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An open letter to Dr. J. Douglas Bremner

Peter Lipson wrote a post last week entitled Before You Trust That Blog…, which was a criticism of Dr. J. Douglas Bremner’s blog Before You Take That Pill. Dr. Bremner was not pleased, and posted a rebuttal entitled Response to Peter Lipson MD of “Science” Based Blogs, My Blog Does Not Suck, Yours Does. Given the kerfuffle and my role as managing editor of SBM, I felt the need to put my two cents in, which is why I’m posting this open letter to Dr. Bremner. This letter started as a much briefer response that I was going to e-mail to Dr. Bremner, but as I wrote it grew and grew to the point where I decided that, given the public nature of the disagreement between Dr. Lipson and Dr. Bremner, I might as well make my commentary public too. Consider it a bonus post from me. I still plan a post for my usual slot on Monday. In the meantime, here’s my open letter:
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Posted in: Medical Academia, Pharmaceuticals, Public Health, Science and the Media, Vaccines

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More Flu Woo For You, Boo Boo

In which we try to be smarter than the average bear.

Flu season is upon us (it kind of never left us this year), and there is a new strain of flu, the H1N1, aka Swine flu that adds a wrinkle or two to the usual potential for influenza related morbidity and mortality. And with the new flu is the new woo. I know that others have addressed flu in this forum and some of this may be redundant. Still, we each have our different styles and interests, so I hope the various posts are additive rather than redundant. I am going to wander through some odds and ends about flu in general and H1N1 specifically and compare some of the woo with the reality. At least my reality.
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Posted in: Public Health, Vaccines

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Swine Flu Vaccine Fearmongering

Fear is a curious thing. It often bears no relation to the actual risk of what we fear. When swine flu first broke out in Mexico, people were understandably afraid.  Travel was restricted, schools were closed, and so many people stayed home that the streets of Mexico City were empty. As the disease spread around the world, Egypt developed a paranoid fear of pigs and committed national pigicide. They ordered the slaughter of all 300,000 of their country’s innocent little porkers, ignoring the fact that the flu is spread person-to-person, not pig-to-person. Now that the disease has officially been labeled a pandemic, fears have switched from the real threat of the disease to an imagined danger from the vaccine. 

Some people just plain hate the idea of vaccines – to the point that they are willing to spread old falsehoods, make up new lies, distort the results of studies, misrepresent statistics, and endanger our public health. There are websites like “Operation Fax to Stop the Vax” and even anti-swine-flu-vaccine rap videos.   Press releases, e-mail campaigns, talk shows, and blogs are being used to stir up irrational fears. These people are irresponsible fearmongers. They are wrong, and they are dangerous.  
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Posted in: Vaccines

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“Oh, come on, Superman!”: Bill Maher versus “Western medicine”

I realize that I’ve spent a fair amount of verbiage (to put it mildly) expressing my frustration with celebrities whose support for pseudoscience and even outright quackery endanger public health. The two most frequent targets of the wrath, sarcasm, frustration, and puzzlement of me and my partners in crime at SBM have been Jenny McCarthy and her boyfriend Jim Carrey for their having emerged over the last two years as the most vocal celebrity faces of the anti-vaccine movement in general and the anti-vaccine organization Generation Rescue in particular and Oprah Winfrey for her promotion of pseudoscience, quackery, and mysticism on her show. That doesn’t even count Oprah’s inking of a development deal with Jenny McCarthy to do her own weekday talk show, which has poised McCarthy to walk in the footsteps of previous Oprah proteges, such as Dr. Phil McGraw and Dr. Mehmet Oz. I’ve also lamented how celebrity physicians like Dr. Jay Gordon, Robert “Bob” Sears, and the hosts of the daytime TV show The Doctors have promoted, through the mantra of “balance,” anti-vaccine views in particular and pseudoscience about health in general.

As bad as celebrities such as Oprah, Jim Carrey, and Jenny McCarthy are, though, no one views them as skeptics, at least no one I know and no one in the skeptical movement. Even the reporters and newscasters who credulously interview them, I suspect, realize that Oprah, Jim, and Jenny are not exactly the most scientific of people. Unfortunately, if there’s one thing I’ve learned over the years since I became more involved with the skeptical movement, it’s that being an agnostic, atheist, or skeptic is no guarantee against falling for pseudoscience. The problem is that when someone becomes associated with the skeptic movement for another reason, even if that person is a total woo-meister when it comes to medicine, they tend to be given a pass. I don’t give such people a pass because of their anti-religion views because I consider myself a skeptic and don’t really care much about religion, except when it intersects issues of science and health, such as Jehovah’s Witnesses refusing blood transfusions, faith healers offering prayer instead of medicine, and fundamentalists undermining the teaching of evolution. If someone who promotes pseudoscience is a prominent critic of religion, to me that makes it even worse when they spout nonsense.

