May 22 2008
Stein: When we just saw that man, I think it was Mr. [PZ] Myers, talking about how great scientists were, I was thinking to myself the last time any of my relatives saw scientists telling them what to do they were telling them to go to the showers to get gassed.Stein (speaking about the Holocaust): …that was horrifying beyond words, and that’s where science — in my opinion, this is just an opinion — that’s where science leads you.Crouch: That’s right.
Stein: … Love of God and compassion and empathy leads you to a very glorious place, and science leads you to killing people.
I am a full time Infectious Disease physician. In the short hand of the medical field, I am an ID doc. Recently, saying I do ID is kind of like having last name like Himmler. No relation, but a vague discomfiture that I might be misrecognized as something else.
My ID, the real ID, along with medicine, is a branch of science (I always hear Mangus Pyke in the Thomas Dolby song when I type the word) with a long history, of, well, saving lives. Lots of lives. Millions and millions of lives. And relieving suffering. The simplest of things have been responsible for the long and reasonably healthy lives we get to have here in the industrialized world.
The Science-Based Medicine Blog deals with what Merlin Mann refers to as first world problems. The fine points of botanicals and prostatism or whether the placebo effect is the cause of the response to acupuncture. Interesting though these topics can be to some, when it comes to the overall health of most of us in the first world the main triumphs of science (Or is Ducks Breath I hear? “I have a masters degree in Science”) occurred over a century or two ago. The science of 200 years ago, by the standards of today, was simple, with simple results, but lead to remarkable advances in longevity and health.
Simple interventions. I always say the three reasons we get to live to be a burden on our children are clean water, good nutrition, vaccines, and antibiotics. And no one expects the Spanish Inquisition. Whether it was 400 years ago or this year, the application of science has saved lives and relieved suffering, or, at least, help us understand, sometimes imperfectly, how best to live a healthy life. And in the future our best chance to survive is through science.
Cholera. Due to the organism Vibrio cholera. It makes a toxin that causes a massive diarrhea. I still doubt the veracity of proponents of transcendental meditation who claim they can levitate. However, that may be possible with the severe diarrhea of cholera. Patients can lose a liter of water an hour and rapidly die of dehydration. Historical mortality rates have been enormous.
Examples of mortality from cholera (From Wikipedia) :
* 1829-1851 – Second cholera pandemic reached Europe, London and Paris in 1832. In London, the disease claimed 6,536 victims; in Paris, 20,000 succumbed (out of a population of 650,000) with about 100,000 deaths in all of France.
* 1849 – Second major outbreak in Paris. In London, it was the worst outbreak in the city’s history, claiming 14,137 lives, over twice as many as the 1832 c outbreak. In 1849 cholera claimed 5,308 lives in the port city of Liverpool, England, and 1,834 in Hull, England.
Cholera spread throughout the Mississippi river system killing over 4,500 in St. Louis, and over 3,000 in New Orleans as well as thousands in New York.
* 1852-1860 – Third cholera pandemic mainly affected Russia, with over a million deaths. In 1853-4, London’s epidemic claimed 10,738 lives.
* 1854 – Outbreak of cholera in Chicago took the lives of 5.5% of the population (about 3,500 people). The Soho outbreak in London ended after removal of the handle of the Broad Street pump by a committee instigated to action by John Snow.
* 1866 – Outbreak in North America. In London, a localized epidemic in the East End claimed 5,596 lives just as London was completing its major sewage and water treatment systems–the East End was not quite complete.
* 1881-1896 – Fifth cholera pandemic ; The 1892 outbreak in Hamburg, Germany was the only major European outbreak; about 8,600 people died in Hamburg
* 1899-1923 – Sixth cholera pandemic had little effect in Europe because of advances in public health, but major Russian cities were particularly hard hit by cholera deaths.
* January 1991 to September 1994 – Outbreak in South America. Beginning in Peru there were 1.04 million identified cases and almost 10,000 deaths.
This small slice of Cholera deaths adds up to 173,749 deaths. Thats only a few cities over a short period of time. Millions have died in Russia, India and China over the centuries from the disease, whose death rates were 25 to 50%.
Cholera is rarely seen in the industrialized world, and mortality rates from the disease are 2-3% with simple, optimized rehydration therapy. Therapy, by the way, that was identified by scientists (5).
Why has cholera faded in much of the world?
“Love of God and compassion and empathy.” I don’t think so. Could it have been………..science (Imagine Church Lady here)?
The science of epidemiology we use today to investigate and identify the cause of Infectious Disease outbreaks started with the Cholera epidemic in London in 1854.
John Snow was a physician who thought that cholera was spread by contaminated water, rather than the by the inhalation of poisonous vapors, the accepted medical opinion of the time. During the outbreak he took the simple (to us) expedient of plotting the deaths from cholera based on where the patients lived. The closer they were to a water pump, the higher the death rates. So what did they do? Offer ” love of God and compassion and empathy?” Nope. They did what I believe is referred to as a scientific experiment. They took off the pump handle and the death rates from cholera fell dramatically. Remember, this was before bacteria were known. Even without knowing about the Vibrio bacillus, the power of the scientific method allowed people to understand disease transmission, make an intervention, and prevent people from dying.
