Sexually transmitted diseases (STDs) are frighteningly common, as highlighted by a study released by the CDC earlier this month. The U.S. is in a unique position: few countries have the resources we do to prevent and treat STDs, and few countries squander such resources so effectively.
Let me give you a brief front-line perspective.
What if we had a vaccine against cancer? Or even against some cancers? Wouldn’t this be a huge news story, with people everywhere clamoring for the shot? Maybe…
Or maybe, some people could find a way to turn that smile upside down. Gardasil, the new vaccine approved for prevention of certain cancer-causing strains of the Human Papilloma Virus (HPV), is the first widely available vaccine aimed directly at preventing cancer. (The Hepatitis B vaccine also helps prevent liver tumors, but that’s another story.) Gardasil can prevent cervical cancer, certain mouth and anal cancers, and perhaps other cancers of the naughty bits. So, who wouldn’t love that?
The Religious Right is who. You see, the infection that leads to these cancers is usually spread by sexual contact. Thats right, sex. SEX!! And sex is a big no-no for the fundies, at least outside of making babies with your opposite-sexed spouse.
But as much as I dislike fundamentalism, most of the “mainstream” fundamentalist groups have taken a more nuanced stand on Gardasil.
For school vaccination requirements, Christianity today favors an “opt-in” policy, while Focus on the Family sets a vaguer, “let the parents decide” policy. Both groups, quite wisely, recognize that the vaccine is valuable and that evangelical children are at risk for HPV. The Family Research Council also has an “opt-in” policy with the additional honesty of explaining why they do not like an “opt-out” policy. All of the groups do seem to over-emphasize potential negative arguments, however. Cost comes up as an issue–as it should with any medication. But if the vaccine prevented, say, ovarian cancer, I don’t think anyone would focus much on the price.
“The wages of sin is death”, and while most Christians do not subscribe to a literal interpretation of this idea, it does infuse the Right’s decision-making, perhaps blinding them to the benefits of this vaccine. In order for the vaccine to be effective, it must be given before the onset of sexual activity (which can even mean touching “down there”). While none of us likes to think about our kids having sex at 14, it may happen, and to punish them with cancer seems, well, excessive.
An “opt-in” policy for vaccinations is not a good approach to public health. Vaccines work by protecting people before they may be exposed, and by creating herd immunity. Everything that can be done to encourage vaccination should be. Opt-in carries an implication that the vaccine is either unimportant or of uncertain utility. Opt-out, while less negative, makes it too easy for people do put off a decision until it is too late.
As with any vaccine, safety and efficacy are important. And, as with any disease, education is an excellent public health measure. Mandatory sex education would go a long way toward preventing sexually transmitted diseases and unwanted pregnancies. I wonder how Focus on the Family feels about that?
Urinary tract infections (UTIs) are a very common problem, especially in women. The link provided offers some very good information, but briefly, women’s urethrae (the tube the urine comes out of), are closer to the rectum than those of men (who have a built-in “spacer”). This allows bacteria from the colon to creep over to the urinary tract and cause burning, pelvic pain, frequent urination, etc. I treat UTIs daily. Most are uncomplicated, but some are quite serious (usually in the elderly and chronically ill). As medical problems go, I love UTIs. When a healthy, young woman comes in with the usual symptoms, a quick test can confirm the diagnosis, and, usually, three days of inexpensive antibiotics fixes it. The patient is happy, I’m happy, everyone’s happy. But then there’s the orange stuff.
A few years back, a medication called “phenazopyridine” became more widely available as an over-the-counter drug. It is marketed to treat the symptoms of UTIs. It turns urine and other body fluids bright orange. This medication is useful for reducing the symptoms of UTIs, but does not cure them. The FDA does mandate certain labeling for the OTC preparations, but I can tell you from experience, the subtlety of this distinction is, well, subtle. Fortunately, you don’t have to rely on my experience. Someone bothered to study the question. Most patients do not realize the difference between treating the symptoms and treating the disease. This leads to delay of treatment, and the infection can become more serious. To add insult to injury, phenazopyridine’s orange pigment interferes with the most common tests we use to diagnose UTIs.
In discussions of medical ethics, the concepts of “paternalism” and “patient autonomy” are often thought of as being in opposition to each other. It is sometimes in the name of autonomy that medications are made more easily available to patients by skipping the physician prescribing process. (Also, over the counter meds are quite profitable). This can be very useful for medications such as ibuprofen, or Plan B (post-coital contraception), but any time you cut out the expert, certain risks accrue. Paternalism isn’t the opposite of autonomy. The two work together. Patients see me for my expertise. They don’t consult me about movies, art, or (thankfully) religion—just medicine. They do this because I’m the one with the training. Giving a patient knowledgeable advice is not paternalistic—it’s what they came here for. I don’t paternalistically command my patients to do anything. I dole out advice, and they are free to follow it or not.
