Archive for: July, 2010

One epidemic, two problems

Jul 28 2010 Published by under Uncategorized

Last week, the New York Times reported on the current epidemic of Dengue fever in Key West, FL, so let's back up a bit and get a larger view of this.

Dengue fever is caused by a virus transmitted by mosquitoes. It's the most common arthropod-borne illness in the world, but, like malaria, has been of only limited concern in the U.S. over the last half-century. The illness is characterized by high fevers, rash, and terrible pain that gives it its nickname: Breakbone Fever. As unpleasant as it can be, a case of Dengue usually passes and leaves the victim with nothing worse than bad memories. For a typical American traveler, this can lead to an unpleasant vacation.

But for people who are repeatedly exposed to the virus, it can have much more devastating effects. Exposure to a different strain of the virus can lead to Dengue hemorrhagic fever (DHF), an frightening illness that is rarely fatal when patients have access to good medical care. But many areas where Dengue is endemic do not have access to good medical care. People with DHF have high fevers, but also develop bleeding and vascular leak, causing fluid to accumulate in places it shouldn't, such as the lungs, and can lead to shock and death.

While Dengue fever is a painful inconvenience to travelers, it can be deadly if it becomes a endemic in an area because of the risk of DHF when re-infected. This is the primary reason surveillance and prevention are so important. Which leads to problem number one (asie from the outbreak itself): according to the Times, the CDC is going to be cutting back the Division of Vector Borne Infectious Diseases, which is responsible for important emerging diseases such as Dengue, West Nile Fever, and Lyme disease.

The second problem is also economic, but in more human and less bureaucratic way. The Times is reporting that residents of Key West, who are dependent on tourism, are reluctant to acknowledge and deal with the epidemic. About five percent of the Key West population is believed to have been exposed to Dengue, a huge number considering that this part of the U.S. rarely sees the disease. It is also a popular tourist destination, meaning that travelers can acquire it, and bring it home to their local mosquitoes, potentially leading to its establishment elsewhere.

The worst possible reaction to an epidemic is denial, but reactions in Key West from residents and officials has been disappointing. One local health official called the CDCs report "alarmist". There are active mosquito eradication efforts ongoing, but as we saw with West Nile Fever in other parts of the country, it is possible to inform the public without panicking them.

Prevention of mosquito-borne diseases like West Nile and Dengue requires not only local control of populations, but personal protection. Minimizing exposed skin, and applying a repellent containing DEET (usually at a concentration 20-30%) can provide protection from bites thereby minimizing the risk of acquiring mosquito-borne diseases.
uiring mosquito-borne diseases.

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Scotch Whiskey

Jul 24 2010 Published by under Uncategorized

I'm not going to lie, folks: today has been pretty horrid.  Around five this morning MrsPal and I found out that our friend had just died.  It wasn't unexpected, but since when does that matter?  In the poor timing characteristic of real life, MrsPal and PalKid left town today on a long-ago-planned journey, leaving me with an empty house and memories of a good friend in better times.

And tonight my family gathered to remember a cousin who died last summer.  She was a remarkable woman, and her husband and children spoke eloquently and lovingly over drinks and excellent food, as she would have loved.  It gave me a chance to reflect on my cousin's life, and my friend's, and to take solace in the company of my parents and sisters, who rarely have the chance to be in the same place at the same time.  I only wish my wife could have been here to share in some of that comfort.

People who want to comfort you often tell you tomorrow is another day and other such nonsense.  People like platitudes.  But they're right, I suppose.  Tomorrow morning I'll sit down with my parents and my sister's family over bagels and lox, and talk about the heat, our summer plans, and how remarkable our children are.

There's nothing I can write about grief that hasn't already been written, but since we are all destined to experience it, we all have to find our own way to understand it.  Grief can be a lens, one that magnifies fear and uncertainty, but can also bring into sharper focus that which is important---friendships, successes, failures, loves lost and gained.  We don't get to choose a life without grief, unless we choose a life alone, or enough like alone that there is no real difference.