Dr. Snow’s map.
It was the beginning of epidemiology. Applying and expanding the concepts started by Dr. Snow has saved countless lives. Pick a disease. How do we know how it is spread and how to stop the spread? The science of epidemiology. Infections have a wide variety mechanisms of spread: Coughing, sex, mosquito bites, direct contact, blood. Who knows what infection you would get if you did all the above at once. It has been the science of careful epidemiology that has identified the source of these infections and allowed us to break the chain of transmission.
New sources and mechanisms of spread are discovered yearly. There was a recent outbreak investigated by the CDC of norovirus in an elementary school where disease transmission was traced in part to contaminated keyboards and computer mice (6).
When a new epidemic hits, be it avian flu or something unexpected, it will be the science of epidemiology and scientists that will decrease the morbidity and mortality of the disease. It will be science that will be saving lives.
Unfortunately, 1/3 of people still have no access to clean drinking water and an estimated 2 to 5 million people die every year from drinking contaminated water (WHO estimates). At the low estimate, that’s six people every minute. Next time you turn on your tap for a glass of water, say a toast to Dr. Snow for the safe water.
In the US the problem is excessive nutrition. Occasionally, in the alcoholic, nutritional deficiency is an issue, but in my hospital too much rather than too few calories is the issue.
Good nutrition is important for health, and eating a balanced diet can ensure we get sufficient vitamins to stay healthy. How do we know what vitamins we need? The “Love of God and compassion…………..” I know, I know. I’ll stop. I am sure you get the point.
Vitamin C deficiency leads to scurvy, an unpleasant disease with an unpleasant death. Vitamin C is required to make collagen. Without it you cannot make your supporting tissues and there would be nothing to augment your lips. Your soft tissues fall apart and you bleed and painfully die.
Vitamin C is easy enough to find in the diet: fresh fruits and vegetables are the key.
Tell that to the British Navy. While out at sea conquering the world and making sure the sun never set, their sailors came down with scurvy. Sailing ships, in the era before food preservation, were not noted for having fresh fruits and vegetables on the menu. Think of travel in the 1700′s next time you complain about airline food.
In 1747 James Lind did a simple experiment.
“Lind thought that scurvy was due to putrefaction of the body which could be prevented by acids; that is why he chose to experiment with dietary supplements of acidic quality. In his experiment he divided twelve scorbutic sailors into six groups. They all received the same diet, and in addition group one was given a quart of cider daily, group two twenty-five drops of elixir of vitriol, group three six spoonful of vinegar, group four half a pint of seawater, group five received two oranges and one lemon and the last group a spicy paste plus a drink of barley water. The treatment of group five stopped after six days when they ran out of fruit, but by that time one sailor was fit for duty and the other had almost recovered. Apart from that, only group one also showed some effect of its treatment. (Wikipedia)”
He found out that lemons and oranges (why were the British not referred to as Lemonies or Orangies?) prevented scurvy. Like cholera, he had no understanding of the biology of scurvy, but the power of the scientific method is such that if the experiment is done right, the results can still be meaningful. It was the first randomized controlled study in history. But it started medical science down the path of increasingly complex and sophisticated clinical studies to tease out the effects of therapies on diseases.
The importance of good nutrition and vitamins is well established, the uselessness of extra therapeutic doses (aka supplements), especially when used as antioxidants, is increasingly being established.
A recent JAMA (1) looked at
“5442 women who were US health professionals aged 42 years or older, with either a history of CVD or 3 or more coronary risk factors, were enrolled in a randomized, double-blind, placebo-controlled trial to receive a combination pill containing folic acid, vitamin B6, and vitamin B12 or a matching placebo, and were treated for 7.3 years from April 1998 through July 2005.” to see if they had a reduction in cardiovascular events.
A wee bit more complicated than Lind’s study. The results?
“After 7.3 years of treatment and follow-up, a combination pill of folic acid, vitamin B6, and vitamin B12 did not reduce a combined end point of total cardiovascular events among high-risk women, despite significant homocysteine lowering.”
When used as antioxidants, these vitamins did not alter rates of stroke and heart attack, a result supported by Cochran reviews (2). So if you are taking vitamins as an antioxidant, you can stop. But do not come after my beer or chocolate, although future studies may show their uselessness as antioxidants and I will be forced to enjoy them only for the pleasure they provide.
Smallpox. Bad disease. And it was only a ‘’small’ pox. Like evolution is only a ‘theory’. 20-60% of people who contracted smallpox died. It has killed millions upon millions since it came into human populations around 10,000 BC.
