Denialism Blog

Author: denialism_bv2x6a

  • I don't like this at all

    Yesterday my daughter (the one in my picture, but older now) started sneezing—a lot. Allergy season in this part of the country is brutal. We keep a box of kleenex on every flat surface in the house. But this morning she started coughing, and had a low-grade fever, so we knew she was sick, not just allergic. My wife stayed home with her while I represented us at our family’s Passover Seder. When I got home, she was still coughing—a lot. I grabbed a stethoscope and listened to her chest. It wasn’t perfectly clear, but she was coughing and crying so it was hard to hear (also, I’m not a pediatrician). I stepped back for a minute and looked at her. She was miserable. She was using her neck and chest muscles to help her breathe, and her stomach was moving in and out in what’s called a paradoxical pattern. She was clearly not doing well. We grabbed a few things and jumped in the car, heading for my hospital.

    When we got there, she was really struggling. Thankfully, lots of people I knew were working, and we got plugged in pretty fast. After a breathing treatment, she was a little more cheerful, but still breathing about 40 times per minute.

    Any parent knows what it’s like to see your child ill. When I look at her as a patient, I can see how sick she really is, but I try to keep a calm demeanor for her and for my wife—inside I’m screaming, tearing at my clothing, shaking. Her oxygen saturation is in the high 80s to low 90s, but she’s improved since we came in. My wife sends me home to get some rest (like hell!), and the plan is for me to pick them both up in the morning when I come in to round—assuming the little one is well enough.

    I feel horrible leaving them there without me, but one of my residents is taking care of them and I know he’ll call me if anything is going on. Still, it’s laughable to think I can just come home and sleep.

    It turns out she has respiratory syncytial virus (RSV), a nasty little respiratory virus that makes little ones miserable. Unfortunately, there is no vaccine for this one. We’re stuck with chance, and I don’t like chance very much tonight. In fact, I don’t like anything very much tonight except my daughter and her big, brown eyes that shine when she laughs, which is most of the time. When she coughs so hard that she can’t speak, I want to vomit.

    But instead, I’m sitting at home next to the phone, typing, and hoping and waiting.

    Addendum:
    So, as soon as I settled in at home, I got called back to the hospital. She’s doing a little better, but not well enough to go home. More later.

    More under the fold—>
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  • Congress Isn't Priceless!

    The financial services industry pumps a huge amount of money into politics. So much so that the industry has special status and gets pretty much what it wants. Things are a bit different now, because the downturn in the economy and mortgage screwup has given Washington some leverage to examine some of the industry’s worse practices, and look at what happens–

    Imagine that you were invited to Washington DC to testify at a hearing on the “Credit Cardholders’ Bill of Rights.” You travel to Washington, probably on your own expense, to share your frustrations with the one-sidedness of credit card contracts and policies, only to learn that you can’t testify, unless you:

    …would sign a waiver that would permit the credit card companies to make public anything they wanted to tell about their financial records, their credit histories, their purchases, and so on. The Republicans and Democrats had worked out a deal “to be fair to the credit card lenders.” These people couldn’t say anything unless they were willing to let the credit card companies strip them naked in public.

    That craziness is Professor Elizabeth Warren, a Harvard Law faculty member who has been very critical of the financial services industry and their denialist lackeys. I’ve never heard of a legislative witness having to give up their credit card and bank statements to the public in order to discuss an issue.

    In light of this requirement, Warren asked that the credit card companies be subject to similar terms!

    …During the preceding 3 1/2 hours the credit card issuers had repeatedly made various factual statements about their practices, their customers, their revenues and so on (e.g., “College students have the same default rates as our other customers,” “98% of payments are made for free,” or companies raise interest rates “to control risk, not to increase profits.”) So I asked if the credit card companies were going to testify to such factual statements, would they be required to produce the data to back up the claims so that we could all see it and evaluate it. Katie, Adam, Larry and I all used public data and footnoted our work. Surely it wouldn’t be fair for the credit card companies to make factual assertions that no one could challenge because no one else had any access to their underlying data. If the new rule is that everyone has to release everything so others can challenge it, when the card issuers want to testify as to “facts,” shouldn’t hey have to back up their claims by showing us the numbers?