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Twenty years, another world

Jul 22 2010 Published by under Uncategorized

My family has always been quick to embrace new technology.  When my oldest sister went off to college in the early mid-70s, her university was unusual in that it had a computing center and apparently (I was a wee lad at the time) encouraged education in computing.  When I was slightly less wee, my middle school offered a computing class.  We learned to make flow charts and to program in BASIC.  Once we'd written our little programs, we would head over to the teletype machine in the closet in the back of the room, dial up the county mainframe, and if all went well, find out if our programs worked.
Around that time, my folks bought a computer.  I think the first one was an Apple II +, which was roughly shaped like a flattened typewriter on which you could perch a TV.  My parents took computer programming classes at the local community college, and we used the computer to play with programming, and even to do some very basic word processing. (For you young folks, the word processors were characters and markup---there was no WYSIWYG.)

Then the Macintosh came out.  It was beautiful.  And my parents got me one as a graduation present.  Always ahead of the curve, they were (and still are, mostly).  My computer served me and many others through my years in Ann Arbor.  During my time there, typed papers faded away, and computing centers (filled with Macs) opened up in central campus locations.  And one day, while sitting at one of those computing centers with a friend, I was told I could write a letter to a friend of ours overseas---on the computer.  It was called "electronic mail", and it was instantaneous, and no, it didn't cost anything.  Remarkable.  Of course our email addresses at the time were rather different as I recall.

This was an exciting time.  In high school we had learned how to use libraries to our advantage, searching card catalogs, reference indexes, and huge books full of citation indexes.   When I got to college, we continued with this system, with a little help form computer terminals that could help us find the huge books that helped us find smaller books and articles.  By the end of college, I'm not sure anyone used a card catalog or any of the heavy tomes, or even knew where they were.

All of that seems rather quaint now.  I can sit here at my computer and search for articles about, for example, direct current cardioversion, or murine models of MDMA tolerance.  Often enough, I can find the full text with citations, and the citations themselves are linked to their sources.

The technical aspects of science blogging aside, I don't think we could have had science blogs twenty years ago.  There was no way to get up to date information on discoveries, no way to quickly find references, no way to produce a well-referenced post on breaking science news.  Writing a blog post without modern information science would be more like writing a term paper.  And who wants to read a blog that's only updated a couple of times a year?

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Book Review: Breakthrough

Jul 19 2010 Published by under Uncategorized

I envy writers of medical history, especially those who can create a really good read.  Someday, I would love to be able to write a good medical history, but this is not that day.  Today is one of the many days I get to tell you about another good book on medical history written by someone other than me.

The book is Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle.(amzn/b&n/pwll) When I read the preface, I had some reservations.

This book is based on a true story, and relies heavily on primary historical sources and documents.  With one exception, detailed in the section Notes and Sources, all characters are historical figures.  Most dialogue and incidents have been drawn from contemporaneous sources, but in some cases have been invented or augmented for narrative purposes.

This gave me pause, as there is something about authenticity that seems particularly important in both history and medicine.  We've all read histories, and we've all read historical fiction, and most of us have an idea of which is the better read.  One of my favorite authors in the genre, Rebecca Skloot, said in a recent interview:

When you write nonfiction in a way that will hopefully read like fiction, with scenes and dialog, there’s an assumption that you made it up or made some things up. When I do Q&As, people in the audience will ask, “So how much liberty did you have to take?” Not did you take any, but how much? There’s this assumption that it’s impossible to recreate history in a way that reads like a story.

[...]

I think it’s interesting that people assume that when they read dialogue that took place in the 1950s, it was made up, because I wasn’t there. But in fact there are ways you can recreate that accurately in reporting. It is absolutely possible to recreate nonfiction in a narrative way and still be factual. It takes a heck of a long time, but it’s worth it.

So it is possible to create compelling and accurate dialog.  But authors Thea Cooper and Arthur Ainsberg chose a particularly difficult protagonist around whom to build a story.

Elizabeth Hughes was the daughter of a powerful American politician in early 20th century America.  She was also one of the world's first insulin patients.   At the time of her diagnosis, the most sophisticated treatment for diabetes involved controlled starvation, a horrific process described in some detail in the Breakthrough. Dr. Frederick Allen, the doctor behind the starvation protocol, believed that something like insulin was just around the corner, and that it was worth putting his patients through the misery of starvation to help them survive long enough to take advantage of this cure.

