Denialism Blog

Author: MarkH

  • The Supreme Court Overturns the Handgun Ban

    I must admit I’m a bit surprised to see the Supreme Court overturning the handgun ban (full ruling – PDF). I thought the court would have to take the position that gun ownership may be a right but one in which the state had enough of a compelling interest to regulate that bans like DC’s could stand. Any other decision would seem to suggest that the state couldn’t regulate weapons at all, thus overturning the 1934 automatic weapons ban and other restrictions on ownership of highly dangerous equipment for the hunting of today’s super deer.

    However, as Ed Brayton discusses, they overturned the ban yet still found a middle-way. I tend to agree with Ed and with the typically-mercenary decision from Scalia. As usual Scalia is happy to pick up whatever legal tools are laying about that suit his fancy. Today it’s individual rights! Holy cow. I hope someone has the stones to throw that back in his face if gay marriage comes up in front the SCOTUS.

    He writes for a 5-4 majority:
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  • A pregnancy boom at a Massachusetts high school

    Surprisingly, it’s not due to the horribly misguided abstinence education nonsense. In fact, I can’t even begin to wrap my mind around this one.

    As summer vacation begins, 17 girls at Gloucester High School are expecting babies–more than four times the number of pregnancies the 1,200-student school had last year. Some adults dismissed the statistic as a blip. Others blamed hit movies like Juno and Knocked Up for glamorizing young unwed mothers. But principal Joseph Sullivan knows at least part of the reason there’s been such a spike in teen pregnancies in this Massachusetts fishing town. School officials started looking into the matter as early as October after an unusual number of girls began filing into the school clinic to find out if they were pregnant. By May, several students had returned multiple times to get pregnancy tests, and on hearing the results, “some girls seemed more upset when they weren’t pregnant than when they were,” Sullivan says. All it took was a few simple questions before nearly half the expecting students, none older than 16, confessed to making a pact to get pregnant and raise their babies together. Then the story got worse. “We found out one of the fathers is a 24-year-old homeless guy,” the principal says, shaking his head.

    Really? Assuming this isn’t some bizarre error of mis-reporting, this is clearly not a failure of contraception, but what I can only assume is a failure of our culture. Here’s why:

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  • Too disgusting to ignore

    Reading Ed Brayton’s discussion of the contrasting behaviors of our two presidential candidates with regards to law and Supreme Court decisions, I couldn’t resist comment.

    One of the few advantages of medschool is that it keeps me from reading the news while I’m studying for exams, most recently my internal medicine shelf exam yesterday. Thus I’m protected from a state of constant fury from the idiocy of our dear leaders. This being a post-study day I unfortunately ended up reading this statement from John McCain from George Will’s article that giving Gitmo prisoners habeus rights was “one of the worst decisions in the history of this country.”

    Wow. To his Will’s everlasting credit – he is a legitimate conservative and not a self-righteous hack serving a single political party – he follows this statement with what I immediately thought of in response to such an inane statement:

    Does it rank with Dred Scott v. Sanford (1857), which concocted a constitutional right, unmentioned in the document, to own slaves and held that black people have no rights that white people are bound to respect? With Plessy v. Ferguson (1896), which affirmed the constitutionality of legally enforced racial segregation? With Korematsu v. United States (1944), which affirmed the wartime right to sweep American citizens of Japanese ancestry into concentration camps?

    And now I’m back to fury again. A candidate for presidency of this country states that a ruling that protects a right existing since the Magna-Freaking-Carta is one of the worst ever? On the level of Dred Scott?

    Time to study some pediatrics. Politics in this country is just embarrassing when we can actually be debating a 800-year-old human right.

  • Faith Healing in the WSJ

    The WSJ brings us news of increasing opposition to laws that would protect faith healing. Or as I call it, negligence. As usual it has required the death of innocents before people will come to grips with common sense.

    The recent death from untreated diabetes of an 11-year-old Wisconsin girl has invigorated opposition to obscure laws in many states that let parents rely on prayer, rather than medicine, to heal sick children.

    Dale and Leilani Neumann of Weston, Wis., are facing charges of second-degree reckless homicide after their child, Madeline Kara Neumann, died on Easter after slipping into a coma. The death, likely preventable with insulin, has renewed calls for Wisconsin and dozens of other states to strike laws that protect parents who choose prayer alone in lieu of medical treatment.

    I’ll take issue here. “Likely preventable with insulin” should actually be, “completely and totally, unquestionably, preventable with insulin.” In fact for type I diabetics, and critically in diabetic ketoacidosis, the choice really is insulin or death, with no middle ground. You need insulin to live. But I digress.

    Lawyers nationwide say they are eager to see if the Neumann case sparks more changes in state laws. It raises a “national discourse as to whether children can be medically neglected legally,” says Marci Hamilton, a professor at the Benjamin N. Cardozo School of Law in New York who writes about children’s rights. In another recent case, a 15-month-old child in Oregon died in March from a form of pneumonia and a blood infection after her parents opted to try to heal her with prayer. Oregon law provides no defense for parents charged with causing the death of a child through neglect or maltreatment, and the couple has been charged with second-degree manslaughter and criminal mistreatment.