    I never quite understood the Congressman’s reply. I’m still waiting to find out what fair-is-fair really means.

    This is a great point. I was always a bit disappointed in industry testimony, because they make big points without bothering to provide a footnote, while proponents of reform write substantial critiques, fully footnoted. But when you have the big money that the banking industry has, that doesn’t seem to matter–to republicans or democrats!

  • Whoopie!

    Last night I was reading a book to my daughter at bedtime. It was all about a kid who had chickenpox. I looked at my wife and said, “this is a bit outdated.”

    “So what, it’s cute,” she accurately replied.

    Wow. I hadn’t thought about it much lately, but chickenpox in the U.S. is disappearing rapidly. “Pox parties” are gone. Kids aren’t missing weeks of school. Pediatric ICUs aren’t seeing much varicella pneumonia. Now that I think about it, a number of important lessons I learned in medical school are becoming historical oddities. On my pediatric rotation, we learned to watch for the ominous “thumb print sign” on lateral neck x-rays, along with the stridor and drooling that accompanies epiglottitis. Thanks to the Hib vaccine, this entity is now very rare.

    Of course, these childhood diseases still exist. Mumps is still with us. Measles waxes and wanes. And pertussis (whooping cough) is alive and well.

    In my work as an internist, I see a lot of coughs and colds. They are very common, and a lot of my time is spent dispensing grandmotherly advice and helping people understand why antibiotics are not going to cure a virus. But not every cough is completely benign, and much of the teaching I do is helping young doctors to distinguish the difference.

    Over the last year, I’ve diagnosed around 4 cases of pertussis. Ideally this shouldn’t have happened. Pertussis is relatively harmless in adults, but it is very dangerous to young children. Pertussis used to be a widespread disease. It is fairly benign in adults, causing a bronchitis-like illness. But children are at high risk of becoming very ill. The greatest risk is for children under 6 months old. If they get pertussis, they almost always need to be hospitalized. Pneumonia occurs in about a quarter of them, seizures and brain damage in about 3-5%. Death rates are about 1-2 in 1000. Serious allergic reactions to the vaccine occur in less than one in 100,000 cases.

    If you are unvaccinated and live with someone who has the disease, you will catch it (80-100% transmission rate). Vaccination prevents disease, and when it does not, it lessens the severity. Most importantly, vaccination prevents transmission to those most vulnerable…babies. They are too young to have developed proper immunity. So getting vaccinated is not just for personal protection; it is for the protection of others.

    Vaccination is safe and effective…we already have a way to fight this. The problem is, the vaccine’s effects do not last forever, and if an adult catches it, it looks a lot like a common cold; there is no way to identify and isolate the infected to prevent transmission. Vaccinating everyone protects our most vulnerable, and failure to vaccinate everyone puts our infants at risk.

    Since pertussis immunity wanes with time, a new adult vaccine containing acellular pertussis is now available bundled with tetanus and diphtheria (if you’re under 65). When you go for your next tetanus shot (every 10 years), ask about it. By vaccinating yourself and your family, you can help prevent a child from getting ill. You might even save a life.

    CDC Pertussis Information

    More pertussis information

  • Christian Apologists don't have enough faith

    I don’t normally blog on religion, but there has been an jump in foolish writing coming from the wacky end of the religious spectrum. On the top of the list are folks like Vox Day and Geisler and Turek (I Don’t Have Enough FAITH to Be an ATHEIST). For some Christians, faith isn’t enough, apparently—they want logic and science to be on their side. Apologists perform some crazy cognitive acrobatics to try to prove that their beliefs have some objective reality. (Huge hat tip to Deacon Duncan over at Evangelical Realism.)