As we know, he was right.  The heroic and probably-insane Frederick Banting received much of the credit for this discovery, and he was hardly unsung.  Elizabeth Hughes, however, was intentionally unsung.  She hid her diabetes for the rest of her life, and her role as one of the first patients to receive it was buried in time.

The authors' narrative is more than readable, and from the available sources about this intensely private person, they created a complex and likable protagonist.  But some of the motivations attributed to her later silence were part of the "augmentation" of available historical documents.  At one point in the story, the powerful Charles Evans Hughes, Elizabeth's father, is portrayed as betraying his instinctive reticence and sense of duty to call up  Banting and pull some strings to get his daughter the insulin that would save her life.  But this phone call never happened, or at least it's never been documented.

And I can live with that.  The book successfully weaves together the personal struggles of the patients, doctors and scientists living and dying on the edge of one of medicine's greatest discoveries.  It also captures the beginning of the modern pharmaceutical industry, and how Eli Lilly and Company was poised to take advantage of this new discovery.  The scientists in Toronto were working day and night to come up with a process to reliably isolate insulin, but once they did, Lilly was able to turn it into an industrial process, quickly supplying insulin to thousands of diabetics.   Cooper and Ainsberg create vivid images of the solo chemist sweating over borrowed equipment, the industrial might of a large corporation, and Lilly employees spreading across the Midwest to talk slaughterhouses into harvesting pancreases by the ton.

Breakthrough is to be published in Fall of 2010 by St. Martin's Press, so it won't be out in time for a summer read.  But it should be an interesting one to discuss with friends over apple cider, something that many diabetics can enjoy with caution thanks to the discoveries documented in  this book.

An advance proof of this book was provide to me at no cost by the publisher.

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Ethics and goals: always a challenge

Jul 19 2010 Published by under Journalism, Uncategorized

My formal ethical training began in medical school with an introduction to the basic concepts of medical ethics. This training continued as I encountered difficult cases and thought through them, often with the help of the hospital ethics committee. While I haven't continued my formal education in ethics, I've continued my own reading, and I enjoy writing on ethical conundrums.

I've been blogging now for over three years, which, in internet time, is quite a while. During that time, I've begun to take the writing itself more and more seriously. I've begun to recognize the implications of the medium itself, especially in conversations with mainstream journalists. We bloggers are, for better or worse, part of "the media".  So I've had to learn something about journalism ethics as well.

This has changed the way I write. When I look back at some of my earliest posts, I cringe. In many ways that's a good thing; as it turns out, I have the ability to learn and improve. My commenters and my colleagues help keep me honest, and without them, I'd write just as poorly as I did five years ago. I've also expanded the type of writing I do. In addition to my always well-reasoned rantings and my discussions of science-based medicine, I've done some more investigative pieces, interviewing sources, and consulting other journalists about ethics and approaches.

Given that much of my writing is very critical of unethical medical practices, I don't have a lot of wiggle room in my own public behavior.  This isn't to say that to be ethical is to be perfect; far from it.  But behaving ethically is hard work that involves hard decisions, and frequent mistakes.

ScienceBlogs has not made such a mistake. With the mishandling of the launch of a commercial ad-blog, Seed Media Group showed incompetence and mismanagement.  They also showed that they do not consider themselves (or we bloggers) to be "media" or journalists.  Whether we like it or not, we are the media, and while we may enjoy a great deal more freedom in style and content than most mainstream media, we cannot claim immunity from their ethics.

It is for these reasons (and others, most of which have been eloquently and completely laid out by Bora Zivkovic) that I'm leaving ScienceBlogs, something I do with great regret.  I have gained immeasurably from my association with Sb and with the people here.  It has given me incredible opportunities.  But despite the advantages in exposure, the fit just isn't good anymore.

