Articles

Archive for Public Health

Who Should Ascend To The Office Of Surgeon General?

President-elect Obama’s nomination of CNN medical correspondent, Sanjay Gupta, for the Office of Surgeon General of the United States has ignited a firestorm of debate across the Internet. Some argue that he is not qualified for the position, others say that his charisma would be a boon to public health communications, though the lay majority appear to have mixed feelings.

It is highly irregular for a Surgeon General nominee to be announced before the Secretary of Health and Human Services is confirmed. This faux pas in itself may speak to an irresistible opportunity for self-promotion, or that the Senate confirmation hearing is not the independent review event that we assume it is.

At age 39, Gupta has long aspired to become the Surgeon General, as sources close to him report that he has been saying (since age 33) that “it’s the next logical step in his career development.”

But before we draw conclusions about who’s right for the job, we need to understand what the job entails.

I asked Dr. Richard Carmona, 17th Surgeon General of the United States, to explain the roles and responsibilities of the office. A summary of our conversation follows:
(more…)

Posted in: Politics and Regulation, Public Health, Science and the Media

Leave a Comment (50) →

Christine Maggiore and Eliza Jane Scovill: Living and dying with HIV/AIDS denialism

Christine Maggiore

On Science-Based Medicine, we strive to apply the light of science and reason on all manner of unscientific belief systems about medicine. For the most part, but by no means exclusively, we have concentrated on so-called “complementary and alternative medicine” (CAM) because there is an active movement to infiltrate faith-based, rather than science-based, modalities into “conventional” medicine. Indeed, such efforts are well-financed, both by public and private organizations, and are alarmingly successful at insinuating postmodernist and pseudoscientific beliefs into academia to form an unholy new monster that has been termed by some as “quackademic medicine.”

However, one pseudoscientific belief system about medicine that we at SBM have perhaps not dealt with as much as we should is the belief that, contrary to the overwhelming scientific consensus built up over 25 years, the Human Immunodeficiency Virus (HIV) does not cause Acquired Immune Deficiency Syndrome (AIDS). True, working with Tara Smith, our fearless leader Steve Novella has published an excellent primer on the phenomenon, but not on this blog. This belief system, which is commonly called HIV/AIDS denial or HIV/AIDS denialism, is championed by virologist Peter Duesberg, along with a panoply of groups, such as Alive & Well AIDS Alternatives and Rethinking AIDS; blogs, such as Science Guardian, HIV/AIDS Skepticism, and AIDS Is Over; podcasts, such as How Positive Are You?; books, such as What If Everything You Thought You Knew About AIDS Was Wrong? by Christine Maggiore; and movies, such as The Other Side of AIDS (which resembles in many ways the anti-evolution movie Expelled! and the pro-quackery movie The Beautiful Truth). The influence of HIV/AIDS denialism is horrific, too, particularly in Africa, where advocates of such nonsense, such as Matthias Rath, have advocated quackery over antiretroviral therapy and had the ear of South African President Thabo Mbeki, who lost power in late 2007.
(more…)

Posted in: Health Fraud, Public Health, Science and Medicine, Science and the Media

Leave a Comment (40) →

The $150,000 Vaccine Challenge

At the request of a correspondent from the Quackwatch Healthfraud discussion list, I recently got embroiled in a debate with a couple of anti-vaccinationists in the pages of an Amish community newspaper, Plain Interests, published in Millersburg PA. They followed the usual pattern: they told the same old lies, they told partial truths distorted out of all recognition, and they omitted all those other truths that contradict their beliefs. Then they both challenged me to take all the recommended baby vaccines adjusted for weight to “demonstrate that vaccines are safe and effective.” If I refuse to do this, they say it will show that vaccinators are dishonest and that I’m afraid of my own medicine. They said I could win $150,000 by taking the challenge.

I did a little investigating. There is indeed a published challenge by Jock Doubleday, although the exact amount of money currently offered is unclear. His challenge reads:

The offer will continued to increase $5,000 per month, in perpetuity, until an M.D. or pharmaceutical company CEO, or any of the 14 relevant members of the ACIP (see below), agrees to drink a body-weight calibrated dose of the poisonous vaccine additives that M.D.s routinely inject into children in the name of health. The mixture will include, but will not be limited to, the following ingredients: thimerosal (a mercury derivative), ethylene glycol (antifreeze), phenol (a disinfectant dye), benzethonium chloride (a disinfectant), formaldehyde (a preservative and disinfectant), and aluminum.