Smallpox killed an estimated 400,000 Europeans each year during the 18th century. That’s 45 people an hour, every hour, for 100 years.
During the 20th century, it is estimated that smallpox killed 300–500 million people. That one disease killed more than twice the number of people killed in wars during the same time (7). In 1967, the World Health Organization estimated that smallpox killed two million people.
That’s just a small sample of the mortality from small pox, from times and places where the data has been available. In most places, through most of of time, millions died unknown and unregistered.
Smallpox is almost gone now, existing in few freezers and, given that we know the genome, can be reconstructed anytime. I guess those scientists may kill us all in the future after all.
We don’t have smallpox because of vaccines.
It started with the simple experiment by Jenner in 1796. He noted that people who developed cowpox did not get smallpox. So he took the fluid from the lesion of a milkmaid with cowpox and infected the most courageous man in history, a farmer named Phipps, who developed cowpox. Then a few weeks later he repeated the process with smallpox. Jenner must have been one convincing talker to get Mr. Phipps to take the smallpox. Jenner later went into multilevel marketing and Farmer Phipps did not get smallpox.
At one time I would have said that this study would not have passed an Institutional Review Board as ethical, but after reading the blog entries here on the Gonzales pancreatic cancer trial at Columbia University, I bet it could have been done at Columbia as long as it was funded by NCCAM.
The number of vaccines keep on growing and continue to decrease morbidity and mortality from communicable illnesses. There are many factors that contribute to spread and deaths from infection, like good nutrition and good hygiene. But do not underestimate the benefit of vaccines. A recent JAMA looked at the effects of vaccines on mortality and morbidity in the US
“…before and after widespread implementation of national vaccine recommendations for 13 vaccine-preventable diseases for which recommendations were in place prior to 2005. A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively. (3)”
A. Maze. Ing.
It is incomprehensible the number of people who have gone on to live long lives thanks to vaccines. The most recent vaccine is the HPV, which will prevent death from cervical and throat cancer.
If the past predicts the future, and in infectious diseases it often does, if we cannot eradicate a disease it will return. There will be anther influenza pandemic like 1918 -1919 that killed about 6% of the world, about 10x what were killed in the trenches of WWI in 4 years.
And when it comes our best hope for preventing disease will be an effective vaccine.
Clean water. Good nutrition. Vaccines.
A few of the benefits that science has given us that will allow most of us to grow old enough to be screwed by Medicare.
As an aside, it should be noted that these basic foundations of science-based medicine were simple experiments. If you look over the history of science, all the basic studies that set the fields in motion were simple, but well done, studies that can easily be reproduced by high school or grade school students. Or even 10 year olds.
Simple experiments. After all the millions sent down the rathole of alternative medicine by the NCCAM, there has yet to be a single, clear cut study that demonstrates the plausibility of the science behind their interventions or a single clear cut study to show efficacy.
However a 10 year old, with a simple study, can show that the underlying premise of Therapeutic Touch, that human energy fields can be felt and manipulated, is nonsense (4). Maybe the NACCM needs some smart 10 year olds to devise some simple experiments for them.
So when I hear Ben Stein, a Columbia (Hmmmm. Columbia again. Is a pattern emerging?) educated lawyer, I think, no way is he that stupid. No one can be that willfully ignorant.
Then it hit me when I read “http://scienceblogs.com/evolutionblog/2008/05/what_i_really_think.php”
It’s obvious. Stein is doing performance art. It’s a put on. He is pulling a Borat. He is the Sacha Baron Cohen of the Intelligent Design crowd.
It is the ONLY possible explanation.
You wait. Someday the truth will be known about Ben Stein and we will all laugh at being taken in by his elaborate hoax.
(1) Effect of Folic Acid and B Vitamins on Risk of Cardiovascular Events and Total Mortality Among Women at High Risk for Cardiovascular Disease: A Randomized Trial. Christine M. Albert; Nancy R. Cook; J. Michael Gaziano; Elaine Zaharris; Jean MacFadyen; Eleanor Danielson; Julie E. Buring; JoAnn E. MansonJAMA. 2008;299(17):2027-2036.
(2) Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD007176. DOI: 10.1002/14651858.CD007176
(3) Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United StatesSandra W. Roush, MT, MPH; Trudy V. Murphy, MD; and the Vaccine-Preventable Disease Table Working GroupJAMA. 2007;298(18):2155-2163.
(4) A Close Look at Therapeutic Touch. Linda Rosa, BSN, RN; Emily Rosa; Larry Sarner; Stephen Barrett, MD. JAMA. 1998;279:1005-1010.
(5) Amylase-Resistant Starch plus Oral Rehydration Solution for Cholera NEJ, Volume 342:308-313 February 3, 2000 Number 5
(6) Norovirus Outbreak in an Elementary School — District of Columbia, February 2007. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5651a2.htm
Deaths from war are subject to wide variations. My source: http://users.erols.com/mwhite28/warstat8.htm
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