This is a personal decision, not one that can be generalized to include anyone writing here.  The bloggers here are some of my favorite science writers, and always will be, whether they remain at Sb or go elsewhere.  I have nothing but respect and admiration for them.

As the science blogosphere has evolved, and as my own writing has, I feel that the risk of leaving is not what it might have been once.  I will continue to write White Coat Underground at my old wordpress site for now, and will announce further plans there.   And I will continue my occasional pieces at Forbes.com and Science-Based Medicine.

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Reminder: Whooping cough is serious business

Jul 16 2010 Published by under Uncategorized

I shouldn't see any cases of pertussis ("whooping cough"), but I do. We have a safe, effective and affordable vaccine. But still, people are getting this disease. In the age group I see (adults), immunity has often waned, and if they haven't been revaccinated, they can get the disease and pass it on. In adults it often looks like a cold, but not in kids. Most properly vaccinated children are immune and remain so until there little airways are large enough to cope with the illness. But a certain percentage of kids either don't get vaccinated or aren't successfully vaccinated, leaving them vulnerable to a disease that shouldn't even exist at a measurable rate.

In small children, with their little airways, pertussis often leads to hospitalization, and not infrequently kills. It kills children who should never have been put at risk, either because their parents refused to vaccinate them, or people around them did and gave them the disease.

Children and adults who should be vaccinated but are not represent a public health failure, and in the case of parents who deny their kids the vaccine, an ethical failure as well.

As a reminder, this is what pertussis looks like in little kids.

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HuffPo blogger claims skin cancer is conspiracy

Jul 14 2010 Published by under Uncategorized

I was a bit torn when trying to figure out how to approach this piece.  A reader emailed me about an article in the Huffington Post, and there is so much wrong with it that I felt overwhelmed.  My solution is to focus on a few of the problems that can help illuminate broader points.

There is a small but vocal movement of people who refuse to believe that skin cancer caused by sunlight is a significant health risk.  These people tend to also believe that the risk is being purposely hyped by others, and that our current approach to skin cancer prevention is causing an epidemic of vitamin D deficiency. Leaving aside the seemingly insane denialism regarding sunlight and cancer, there are two broad problems with this article.  The first is pretty bad.

With the summer months upon us I wanted to find out firsthand what exactly the mantra is that dermatologists are telling patients. So I went undercover to several San Francisco dermatologists in order to see if there is legitimate concern about the sun-scare media hype. Are these doctors being sensible or going overboard when it comes to advice on sunscreen use and skin cancer prevention? Is the sky falling with dangerous UV rays or are we being induced into a media panic?

He goes on to give links to recorded conversations, and prints out partial transcripts.  He does not specify whether or not he received permission to record these conversations, as required by California law.  Whether or not the law requires it, the writer should have disclosed to his readers whether or not he had received permission.  This information is important in interpreting the conversations he reports to us.

The next problem is broader, and deals with physicians' willingness to lie on behalf of patients.  The author's presumably-clandestine recordings of his deceptive visits to dermatologists (catching my breath---this is striking and requires a digression.  The act of deceiving these doctors is not only unethical, but can influence the outcome of the visit.  Doctors make the assumption that most patients are interacting with them out of good faith, and are not intentionally deceiving them.)

In the first conversation the author has with a doctor, the interviewer makes it clear that he wants a mole removed, and the doctor essentially leads him to say "the right thing" so that insurance will cover the procedure.  One thing the author seems to miss is that the dermatologist is going to be paid whether or not insurance covers the procedure.  If the insurance company says "no", the patient will be billed.  The doctor is lying for the patient, not for herself.

Data have shown that physicians are willing to lie on behalf of patients. There are a number of reasons that this poses ethical problems.  It could be argued that the doctor is lying to help get the patient something that they need, and that lying is a peccadillo compared to the benefit.  This can backfire in a number of ways, not least of which is that both the doctor and the patient can probably be prosecuted for fraud, something that is unlikely to be of benefit to either one.

But there is a fine line between a lie and a truth, one that anyone familiar with the intimacies of the exam room will often experience.  As a doctor, your overall impression may be that the patient is at high risk for coronary artery disease, but perhaps the patient doesn't quite meet the insurance company's criteria.  You can then lay out the cost of the test and the risks and benefits for the patient, but I wouldn't be surprised if some doctors took the short cut of asking, "are you sure you've never had any chest pain or difficulty breathing?"