I’m referring to Bill Maher, comedian and host of the HBO show Real Time With Bill Maher. Thanks to an anti-religion movie (Religulous) and his frequent stance as a “skeptic,” many of my fellow skeptics consider him one of our own, even to the point of giving him an award named after Richard Dawkins. Yet, when it comes to medicine, nothing could be further from the truth. Maher’s own words show that he has anti-vaccine views, flirts with germ theory denialism and HIV/AIDS denialism, buys into extreme conspiracy theories about big pharma, and promotes animal rights pseudoscience. That’s not a skeptic or a supporter of science-based medicine.
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Posted in: Pharmaceuticals, Public Health, Science and the Media, Vaccines

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An Influenza Primer

The President’s Council of Advisors on Science and Technology recently submitted its report to the president in which they stated that this influenza season might kill 30-90,000 people in the US.  This forecast of the upcoming season caught the media’s attention and appears to have stoked the public interest in influenza.  We have had many requests for more information about influenza here at SBM, and so in this post I am going to discuss the basics of influenza and try to put the current pandemic and upcoming season in perspective.

I find it is best to start at the beginning.

What Is Influenza?

Within the public sphere, “The flu” has become shorthand for “I feel like crap.”  I suspect that this is part of the reason why some people think the influenza vaccine doesn’t work.  Medically speaking, however, influenza is a very specific family of viruses that cause a reasonably narrow set of problems for humans.

The influenza season in the Northern hemisphere usually runs from October through May, with a peak mid-February.  Every season in the US between 5-20% of the US population is infected by influenza, and while the majority of people recover well from an influenza infection, not everyone will.  Annually 200,000 people are hospitalized, and on average 36,000 will die either from influenza or its complications.

The classic influenza infection incubates for 1-4 days after exposure.  Its onset is rapid, with most people experiencing high fever, headache, muscle aches, dry cough, sore throat, and nasal congestion.  Gastro-intestinal symptoms like nausea, vomiting, and diarrhea are less common.  Symptoms last from several days to almost two weeks, and a person is contagious from one day before symptoms begin to more than a week after symptom onset.

There are many strains of influenza. The current seasonal influenza is made up of three different influenza subtypes: A(H3N2), A(H1N1), and B.  Don’t confuse the seasonal A(H1N1) strain with the current pandemic 2009 A(H1N1); they are distinct.  I will refer to them as A(H1N1) for the seasonal strain, and 2009 (H1N1) for the pandemic “swine flu” strain.  Influenza B is less common, less virulent, has a slower mutation rate, and is thus a lesser risk; the rest of this discussion is focused on Influenza A. (more…)

Posted in: Public Health, Science and Medicine, Vaccines

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“There must be a reason,” or how we support our own false beliefs

ResearchBlogging.orgFor a change of pace, I want to step back from medicine for this post, although, as you will see (I hope), the study I’m going to discuss has a great deal of relevance to the topics covered regularly on this blog. One of the most frustrating aspects of being a skeptic and championing science-based medicine is just how unyielding belief in pseudscience is. Whatever realm of science in which there is pseudoscience I wander into, I find beliefs that simply will not yield to science or reason. Whether it be creationism, quackery such as homeopathy, the anti-vaccine movement, the “9/11 Truth” movement, moon hoaxers, or any of a number of pseudoscientific movements and conspiracy theories, any skeptic who ventures into discussions of such a topic with believers will become very frustrated very fast. It takes a lot of tenacity to keep going back to the well to argue the same points over and over again and refute the same nonsense you’ve refuted over and over again. Many do not have sufficient stick-to-it-iveness, leading them to throw up their hands and withdraw from the fight.

Although some of us here have blamed this phenomenon on “cultishness” and, make no mistake, I do think that there is an element of that in many of these movement, particularly the anti-vaccine movements, cultishness alone can’t explain why people hold on so hard to beliefs that are clearly not supported by science or evidence, such as the belief that vaccines are responsible for an “autism epidemic.” Then last week, what should pop up in the newsfeeds that I regularly monitor but a rather interesting article in Science Daily entitled How We Support Our False Beliefs. It was a press release about a study1 that appeared a few months ago in Sociological Inquiry, and the the study was described thusly:
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Posted in: Clinical Trials, Politics and Regulation, Science and Medicine, Vaccines

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The perils and pitfalls of doing a “vaccinated versus unvaccinated” study

The anti-vaccine movement is nothing if not plastic. It “evolves” very rapidly in response to selective pressures applied to it in the form of science refuting its key beliefs. For instance, when multiple studies looking at the MMR vaccine and autism failed to confirm the myth that the MMR causes autism or “autistic enterocolitis,” most recently late last year, it was not a problem to the anti-vaccine movement. Neither was it a major problem to the movement when multiple studies similarly failed to find a link between mercury in the preservative thimerosal that used to be in most childhood vaccines and is no more (except the flu vaccine) and autism. No problem! Andrew Wakefield is alleged, based on strong evidence, to have falsified his data alleging a link between the MMR vaccine and “autistic enterocolitis”? Fuggedabouddit! The anti-vaccine movement simply pivoted neatly, de-emphasized points that the evidence was so clearly against that even they couldn’t spin it to a positive anymore, and found new bogeymen. These days, it’s the “toxins” (such as formaldehyde and the latest antivax bogeyman, squalene), and “too many too soon” (a gambit given seeming respectability by Dr. Bob Sears and Dr. Jay Gordon, apologists for and supplicants to the anti-vaccine movement both.