According to Ratbags, this offer is bogus. (more…)

Posted in: Public Health, Vaccines

Leave a Comment (27) →

Influenza Deaths

“There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.”- Donald Rumsfeld

How do we know what we know? It is said by some anti-vaccine proponents that vaccines are not needed because the diseases they prevent are either gone or no longer as severe as they were in pre vaccine times. People may have suffered and died in the distant past, but no longer. The risk now is from the vaccines not the diseases they no longer prevent.

36,000 people, more or less, die every year from influenza. That is the number of deaths according to the CDC web site; the NEJM review uses the higher number of 56,000 (7). Which number is correct? Isn’t that why the flu vaccine is recommended: to prevent all those people from dying.

36,000 is a lot of people. That’s about 120 deaths per million people in the US. In Oregon, population about 3 million, that would be about 360 people a year, which is two deaths a day for the six month flu season.

“Death is caused by swallowing small amounts of saliva over a long period of time.”–George Carlin.

2,400,000 people die every year in the US, about 6600 a day. In Oregon, that is about 65 deaths a day. No one outside a epidemiologist is going to notice 2 extra deaths a day during flu season. I have seen a lot of people die of influenza, but I have a biased experience: I am an infectious disease doc, so I am likely to see people with influenza, especially patients with disease severe enough to kill them.

About the same number of people die from car accidents and die from handguns in the US each year as die from influenza. I have never known a person in my real, as opposed to my professional, life to die from influenza or handguns or a car accident. My personal experience suggests no one dies from these causes, but since I take care of patients at one of the Portland trauma hospitals, I know what cars and guns do to people. My professional life confirms that people do indeed die from being shot or car accidents. I would wager that most people reading this blog have not known anyone who has died from influenza, guns or car accidents. The fact that people do die of influenza seems contradicted by experience. Why get the vaccine? I don’t get the flu and and no one I know has ever died from it.

As an illustrative example, a relative of mine, a retired physician, mentioned that he thought the shingles vaccine was a waste of time and money as he had never known anyone to get shingles. Using personal experience to judge disease prevalence is unreliable. If I applied the same rationale to driving, I would not wear a seat belt as I have never been in a high speed crash.

36,000 people die of influenza each year. What is the source of that statistic? From “Mortality associated with influenza and respiratory syncytial virus in the United States”. JAMA 2003. Is that really how many deaths are there from influenza? It depends on what you mean by ‘death’ and what you mean by ‘influenza’ and what you mean by ‘from’.

“It depends on what the meaning of the words ‘is’ is.” – Bill Clinton

(more…)

Posted in: Basic Science, Public Health, Vaccines

Leave a Comment (10) →

The Infection Schedule versus the Vaccination Schedule

A baby’s body is bombarded with immunologic challenges—from bacteria in food to the dust they breathe. Compared to what they typically encounter and manage during the day, vaccines are literally a drop in the ocean”, and Dr. Offits studies theoretically show an infant could handle up to 100,000 vaccines at one time … safely (6).

It is not the mercury in vaccines, its the vaccine schedule that is the problem. Too many shots, too many antigens, too close together. Our children need to be exposed to fewer antigens, less often, so they don’t get complications from the vaccine like autism and autoimmune diseases. It is all part of greening our vaccines.

That is part of propaganda on vaccines from the More Infectious Diseases for Children, a.k.a. antivaccine groups.

What is the vaccine schedule? How much exposure do children receive from organisms and antigens as part of the vaccination schedule? The entire schedule is at CDC.

In summary there are 5 live attenuated or altered organisms and 21 different antigens by age 6. A couple of vaccines are added from age 7 to 18, but by then it is too late, your child already has autism and autoimmune diseases from the immunologic and toxic scourging of vaccines. BTW. Sarcasm.