He begins his second dermatology visit by telling the doctor that he has a family history of melanoma, and finds fault in the doctor's description of the statistics of the disease.  The problem of properly rendering statistics is a common one, and he links to an excellent piece by Ivan Oransky explaining the difference between relative risk and absolute risk.  Unfortunately, he uses this to spin a tale of some sort of dermatology conspiracy to inflate cancer numbers.  Skin cancers (including melanomas and non-melanoma skin cancers) are very, very common, and though many are not fatal, their diagnosis and treatment can be expensive and disfiguring.

His visit continues and the doctor tells him that insurance won't cover his mole removal because it's not necessary, and refuses to lie in the medical record. The doc then gives some sound medical advice about how to prevent skin cancers.

I then ask what measures I should take to prevent skin cancer. I'm told to apply sunscreen 24/7, wear a hat and sunglasses, as well as avoid the sun as much as possible. (The only thing she doesn't mention is to live underground with the mole people.)

"Mole people"?  He asked the doc how to prevent skin cancer, the doc gave the correct answer.  It's up to the patient to decide if the application of sunscreen is too onerous for the potential benefit.

This article shows a misunderstanding of journalistic ethics, medical ethics, and medical science.  It's a disaster.  And it's no surprise that it's in the Huffington Post.

I was a bit torn when trying to figure out how to approach this piece.  A reader emailed me about an article in the Huffington Post, and there is so much wrong with it that I felt overwhelmed.  My solution is to focus on a few of the problems that can help illuminate broader points.

There is a small but vocal movement of people who refuse to believe that skin cancer caused by sunlight is a significant health risk.  These people tend to also believe that the risk is being purposely hyped by others, and that our current approach to skin cancer prevention is causing an epidemic of vitamin D deficiency. Leaving aside the seemingly insane denialism regarding sunlight and cancer, there are two broad problems with this article.  The first is pretty bad.

With the summer months upon us I wanted to find out firsthand what exactly the mantra is that dermatologists are telling patients. So I went undercover to several San Francisco dermatologists in order to see if there is legitimate concern about the sun-scare media hype. Are these doctors being sensible or going overboard when it comes to advice on sunscreen use and skin cancer prevention? Is the sky falling with dangerous UV rays or are we being induced into a media panic?

He goes on to give links to recorded conversations, and prints out partial transcripts.  He does not specify whether or not he received permission to record these conversations, as required by California law.  Whether or not the law requires it, the writer should have disclosed to his readers whether or not he had received permission.  This information is important in interpreting the conversations he reports to us.

The next problem is broader, and deals with physicians' willingness to lie on behalf of patients.  The author's presumably-clandestine recordings of his deceptive visits to dermatologists (catching my breath---this is striking and requires a digression.  The act of deceiving these doctors is not only unethical, but can influence the outcome of the visit.  Doctors make the assumption that most patients are interacting with them out of good faith, and are not intentionally deceiving them.)

In the first conversation the author has with a doctor, the interviewer makes it clear that he wants a mole removed, and the doctor essentially leads him to say "the right thing" so that insurance will cover the procedure.  One thing the author seems to miss is that the dermatologist is going to be paid whether or not insurance covers the procedure.  If the insurance company says "no", the patient will be billed.  The doctor is lying for the patient, not for herself.

Data have shown that physicians are willing to lie on behalf of patients. There are a number of reasons that this poses ethical problems.  It could be argued that the doctor is lying to help get the patient something that they need, and that lying is a peccadillo compared to the benefit.  This can backfire in a number of ways, not least of which is that both the doctor and the patient can probably be prosecuted for fraud, something that is unlikely to be of benefit to either one.

But there is a fine line between a lie and a truth, one that anyone familiar with the intimacies of the exam room will often experience.  As a doctor, your overall impression may be that the patient is at high risk for coronary artery disease, but perhaps the patient doesn't quite meet the insurance company's criteria.  You can then lay out the cost of the test and the risks and benefits for the patient, but I wouldn't be surprised if some doctors took the short cut of asking, "are you sure you've never had any chest pain or difficulty breathing?"