    There’s been a small, steady pushback against state provisions protecting spiritual healing. A Massachusetts bill that would have protected parents who used prayer in lieu of medical treatment stalled in committee last year, despite the measure’s broad sponsorship by 33 lawmakers.

    In Maryland, lawmakers in 2005 repealed part of a law that had protected parents from losing custody if they withheld medical treatment because of religious belief. And in Maine that year, legislators amended several laws regarding religious treatment, and repealed part of its family law that stated that children couldn’t automatically be considered abused solely because they were treated “by spiritual means by an accredited practitioner.” Evert Fowle, the district attorney in Augusta, Maine, said the amendments would now allow him to bring charges against guardians should a child be harmed after being treated with prayer alone.

    And here is the question for my readers, although to me it isn’t much of a question at all. Do parents have a duty to their children to protect their health using the best information available? Or does freedom of choice dictate the ability of parents to decide whether their children can live or die based upon unethical human experimentation with prayer or quack therapies? Because that’s what you call it when you take an unproven modality and try it out on someone to see if they get better – experimentation. Did I load that question heavily enough?

    More below the fold:

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  • Skeptic's Circle Number 87 is up

    It’s a must read over at action skeptics. Dirty limerick skepticism!

    Of note, Orac on quackademic medicine, and Greta Christina on the science of sexuality.

  • It's got electrolytes – Real Medical Case Presentation Number Two

    But why? Why does Brawndo have electrolytes?

    Because you need electrolytes to live. Every cell in your body uses electrolytes like sodium (Na), Potassium (K), Calcium (Ca), Magnesium (Mg) and other critical ions for cellular functions, proper osmotic gradients, enzymatic activity and even coordination of complex functions like muscle contraction and nerve conduction. All the cells in your body are full of little ion channels that are importing or exporting (or passively diffusing) these ions for physiological functions, and several organ systems (pituitary, adrenals, kidneys) in your body are in charge of maintaining tight control of their concentration in the blood. Very small changes in their concentration – often as little as a doubling or halving of their normal concentrations – can lead to disaster. If, for instance, you became profoundly low in calcium your heart will very quickly fail to beat as muscle requires calcium gradients for contraction.

    The measurement of the electrolytes in your blood is a critical component of the evaluation of the health of almost every patient in the hospital. The basic metabolic panel is collected on most inpatients every single day as a critical tool in understanding what’s going on with your patient’s overall health. It provides vital clues into what their kidneys are doing, how their endocrine system is functioning, what disease processes may be at play, and occasionally whether someone is in acute need of rescue. We usually present the data like so:

    Na+ | Cl – | BUN
    ——————————–< Glucose K+ | bicarb | Creatinine 135-145 | 98-106 | 7-18 ------------------------------------< 70-115 3.5 - 5.1 | 22-29 | 0.6-1.2 (BUN = Blood Urea Nitrogen) Seeing this little diagram gives you a great deal of information about what's going on with your patient in a minimum of space. Also of note is what is called the anion gap. The primary cation - Sodium (Na) - and the primary anions (cloride and bicarbonate) don't balance out in terms of charge. Usually if you add the chloride concentration to the bicarb concentration (e.g. 104 + 22 = 126), and then subtract this from the sodium (138 - 126 = 12) you get a value called the "gap" which represents other cations in the blood that are not measured in the basic panel. I realize this seems complicated but it's really not. Basically if it's in the normal range (12 +/-2) it means there likely isn't some hidden anion not being measured and causing trouble - like the ketoacids that run amok in diabetic ketoacidosis. So with that little introduction it's time to go over electrolyte troubles, and because you guys liked the last case presentation so much, I think it’s time for another. This one will be much more challenging. Let’s start with the case, again, based on a true story but jumbled/scrubbed for privacy.

    Chief complaint:     Shortness of breath (SOB)

    History of Present Illness: A 53 year old white male farmer with a 5 year history of chronic obstructive pulmonary disease (COPD) and three year history of type II diabetes presented to his doctors office with SOB of 5 days duration. His primary care doctor had managed several previous episodes of COPD exacerbation with 2-4 week courses of prednisone, and nebulizer treatments (bronchodilators). Concerned that the patient was failing to adequately oxygenate after several such treatments in her office his doctor refers him to the ER for admission to the hospital.

    The rest of the case, and more fun with electrolytes below the fold.
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  • About that crank

    So on the blog birthday we asked our dear readers what they’ve learned over the last year, and as a test we gave them this crank who attacks the bisphosphonate anti-osteoporosis drugs in his article “the delusion of bone drugs”.

    I think the reader with the best grade is LanceR or Martin, but SurgPA would have done better if he had shown his work.

