Archive for: October, 2010

In which I continue to whine about crappy science journalism blogging

Oct 21 2010 Published by under Journalism, Medicine

Note: Since publication, the referenced article has been removed without note.  Some might argue that a more useful, nuanced, and sophisticated approach to posting a terrible blog post would be to leave the critical discussion intact and perhaps annotate or addend the offending post.  But the memory hole is always tempting, no? --PalMD

From time to time, I write pieces rather critical of the way mainstream media cover science and medicine.  Unfortunately for me, there's nothing terribly unique about that, as there are a number of fine journalists and websites that do that every day, and do it well (see, among others, here, here, here, and here). Last year I had the good fortune to attend an event at USC's Annenberg School of Journalism, and met a number of terrific journalists.  One thing that is clear to me is that I don't know enough about journalism.  For one thing, I'm free of many of the pressures faced by mainstream journalists.  I've broken ties with two media organizations that I've written for in the past (Scienceblogs and Forbes) because of the blurring of advertising and news/editorial content.  As a full-time, practicing physician, I have that luxury.  But many journalists do not.

During the Pepsigate scandal at Scienceblogs, I forced myself to think a bit more about what I want out of my own writing.  I felt that if I am to continue to deliver accurate health information online, I'd better learn  a bit more about journalism and about how reporters think and write.  Blogging has become for me more than a simple hobby, but less than an actual journalism gig.  I've found science writers to be an incredibly generous and approachable lot, and every day I strive to improve my writing, to show that there is no reason that a humble blog like this one cannot be a useful stop for decent writing on science and health.

Some have argued (I think correctly) that it may be impossible to be a practicing doctor and a practicing health care journalist, but I'm arrogant and crazy enough to think that I may be able to pull it off.  Not that I think I can be a good full-time journalist, but I think I have something useful to add to coverage of science and medicine.  I take my writing seriously, even though "it's just a blog."  I would love to spend more time formally studying journalism, but hey, I have disease to stamp out, so I'll just have to do my best.

And while not everyone will look at their own blogging as something delusionally serious, I think that people writing about health and science have to be ready to be taken to task for bad reporting.   LabSpaces, a fairly new network emerging in this second wave of science blogging, has some terrific writers, but one of their projects is a disaster.

Many of us receive daily press releases and other announcements about the latest studies or breakthroughs.  Journalists, with their particular education and experience, usually know how to view these critically.  Usually. But we naive bloggers may succumb to the temptation to treat every press release as conveniently-delivered facts rather than the publicity and PR tools that they are.  The folks at LabSpaces are falling into this trap.

The piece linked above is cribbed directly from a press release (I'm on the same mailing list) and is pure PR, with no supporting data or citations.  It makes very bold claims (such as, "[scientists] have now scientifically demonstrated that strep can lead to brain dysfunction and OCD").  These are just the sort of claims that should lead a writer or journalist to either file away the info for later, or to contact the institution to ask some hard questions.  To do anything else is to serve as a free publicity conduit.

So while you may not take your blog as seriously as some, others may.  More and more, it seems, the mainstream media is blowing it on science coverage.  There is no reason we should make the same mistakes.

5 responses so far

Donors Choose: Kids in Flint need your help

Oct 20 2010 Published by under Donors Choose

Since Roger & Me documented the devastation of Flint, MI over two decades ago, things have gotten even worse.  More than a quarter of the population lives below the poverty line.

But people try to survive, and one of Flint's teachers is trying to help. She's trying to purchase basic math and science supplies for her kids, kids whose families are often too busy trying to stay fed and housed to worry about non-immediately-vital needs like education.  One of our most successful donors suggested we bump this project up the list, as it will expire in a few weeks.  It will take another $411 to get this classroom the needed supplies.  Even very small donations---$1-$5---make a big difference, and history has shown my readers able to round up a lot of money in small donations.  Still, it's a lot of money.  Maybe we can get this one done before Friday?

3 responses so far

Donors Choose

Oct 19 2010 Published by under Donors Choose

Once again, I'm amazed by the generosity of my readers.  The huge project you funded which will give science supplies to an inner city school was finished just in time, and the giving frenzy was sparked by a very small donation.  Small donations can do this---they become a nidus for more giving and from a moral standpoint are at least as good large donations.

The other thing that amazes me is that we (you, me, Scientopia readers) are doing really well in our competition with other groups of science bloggers.  We are only a little bit behind mega-groups ScienceBlogs and DiscoverBlogs.    The best thing about the contest is that kids win no matter what.