    Apologists like to think that they are persecuted for their pursuit of “truth”. For example, to Apologists, there is a vast anti-Christian conspiracy. Whether it’s the crazy atheists keeping all that good Creationist learnin’ out of the public schools, or the New Atheists’ attempt to TAKE OVER TEH WORLD!!11!!, conspiracies are a major part of apologist thinking. As a non-Christian and a true minority, I can tell you that to the rest of us this seems truly bizarre. Every president of my country, the vast majority of Congressmen and women, and most of the residents of the United States are Christians of one sort or another. It hardly seems likely that there is or even could be a conspiracy to oppress them in some way. The U.S. is remarkable in its ability to tolerate every kind of religious wacko, mainstream or not. There has never been a nation more friendly to the religious freedoms of individuals. I’ll tell you what—next time a teacher says in class, “all of the Jewish students may now follow me in the Shema. Anyone who is ‘other’ may sit in a moment of silence. If you are a follower of Jesus the false messiah, I pity you,”—next time that happens to someone you know, I’d like to hear about it. Next time a teacher tells your kid, “Well, Saturday is the Sabbath, not Sunday. I’m sorry, but you fail this quiz,”—next time that happens let me know. I’d especially like to know about the next time someone spray paints Jewish stars all over your church and says, “Nero was right—to the cross with all of you.”

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  • Flu roundup

    This was a really crappy season. The system for developing flu viruses is the best we’ve got, but it’s imperfect. This year, we had significant mismatch between the vaccine and the circulating strains.

    According to the CDC, this season peaked in mid-February, and was “moderately severe”—and the worst season in four years.

    Improving our system of flu prevention will take lots of work, including epidemiology, basic science, and front-line medicine.

    A lousy flu season not only causes suffering and death, but also fuels denialits, who sit at their keyboards drooling at the prospect of pointing out vaccine failures. Most arguments center around the tu quoque fallacy: “maybe my vaccine lunacy is useless, but look, you made a big boo-boo this year.” The problem with this reasoning is that in the final analysis, vaccines always do far more good than harm.

    Some critics (OK, one obsessive-compulsive commenter) bring up outbreaks of vaccine-related polio in Nigeria and India. This is an example of imcomplete knowledge. The response to a vaccine-related polio outbreak is the same as a natural outbreak—mass vaccination.

    As I’ve told you before    , there are two types of polio vaccine: IPV and OPV. Both have certain advantages and disadvantages. The OPV (oral polio vaccine) is a live virus, but usually does not cause disease. The disadvantage is that rarely it can cause human disease. The advantage is that if you give it to several children in a rural village, it will be passed to the rest of the village via contaminated drinking water—the same way that wild-type poliovirus is spread. Kids take the vaccine and poop out the virus. Poor sewerage takes the vaccine to the water supply, and the villagers drink it. Mass vaccination then occurs passively. In the U.S., this has been phased out. One of the reasons for this is the large number of immunosuppressed people in this country—those undergoing chemotherapy, etc. They are the ones most at risk for having problems with the live oral vaccine.

    The other polio vaccine is the IPV, which is an inactivated virus that is injected. This confers immunity, and avoids the problems of the live vaccine. What it doesn’t do is passively immunize others like the OPV.

    The usual effective response to an outbreak of vaccine-preventable disease is to create a wide area of vaccination around the center of the outbreak. This has been very effective. The correct response is not to throw your hands in the air and say, “I guess vaccines don’t work, let’s give up.”

    One of the basic problems with the anti-vaccine crowd is that they offer no real solutions. Vaccines have been found in study after study to prevent death and debility from many different illnesses. Since denialists don’t have the data on their side, they like to simply point at the problems with current vaccines, without offering solutions.

    If they really wanted to help, denialists could get an education and join the fight. Help us find ways of improving our methods of developing and delivering flu vaccines.

    But quit yer whining.

  • Authoritah! wars

    There has been a terribly pedantic interesting debate going on around here about the nature of authority in science.

    I won’t bore you with the origins of this debate. OK, maybe I will a little, but I’ll try to make this foray into meta-blogging interesting.

    First, blogging is not scientific writing as such. It isn’t peer reviewed, it isn’t a systematic presentation of research—it’s whatever the author feels like writing about that day. Now for various reasons, many bloggers write under a pseudonym. There are many reasons for this. First, most of us are not professional writers by trade, so we don’t care as much about being identified with our work. Second, given our fields, many of us wish to avoid having our colleagues or patients identified serendipidously. Lastly, some of us are early in our careers and might not wish to be identified with our non-professional writing.