However, there is one trait of the anti-vaccine movement that, however its camouflaging plumage may evolve, never, ever changes. It is as immutable as believers say that God is. That trait is that, whatever other claims, the anti-vaccine movement makes, at its core it is always about the vaccines. Always. No matter how often science fails to find a link between vaccines and autism or vaccines and whatever other horreur du jour the anti-vaccine movement tries to pin on vaccines, no matter how many studies do not support the viewpoint that vaccines cause autism, no matter how much the anti-vaccine movement tries to deny and obfuscate by saying that it is not “anti-vaccine” but rather “pro-safe vaccine,” at its core the anti-vaccine movement is about fear and loathing of vaccines. Always. When inconvenient science doesn’t support their views, anti-vaccine activists either ignore the science, distort the science, or launch ad hominems against the people doing the science or citing the science. And, as I said before, the claims of the anti-vaccine movement evolve. Never again will the anti-vaccine movement make the horrific mistake of yoking itself to a hypothesis that is as easily testable as the hypothesis that mercury in vaccines causes autism. The claim that mercury in vaccines causes autism predicted that, if thimerosal were removed from vaccines or reduced to pre-”epidemic levels” of the early 1990s, then autism rates should plummet. Thimerosal was removed from nearly all childhood vaccines (the sole exception being some flu vaccines), reducing infant mercury exposure from vaccines to levels not seen since the 1980s; yet autism rates continue to rise. This is about as resounding a refutation of the hypothesis that mercury in vaccines is a major cause or contributor to autism that even the anti-vaccine movement has backed away from the pure claim, which has now evolved to unnamed “environmental toxins,” either in concert with mercury or with other nasty things, as being the Real One True Cause of Autism.

It’s evolution in action. These new claims are much “fitter” because they are much harder to falsify through scientific research, epidemiology, and clinical trials.
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Posted in: Clinical Trials, Medical Ethics, Public Health, Science and Medicine, Vaccines

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A Defense of Childhood Influenza Vaccination and Squalene-Containing Adjuvants; Joseph Mercola’s “Dirty Little Secret”

Fall is around the corner, and with it comes the influenza season.  Each year an average of 200,000 people in the US are hospitalized with influenza, and 36,000 die.1,2 With the addition of the novel H1N1 strain (swine flu), this season promises to be more interesting, and even less predictable, than most.  There can be no doubt, however, that this one set of viruses will exact a heavy toll for thousands of families this season.

Too often in medicine we find ourselves confronted with problems we cannot fix.  Some traumas are too severe, some infections have too much of a head start.  Some diseases are poorly understood, while others have no known treatment.  One of the darker adages of medicine still holds true: In spite of all our advances, the world mortality rate seems to be holding quite steady at 100%.

Thankfully, influenza is not a disease against which we are helpless. We have ways to limit its spread, and medicines with a modest effect in assuaging symptoms and shortening the length of illness.  Most importantly, we have vaccines that can safely prevent the disease altogether.

There are myriad misconceptions and fears surrounding the influenza and its vaccines, most are not new and have been addressed elsewhere, including the concern that the influenza vaccines cause the flu (they don’t), that the thimerosal they contain causes autism (it doesn’t), and that it can trigger Guillan Barre Syndrome (it can3, at a rate of 1/1,000,000, similar to the background rate of Guillan Barre in the population4).  The confusion has been compounded by the emergence of the novel H1N1 pandemic.  With so much at stake, it is exceedingly important to have clear, accurate information available to physicians and the public alike. (more…)

Posted in: Public Health, Vaccines

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New SBM Resource – and a Word on Vaccines

We frequently receive requests from readers, our colleagues in medicine or fellow science bloggers for the best reference site that has all the information they need on a specific topic. There are many excellent resources on the net, but nothing I know of that quite puts it all together in that way – one-stop shopping for up-to-date information on the topics we are most concerned with.

So we decided to create just such a resource.

You will now see at the top of this page a new link for SBM Topic-Based Reference which leads to our new section by that name. There you will see the list of topics we are currently working on, and once they are complete more will be added. As of today only one topic is reasonably complete, Vaccines and Autism.

The format (which is subject to change as we build and use the resource) is as follows: We start with a brief topic overview. This is not meant to be a thorough discussion of the topic, but a quick summary to get people started. This is followed by an index of all SBM posts on that topic and then links to outside resources that we recommend.

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Posted in: Announcements, Science and the Media, Vaccines

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