Archive for: March, 2010

So-called animal rights activists are evil and idiotic

Mar 15 2010 Published by under Absurd religious wingnutery

I learned from a couple of colleagues (who I won't name) a couple of facts that reinforce just how hypocritical, hateful, and inane animal rights activists can be.
First, the terrorists are still targeting researcher Dario Ringach. Ringach, a former primate researcher, left the field due to violent pressure from these assholes. He's done. He is a former primate researcher. But for these goatfuckers, it has never been about helping animals but hurting people.
The Houston Press is reporting that those charged with participating in a large dogfighting ring in Texas served little or no time. As far as I can discover, none has received as much as a nasty postcard. (Nor am I suggesting they be harassed. The courts have spoken. If you're pissed, write your representative.)
So the animal rights anencephaly squad are spending their resources and hate on ex-researchers, people who used animals under close scrutiny and regulation for the betterment of humanity, instead of going after people who torture animals for pleasure and monetary gain. What a bunch of fucking idiots.

11 responses so far

Back on the nets---but why bother

Mar 14 2010 Published by under Medicine

Mark Crislip has a nice piece up at Science-Based Medicine about the battle against the medical "de-lightenment". In his post, he looks at some data about what sorts of criteria anti-vaccinationists use in their propaganda. Not surprisingly, appeals to emotion and to pre-existing beliefs are much more common than actual facts. The question then becomes, "Why bother?" We on the side of science-based medical humanism tend to believe that education is the best solution to problems such as implausible health claims, but since these things function more as belief systems than as opinions informed by facts, what's the use? Do we seriously think we can de-program the victim of a medical cult?

Certainly there are those who are nearly beyond our reach, but only nearly. As I allude to in my Quack Miranda Warning, there are a number of categories of people we need to reach. There will probably always be those who are quite beyond redemption, but my optimistic side believes (without too much data, granted) that there is a large group of those who, while not experts, and relying on their own interpretations of their own observations, are humble enough to be swayed by facts. I view the population as being in a dynamic equilibrium of sorts, with perhaps a core of unalterables, but a vast pool of those who might be swayed by fact or emotion into one camp or another. Our job is to help them favor the right side.  And their is a right side. It is not a matter of two paths to the same destination because some things make and keep people healthy, and some do not.

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25 responses so far

An unfortunate happening

Mar 12 2010 Published by under Uncategorized

Our beloved, beat-up laptop is ill--very ill. The family is considering consenting to a Do Not Resuscitate order. Symptoms of this grave illness include inability to exit the start up screen and freezing up in "safe mode". The agonal Blue Screen of Death has not yet appeared, but is believed to be immanent.

23 responses so far

Victory for science, humiliation for antivax nut

Mar 10 2010 Published by under Medicine

A few months ago, attorney Ames Grawert and I wrote about a defamation case filed by noted anti-vaccine crank Barbara Loe Fisher against respected journalist Amy Wallace, vaccine expert Dr. Paul Offit, and Conde Nast. The suit arose from a statement by Offit in an excellent article by Wallace. At one point in the lengthy article, Offit is quoted as saying, regarding Loe Fisher, "She lies."
Loe Fisher launched the defamation suit based on these two words, claiming they made her appear "odious, infamous, and ridiculous." Anyone who has read Loe Fisher's writing at her National Vaccine Information Center knows that she needs no help in this regard.
But the judge who drew the case didn't comment on Loe Fisher's idiocy, just her error in thinking that the law protects her from heated criticism. The case was dismissed today. In his ruling, US District Judge Claude Hilton stated that since it is nearly impossible to prove or disprove the statement "she lies", something statute requires, and that since hyperbole uttered in heated debates is clearly protected free speech, the case cannot proceed.
Thank the US Constitution and our long history of protection of free speech for our ability to duke it out verbally without fear of an avalanche of frivolous lawsuits. Scientific fact is not a matter of law, and science cannot proceed in an atmosphere of fear of open debate.
Shame on you Barbara (of course, there will always be an England).
(h/t CS)

32 responses so far

What else does Dr. Kaiser have to offer?

