Denialism Blog

Category: Medicine

  • The Origin of HIV in the Americas

    Blogging on Peer-Reviewed ResearchThe mainstream media has been reporting on this paper (open access at PNAS) on the hunt for the origin of HIV in the Americas.

    The surprising result was the finding that HIV first came to the United States from Haiti (rather than the previous origin which was thought to be a flight attendant from Canada) between 1966 and 1972, and flew under the radar of public health authorities for over a decade. The infection, spread initially by heterosexuals from Haiti, went undetected from as early as 1966 until 1981 and then only because it had jumped into a highly susceptible population. This article is rather humbling, because in perhaps the medically advanced country in the world, it evaded detection for so long until it finally created an epidemic in the male homosexual population.

    So how did they figure this out?
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  • The Placebo effect, how significant is it?

    Are placebo’s really effective? So asks Darshak Sanghavi in Slate, citing this study from 2001 that shows the placebo effect, compared to passive observation, to be relatively minor for improvements in pain or objective measures of health.

    This is an interesting topic, but unfortunately, a really bad article. Given how many alties love to stress the role of placebo and its apparent proof of the benefit of positive thinking, we should critically re-evaluate the evidence that placebos on their own can do anything more than improve subjective symptoms. Although there is a fair amount of proof that the placebo effect is a lot less significant than many believe even for those. It would be worth evaluating the effect of placebo itself – if ethically possible – more rigorously for specific symptoms and illnesses.

    It’s an interesting article all the same and, deserves some consideration, but I worry Sanghavi’s analysis is so unsophisticated it damages an otherwise worthy goal. For one, he starts with a pretty egregious genetic fallacy:
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  • Toxins!

    I’d love to see what the angry toxicologist thinks of this scary article from CNN Tests reveal high chemical levels in kids’ bodies.

    Michelle Hammond and Jeremiah Holland were intrigued when a friend at the Oakland Tribune asked them and their two young children to take part in a cutting-edge study to measure the industrial chemicals in their bodies.

    “In the beginning, I wasn’t worried at all; I was fascinated,” Hammond, 37, recalled.

    But that fascination soon changed to fear, as tests revealed that their children — Rowan, then 18 months, and Mikaela, then 5 — had chemical exposure levels up to seven times those of their parents.

    “[Rowan’s] been on this planet for 18 months, and he’s loaded with a chemical I’ve never heard of,” Holland, 37, said. “He had two to three times the level of flame retardants in his body that’s been known to cause thyroid dysfunction in lab rats.”

    Oh noes! The toxins!

    I kid, but in the midst of an article which is a bit over-the-top in scaremongering are some important issues that probably should result in increased regulation of chemicals going into everyday products. For one, Elizabeth Whelan of the ACSH, true to form, spouts the standard industry denial – no problem:

    i-e80414ff40124a19710b000fc9c565bc-2c.jpg

    Elizabeth Whelan, president of the American Council on Science and Health, a public health advocacy group, disagrees.

    “My concern about this trend about measuring chemicals in the blood is it’s leading people to believe that the mere ability to detect chemicals is the same as proving a hazard, that if you have this chemical, you are at risk of a disease, and that is false,” she said. Whelan contends that trace levels of industrial chemicals in our bodies do not necessarily pose health risks.

    Public health advocacy group? The ACSH? Please. Try instead, an industry can do no wrong advocacy group. While I agree that trace measurements of most of these chemicals is likely not a health problem, that doesn’t mean there is “no problem”.

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  • Another monkey put in charge of the zoo

    WaPo reports on the appointment of Susan Orr:

    The Bush administration again has appointed a chief of family planning programs at the Department of Health and Human Services who has been critical of contraception.

    Susan Orr, most recently an associate commissioner in the Administration for Children and Families, was appointed Monday to be acting deputy assistant secretary for population affairs. She will oversee $283 million in annual grants to provide low-income families and others with contraceptive services, counseling and preventive screenings.

    In a 2001 article in The Washington Post, Orr applauded a Bush proposal to stop requiring all health insurance plans for federal employees to cover a broad range of birth control. “We’re quite pleased, because fertility is not a disease,” said Orr, then an official with the Family Research Council.

    The Family Research Council. Why should I be surprised? When they’re not sending Charmaine Yoest out to lie about Plan B, or trying to hide where their chief Tony Perkins looks for political support (*cough* David Duke *cough*), they’re bashing gays or women’s rights.