Is the vaccine schedule a lot of virus and a lot of antigens? Is this an enormous load on the immune system, sending it spiraling out of control to damage the child? Lets find out.
(more…)

Posted in: Public Health, Science and the Media, Vaccines

Leave a Comment (26) →

Robert F. Kennedy, Jr., vaccines, the EPA, and the interface with science-based medicine and public policy

This blog is entitled Science-Based Medicine for a reason, and that’s because we here at SBM believe that the best method to result in the most efficacious treatments for the most people is through the application of science to the evaluation of the biology, pathophysiology, and treatment of disease and disorders.

I may (or may not) be departing a bit from the views of my co-bloggers with this belief, but for purposes of this blog I consider “medicine” to go far beyond what we as physicians do when we undertake to treat patients. In fact, in my view, the purview of science-based medicine should not be so limited but should include any area where decisions, actions, or policy have a direct impact on health. Thus, my definition of science-based medicine encompasses environmental policy, because of the profound effect on human health environmental pollution and toxins can have. Unfortunately for those of us who don’t like its messiness, such a view drives me even more directly into politics than previous issues I’ve taken on. Like Dr. Novella, I rarely write about politics, but when it directly impacts science-based medicine. Mostly, such discussions here on SBM have involved the regulation of the medical profession by government, as Dr. Atwood discussed recently (1, 2, 3) in the context of the difficulties medical boards have in preventing quackery to my discussion of how a quack like Dr. Rashid Buttar could continue to practice in North Carolina, despite his despicable preying upon desperate cancer patients and the parents of children with autism, not to mention the frequent criticisms of the National Center for Complementary and Alternative Medicine. Dr. Sampson, on the other hand, was more than willing to examine a much more explicitly political issue, namely the number of Iraq War dead (1, 2), and that provoked a bit of disagreement with our commenters, not to mention me.

Recently, hot on the heels of the election of Barack Obama in the Presidential election last week, an issue relevant to several aspects of where science-based medicine intersects public policy popped up. Steve Novella has already commented on it on his own blog, as have numerous other medical bloggers, science bloggers, and political bloggers but I feel justified in commenting on it here, for the reasons that I’ve just mentioned. The controversy is that antivaccine activist and true believer in the scientifically discredited notion that mercury in the thimerosal preservative in vaccines causes autism, Robert F. Kennedy, Jr., is being seriously considered by Barack Obama either to head the Environmental Protection Agency or even to be Secretary of the Interior. Like our fearless leader Steve, I believe that such a selection would be an unmitigated disaster for science policy in government.
(more…)

Posted in: Politics and Regulation, Public Health, Science and the Media, Vaccines

Leave a Comment (18) →

Wyeth vs. Levine: Should Drug Label Standards Be Determined By Juries?

It is with some degree of trepidation that I enter the fray on the Wyeth vs. Levine case. I’ve been watching the media frenzy about the lawsuit with interest – mostly because (for the first time in a while) I think that the pharmaceutical company is in the right on this one – and that most journalists (and even medical journal editors) have missed the salient points.

I think that a close review of the case is instructive in two ways. It shows: 1) the dangers of making legal decisions based on the perspective of the victim (a risk of harm equal to 1 in 20 million is unacceptable to that one person who suffered the consequence, but tolerable to the other 19,999,999 others) and 2) that a simple case of medical malpractice has made it all the way to the US Supreme Court because (as I discussed in my last post) a democratization of knowledge (juries reading a drug label) was believed to democratize expertise (how a physician would understand the label).
(more…)

Posted in: Pharmaceuticals, Politics and Regulation, Public Health

Leave a Comment (20) →

Knowledge Versus Expertise: The View From Consumer Land

“The internet, in democratizing knowledge, has led a lot of people to believe that it is also possible to democratize expertise.”

- SBM Commenter, yeahsurewhatever

I’ve spent the last few years of my life in Internet “Consumer Land,” doing what I can to bring accurate health information directly to patients. Of course, I have been surprised by the push-back, and the demand for misinformation. When I first left full time clinical work, it never occurred to me that people would prefer to read falsehoods when provided a clear choice between truth and error. I guess I was pretty naïve.

Journalist Lesley Stahl provided me with some helpful insights during a recent conference. She explained that the Internet has catalyzed a new method of information transfer – speed trumps accuracy, the line between pundits and journalists is blurred, and anyone who can get to a microphone can become an “expert.” Gone are the days of careful sourcing and fact-checking. And gone is the public trust in “mainstream media.”

