Archive for: March, 2010

Chopra, soul, and a big, insoluble mess

The recent arrests of the Hutaree cult here in Michigan are part of a tradition of militant separatism in this part of the country, beginning with the militia movements in the late 20th century and climaxing (hopefully) in the terrorist acts of Timothy McVeigh and Terry Nichols. This latest incident is interesting in that it appears to share some qualities of the militia movement, the Christian Identity movement, and the Tea Party movement (although what sorts of ideologic connections there really are will take some time to figure out.)

Cults in general scare me. They scare me not just because of their acts and their ideas, but their attractiveness. They have the ability not just to attract those of similar ideas, but they also seduce those who may simply be vulnerable to their philosophies. The flames of hatred are being fanned by those on the right, including teabaggers and so-called mainstream right wing commentators. The economic times, an "ethnic" president who represents the future of the US population, and an utter failure of others on the right to speak out against the hate feed these right-wing violence cults.

But cults don't just feed on hatred. Cults, like street gangs, also seduce with love, with pleasant-sounding ideas that are congruent with and confirm one's own beliefs. The antivaccine movement (as opposed to individuals with their individual beliefs) are a cult. They have charismatic leaders (such as Barbara Loe Fisher, JB Handley, and Jenny McCarthy), they have their own beliefs that are impervious to the assault of actual facts, and they accrue followers, spreading their lies. Their lies have helped to lower vaccination rates and increase the incidence of vaccine-preventable diseases. And their success depends upon a general cheapening of the meaning of "experts", and a vilification of earned scientific authority when it disagrees with their beliefs.

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17 responses so far

Sanity vs Insanity: cage match at HuffPo

Mar 27 2010 Published by under Medicine, Vaccination inanity

I love Icelandic names. Just reading them makes me think of Vikings and valkyries. One name that I can't get out of my head right now is "Iris Erlingsdottir". She's an Icelandic journalist who put up a pro-vaccine piece on Huffington Post. Not only is the piece pro-vaccine, but it is quite critical of her fellow HuffPo blogger "Dr." Jenny McCarthy, the actress who, after having a child and doing a lot of googling, decided that vaccines are evil. She is so convinced of the danger of vaccine that she explicitly wishes our children to suffer from vaccine-preventable diseases to try to prove her point.
I'm not sure if Jenny is a liar, or just so damned stupid that she'll parrot everyone else's lies. But Ms Erlingsdottir doesn't seem to be too concerned with Jenny's lies, but the truth about vaccine-preventable illnesses. Given HuffPo's history, I'd imagine She'll get some pretty unpleasant responses. It couldn't hurt to go over there and give her some support.

53 responses so far

Vaccinations and autism: we're number one?

Mar 24 2010 Published by under Absurd medical claims, Medicine, Vaccination inanity

It has been alleged by Great Minds such as Jenny McCarthy (D.Goog.) that the US recommends far more vaccinations than other countries.  Her precise statement was, "How come many other countries give their kids one-third as many shots as we do?" She put this into the context of wondering if our current vaccine schedule should be less rigid.  The entire piece was filled with what could charitably called less-than-truthful assertions, but I'm not feeling that charitable: they are lies (or the rantings of an idiot, or the delusions of lunatic.  There are probably other possibilities that I haven't thought of). 

Oh, Jenny.

First, we need to parse out this "more shots than everyone else" statement. Dr. Jenny may think she understands what this means, but I doubt it.  Some countries--Haiti, for example--give far fewer vaccines than we do because they are desperately poor and in a constant state of crisis. Because of this, they have very high rates of vaccine-preventable diseases.  They want to vaccinate more, but can't.  Then there are countries who can afford to vaccinate. Let's look at what three industrialized nations recommend before six years of age.

Vaccinations, by disease and country, 0-6 years of age

Vaccine France Germany USA Iceland
Hepatitis B Yes Yes Yes No
Rotavirus No No Yes No
Diphtheria, tetanus, and pertusis Yes Yes Yes Yes
Hib Yes Yes Yes Yes
Pneumococcus Yes Yes Yes No
Polio Yes Yes Yes Yes
Influenza Not reported Not reported Yes No
Meales, mumps, rubella Yes Yes Yes Yes
Varicella No Yes Yes No
Hepatitis A No No Yes No
BCG (disseminated TB) Yes No No No
Meningococcus No Yes For some Yes

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22 responses so far

Health care reform---democracy in action

Mar 22 2010 Published by under Health care reform, Medicine

It's hard to imagine the that the hyperbolic rhetoric that characterized the health care reform debate could get any worse (death panels, etc.). But it will.  Representative John Boehner (Asshat-OH) started it of last night with what amounted to a call for the overthrow of our democracy.