He begins his second dermatology visit by telling the doctor that he has a family history of melanoma, and finds fault in the doctor's description of the statistics of the disease.  The problem of properly rendering statistics is a common one, and he links to an excellent piece by Ivan Oransky explaining the difference between relative risk and absolute risk.  Unfortunately, he uses this to spin a tale of some sort of dermatology conspiracy to inflate cancer numbers.  Skin cancers (including melanomas and non-melanoma skin cancers) are very, very common, and though many are not fatal, their diagnosis and treatment can be expensive and disfiguring.

His visit continues and the doctor tells him that insurance won't cover his mole removal because it's not necessary, and refuses to lie in the medical record. The doc then gives some sound medical advice about how to prevent skin cancers.

I then ask what measures I should take to prevent skin cancer. I'm told to apply sunscreen 24/7, wear a hat and sunglasses, as well as avoid the sun as much as possible. (The only thing she doesn't mention is to live underground with the mole people.)

"Mole people"?  He asked the doc how to prevent skin cancer, the doc gave the correct answer.  It's up to the patient to decide if the application of sunscreen is too onerous for the potential benefit.

This article shows a misunderstanding of journalistic ethics, medical ethics, and medical science.  It's a disaster.  And it's no surprise that it's in the Huffington Post.

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Rethinking blog networks and ethics

Jul 06 2010 Published by under meta-blag

One of the wonderful things about blogs is their independence. Most are hosted by wordpress or blogger and there isn't much advertising or sponsorship. Notable exceptions are blog collectives, such as ScienceBlogs and the Discover Magazine blog network. These networks have significant advantages, including technical support, increased reach, and collegiality (your results may vary).

One of the potential disadvantages is advertising and sponsorship. Here at Sb, we've been very fortunate in that our content is completely independent. We control anything in the center column. The top and right however belong to Sb, and they use this space to keep the place running. There have been several times when the advertising has been less-than-appropriate, and SEED has responded by altering it, but in this economy, it pays to be flexible. Ad content can serve as blog fodder. There's nothing preventing those of us who blog here from critiquing the ad content as vigorously as we wish to.

While the various bloggers under the ScienceBlogs banner are independent of Sb and of each other, there is certainly a penumbra of association. We all may benefit from good publicity, and we may be harmed by bad publicity, even if it comes from other blogs in the network. Given that we may benefit from good publicity generated by the network, it could be argued that we bear some responsibility when we don't speak out against bad practices on the network.

All that is my way of justifying what I am about to write: ScienceBlogs is launching a new blog, and in doing so they are making a spectacularly foolish decision. Today they announced a new blog called Food Frontiers, and I think a few simple quotes will allow you to see why I'm concerned.

On behalf of the team here at ScienceBlogs, I'd like to welcome you to Food Frontiers, a new project presented by PepsiCo.
As part of this partnership, we'll hear from a wide range of experts on how the company is developing products rooted in rigorous, science-based nutrition standards to offer consumers more wholesome and enjoyable foods and beverages. The focus will be on innovations in science, nutrition and health policy. In addition to learning more about the transformation of PepsiCo's product portfolio, we'll be seeing some of the innovative ways it is planning to reduce its use of energy, water and packaging.

So PepsiCo's PR flacks basically own a the center column content on one of our blogs.  This is not only a fundamental conflict of interest, it's also deceptive.  If PepsiCo is providing the content, it should, in my opinion, be clearly labelled as advertising.  It could be argued that since it is clearly announced that the content is PepsiCo's, that transparency is maintained, but it's not.  Readers of the other 70-odd blogs at Sb expect independent content in the center column.  What's more, Sb is indexed by Google News.  As a news outlet, we should be held to a high standard.  If the SEED management can't see what's wrong with this, this may be an insoluble problem.