(more…)

Posted in: Health Fraud, Humor, Public Health, Science and Medicine, Science and the Media

Leave a Comment (17) →

Dr. Jay Gordon and me: Random encounters with an apologist for the antivaccine movement

27452983Although he doesn’t detest me nearly as much as antivaccine honcho and founder of Generation Rescue J. B. Handley does, Santa Monica celebrity pediatrician Dr. Jay Gordon doesn’t like me very much at all.

Actually, I’m not sure whether that’s entirely true or not, but Dr. Gordon sure doesn’t like it when I criticize him for his antivaccine rhetoric. He affects an oh-so-wounded posture and self-righteously assures me that he is not “anti-vaccine” and that it is “beneath me” to use such rhetoric against him. Whether such rhetoric is “beneath me” or not, however, I’ve never quite understood why Dr. Gordon gets so upset at when I describe him as “anti-vaccine.” After all, his words are frequently apologetics for the anti-vaccine movement, and his actions frequently give it aid and comfort. After all, he is Jenny McCarthy‘s son Evan’s pediatrician, and as a result of that connection he has been giving speeches to antivaccine rallies, such as the “Green Our Vaccines” rally in Washington, D.C. in June. (He is the man in the sunglasses behind Jim Carrey in the picture at the top of this post by me.) After all, he has been palling around with luminaries of the antivaccine movement, such as Jenny McCarthy and her boyfriend Jim Carrey, the aforementioned J. B. Handley, Robert F. Kennedy, Jr., Boyd Haley, and numerous others at events like the “Green Our Vaccines” rally.

But, above all, over the last three or four years, Dr. Gordon has become the go-to pediatrician that the media seemingly always wants to interview when a vaccine “skeptic” with an MD after his name is required to provide the “balance” that journalists worship above all else, even when that “balance” gives undue credence to pseudoscientific nonsense. He clearly relishes that role, too, most infamously on his appearance with Jenny McCarthy on Larry King Live!, in which McCarthy shouted down pro-vaccine physicians and yelled “Bullshit!” (as if she who yells the loudest and is the most foul-mouthed wins the debate) and as evidenced by his appearances on certain antivaccination mailing lists, from which messages are occasionally forwarded to me.

What else am I supposed to think, except that Dr. Jay is at the very least an apologist for the antivaccine fringe, if not a card-carrying member himself?

Unfortunately, Dr. Gordon strikes me as being mostly a nice guy. I say “unfortunately” because it would be much easier to be as harsh on him as his promotion of antivaccine pseudoscience deserves if he were not. He also clearly believes that he is right based on the evidence. Based on science and clinical evidence, he most definitely is not. Recently, I had decided more or less to lay off him for a while, so as to avoid the wounded cries that invariably accompany valid charges that he is an apologist for the antivaccine fringe. Also, I felt kind of bad beating up on him so regularly and thought that perhaps a respite was in order. Then I found out that Dr. Gordon wrote the foreword to Jenny McCarthy’s new antivaccine and pro-autism quackery book, Mother Warriors: A Nation of Parents Healing Autism Against All Odds. Then, one of my readers actually took the time to transcribe Dr. Gordon’s foreword and e-mail it to me.

I read it, and I was appalled.
(more…)

Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

Leave a Comment (121) →

Calories, Thermodynamics, and Weight

When arguing against a specific scientific claim it is always desirable to be able to say that the claim violates an established law of science. Creationists attempt this with their argument that evolution violates the second law of thermodynamics (it doesn’t). The temptation is that such arguments are short and pithy, they seem conclusive, and they avoid the need to wade through a dense and complex set of scientific evidence and theories.

In the “diet wars” the first law of thermodynamics has been thrown around a lot. Up to now I have been aware of two camps defending their position with thermodynamic arguments. The first (and the one that I find most compelling) is the calorie in vs calorie out camp, that argues that the laws of thermodynamics apply to people too. This means that weight management must be a function of calories in (the total calories consumed by a person) – calories out (the total caloric expenditure, including metabolic processes, waste heat, exercise, and others). Thermodynamics must be obeyed and so if one wishes to lose weight they must burn more calories than they consume.

(more…)

Posted in: Public Health

Leave a Comment (16) →
Page 19 of 23 «...101718192021...»