"Today we stand here amidst the wreckage of what was once the respect and honor that this House was held in by our fellow citizens.

"And we all know why it is so.

"We have failed to listen to America.

"And we have failed to reflect the will of our constituents.

"And when we fail to reflect that will - we fail ourselves and we fail our country.

[...]

My colleagues, this is the People's House.

"When we came here, we each swore an oath to uphold and abide by the Constitution as representatives of the people.

"But the process here is broken.

"The institution is broken.

"And as a result, this bill is not what the American people need, nor what our constituents want.

"Americans are out there are making sacrifices and struggling to build a better future for their kids.

[...]

"And they are angry. They are angry that no matter how they engage in this debate, this body moves forward against their will.

"Shame on us.

"Shame on this body.

"Shame on each and every one of you who substitutes your will and your desires above those of your fellow countrymen.

[...]

"If we pass this bill, there will be no turning back.  It will be the last straw for the American people.

"And In a democracy, you can only ignore the will of the people for so long and get away with it.

"And if we defy the will of our fellow citizens and pass this bill, we are going to be held to account by those who have placed us in their trust.

"We will have shattered those bonds of trust.

I'm sure if asked he will say that "being held to account" means being voted out of office.  And that's fair.  If, as Boehner says, our representatives ignored the will or their constituents, then they will probably lose their seats.  My own rep voted exactly as I would have instructed him: "Yea." This will earn him my future vote.  The true subversion is Beohner's claim that his opinion is the majority opinion, and that those have fought for health care reform have subverted democracy.

I have news for Boehner.  His party lost the last election.  They may win the next one, but this one they lost.  That means they are in the minority, a word seemingly unfamiliar to him.  What "minority" means is that he represents the smaller part of the American public.  He cannot rightly claim to represent me or anyone else outside the 8th district of Ohio or the House republican delegation, a delegation that is currently in the minority.

This is how democracy works: if the voters like what you're doing, they vote for you.  If they don't, you're out.  Continuing calls for subverting the will of the people as expressed in last night's vote are immoral and antidemocratic. 

69 responses so far

Chalk one up for spring

Mar 21 2010 Published by under Fatherhood

After a week of fine weather, the first weekend of spring was forecast to be cold, rainy, and snowy. I love it when they're wrong.
I would love to be able to sleep in, but if I can't sleep in, I don't mind the sound of tiny footsteps. After whipping up a batch of heart-shaped Daddy pancakes, the kiddo and I took off for work. It wasn't looking good out---cloudy, windy, a little bitter.
Rounds were brief, and we had time for a stop at the bookstore before lunch. PalKid loves to go to our local sushi joint for rice, edemame, and udon soup, and to watch me eat various raw and wriggly things.
After a brief rest, the kiddo noticed something---the sun was out, and so were the neighbor kids. It's funny how in this part of the world everyone disappears for the winter, popping out like crocuses as soon as the snow melts. We took a couple of turns around the block on the Trail-a-bike with the neighbor girls close behind, and then PalKid was ready---she wanted to take off her training wheels. Luckily, my neighbor has taught three girls how to ride already, and he lent a hand. In a little while, she was taking a few yards of road and making them her own---until falling off and skinning her knee, milking the injury for all it was worth.
I was pretty sure we'd be locked inside all day, looking for a good movie to watch. Seeing my kid take her first---brief and tentative---bike ride beats it hands down.

4 responses so far

With or without health care reform, doctors' jobs get harder

Mar 21 2010 Published by under Medicine

Early in the prolonged economic crisis a patient who had lost his factory job came to see me. He no longer had insurance, but he had plenty of health problems. Our office normally doesn't see uninsured patients (we simply can't afford to) but from time to time we make exceptions. I changed his prescriptions to the cheapest possible effective medications and gave him an online resource for the meds that did not have inexpensive alternatives. I referred him to a clinic that has the resources to care for the uninsured and that may be able to help him get his diabetic supplies.
By doing this, I shifted the cost of this man's care from my small office to a larger entity. But the money for his care still must come from somewhere. It's possible that his new clinic may get "disproportionate share (DISH)" dollars from the federal government if they care for many uninsured patients, but it's also likely that the clinic will never completely recoup the cost of his care.
The uninsured are an unnecessary burden on our health care system. Treating someone without insurance is the most expensive way to provide care. Rather than having the cost and risk of their care pooled with others, the cost falls directly on the patient, who cannot afford it, and is taken on by hospitals and clinics struggling to stay open. Doctors' fees are only a small part of this burden.