Orange urine not only removes the expert, it fools the patient. It does not increase autonomy, it actually decreases it by deceiving the patient, perhaps causing them to become more ill.
<End of rant>
Cults kill. It’s really that simple. But different cults kill in different ways. It’s not just Jonestown and Killer Kool Aid (OK, Flav-r-Aid). The so-called mainstream cults that are particularly dangerous, because we tolerate them.
Jehovah’s Witnesses have their own brand of craziness. It’s not bad enough that they come to your door to annoy you in person, but they forbid their members life-saving medical interventions—for no good reason.
Christian Scientists decline medical care because some lady 150 years ago got better despite the interventions of 19th century quacks.
Then there’s Scientology. This is a particularly pernicious cult. It preys the most vulnerable—those least able to make rational decisions, and often denied access to health care—the mentally ill. Instead of offering real mental health care to those in need, they inculcate them into their cult, convincing them to avoid modern psychiatry, often with tragic results.
Look, I’ve got nothing against religion. I’m not religious, but I know it’s possible to be a rational thinker and still be a believer. Unfortunately, it’s also possible to be religious and avoid rational thought completely.
We often hear that “religious education belongs in the home”, a sentiment with which I’d agree. What’s less often said, but needs to be, is that critical thinking belongs in the classroom, even if it insults a family’s religions sensibilities. Kids need to learn to evaluate evidence and make good decisions. If this means they learn about evolution against their parents wishes, good. If it means they learn to doubt their parents beliefs on transfusions, that’s good too.
Religion can be comforting, uniting. But in the marketplace of scientific ideas, religion is bankrupt.
As the anti-vaccine mercury militia’s limited credibility shrinks even further, actual scientists are investigating real mercury-based toxins.
Remember how followers of the mercury militia were getting all their old mercury amalgam fillings pulled? It turns out that maybe that’s not the greatest idea.
A group from the U of I found that once you dig out the fillings, under the right conditions, mercury can become exposed to certain bacteria that methylate it, forming toxic methylmercury compounds.
If this pans out, it may change the way mercury fillings are removed and the waste products disposed of.
Look! Science!
University of Illinois at Chicago (2008, March 27). Dental Chair A Possible Source Of Neurotoxic Mercury Waste. ScienceDaily.
At long last I have finished my surgical requirements. After 12 weeks of nonstop surgery rotations, despite enjoying it thoroughly, I’m ready to try something else for a while. Or at least I’m looking forward to waking up at 6AM rather than 4AM for a few months. It seems like such a small difference, but it’s literally the difference between night and day. Especially during the winter, starting at 5 on the wards and finishing usually well after dark, you begin to wonder if you’ll see the sun again. Being able to walk into work when it’s actually light out is very appealing.
My traffic has, of course, slowed. But I’ve still been thinking about good topics to write about this whole time. At the end of most days I’ve just been passing out rather than taking the time to mock crankery. Now I think my schedule will be a little more amenable to extramural writing, I have a backlog of things to discuss, and the first thing we’re going to be dealing with is this polling-based nonsense about ignoring denialism I’ve been hearing about lately. I’ll also talk some more about the fun things I’ve done, and if various people can avoid getting their panties in a bunch over little old me, I might be able to relate some more amusing things about medical education.
It had seemed at first that there would be no help for the living children of the killer parents in Wisconsin. But, in a fit of rational behavior, the authorities removed the remaining children from their parents care. I hate to see families broken up, but until the parents are deprogrammed, it simply isn’t safe for kids to live in that house.
The parents apparently have ties to the “Unleavened Bread Ministries”, who admit to eschewing medical care in favor of prayer. The cult has been unenthusiastic about claiming the family as members. As quoted by ABC news, David Ells, the cult leader of the “Matzoh Ministry” (at least, that should be their name, due to the alliteration):
“We are not commanded in scripture to send people to the doctor but to meet their needs through prayer and faith. As anyone here in the ministry will tell you, we are not against doctors for those who have their faith there and never condemn or restrict them in any way,” Eells writes. “But we know that the best one to trust in for healing is Jesus Christ. The foundation for receiving this benefit from Him is repentance and faith in His promises.”
