difficulty of treating thyroid disorders) and selling a solution (the book) seems a little icky too me. It just doesn’t seem to mesh well with my duty to help those in need with proven techniques, without selling them something they probably don’t need. Perhaps I’m being too critical. If I have a patient with simple hypothyroidism, I do an evaluation, and I can often treat them with a medication that costs pennies a day. I rely on the medical literature and my relationship with the patient to make a treatment plan. I don’t rely on charisma (I just don’t have that much) and I don’t rely on extravagant promises (seems too much like lying).

    Well, to each his own.

  • More madness from PETA

    My earlier post on People for the Ethical Treatment of Animals (PETA) was perhaps not clear enough.

    PETA is not for “the ethical treatment of animals”. They are for treating animals as if they were furry humans. In fact, they are for treating animals better than we treat humans. This is a dangerous philosophy.

    To equate human rights with animal rights is to diminish the value of human beings. First, which animals do we apply these rights to? The cute ones? Bunnies? Drosophilia?

    And in their battle for equal rights for all animals, humans included, do they work for the rights of people?

    One sick post on their website (to which I will not link) has a “Final Four” of scientists who work with animals. This page posts the locations and photos of the researchers, with inflammatory language, such as “remov[es] cats’ eyes while they’re still alive”, but of course doesn’t mention the goals or accomplishments of the research.

    Do you think their propaganda is harmless? Here’s some comments from the site:

    they should have to suffer just like those animals had to do for their unright (sic) and cruel experiments.

    Someone should put steel rods in their heads

    I say they experiment on them, how about that:)

    So, I guess we need to be nice to non-human animals, but it’s open season on humans.

    I’d venture a guess that most people feel we should be nice to animals. There are exceptions of course, but in general, people are against undue cruelty to animals. PETA argues than any harm to animals is “undue”.

    The problem with this stance is that it devalues human lives. For example, a recent news item from Europe previews an ad campaign by PETA. They will run ads during the war crimes trial of former Liberian president Charles Taylor.

    I’m really not sure how to state this any more clearly—the slaughtering of human beings is not morally the same as the slaughtering of animals.

    Those who believe that it is create a dangerous devaluation of human life.

  • Salt your way to health

    As it turns out, in my own neck of the woods there is a small woo-factory. I came upon it when I saw an internet add extolling the virtues of salt, as long as it’s expensive salt. The author of the article turns out to be a doctor in my very metropolitan area. There is so much woo here that it may take a few posts to get through it all.

    The article is called “Salt Your Way to Health” and is featured on the website for a company that just happens to sell, well, fancy salt. There is a bit of a cage match going on with my internal writer and internal scientist. To properly deconstruct and critique this article would create an unreadably long post. So please indulge me with a little patience as I toe the lines of readability and de-wooification.

    Salt and Hypertension

    Before firing up the de-wooificator, I’m going to have to tell you a little bit about salt and hypertension. Sodium chloride (salt) is essential to human life. Salt is the primary extracellular electrolyte in the body, and we can’t live without it. Common American table salt also contains trace amounts of added iodine to prevent goiters. That being said, consuming too much salt has health consequences. First, in people with congestive heart failure, too much can make it difficult to breath, and even kill.

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  • Bill Maher is a crank

    I must admit I have a love-hate relationship with Bill Maher. He is a funny guy, he is good at mocking some of the more ludicrous aspects of politics, and he has been an effective critic of this administration and some of its more egregious policies.

    However, I’ve also long held the position that both liberals and conservatives alike must own up to their own extremists. Liberals must own up to the fact that they don’t have a universally-solid grasp on scientific truth, and just like the right wingers, we have people and movements within the left wing that are cranky and denialist. I would say left wing crankery includes animal rights extremism, altie/new age woo, and anti-technology Luddites.

    Bill Maher is one of these cranks (he scores 3/3), and if the liberals want to represent themselves as truly pro-science we must make a concerted effort to reject the unscientific beliefs of these crackpots. We must call out Bill Maher on his BS (we have before as has Orac), and call him a crank for his unscientific, and frankly insane beliefs about medicine, disease, “toxins” and health.

    As PAL has already pointed out and I wholeheartedly agree, Bill Maher made an outrageous statement Friday night on his show Real Time. In an interview with Arlen Specter, who’s life was saved by medical science, he said:

    Because President Bush actually brings up a good point, because you can’t catch cancer, but people in this country treat it like you can. What you do is you hatch cancer by human behavior. Most cancer, there is of course some genetic cancer, but most of it is by behavior…

    But doesn’t that tell you something about our system, why do you have so much faith in Western medicine when they get it so wrong, when the third-leading cause of death in this country the health care system itself. Isn’t the paradigm wrong?

    Where to begin with such a pair of despicable statements? For one, this is a classic crank attack on medicine, using the IOM report, as PAL mentioned, to attack medicine ironically in the midst of one of its attempts to be self-correcting. The misunderstanding that anti-medicine cranks are exploiting in this report are that the overwhelming majority of “mistakes” in that report were things like failure to rescue (failing to recognize when a patient starts circling the drain) and hospital acquired problems like decubitus ulcers and nosocomial infection. What does that mean? That means the failure of medicine that the IOM is being critical of reflect failures to save the lives of people that are critically, critically ill. These are failures in saving people from death. These are mistakes in a population that are actively dying (failure to rescue), or so sick that they are unable to even move under their own power (decubitus ulcer), or immune compromised enough that they can’t defend against infections (nosocomial infections). These mistakes are a problem, and I don’t seek to diminish the importance of finding ways to avoid them. The IOM report represents the efforts of medicine to correct preventable failures in medical care that are very serious, and we’ve spent the last decade trying to resolve (we will likely spend many more). For example the recent War Games video I posted was an example of attempts to train medstudents and interns how to recognize and deal with rescue situations more quickly and effectively.