So keep the donations coming, especially the smaller ones.   And here's a great project for the donations: a teacher in an inner city school wants an aquarium so that her kids can observe  frog growth and development.  As a fellow blogger has pointed out, there are some significant successes out there in education.  We can help build on these successes by helping talented, creative teachers elevate our children.

So, $224 by tomorrow will help another teacher help her kids.  That helps all of us.

2 responses so far

Smoking bans are good for barkeeps

Oct 18 2010 Published by under Medicine

Barkeep and blogger Scribbler has a piece up giving one bartender's view of New York's smoking ban.  Since I like Scribbler, I wondered what the data say about the effect of smoking bans on his health.  Cigarette smoke has many harmful physiologic effects, and the data are pretty clear that you don't have to be the one holding the cigarette to suffer the consequences.  Tobacco smoke damages lungs and increases vascular inflammation which leads to heart attacks and strokes.   While permanent damage is done to the lungs with smoking, damage slows after quitting.  Lung cancer risk is probably not significantly reduced by quitting in long time smokers, but the risk of dying of heart disease declines very rapidly after quitting, and it is heart disease that is the biggest killer.

Smoking bans appear to reduce the number of cigarettes consumed by smokers, and reduce the amount of smoke that all workers are exposed to.  What about Scribbler?  As a bartender, how is his heath likely to be affected?

A number of studies have looked at this question, and the results are encouraging.  After smoking bans, bartenders and other hospitality workers reported a decrease in respiratory symptoms and improvements in objective tests of lung function.  There are also measurable reductions in some blood measurements of inflammation which may be a marker for cardiac risk.  In New York in particular, the smoking ban led to a rapid decrease in smoke exposure among hospitality workers.  Given what we've seen in other cities, we can expect rapid subjective and objective improvements in health in Scribbler and his comrades due to the smoking ban.  Since we like Scribbler, this is a good thing.

While many may cringe at the paternalistic nature of public health laws, few complain about the availability of clean water and the notable absence of open sewers.  The smoking ban is in the same category. Continue Reading »

24 responses so far

Mercola appears to lie about vaccines and fertility (#vaxfax)

Oct 18 2010 Published by under Absurd medical claims, Medicine, Vaccination inanity

When well-reasoned discussion fails to convince someone of your strongly-held beliefs, the most effective tool of persuasion you have left is lying. This has always been the fall back position for quacks and politicians (a group with perhaps some significant overlap). This week, as reported by Respectful Insolence, anti-vaccination activists are launching a week of activism based on their usual fall back strategy.  Everyone is encouraged to spread the news, and help refute the lies with the cold, harsh light of truth.  On twitter, the news will be trending at the hashtag #vaxfax.  There is not formal aggregation of posts yet, but we'll let you know as soon as we have a website up.

Meanwhile, bloggers and others are strongly encouraged to refute the lies coming from infamous antivaccination nuts such as Barbara Loe Fisher and Joe Mercola.  As my first contribution to this week's battle, I give you an over-the-top piece of idiocy which is either mendacious or blindingly stupid.  Or maybe both, who can really say.

It comes from one of the biggest gurus of medical misinformation, Joe Mercola.   He titles his post, "What is in the flu vaccine that can cause infertility?" which is akin to asking, "when did you stop beating your wife?"  He could just as easily have asked, "What is in the flu vaccine that can cause an alien invasion?"  In this case, he bases his question (which I cannot say with completely certainty to be the product of fantasy, intentional lying, idiocy, or whatever) on a package insert for flu vaccines.  His entire article goes on to state the usual thought-free lies about vaccine contents, but we'll focus on his headline.  Is there evidence that flu vaccines cause fertility problems?

First, is the idea plausible?  What causes infertility?  Fertility can have male causes, female causes, or can be a combined cause.  It can be temporary or permanent.  Common causes (other than intentional interruption of fertility) include disorders of sperm production, egg production, fertilization---there are many causes and combinations of causes.  If a flu vaccination were to be contaminated with a significant amount of a hormone or hormone analog, I suppose it could contribute to temporary infertility, but it's hard to conceive of how this could happen.

Here is Mercola's smoking gun:

A study done in Slovakia on female rats found that when newborn rats were injected with the substance [flu vaccine] within a week of birth, they developed damage to the vagina and uterine lining, hormonal changes, ovarian deformities and infertility.