    This leads to some interesting conflicts. In my field (internal medicine), we often revere our older, smarter colleagues for their diagnostic and therapeutic acumen. Their skills may arise from experience, reading, research, or, more likely, all of the above. Many physicians improve with age and experience—diagnosis, in particular, relies on pattern recognition, and experience may improve this. And while we may respect our elders for these abilities, we temper this with the knowledge that most medical decision making must be viewed through the lens of evidence-based medicine—just because Dr. X, said it, that doesn’t make it so—but it may improve the likelihood of it being true. Still, show me the evidence! Of course, when you first see a patient, you form diagnostic impressions without the help of evidence-based diagnostic procedures. These impressions help you decide how to proceed. When you read something by a pseudonymous blogger, you don’t have any clear idea of the level of authority of your source.

    (OK, I said I’d try to make this interesting. Sorry.)

    Experience counts for a lot in medicine. Authority figures mean something. If someone says to me, “I think he might have lupus…that’s what Dr. Random Guy thinks,” I’m less likely to care than if they say, “Dr. Landsberg thinks the guy’s got lupus.” I know that Landsberg has the judgment, experience, and knowledge to make good diagnoses. I know that he wouldn’t just throw a disease name out there.

    But I know this because I knew the man, I read his writings, I saw him work. I knew him to be good based on what he did. I accepted him as an authority, and if I asked his opinion, I’d be willing to believe it.

    In medicine, no one specializes in everything. We rely on our colleagues in various sub-specialties to help us out with our patients. We don’t check up on every decision they make, every bit of data they collect, because we can’t.

    And here is one of the core issues about authority and science on the web. When you write about science, “because I said so” is not useful evidence. But in transmitting these ideas in writing, no one expects to know everything you do. It’s just not possible.

    There is a balance in scientific blogging between giving evidence for every fact we jot down and saying, “hey, I’m a doctor, trust me on this one.” This intersects with some of the principles behind denialism—the reliance of fake experts, and the logical fallacy of “appeal to authority”.

    If you don’t trust your source, no amount of evidence they give may convince you. If you trust your source too much, you may be lulled into a false sense of fact-security. But we all must rely on experts at some point.

    We all must beware of what we read, and judge its content based partly on the source. If the source agrees with other reputable sources, that is a mark in its favor. It it is sitting alone in the woods crying “Conspiracy!”, well, the trust level drops a bit.

    This has nothing to do with qualifications, pseudonyms, or any other blogorrhea. It’s about how to read science. Read as much as you can, from as many reliable sources as you can, and if you are interested in a particular topic, keep up on it, as facts will change.

  • Measles—it's no joke

    A new patient came to see me a few months back. She is in her 60’s or 70’s and not in the best health. She is very nice. And simple—very simple. I spoke to her brother before the appointment. He told me that she was a normal, happy kid until the age of seven.

    Then she got sick. At first it wasn’t much, just a cold. Then there was a rash. Then she got very, very sick. She had measles, and she was one of the about 1-1000 people who develop acute encephalitis as a complication of the disease.

    The rest of the kids in the family are quite bright and successful. My patient came to her appointment with a caregiver who assists her in basically any function that requires thought. She’s quite nice, but she’s not happy. She is anxious, perhaps partly because she can’t understand what is going on around her. And she is completely dependent on others for all but the most basic of her physical needs.

    Denialists point to all kinds of pseudo-evidence (i.e. made-up crap) when it comes to vaccination. The point they always miss, partly because they never see it in real life, is that these diseases have real consequences for real people—not just made up connections with autism and other problems. The statistics are quite clear. Vaccines save lives. People who were around in the pre-vaccine era will tell you about the fear.

    I recently did an oral history with my father. During a whooping cough epidemic, his mother rented a cottage on a lake outside the city to keep her kids from getting pertussis and perhaps ending up dead or brain-damaged from hypoxia. As an intern in the 40s he remembers how summer would bring a flood of polio victims to the hospital.

