Archive for: April, 2009

Influenza---virus, not magic

Apr 26 2009 Published by under Medicine

With all the news abuzz about swine flu, it's important to remember a few things. Influenza can be very, very dangerous, but it's still just a virus, and one that we know quite well. There have been a number of flu pandemics in the last century, the most famous (and most deadly) being the "Spanish flu" of 1918-1919. That pandemic was a perfect storm. Soldiers moved back and forth between Europe and the U.S., and military bases in the U.S. weren't much better than the Western Front. Soldiers on U.S. bases lived in crowded, cold, wet conditions, and the flu moved through them rapidly, spreading to surrounding civilian populations.
Our yearly flu season kills somewhere in the neighborhood of 35,000 Americans yearly. Most of those who die are very old, very young, or very sick. The Spanish flu epidemic was different. It struck down young, otherwise healthy people, and it killed them quickly.
So far we have very little data on the current flu outbreak. It does appear to be hitting healthier people, but it is far to early to make any judgments. We are far better prepared to handle a pandemic, should one emerge, than we were 90 years ago. Medicine has improved over time.
So,follow the news, don't panic, and pay attention to the advice of local health authorities, if it should become relevant. At this point, most Americans don't need to change a thing, other than paying more attention to the news.

11 responses so far

Swine flu---don't panic

Apr 26 2009 Published by under Medicine

So far, it looks like the US Gov't is on top of this one. If you're interested in following along with the story, I strongly suggest following the Effect Measure blog. The writers know their stuff, and so far, government websites aren't all that much health.
Some basics:
As you remember, the flu virus changes over time due to "antigenic drift" and we need to make new vaccines every year. Sometimes, often due to multiple strains co-infecting the same animal, the influenza genome undergoes a more dramatic change called "antigenic shift". Influenza A is commonly found in birds, pigs, and humans. If strains from different species co-infect say, a pig, the genes can undergo some mixing (to be completely un-technical) producing an antigenically new strain which may then move back to other animals.
In the current case, it appears as if a swine flu virus underwent some of these genetic shenanigans and then moved to the human population. Since the strain is new to us, immunity is low. It does appear that this new swine flu strain is being transmitted from humans to humans, which is not always a given---many strains are limited to one species, or can only move from a particular species to another.
So what we may have here is a perfect storm of sorts; a flu virus to which we have little immunity (this year's flu shot won't cover it), and an ability to pass it from person to person. Still, this doesn't mean it will be some horrid medieval killer. Yes, the number from Mexico are discouraging, but so far at least, the impact in the States has been minimal. This is certain to change, but where it will go from here is unclear.
The flu isn't magic. It's a virus we see every winter. It passes through respiratory droplets, so if it hits hard, masks and frequent hand washing will go a long way. Drugs exist to treat these infections, and the U.S. has an additional emergency stockpile. Also, hospitals and local public health departments have emergency pandemic plans (which we will hopefully not need). Unfortunately, the only way to really know how well (or badly) we've prepared is to get hit with a pandemic.
We may have that chance.

6 responses so far

PalCast 10---backyard edition

Apr 25 2009 Published by under PalCast

My latest "on location" PalCast is up and ready for your listening pleasure.

One response so far

More lousy health reporting in my home town

Apr 25 2009 Published by under Absurd medical claims, Medicine

I used to teach at a hospital downtown. While on rounds, I'd often ask my residents and students where they were born, and get answers such as, "Alabama", "Kerala, India", "Damascus, Syria". Inevitably, they'd ask me where I was born, and I'd point to the floor and say, "Right here".
"You mean in Michigan?"
"No," I'd explain, "I mean right here in this hospital."
So I have a certain pride about my hometown. I like Detroit, and although I, like many others born there, don't live in the city, I always hope for a recovery. So it saddens me whenever I see news stories that paint my natal city in a poor light. Whether it's a focus on the execrable city government that's never met a bad decision it didn't take, or the crime, or the sexting ex-mayor, these stories dominate the headlines. We see less often stories of citizens who take over vacant properties and create neighborhood gardens, or neighborhoods where average house prices of less that 10K are bringing artists back into the city. Still, sometimes, our hometown media are our own worst enemy.
I've lived in a lot of different cities and watching the local news often gives you a feel for the sophistication of a place. In San Fran, in Chicago, the local TV news reports were very different from each other, matching the west coast and third coast sensibilities, but both often broadcast well-produced stories of local relevance.
And since Detroit has plenty of goings-on of local relevance, it's just a wonder to me that WXYZ-TV would broadcast another horrid medical scare-piece. (H/T Orac)

It's nominally about Gardasil, the HPV-cervical cancer vaccine, and entitled (perhaps predictably), "Are You or Your Daughter at Risk?" Rather than exploring the risk of HPV-related diseases...well, let the reporter tell you:

When it was first released in 2006, it sounded like a real medical breakthrough. Gardasil has the potential to prevent 70% of cervical cancers. But the question is: Does it cause problems that are just as serious?