    Yes, fertility is not a disease, but it is a problem. Women simply don’t want to push out a baby a year for their entire reproductive lifetime. And who can blame them?

    The motives of the FRC are pretty clear, disempower women, suggest they’re bad parents if they don’t stay home at the beck and call of their rugrats, keep them pregnant for 30 years, out of the workplace, and subservient to men. Think I’m kidding? Why the vehement opposition to birth control? It prevents conception – you’d think they’d approve. Why should they oppose contraception if not to tie women down by the uterus? Or to deny them from possessing sexual power equivalent to men?

  • The Road to Sildenafil – A history of artifical erections

    The inability to achieve erection has been a source of consternation for men for, well, a really long time. But the recent history of treatments for impotence, wait, I mean Erectile Dysfunction, oh no, now they’re calling it Male Sexual Dysfunction, represents a medical revolution. In the last 100 or so years, we’ve gone from nonspecific and largely ineffective treatments, to progressively more successful treatment, finally resulting in a highly specific and effective pharmaceutical solution to the problem. The goal of this post is to share a history of this unique field of medical endeavor, the medical and biological insights we’ve gained, and the rather interesting characters involved along the way.

    Erectile dysfunction is reported in about one out of five of all men and increases with age. It is therefore a serious problem for millions of American men (and their spouses a fair amount of the time), and hundreds of millions worldwide.

    Our story starts with one of the earliest “medical” treatments for male impotence. Starting in the late 1800s, sheep testis extract was injected as a source of testosterone (although they didn’t know it at the time). This was the standard of care until testosterone was purified in the 1940s. However, testosterone as a treatment for impotence was pretty poor. The inability to obtain an erection has little to do with levels of androgens, and in studies at the time testosterone fared no better than placebo.

    Thus, this was the treatment that failed for Geddings Osbon in 1960, leading to the next great leap forward in treatment of male erectile dysfunction. Osbon, a successful owner of a tire-retreading business, did what doctors dread their patient will do. He went home and looked around his shop and home and tried to come up with a solution to his medical problem. Usually, this results in disaster, and many doctors have hilarious stories of the attempts of such patients to cure less mechanical disorders with household materials. However, in this case, Osbon invented a device which he called the “YED” or “youth equivalence device” that is still today one of the most effective solutions to erectile disfunction. It’s also known as the penis-pump.

    I’m afraid the rest must continue below the fold. I think it’s safe for work, but you never know…the description of probably the most infamous urology lecture of all time might be a bit much.

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  • Obesity – Primary vs. Secondary prevention

    I will never forget the very first patient history I ever took. Part of medical school training is they send you onto the wards to gather patient histories and physicals so you learn to gather information effectively as a clinician. My first patient history was on a woman about 35 years old on the orthopedics ward, who was a triple-amputee. She had her legs removed below the thigh, and one arm amputated below the elbow. The cause was imminently preventable. She had type II diabetes that was poorly controlled. She was obese, weighing about 180 lbs despite the removal of large parts of her body. A common problem with diabetics is that they are susceptible to infection in their bones. Diabetics have have poor pain perception from diabetic neuropathy and poor blood supply, the result is that cuts on their extremities go unnoticed, heal poorly, and ultimately result in infection that frequently goes into the bone. The result, osteomyelitis, is persistent infection of the bones from these infections, and, if antibiotics are ineffective, the only treatment is to surgery to remove the infected tissue and often amputation. Such was the case with my patient. She was poor, from Appalachia, had inadequate control of her diabetes, and as a result lost multiple limbs from infection (she was hospitalized for yet another infected bone).

    The major reason for the increase in Type II diabetes rates is obesity and lack of exercise. Disturbingly, younger and younger people are presenting with diseases often only seen with age, like type II diabetes and gout. This is unquestionably due to increasing rates of obesity in the US population. Thus, it is with dismay, that I read Sandy Szwarc’s blog Junkfood science, that seems to exist for the sole purpose of denying the health risks of obesity and of being overweight. Sandy, who is on CEI’s staff, routinely writes about obesity as a health-scare, that is not harmful as doctors and health scientists suggest.