    But let’s talk about some signs that something you’re reading is unscientific crankery. In this case, we don’t have a particularly sophisticated crank, and he let’s the cat out of the bag in his very profile:

    Because of Bill’s increasing concerns about the serious, sobering and perilous times we are living and being manipulated into, his intentions will be mainly devoted (as he has been) to posting articles that will alert, inform, expose, and wake up a sleeping reading public. This involves the issues that are not covered, or not covered truthfully by the “National News Media.” “In the time of universal deceit, telling the truth is a revolutionary act.” – George Orwell. To warn the public of the present and coming danger of permitting the federalizing of local police departments across our nation is of the utmost importance. If allowed to continue, the federalizing of local police departments, will result in the planned replication of the infamous “Nazi storm troopers” reminiscent of Hitler´s Germany in recent past history. “A prudent person foresees the danger ahead and takes precautions; the simpleton goes blindly on and suffers the consequences.” –

    The guy mentions Orwell and Hitler in his profile! He’s already way behind in presenting himself as a rational source of information that should be listened too. But let’s give him the benefit of the doubt, it was written in the third person, maybe his profile-writer was the crank. What does he have to say about bisphosphonates?
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  • 2 weeks of General Medicine

    I’m sorry I’ve been buried the last couple weeks, as I’ve just started my general medicine rotation. Today is my post-call day, which means I get to sleep in and then study all day long. The fire hydrant of information is cranked open full bore again, and the shelf exam for medicine is supposed to the hardest. There is an incredible amount to know, and only a limited amount of time to assimilate it.

    Inpatient medicine is especially challenging. It’s funny because most people’s perception of medicine is from all the TV shows about medicine and you see doctors constantly fixing some patient’s problem and then they get better. If I had to pick one thing to change about the fictitious practice of medicine it would be this idea that people ever have a single problem. The more realistic medicine patient would be someone over the age of 50 with at least 5 or 6 chronic problems, and just one (or two, or three) that has put them over the edge requiring hospitalization. It’s not about solving the medical mystery of the one thing wrong with your patient, it’s about first stabilizing people who are very ill and then figuring out why someone who already has half a dozen things wrong is suddenly getting worse.

    Let’s do some recaps of fake medicine versus real medicine for fun. Let’s start with a good House patient (spoilers abound):
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  • One Year of Denialism Blog

    Today represents one year since we joined scienceblogs, and I think we’ve had a great deal of success in defining the problem of denialism, establishing a new vocabulary for dealing with the problem of pseudoscience, and establishing uniform standards for what is legitimate scientific discourse and debate.

    Our first post describes the problem of denialism, and our subsequent posts on cranks, and the 5 tactics of denialism – Conspiracy, Selectivity, Fake Experts, Moving Goalposts, and Fallacies of Logic – have stood the test of time. They accurately describe the types of argument that fail to meet the standards of legitimate scientific debate and inevitably are utilized by those that, for one reason or another, choose to deny reality.

    Ultimately my goal with this blog is to educate people about how to detect pseudoscience and dismiss it without requiring an impossible level of expertise in every scientific discipline. I want people to understand that when they see an article that alleges conspiracies, and cites some crackpot, and makes crazy claims of causation that they don’t need to spend a year looking up legitimate sources of information to debunk it.

    Pseudoscience follows a predictable pattern of argument. Sources are selectively quoted to provide a sciencey-sounding argument (often using logical fallacies of causation etc.), fake experts are cited to confer a patina of scientific legitimacy, conspiracies are alleged to dismiss the vast expanse of contradictory data and scientific opinion, and criticism is further deflected by constantly moving goalposts to deflect mounting evidence against the fixed belief. In a way science should be flattered – it is the gold standard of reality after all – and the efforts of pseudoscientists to make their nonsense sound like science inevitably indicates the esteem of anti-science movements for the legitimacy of scientific belief.

    Detection of denialism by now should be a reflex (if not review the 5 tactics above). You should be able to smell a bad argument by now. Granted, authoritative debunking requires a certain amount of research to familiarize oneself with a topic and understand the basis of denialist argument. But as a practical guide, the 5 tactics should have armed you with the basic tools you need to sort through the vast amounts of information available to the average Joe these days, and decide rapidly that which should be listened to, versus that which belongs on the junk-heap of pseudoscientific nonsense. I’m writing this blog not just to vent about this nonsense that pisses me off, but hopefully to arm the the rational with a vocabulary for systematically dealing with bullshit. I think success for this effort will ultimately rest with my readership, and hopefully one day the media and public at large, regularly applying these tests to information sources to see whether they meet the basic standards for legitimate discussion of scientific fact.

    So my friends, show me what you’ve learned. I received an email asking me what I thought of this article appearing in the American Chronicle – a news/opinion aggregater with no standards for inclusion. Tell me what you you guys think, and if you can’t spot the problems that should allow you to dismiss it out of hand. I’ll post my analysis based on denialist factors and the scientific evidence later in the comments and we’ll compare notes. Good hunting!

  • Welcome ERV

    No time for blogging today but make sure to welcome ERV, on of my favorite bloggers, to the network.

    Welcome ERV!