Mar 10 2010 Published by under Medicine

The other day I told you about a doctor promoting a dietary supplement for the treatment of HIV, despite the lack of any significant data to support his claims. If there's anything medical bloggers have found over the years is that woo rarely walks alone.
In my post I expressed some incredulity at the fact that Kaiser promotes himself as an internist and HIV expert despite any of the usual formal education required for these designations. Examination of his website reveals that he is also an expert in "longevity", cancer, chronic fatigue, autoimmune disease, and intestinal parasites. Fascinating.
According to Kaiser's website:

Integrative Health Consulting believes that a comprehensive healing program of aggressive natural therapies, combined with standard medical treatment and mind-body healing techniques, is vital to the successful treatment of most serious medical conditions.

Every day I hear from patients and friends with serious diseases who are trying to sort through the piles (pun intended) of unsolicited advice about their serious diseases. When I see bullshit like this, all I can think of is my friends who might read this and be taken in. The statement that "Integrative Health Counseling believes that..." is wonderfully useless. What the company does or does not believe about its offerings is not a good gauge of their utility. What are "aggressive natural therapies" and what data supports their use? As with most questionable medical practices, their program just happens to be good for everything. That's terribly convenient.

Comprehensive Healing Programs consist of recommendations from each of the following seven categories:
1) Diet
2) Vitamins & Nutritional Supplements
3) Herbs & Acupuncture
4) Individualized Exercises Programs
5) Stress Reduction/Positive Attitude
6) Hormone Balancing
7) Medical Therapy
The use of a combination of recommendations from the above categories imparts a far better success rate than the use of one category alone (i.e. medical therapy). When an approach such as this is taken to the treatment of chronic conditions such as cancer, hepatitis, autoimmune disorders, and chronic fatigue syndrome a high success rate is achieved.

Really? How do you know that? So, you're claiming that by combining medical therapy with a bunch of unproven and disproved modalities, you fix people with serious diseases.

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9 responses so far

Dr. Kaiser responds

Mar 10 2010 Published by under Medicine

I was pleased to see that Dr. Kaiser responded to post from earlier this week. If you'll recall, Dr. Jon Kaiser is a doctor in California who is promoting a nutritional supplement to help treat HIV disease. I was hoping his response would be substantive, containing references to data I had missed in my research of the story. In this I was disappointed.

Dr. Lipson,
I was surprised when I read your recent blog about my career, expertise and perspective on HIV treatment.
Facts and science can be manipulated to support any opinion, so it is a fruitless exercise to engage in a point by point correction of your numerous mischaracterizations. But I will speak to a few of the core issues you raised.

Translation: "I have no actual data to refute your points, but I am about to drag you through a tangled heap of rhetorical mis-steps and logical fallacies."

I arrived in San Francisco during the height of the AIDS epidemic. Since that time, I have treated over two thousand HIV-positive patients and have dedicated my life to helping individuals with this condition live normal life spans. Back in the days before any effective drugs were available to treat this condition, and HIV infection was regarded as 100% fatal, I decided reject that belief. I then began exploring ways to help my patients outlive that prediction. Many of these patients are still healthy and alive today.

As I stated in my original piece, a number of older HIV docs were internists or other type of specialists, such as hematologist/oncologists, rather than infectious disease specialists and had to invent the field of HIV medicine as the epidemic developed. Not that Kaiser is an internists, having completed only one year of post-graduate training, but arriving in SF during the height of the epidemic would give any doctor an interesting, frightening, and humbling experience. Except Kaiser wasn't humbled in the face of disease; he "decided to reject" the fact that before anti-retroviral therapy became available, HIV was almost uniformly fatal. There have always been a few long-term non-progressers, some of whom may have certain genetic protection against HIV, such as a CCR5 mutation. But I view with some skepticism his claim that he yanked patients away from certain death with his revolutionary ways.

I would be surprised if the seven pharmaceutical companies who have enjoyed my participation as a consultant or speaker, the American Academy of HIV Medicine on whose Reimbursement Committee I have served, the International Journal of Infectious Diseases on whose editorial board I have participated, or the World AIDS Conference which invited me to present my research study results, share your perspective on my expertise and legitimacy as an HIV researcher and treatment specialist.

None of those facts actually make one an "HIV expert". I'm not saying he isn't an expert, but serving on the "reimbursement committee" of a lower-tier HIV organization hardly makes one an expert. As for his presentations, well, one traditional definition of "expert" is someone from out of town with slides. He seems to fit this definition, but having only one peer-reviewed publication in his field, one that required an editorial note to explain his conflict of interest, argues against him being an expert by other standards.