    To illustrate the problems with her analysis, let’s go through one of her more recent posts on the Obesity Paradox – the apparent decrease in mortality in studies of the obese.
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  • Two articles on building immunity in kids

    The first from the NYT discusses the fallacy that childhood illness somehow builds up the immune system making them healthier adults. Rather, it emphasizes correctly, that exposure to lots of harmless antigens seems to be the key to making kids less susceptible to asthma and allergies, not exposure to harmful ones. In other words, let your kids go outside and eat dirt, but don’t take them to chicken-pox parties (vaccinate them instead).

    In a similar vein, Slate has an articleon eating more crap. While the point is made more carelessly, the idea is the same, that exposure to common harmless antigens may be protective for later exposures in preventing auto-immunity and decreasing severity of illness.

    It reminds me, of All Creatures Great and Small, when Herriot is discussing the children of the local “knacker man” Mallock. The man spent all his time cutting up, and processing diseased carcasses of farm animals, and Herriot remarked that his kids, despite being surrounded with all the stinky filth imaginable, he were the healthiest children in the district.

  • Breast Cancer Crankery From Mike Adams

    The latest crankery from Adams is the evil male-chauvinist conspiracy to perpetuate breast cancer for fun and profit being led by none other than those dastardly villains of the American Cancer Society. With his stunning report and links to the thinkbeforeyoupink campaign, he rails against the ribbons that are a “symbol of male-dominated control over women”, and exposes the insidious lies of those who spend their lives looking for cures for this deadly disease.

    In this report, you’ll learn how the cancer industry — which is dominated by powerful men — uses the same tactics today to control women while pretending to serve them. You’ll learn truly shocking information about how the cancer industry exploits women’s bodies to generate profits for pharmaceutical companies while systematically denying those same women access to information that could teach them how to avoid breast cancer (and other cancers) in the first place. A single nutrient, for example, has been shown to prevent 77 percent of all cancers, and yet the cancer industry — including top cancer non-profits — refuse to recommend this nutrient.

    And unlike virtually every major cancer group in existence today (with a few exceptions that will be noted later), this report was not funded by a pharmaceutical company. That’s why it tells you the truth about an industry that prioritizes profits over public health — an industry that works hard to keep women ignorant about the real solutions to breast cancer (cancer-free women are no longer revenue-generating patients for cancer drug manufacturers.)

    Adams truly has a sick and warped mind, and this report is yet more evidence that the altie-med movement isn’t satisfied pushing their ineffective pharmaceuticals, they also must denigrate evidence-based medicine and scare people away from potentially life-saving treatments.
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  • A Critical Appraisal of "Chronic Lyme" in the NEJM

    Blogging on Peer-Reviewed Research

    The New England Journal has an article on the phenomenon known as chronic Lyme disease. Lyme disease, is a tick-borne infectious disease caused by an bacterium known as Borrelia burgdorferi carried by ticks in certain regions of the United States and Europe in which it is endemic. Here is the US map of cases below.
    i-a90e638578fa986772d199550338e1e2-lyme.jpg

    It can result in a fever-like illness with a characteristic rash (although not in all cases) called erythema migrans, and if left untreated, can cause more serious problems like arthritis, and cardiovascular and neurological complications.

    A small number of people and doctors have come to believe that in addition to these known presentations, Lyme disease can also cause a chronic syndrome after treatment with antibiotics has cleared the disease. The problem is this syndrome has all the hallmarks of being a quack diagnosis. While a small subset of patient may actually have such a syndrome, for a large number of diagnoses, there are a number of red flags indicating this diagnosis is inappropriately applied and treatment worthless. Here’s an excerpt from the paper, see if you can spot them all:

    The diagnosis of chronic Lyme disease and its treatment differ substantively from the diagnosis and treatment of recognized infectious diseases. The diagnosis is often based solely on clinical judgment rather than on well-defined clinical criteria and validated laboratory studies, and it is often made regardless of whether patients have been in areas where Lyme disease is endemic.6,7 Although proponents of the chronic Lyme disease diagnosis believe that patients are persistently infected with B. burgdorferi, they do not require objective clinical or laboratory evidence of infection as a diagnostic criterion.5,8,9,10

    Several lines of reasoning are used to provide support for this diagnostic rationale. One is the unproven and very improbable assumption that chronic B. burgdorferi infection can occur in the absence of antibodies against B. burgdorferi in serum (Table 2). Negative results of serologic tests are often attributed to previous antibiotic therapy or to the theory that chronic infection with B. burgdorferi suppresses humoral immune responses; neither theory is well supported by scientific data.12,13,14 When physicians who diagnose chronic Lyme disease obtain laboratory tests to provide support for their diagnoses, they often rely heavily on “Lyme specialty laboratories.” Such laboratories may perform unvalidated in-house tests that are not regulated by the Food and Drug Administration, or they may perform standard serologic tests interpreted with the use of criteria that are not evidence-based.11,12,15,16,17