So, unless they have somehow proven to themselves or their leader that their faith is strong, doctors are out.
According to Unleavened, these are “America’s last days.” It’s not surprising that an apocalyptic cult would focus more on death than life.
Unsurprisingly, the dead child was pulled out of public schools. Maybe home-schooling should raise a red flag for authorities. Or maybe these death-cults should be monitored more carefully. Or maybe we should make an example of the parents, and lock them up, although I’m not sure that would really help anyone.
It’s too bad their minister can’t be held responsible. But then, he probably speaks for God, so maybe the buck stops there.
I am not pleased. I am not pleased at all. Of course, hospitals need to make money, and in my part of the country, that’s getting damned hard. More and more people are jobless, without insurance, and broke. Hospitals are focusing more on customer service—and that includes providing what the customer wants whether or not there is any evidence to support it. Orac maintains a database of such atrocities occurrences. This is from a table card at a large, local hospital.
$1 per minute (15 minutes=$15)
For an appointment call
Integrative Medicine at (redacted)
This service can be billed to your room.
Arghh!!! Here we are, well into the evidence-based revolution, and a hospital is offering the Reiki-equivalent of a 900 number. I wonder if they also try to drag it out. I can just see what’s going to happen when I come in with my next kidney stone:
Pal: How is my energy field doing?
Obi Wan: I can’t tell yet. You must continue.
Pal: How are you measuring the effect?
Obi Wan: I’m trained. You must continue.
Pal: Are you done yet?
Obi Wan (checking watch): I should be finished in another 45 seconds. You must continue.
Pal: Is this really gonna cost me 10 dollars?
Obi Wan: No. We’re up to $15. Tip isn’t included.
I really, really hope my patients aren’t being offered this service. It seems to me that if anyone is claiming that this treatment has an effect, there must be a doctor’s order for it. And this doctor ain’t ordering any.
In another fit of sloth, I am migrating one of my favorites over from my old blog. If you haven’t read it, it’s new to you! –PalMD
Many of my patients ask me about it; the TV is full of ads for it; you can’t avoid it. “Detoxification” is apparently the pinnacle of modern health care, if you believe folks like Joseph Mercola and Gary Null, and the dozens of adds on late-night TV.
For me to explain to you why even the very idea is laughable, I have to teach you a bit of human biochemistry—just a little, I promise. My scientific readers will find this grossly oversimplified, but hopefully they will forgive me.
It’s amazing that anti-vaccine crankery persists. I went over to Joe Mercola’s woo-palace again, and what should pop up but an article by Dr. Woo himself, Russell Blaylock. Apparently Russ and Joe are “good friends”, which is appropriate, since both are doctors that aren’t welcome in the profession. Blaylock believes that vaccines kill your brain. How does he know?
“A tremendous amount of research has now demonstrated the link between chronic low-level brain inflammation, elevated brain glutamate levels and major depression”
and
“A great number of studies have shown that when you vaccinate an animal, the body’s inflammatory cytokines not only increase dramatically, but so do the brain’s inflammatory chemicals.”
OK. This is a load of bubkes. You can read the article if you’re bored, but let me at least parse out his citations for you. To summarize, his hypothesis is that vaccines somehow make the nervous system all cranky, and local glutamate toxicity in the brain is induced, leading to neuropsychiatric problems. Here’s a few of his supposedly supporting citations:
1) McGeer PL and McGeer EG. Local neuroinflammation and progression of Alzheimer’s disease. J Neurovirology 202; 8: 529-538. This is an article about the role of the innate immune system in brain inflammation from autopsy specimens. The innate immune system is not the arm that is specifically activated by vaccines.
2)Tavares RG, et al. Quinolinic acid stimulates synaptosomal glutamate release and inhibits glutamate uptake into astrocytes. Neurochem Int 2002; 40: 621-627. Interesting basic science about glutamate metabolism. Irrelevant.
11) Anderson T et al. NMDA-receptor antagonist prevents measles virus-induced neurodegeneration. Eur J Neurosci 1991; 3: 66-71. Irrelevant
13) Renault PF, et al. Psychiatric complications of long-term ineterferon-alpha therapy. Arch Internal Medicine 1987; 147: 1577-1580. Irrelevant
Basically, none of his citations support his hypothesis in any way. It’s an interesting hypothesis. It just isn’t supported by his data.
If this is the best “evidence” the uber-cranks can come up with, it’s no wonder they aren’t getting lots of grants and tenured academic positions.
So what are some other strategies employed by the anti-vax cults? How about fear? Lies?