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16 responses so far

Will health care reform cause physicians to flee?

Mar 18 2010 Published by under Medicine

A physician friend asked me today if I had seen the survey in the New England Journal of Medicine that says nearly half of us will quit medicine if health care reform passes.   My fried, a life-long Republican, found the numbers difficult to believe.  So did I.

The New England Journal of Medicine (NEJM), one of medicine's most respected journals,  did not publish such a poll.  Apparently, in an earlier version of a web-based story posted on their jobs page, they reported the results of a poll conducted by a physician recruitment firm.   Partisan bloggers and networks jumped on the story as an argument against health care reform.

The Journal changed it's website to reflect explicitly the fact that the survey was industry-produced content in an advertising newsletter, not actual journal content.  I find the behavior of the Journal a bit problematic.  It looks bad when you have to clarify the origin and purpose of your content.  But this was clearly never a peer-reviewed journal article.

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60 responses so far

Why I am not a primatologist

Mar 17 2010 Published by under #FWDAOTI, Science-y stuff

One of the things I love about the blogosphere is the give and take, the ability of people to comment on each others' work, and the diversity of topics. The conversations that take place in the blogosphere have real value (a value which is so far under-recognized and under-utilized). Without the blogosphere, I would never be exposed to many of the things I read online, such as basic research in neuroanatomy and drug abuse, physiology, and primatology.
Interest in primatology is sort of like love of chocolate---I suspect most of us are born with it. As the Bare Naked Ladies sang, "Haven't you always wanted a monkey?" I suspect that the more an animal appeals to us, either as being similar or being cute, the more we tend to endow it with human characteristics. We are narcissistic both as individuals and as a species, and we see more value in an animal the more "human" it is.
I think anyone would be hard-pressed to say that a bonobo is not more like us than an opossum. But that doesn't mean that bonobos are little people. We are---I think rightly---more likely to respect the needs of humans than other animals, and we tend to create an informal hierarchy of which animals can be treated in which ways, often based on our perceptions of an animal's ability to perceive and understand noxious stimuli. Most of us feel comfortable swatting a mosquito just because it bothers us, but few of us would approve of killing a chimpanzee just because it looks at us funny. A high school biology student may cut paramecia into bits to see what happens and sleep well that evening, but if they were asked to do the same to an ape, they would likely balk (I hope).
These admittedly obvious and somewhat unsophisticated observations arose because of a post I read today over at the Primate Diaries. In it, Eric Michael Johnson uses a clever writing device to argue for a moral stance greater than humanism, one that explicitly places us face-to-face with non-human primates.

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57 responses so far

Channel 7 doesn't pluck the pigeons, they just lead them to slaughter

Mar 17 2010 Published by under Absurd medical claims, Medicine

(This piece appears today at Science-Based Medicine and is re-posted here today because I like it and I'm lazy. --PalMD)
A couple of years ago, a number of us raised concerns about an "investigative reporter" at a Detroit television station.  At the time I noted that investigative reporters serve an important role in a democracy, but that they can also do great harm, as when Channel 7's Steve Wilson parroted the talking points of the anti-vaccine movement.  Wilson has since been canned but apparently, not much has changed.  While performing my evening ablutions, I stumbled upon the latest abomination.

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4 responses so far

Crowd-sourcing your medical care

Mar 15 2010 Published by under Medical ethics, Medicine

The work up of "fever of unknown origin" (FUO) is a classic exercise in internal medicine. Originally defined as a temperature greater than 38.3°C (101°F) on several occasions for more than three weeks with no diagnosis after one week of inpatient study, the definition has shifted. This reflects the dramatic increase in the sophistication of outpatient work ups in the fifty or so years since the term was formally defined. About a third of cases turn out to be infection, another third cancer, a smaller percentage so-called collagen vascular diseases such as lupus. A significant percentage go undiagnosed. The work up can be time-consuming and difficult, and various consultants are often called in. In a modern twist, a Chicago man has asked "the internet" to help with his own FUO work up (h/t reader HP). It is just the sort of puzzle internists love, and it looks like he and his significant other have been getting a lot of input.
I have nothing to add to the work up at this point, although it's interesting. What has me thinking is the potential pitfalls, ethical and otherwise, of crowd-sourcing one's medical care. The problems can be divided into two broad categories: those centered on the patient, and those centered on health care professionals.

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13 responses so far

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