The answer is clearly "no", but there are still reasonable controversies surrounding the vaccine, such as whether or not it should be mandatory. Still, this report is even more horrible because of some important demographics. The city of Detroit is about 82% African American (and depending on whom you believe, perhaps more). Cervical cancer, the disease that the vaccine is intended to prevent, is much more common among Black women than White women (12..6 vs 8.4 per 100K). Combine that with the fact that Detroit has a spectacularly high rate of sexually transmitted diseases (STDs)*, and this report is more than wrong, it's irresponsible and dangerous.
Combine idiotic "both side-ism" reporting with foolish "abstinence programs", and pour that over an impoverished minority population with unemployment rate in the 20% range, and channel 7 is simply pouring gasoline on tinder.
Our highest risk populations deserve our best public health and public health education. If a reporter wants to help "save" Detroit and do a story on STDs, maybe she should focus her energy on finding ways to combat STD's in Detroit through providing real information in prevention. But that's probably too much to hope for.
*For example, national syphilis rates in 2007 were 13.7 per 100K. In Detroit the rate was about 29 per 100K.

6 responses so far

Who is Patricia Fitzgerald (and why should you care)?

Apr 24 2009 Published by under Absurd medical claims, Medicine

The other day, I wrote about the fake health experts at the Huffington Post. Prominent among them is "Dr" Patricia Fitzgerald. Now, we already talked about how writing a health piece in a major media outlet and using the title of "Dr" can be deceptive; the reader is likely to assume you are a medical doctor. In Fitzgerald's case, she isn't anything resembling a medical doctor, or even a health expert.
Like many of HuffPo's so-called health experts, she's selling something. While I'm all for capitalism, she presents herself as something she is not---a legitimate doctor. Let's examine what she is and is not.

Patricia Fitzgerald is a licensed acupuncturist, certified clinical nutritionist, and a homeopath. She has a Master's Degree in Traditional Chinese Medicine and a Doctorate in Homeopathic Medicine.

There are two types of "real" doctors licensed to practice medicine in the US: Medical Doctors (MDs), and Doctors of Osteopathy (DOs). Anyone else claiming to treat common medical conditions is often practicing unlicensed care, or is licensed in a limited way to provide some health-related services.
None of the qualifications listed make her an expert in immunology, infectious disease, toxicology---all topics she has addressed at HuffPo. I'll have to take her on her word that she is Doctor of Homeopathy---most doctors would give a little more information, like what the hell this doctorate is and what institution and board granted it. This is pretty important given that homeopathy is seen as a fringe cult-like practice by anyone who understands science.
She sells a book on detoxification, and founded the Santa Monica Wellness Center, at whose website she is referred to as Patricia Fitzgerald, L.Ac., D.H.M, C.C.N., which is terrific and all, but most of those designations aren't widely recognized as having any meaning (I'm not sure about the "CCN", but apparently it involved nutrition through recognition of "biochemical individuality".)
The Center offers all kinds of great stuff, like acupuncture, Emotional Freedom Technique, detoxification, and diagnostic testing such as "parasite and candida profile". In other words, she is so steeped in invalid, dangerous, and deceptive medical practices, that calling her "Dr" of any kind of healing is like calling Jack Kervorkian a sleep specialist.
If HuffPo wants to crawl out of its pit of immoral and dangerous health deception, it's going to have to learn to vet its writers a bit better. It's time for them to drop their woo-meisters and get some real health experts over there.
Or, they could give up and continue to be the National Enquirer of health reporting.

61 responses so far

Help out science---poll crash

Apr 24 2009 Published by under Politics

So, this whole animal rights extremism thing isn't really my thing---I'm not a researcher, and I think the ARA's like ALF and PeTA are all fucking nuts. Still, they're bad, bad nuts, so I have to care. Out in California, they've been threatening researchers and committing senseless acts of violence. That's why you have to visit this LA Times Poll.
For details:

2 responses so far

Torture is torture

Apr 23 2009 Published by under Politics

I'm no expert on interrogation. From what I've read, most of these experts find torture to be a modality with minimal utility, but I'm sure there are those who want to keep it around. My personal opinion is that it is horridly immoral, and rather difficult to justify. The "ticking bomb" scenario is vanishingly rare, and I'm sure out in the field, certain things are done from time to time without government approval. It is important to separate what the government overlooks, and what the government explicitly endorses. Still, these are issues for someone else.
What bothers me is all this talk of what is or isn't torture. People will say, "well I tried the waterboarding thing, and it wasn't so bad," or, "I pulled all-nighters in college, and it sucked but it wasn't torture."
Commentators have been splitting hairs about the nature of torture---what level of discomfort constitutes torture, and how important long-term outcomes like PTSD are in defining torture. One of the arguments put forth in the Bush Torture Memos was that we have studied many of these techniques quite well in the military's Survival, Evasion, Resistance and Escape (SERE) program. The soldiers who pass through this program have not been found to suffer long-term ill-effects.
My answer: so the fuck what? I call false analogy.
Pulling all-nighters and going through harsh army training are qualitatively different then being involuntarily imprisoned and subjected to the same physical experiences. Can anyone reading this spot the problem with this?
That's right. When you are captured and tortured YOU CAN'T GET UP AND LEAVE. This is a big fucking difference.
Let's apply this test: if your son was captured in Afghanistan and subjected to the same techniques, would you consider it torture?