    Once the diagnosis of chronic Lyme disease is made, patients are commonly treated for months to years with multiple antimicrobial agents, some of which are inactive in vitro against B. burgdorferi.2,5,18,19,20 Antibiotics may be prescribed either simultaneously or sequentially, and they are often administered parenterally. Occasionally, these patients are treated with unconventional and highly dangerous methods such as bismuth injections or deliberate inoculation of plasmodia to cause malaria.2,21,22 No other spirochetal infection, including the neurologic complications of tertiary syphilis, is managed in an analogous fashion.2,23 The duration of treatment commonly prescribed for chronic Lyme disease often far surpasses even the conventional 6-month course of therapy successfully used for most cases of tuberculosis.

    This paper is written by eminent experts in infectious disease including Allen Steere – the discoverer of Lyme disease – they systematically evaluate the evidence for and against a chronic infection, or the advantage of current treatments for this disorder. The news gets worse.
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  • Two Court Decisions for Science

    There have been two interesting court decisions, I think both decided correctly for science this week. In the first, a federal court has decided states may regulate greenhouse gas emissions from automobiles. In particular, one statement from the judge seemed to come straight from the deck of cards.

    “There is no question that the GHG (greenhouse gas) regulations present great challenges to automakers,” Judge William Sessions III, sitting in the U.S. District Court in Burlington, wrote at the conclusion of his 240-page decision.

    He added, “History suggests that the ingenuity of the industry, once put in gear, responds admirably to most technological challenges. In light of the public statements of industry representatives, (the) history of compliance with previous technological challenges, and the state of the record, the court remains unconvinced automakers cannot meet the challenges of Vermont and California’s GHG regulations.”

    Exactly correct. They raised the same complaints for seatbelts, crumple-zones, airbags, and CAFE standards, and each time their claims of imminent bankruptcy have been shown to be overblown. If anything, it should be good for the industry. As Toyota has become the largest automobile manufacturer in the world with consistently rising profits, the American car manufacturers have locked themselves into making bigger less efficient cars and consistently show losses and diminishing size. If anything, this kick in the pants will help car manufacturers in this country survive and compete with the cars from Japan.

    The second, from the NYT, a New Jersey court has refused to decide that life “begins” at conception.

    A doctor is under no obligation to tell a pregnant woman that she is carrying “an existing human being” before performing an abortion, the New Jersey Supreme Court ruled today in a decision that had been eagerly awaited by both foes and supporters of abortion rights in this country.

    The 5-to-0 decision came in a case brought in 1996 by Rosa Acuna, who was 29 years old and married when she and her husband, who already had two children, agreed to an abortion about six to eight weeks into her pregnancy.

    People on both sides of the abortion debate said that Mrs. Acuna’s medical malpractice case was essentially asking the court to weigh in on the long-debated issue of when life begins.

    Mrs. Acuna charged that the doctor, Dr. Sheldon C. Turkish, did not provide her with “material medical information” before she and her husband signed a consent form allowing him to perform the procedure. Specifically, she said in her lawsuit, the doctor had a duty to tell her that the procedure would “terminate the life of a living member of the species Homo sapiens, that is a human being.”
    …
    Because there is no consensus within the medical community, or even in the general public, about when life begins, the justices wrote, there is therefore no legal basis for requiring doctors to tell patients “that an abortion results in the killing of a family member.”

    Not only is this fundamentally stupid claim on the part of the plaintiffs, like this 29-year-old woman did not know what an abortion is, but the idea of a court decided when life begins is offensive. I also disagree that there is no consensus (or that there can not be one) within the scientific community. Scientists should acknowledge that life does not “begin”, but is instead continuous from parent to child, and the real question is when we consider a human life to have value. There is no stage in human reproduction in which the components are not living. The real issue is fundamentally religious, and should therefore be outside the purview of the courts, that is when does someone get a soul? Or in more secular terms, become a human being? That is unanswerable, unmeasurable, and should not be determined by any court or government.

    So good news from the courts this week, stepping in where they should, and staying out of where they don’t belong.