The package insert for Fluarix mentions that the manufacturer cannot guarantee your fertility will be unharmed...

What does this compelling evidence actually tell us?  First, from the package insert:

FLUARIX has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.

The issue of fertility and this flu vaccine has not been specifically tested in humans, mostly because the idea is insanely improbable. But what about the rats? He doesn't cite any actual Slovak study, but the package insert says this:

A reproductive and developmental toxicity study has been performed in female rats at a dose approximately 56 times the human dose (on a mg/kg basis) and revealed no evidence of impaired female fertility or harm to the fetus due to FLUARIX. There are, however, no adequate and well-controlled studies in pregnant women.

So other than a putative Slovak study that may have shown "something", a something not borne out in any human studies after billions vaccinations over decades, what does Mercola have to offer?

The package insert for Fluarix mentions that the manufacturer cannot guarantee your fertility will be unharmed.

While I cannot find this particular phrase in the manufacturer's literature, let's pretend it's there.  The manufacturer also cannot guarantee that aliens won't come probe your rectum after your flu shot.  There are lots of negatives that cannot be proven.  The overwhelming evidence is that flu shots are not only safe, but beneficial in preventing flu and complications from the flu.

I got mine, and so did my six year old daughter who is everything to me.  If even one person is harmed by following Mercola's advice, he is morally culpable for the injury or death of that person. He should be ashamed.

18 responses so far

Donors Choose: Project urgently needs help

Oct 18 2010 Published by under Donors Choose

Update: You did it! Thanks to several donations, large and small, there will be a fully functioning hands-on science classroom! You made my day, but more important, you made a lot of days for a lot of kids. A special thanks to Jenny, who set off this challenge. --PalMD

Update: you guys have once again really helped out. But there's still another $434 to go, and only six days left. Even a dollar makes a difference.

You folks have done wonders in the short time our challenge has been running. You've helped to fully fund projects that reach hundreds of students. The donations have been of all sizes and each one has had a significant impact.

A donor this evening brought to my attention a project in particularly urgent need. There are only 7 days left to get this project fully funded or the challenge will expire. This is a big project, and it's going to take some work on our part. The idea is essentially to equip an inner city classroom with a hands-on science curriculum. It's an expensive project, but the materials will be available for around 90 kids each year.

Some of my favorite projects have been funded, thanks to you, and these kids are really lucky. Let's see if we can get a bunch of young folks fired up about science, and education in general. This blog gets hundreds of hits each day, and if even a small number of you leave small donations (1-5 bucks) we can get there pretty quickly.

Michigan schools are in miserable shape, which means Michigan kids are suffering. Please?

5 responses so far

Medical Ethics Friday

Oct 15 2010 Published by under Medical ethics, Medicine

A few readers asked if we could have more frequent ethical discussions.  That seems like a good idea.  Here's a new case.

You are a family physician practicing in a busy urban area where you take care of hundreds of families from diverse backgrounds. You care from them from birth to death, both in the office and in the hospital.  One evening, the emergency department calls you.  Mr. F., a Jehovah's Witness, is in the ED feeling weak and short of breath.  He's a 40 year-old single father of four kids.  You've cared for him since he was a young man,  through his marriage, the birth of his kids (whom you delivered and continue to care for), and the death of his wife.  Lately, he has had terrible back pain from his job at the plant and has been taking a lot of "pain pills".   He has always made it clear to you that his religious beliefs are central to his life, and among these beliefs is an abhorrence of blood transfusions.  He will never accept one, no matter the circumstance.

The ED doctor is frustrated on the phone.  Mr. F.'s blood count is dangerously low.  It looks like he's been bleeding, perhaps from an ulcer.   They are giving him IV fluids, and may consider taking him to the OR, but they are afraid he won't last long.  His kids are in the waiting room with their elderly, infirm grandmother, also your patient.  The ED doc wants to wait until he passes out, then give him an "emergency" transfusion with the patients "presumed" consent.  The ED doc sounds afraid and frustrated and is wondering what you can add to the patient's care.

59 responses so far

Donors Choose Update

Oct 15 2010 Published by under Donors Choose

I'm overwhelmed by the generosity of my readers.    You've completed several projects, most of which are multi-year and benefit a substantial number of students in schools and homes with very limited resources.  What do you guys think about this one?  It really caught my eye as being incredibly cool.