    The diseases that vaccines prevent are very real and much more dangerous than the vaccines designed to prevent them.

    There have been recent outbreaks of measles associated with reduced vaccination rates. Parents who fail to vaccinate their kids bear a portion of responsibility for this, but it’s the noisy idiots like Jenny McCarthy and Gary Null who are more to blame.

    I enjoyed meeting my new patient, but it was a sad visit. Her parents were dead, her siblings had already finished their careers and become grandparents, and she was left behind, a seven year-old in a 70 year-old’s body.

  • Cult of Scientology update

    There are a few news items worth mentioning.

    The daughter of a Norwegian politician     killed herself after taking a “personality test” at a Scientology cult office near her dormitory. Given the cult’s history, I can see why folks would like to draw a causal connection here, but there aren’t many details in the news reports. I hardly seems likely that one encounter with the cult would be enough to drive someone to suicide—it is more likely that she was already depressed, and was unlucky enough to seek help in the wrong place.

    A not-so-well-known TV actor who used to be a cult member is speaking out against the “church” in a new video. He isn’t the most articulate spokesperson for sanity, but the video is pretty damning. It contains a lot of Scientology jargon, and comes off as the testimony of someone who has recently escaped, is pissed off, and wants everyone to know. There’s more from (erp!) Fox.

    The taxpayers of Boston were nearly duped into paying for a Scientology cult school. The school’s grant application specifically states that the curriculum will be based on the methods of Applied Scholastics, an arm of the cult that claims:

    Based on L. Ron Hubbard’s extensive technology, Applied Scholastics™ programs enable individuals to handle the literacy and education of the children and people in their communities.

    Aside from Establishment Clause problems, this is NUTS! It takes 15 seconds on google to find the Scientology connection here. The folks on the school board (or whomever is responsible) either didn’t know, or worse, did know.

    Then, of course, there is the whole “Anonymous” thing—I bet that pisses them off.

    Scientology is one scary cult, and they hate it when you call them out. In fact, they enjoy trying to intimidate those who speak out. All the more reason to do it, folks.

  • Syphilis!

    Southeast Michigan’s Genesee county is experiencing an outbreak of syphilis. The largest city in the county is Flint, made (in)famous in Michael Moore’s film Roger and Me.

    Syphilis is a nasty sexually transmitted disease with an interesting history. It may have originated in the New World. It was the subject of the infamous “Tuskegee Experiment”. It has enough different symptoms that it is sometimes called “the great imitator”.

    In 2007 there were 15 reported cases in the county; so far in 2008, there are 33. According to the county health department:

    Certain risk behaviors that increase the likelihood of contracting syphilis have been associated with this outbreak. These include having unprotected sex with multiple partners and participating in the exchange of sex for drugs or money. Transmission of syphilis is also being seen among men who have sex with men in Genesee County.

    About 13% of the county’s population is below the poverty line, and in Flint the number is over 26 percent. This is not a coincidence.

    As Michigan’s economy has continued to circle the drain, educational and health care systems have be strained and broken. Without access to information, jobs, and hope, STDs flourish.

    I received the notification in an email with the presumption that the outbreak is headed my way. As Michigan continues to suffer, we’ll see what walks in the door here. I’ll let you know.

  • Expelled makes me sick, or it would if I were allowed to see it

    If you haven’t been keeping up, let me give you a quick heads up about this whole Expelled brouhaha.

    A bunch of lying Creationist cultists decided to make a film whining about how oppressed Creationist “scientists” are. Ben Stein got involved somehow. They hoodwinked a bunch of real scientists into talking to them. They excluded any scientists who were religious but accept evolution. They hyped the film to evangelicals, but barred reviewer, journalists, or the scientists who are in the film from seeing it. They expropriated copyrighted material. They lied a lot.

    But really, the part that bothers me the most is that they are trying to link evolutionary biology with the Holocaust, which is bad enough, but they don’t even believe it. It is strictly a scare-tactic. If they believed it, then perhaps they would be less anti-semitic.

    If you want to see the details and haven’t been keeping up, just use Expelled as a search term at ScienceBlogs, but start here.