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Quack-busting is dangerous work

Jul 06 2010 Published by under Medicine

First, I'd like to thank you all on commenting on the weekend's de-lurking post. I really appreciate your taking the time to leave a note. While I write what I feel like, it's nice to get an idea about what sort of things people are reading. For various reasons, I've preferred to write on diverse topics, and it turns out that this attracts readers with diverse interests.
Now down to some serious business. I'm sure that many of you remember the Simon Singh case. Simon is a well-known and well-respected science journalist in England. Last year, the British Chiropractic Association sued him for libel. They weren't too happy when a story of his pointed out that many of their practices are bogus. This was a terribly expensive and presumably traumatic event for Simon, but against all odds (at least those set by English libel laws), he prevailed.
Here in the U.S. we like to think that our saner libel laws give us a bit more protection, and they do, but only to a point. It is still very expensive to mount a defense against a bogus libel allegation. Dr. Paul Offit, one of the leading experts on vaccination, was sued earlier this year by a seemingly unhinged antivaccination activist. This infectious disease promoter, Barbara Loe Fisher, felt that a single phrase he uttered about her during an interview---"She lies"---was terribly damaging to her. Given that she spends an inordinate amount of time making a fool of herself, it's hard to see how anyone else can make her look worse, but she was upset and sued. Her case was thrown out, but I can only imagine what Paul went through.
Last week I learned of similar bad news that hits close to home. Dr. Stephen Barrett has been a tireless crusader against quackery. He has for years maintained the website Quackwatch, which along with several associated websites serves as a remarkably comprehensive repository for data on various medical scams and illegitimate practices. In a series of articles, Dr. Barrett (who is vice president of the Institute for Science in Medicine, of an organization that I am also involved with) explained the trouble with urine toxic metals tests. Doctors Data Labs was mentioned in some of these stories and in a vaguely worded bizarre set of letters, essentially demanded that Barrett not publish anything negative about them. When he asked them to point out specific content to which they objected, they declined and instead sued him. This suit is unlikely to be successful, unless they outspend him enough to break him. Barrett is taking donations for his legal defense. The more cases like this that succeed at trial or by default, the less safe all of us are to combat health fraud.
But what's the big deal about this lab? They offer, among other things, urine toxic metals tests. These tests are promoted as a way to find "toxins" hidden in the body, and are a common tool by those offering chelation therapy. Chelation is an unethical use of dangerous medications, and is used frequently by so-called alternative practitioners to treat nearly anything.
Here's what Doctors Data says about their test:

Urine toxic and essential elements analysis is an invaluable tool for the assessment of retention of toxic metals in the body and the status of essential nutrient elements. Toxic metals do not have any useful physiological function, adversely affect virtually every organ system and disrupt the homeostasis of nutrient elements.

Among the flaws pointed out by Barrett is that this test measures urine metal levels after the patient takes a chelating agent, a drug which scavenges any heavy metal molecules it can find and drags them to the urine. And as a reference range, they use urine levels that are considered high in people who aren't chelated. In other words, the test purposely boosts urine metal levels and them calls the levels "toxic".
The company offers many more tests not offered by labs with more (in my opinion) legitimate reputations. For example, Quest Diagnositics offers several different urine metal tests, none of which are "chelation-provoked".
This is a nuisance lawsuit, but it may be enough of a nuisance to have a significant chilling effect on those of us who are using ethical, science-based practices to help people. To offer unconventional and at best unproven diagnostics or therapeutics, and then sue people who criticize you is unethical, immoral, and dangerous.

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In Congress, July 4th, 1776

Jul 04 2010 Published by under Politics

It's worth re-reading this remarkable document from time to time, especially given that it says something very different from what many on the Right and in the Tea Party seem to think. It does, for example, give special importance to representative government; that is, in fact, one of the main purposes of the document. It does not call for a "right" to toss away any government someone disapproves of but lays out specific grievances and makes its declaration through the representatives of the people, not by mob action.
The document's wording was very carefully developed and has specific meaning to those who wrote it at the time and their descendants. If you've never read it, or haven't for a long time, give it a try.

The unanimous Declaration of the thirteen united States of America
When in the Course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. -- That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, -- That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security. -- Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.

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