Despite your belief that a micronutrient supplement can't possibly act as a potent immune modulator, several pharmaceutical companies have already expressed interest in investigating K-PAX's Immune Support Formula in combination with their drugs.

Perhaps he hasn't read my piece all that carefully, or he just has a thing for straw men. I have no way of knowing what is in his heart, but I never argued against the plausibility of micronutrients assisting in the treatment of HIV---just that the data and claims he presented were not good evidence to support it. Perhaps some day evidence will support the use of his supplement, but that day has not yet come.

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6 responses so far

A nutritional approach to the treatment of HIV infection---same old woo?

Mar 08 2010 Published by under Medicine

I get all sorts of mail. I get mail from whining Scientologists, suffering patients, angry quacks---and I get lots of promotional material. I get letters from publishers wanting me to review books, letters from pseudo-bloggers wanting me to plug their advertiblog---really, just about anything you can imagine.

Most of the time I just hit "delete"; it's obvious that they've never read my blog and they're just casting a wide net for some link love. But a recent email from a PR firm piqued my interest: (it's a long letter, and I won't be offended if you simply reference it rather than read the whole thing now):

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19 responses so far

Coming up at WCU

Mar 07 2010 Published by under meta-blag

For some reason I'm really excited about tomorrow's post. I don't usually write very far ahead of time, but this one took a little bit of extra research. You see, I got this letter from a PR firm hyping some altmed doc, and it was much more interesting than the usual similar things I get. It highlights some of the subtleties at the intersection of science-based medicine and the other stuff.
The post is going up here tomorrow morning, and at Science-Based Medicine in the afternoon.
One thing I've found about blogging, though, is a piece I really work hard on and like a lot may go over like a real dud, and a post I crank out in five minutes may end up with more hits than I've seen in months. Go figure.

8 responses so far

Friday writer's block open thread

Mar 05 2010 Published by under Medicine

Things have been rather busy at Pal's place. For whatever reason, the complexity of patients has been pretty high lately, so I haven't had a chance to get in my usual once or twice a day post.
I'm told that "back in the day" internal medicine patients were a bit less complicated. These days, to get admitted to the hospital, you have to be pretty damned sick. The hospital has to be able to justify your admission based on "severity of illness" and "intensity of service". In simple terms, you have to be sick enough to need care that cannot be provided elsewhere. The days of being admitted for "rest" or for "a workup" are gone.
It's not uncommon for a typical hospitalized patient to have several illnesses, and for the treatment of one to be incompatible with the treatment of another. Many, many patients are treated with various sorts of medications to prevent blood clotting. People with a common heart rhythm problem called atrial fibrillation are usually on a potent anticoagulant called warfarin. Patients with drug-eluting stents in their coronary arteries are often treated with an anti-platelet drug called clopidogrel. If a patient on these drugs develop gastrointestinal bleeding---a common enough problem even without blood thinners---treating them becomes a real dilemma. Stopping the blood thinners may lead to devastating clots, but failing to may lead to life-threatening bleeding.
Patients with atrial fibrillation may have a risk of stroke as high as 8-10% per year, a risk that can be cut in half with warfarin. The risk of severe gastrointestinal bleeding is lower than that (depending on a number of factors), but it still happens. Given this, we're going to see a lot of people with atrial fib in the hospital, either for GI bleeding or for stroke (not to mention for control of the arrhythmia itself).
All this is my way of saying medicine is never boring. But it's sometimes busy.
In addition to hospital rounds, I'm going to a birthday party for a five year old buddy of my kid. Other than that, who knows?
So, what are you up to this weekend?

11 responses so far

Hey, guys, this one is for you

Mar 03 2010 Published by under Medicine

Sexual violence is a huge problem in the US.  Among college-age women, for example, 20-25% report an attempted or completed rape while in college.  Assault itself is prevalent enough to constitute a major public health problem, but add to that the sequelae---STIs, PTSD, fear, etc.---and sexual assault isn't just a major public health problem; it's one of our most common and devastating public health problems.

Given that most perpetrators of sexual violence are men, we have a target population for prevention.  Now, some might argue that focusing on preventing sexual violence by educating men is the wrong approach.  After all, why not teach women how not to get raped.  Right?

This common argument is one of the reasons we men need education.  So let's take a few minutes, guys, and go over a few things, things I've spent a lot of time trying to learn and to understand.

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163 responses so far

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