The classroom is in Detroit, and the teacher wants to take the kids to a farm, milk cows, and make cheese.  This is such an exciting hands on science project.  I think it would be great if we could put together the last $236 $200 for these kids before the weekend.  All it takes is a few small donations.  We've had some large donors, for which I'm thankful, but the small donations ($2, $5, $10) add up very quickly.  There are a lot of people stopping by this blog.  A short detour to drop off a couple of (tax-deductible) bucks would really help some kids out.

No responses yet

Donors Choose Update

Oct 14 2010 Published by under Donors Choose

You guys have been doing great.  Mostly through small donations, you've fully funded two projects reaching 146 students (and many more as most of these projects can be used every year).  It's time to pony up a bit more. This literacy project only needs $111 to get kids out of the 20th century.  Right now, they are stuck with cassette tapes for listening to books.  The teacher is trying to get them MP3 players, which will certainly allow for a larger selection of books.  Maybe we can get it done by breakfast and give those kids a nice surprise before the weekend?

2 responses so far

Should I lick this?

Oct 14 2010 Published by under Medicine

When I lived in Northern California, I would often hear stories about people scouring the back country for psychedelic toads.  In popular imagination, these toad wranglers would then gather around bonfires and with great ceremony and earnestness, they would lick hapless bufoids until they (the humans) fell into ecstatic trances---and then vomited profusely. These stories, often parroted by local media, would end with the news that toad licking had finally been outlawed by the state.   The truth, as usual, is quite a bit more complicated.

Bufotenin, one of many molecules secreted by the skin and parotid glands of some toads of the genus Bufo, is classified by the DEA as a Schedule I drug.  This is the same class as heroin, mescaline, cannabis, and other drugs the DEA feels have a high potential for abuse and little or no therapeutic value.  Bufotenin is also present in certain mushrooms, so I wouldn't swear that is was outlawed because of a pandemic of toad licking.

But many toads are toxic.  While there are few reports in the literature about poisoning due to toad licking, there are plenty of reports of accidental toad poisoning.  Toads are a food product in parts of Southeast Asia.  There have been many reports of accidental toad poisoning in rural Laos, especially when toad skin and toad eggs are part of a meal.

But there's more than one way to get killed by a toad. A traditional Chinese herbal medicine called ch'an su *, which has been sold as an aphrodisiac, topical anesthetic, and a heart medicine, has been responsible for poisonings both in Asia and the U.S. (one of the versions sold in the U.S. was "marketed" as a topical medication, but was taken internally, perhaps for the hallucinogentic affects).  
Some of the chemicals present in toad venom are closely related to cardiac glycosides such as digoxin, a potent naturally-derived heart medication, and intoxication with toad venom closely resembles digoxin poisoning.  In fact, blood tests in victims are often positive for digoxin.  Given the similarities to digoxing poisoning, investigators have tried treating toad poisoning in a clever way. Digoxin (and toad) poisoning requires intensive medical care.  Even with close care, a patient can die of fatal heart arrhythmias.  But a couple of decades ago, an antidote was developed for digoxin poisoning.  Sheep are injected with digoxin and anti-digoxin antibodies are then isolated from their blood.  These antibodies are then chopped up so that only the "Fab" portion is present.  When given to a patient with digoxin toxicity, the Fab binds to circulating digoxin, preventing it from binding to other receptors in the body, and allowing it to be harmlessly excreted by the kidney.

Given how closely toad poisoning and digoxin poisoning resemble each other, and that toad toxins are similar enough to digoxin that they show up as digoxin in toxicology tests, it seems reasonable to think that the same antidote may work for both poisons.  This has been tested in several cases, with apparently good results (there data are limited by the small number of patients).

Cardiac glycoside poisoning is very dangerous.  It would appear that poisoning by sources other than regular medications has a high fatality rate.  Given this, it would seem reasonable to treat suspected toxicity with digoxin immune Fab.  The only catch is cost and availability.  If a kid in New York eats some Chinese toad venom, any hospital can administer the antidote.  If a woman in a small Laotian village eats a bad batch of toad soup, the cure may not be available.  The cost may also be prohibitive.  Each vial costs around $700, and it wouldn't be unusual to give 10 vials.

It may be hard to prevent toad poisoning among rural Laotians without solving societal problems of poverty and hunger.  But in this country we can easily avoid consuming potentially deadly herbal remedies.

*(a special shout-out to my buddy David Kroll who may be interested in this bit of history, if he doesn't already know it).

Continue Reading »

3 responses so far

« Newer posts Older posts »