    But Bill Maher makes it sound like doctors are stalking healthy people in the streets and beating them to death with ball-peen hammers. You don’t go into your doctor’s office for a routine visit and acquire a c. difficile infection or MRSA or decubitus ulcers or a “failure to rescue” mistake. We’re talking about very sick people who often wouldn’t be alive in the first place without medical intervention, who doctors, albeit for some preventable reason, are failing to keep alive or inadvertently make worse. That doesn’t stop Maher from making it sound like we’re running people down in the parking lot, and I don’t appreciate the implication that doctors who sacrifice so much time and effort saving lives are heedlessly killing people.

    Further it is exceptionally ignorant for ignoring the incredible net contribution of medicine to extending and improving life. Why do we live longer on average than any generation in human history? Childbirth no longer represents a major threat to a woman’s life. Children don’t die from ordinary illnesses and infections. Major traumas like gunshots, fractures and massive blood loss no longer are an instant death sentence – we often can put people right back together after amazing injuries. How have we managed to cure diseases like polio, or cure Senator Specter’s Hodgkin’s lymphoma? Evidence-based medicine and the applied science of modern medical care is the answer to all those questions. No magic crystal, acupuncturists needle, or diluted tincture has accomplished these feats.

    Bill Maher is a Luddite, who has tried to blame the death of bees on cell phones has engaged in anti-vaccine wingnuttery, routinely complains of mysterious “toxins”, supports animal rights extremists, and generally has a disgusting “blame-the-victim” mentality towards health. Lung cancer may be a largely self-inflicted illness, but the other big cancer killers? Breast cancer? Prostate cancer? Pancreatic and colorectal cancers? Each may have a small environmental component, but most cancers aside from those caused by cigarettes have much more minor contributions from lifestyle and environment. That is not to say these contributions do not exist, but compared to cigarettes the relative risks of misbehavior are astronomically smaller. Most of these cancers have overwhelmingly genetic risk factors and the number one risk factor is almost always family history. Maher’s statement that cancers are “hatched” or that there is only “some” genetic component is typical of his ignorance of medicine, his blame-the-victim mentality towards disease, and is just as despicable as his depiction of medicine as a killer.

    Liberals have to own up to the fact that they have cranks in their midst as well. Bill Maher is the left-wing version of Dinesh D’Souza or Jerry Falwell. His views on science are no more elevated, and when in conflict with his ideology, no less hateful towards science, or the people he disagrees with.

  • PETA: equating civil rights with steak

    People for the Ethical Treatment of Animals (PETA) is an extremist organization. Some might even call it a cult, and a violent one at that.

    Ingrid Newkirk, the president of PETA, is a particularly objectionable fuckwit. Many of my friends are vegetarians for ethical reasons. They object to the treatment of the animals we use for food, and they object to the impact raising food animals has on the environment. It’s a personal choice. But they don’t think that a chicken is the ethical equivalent of a person. My friends just aren’t that stupid.

    Ingrid is not one of my friends. In her message for the anniversary of the death of Martin Luther King, Jr., she takes stupid to the next level—worse than nauseating, worse than burning, worse than blinding. She equates the assassination of America’s greatest civil rights leader with making omelettes.

    MLK was one of thousands of people who were killed trying to gain equality for African Americans. Thousands more were physically injured, and millions more suffered the burdens of racism, Jim Crow, and segregation.

    As we reflect on the violent killing of a man who stood for peace and equality, it’s a good time to ask ourselves what we are doing — because there’s so much we can do – to help humanity reach those goals.

    We may not be able to stop all the violence in the world, but each of us has the power to end the violence and suffering we’re responsible for every time we sit down to eat, simply by choosing humane vegetarian foods instead of meat, dairy, and eggs. The animals who are killed for our food never have the freedom to do anything natural or enjoyable.

    There are a couple of ways to interpret her idiocy. One is that Blacks are no better or worse than animals, given that both deserve the same rights. I find this abhorrent.

    The other is that all people are no better than animals when it comes to how we treat each other. I find this equally abhorrent.

    If you do not recognize that there is a moral difference between how we treat other humans and how we treat animals, you are missing something fundamental: the world isn’t fair. We were not put on Earth to help other species. We exist in a world of predation. Thankfully, we are most often the predator. Sure, we can choose not to eat animals, but it is not the same as choosing not to eat a person. People are far more intelligent than other animals, and each person is a member of human society. Chickens are not, and will never be, integrated into our society, either physically or morally.

    Anyone who claims that eating animals is the moral equivalent of Jim Crow, lynching, and assassination is not only an idiot, but is a racist idiot, and a dangerous idiot—if animal lives are the equivalent of human lives, then some fucktard out there is going to kill a person to save an animal.

    I don’t think it’s going to far to say that PETA should probably be on a terrorist group watch list, if it isn’t already. People have been hurt, and more surely will be.