18 responses so far

The fake experts of HuffPo

Apr 23 2009 Published by under Absurd medical claims, Medicine, Vaccination inanity

It's no secret that I think the Huffington Post is an teeming den execrable pseudoscientific snakes. Still, when it comes to fanning the vaccination manufatroversy, they are really off the deep end. Take the latest piece of dreck on Jenny McCarthy, GoD (Google Doctorate). It's written by the infamous "Dr." Patricia Fitzgerald, and this is where I get cranky. Worse than all the drivel spouted by Jenny is HuffPo giving their imprimatur of authority to Fitzgerald. Let me 'splain.
Look, there's a lot of ways to legitimately gain the title of "doctor". The most common are to go to a professional school and obtain an MD, DDS, DO, PhD, PharmD, DVM, or a few of the other well-recognized clinical and non-clinical doctorates. Anyone else who calls themselves "doctor" is using a title in a way not generally recognized as legitimate by our society. The reason we are careful with this title is that it confers a certain type of authority and power on those on whom it is bestowed. People who are called "doctor" must be very careful how they use this title. If a PhD in history uses the title, they must make it clear that they are not a doctor in the clinical sense but in the academic sense.
Since this title carries so much authority, manuals of style generally limit who can be called doctor in print. This is especially important in medical writing, as "doctor" invariably leads the reader to assume that the writer is a medical doctor.
Now, I hear the complaint all the time that this is petty, silly, "oppressive", etc. Really, though, these titles mean nothing if anyone can use them. We use these titles to protect people and to help signify a professional's type of expertise.
This is all by way of saying "Dr" Fitzgerald is a doctor the same way I am a tree frog. No, this isn't a turf battle. Its truth, and truth can be harsh. Fitzgerald claims the title of Doctor of Homeopathy. While you and I might know that this is equivalent to Doctor of Magic, a sick person (or a reader) could be easily deceived. Her byline simply says "Dr" and her bio page lists her "doctorate" without explaining that no sane American health care professional looks at homeopathy as being anything other than wishful thinking with a bill.
So, in the fight for truth and honesty in journalism, I propose the following more accurate titles for the HuffPo medical writers who are commonly referred to as "Dr":
Patricia Fitzgerald, Doctor of Homeopathy, "Doctor of Magicks"

Jonny Bowden
, PhD in nutrition, Doctor of Heart Disease Promotion (for cholesterol denial)
Now, there are plenty of other doctors writing at HuffPo. Many of them actually have MD degrees, but many of them practice so far outside the mainstream that their title has lost its meaning. Examples?
Dr Jay Gordon, Doctor of Infectious Disease Promotion via his vaccine denialism
Dr. Srinivasan Pillay, psychiatrist who calls himself a brain-imaging expert despite his lack of significant publications. His belief in distance healing makes him an Adjunct Professor of Magicks.
Dr. Alex Benzer, dating guru, hypnotist, and Master Practitioner of something called NLP, which to my knowledge is the only "degree" with a trademark.
That's all for today's rant.

20 responses so far

Orac's money quote of the day

Apr 23 2009 Published by under Absurd medical claims, Medicine, Vaccination inanity

Orac isn't known for his sound bites. He tends to write pieces which, in the blogosphere, might be considered rather long, and for good reason---he has a lot to say, and he says it well. But sometimes there is a gem of insolence that is so apt, it must be reshared:

But what really makes this analogy so brain dead is that it was the very epidemiological methods that have so consistently failed to find any correlation between vaccines and autism that led scientists to realize that smoking is strongly correlated with cancer. Jim [Carrey], while accepting the epidemiology linking tobacco smoke to cancer, rejects the very same sorts of methodology when it doesn't produce the results he wants to see.

Yep. And that's the difference between science and ideology in a nutshell.

6 responses so far

Jenny McCarthy not dumb enough for ya?

Apr 22 2009 Published by under Absurd medical claims, Medicine

Yes, that's right, the Huffington Post, that broadsheet of blarney, that tabloid of medical trumpery has done it. Not content to risk our mental health by lending legitimacy to all kinds of pseudoscientific charlatans, they just let Jim Carrey write a piece on vaccines and autism. Yes, the boyfriend of uber-fukwit Jenny McCarthy has drunk her Kool Aid, but that's no surprise. I'll leave a good fisking to others, because a few of the commenters showed signs of higher cortical function, and this deserves some coverage.

Take this one for example

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5 responses so far

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