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The Real ID

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.

Clean Water

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).[19] 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.[21]

* 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.

Diet

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.

Vaccines

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.

References

(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

Posted in: Science and the Media

Leave a Comment (32) ↓

32 thoughts on “The Real ID

  1. HCN says:

    Dr. Novella wrote “I am a full time Infectious Disease physician. In the short hand of the medical field, I am an ID doc. ”

    I thought you are a clinical neurologist. Though the writing style is more like Dr. Crislip. (note: I have not been able to access Neurologicablog).

    I would also like to add to those who claim science only brings bad stuff that they step away from their keyboards and computers (does the science that go into them need to be explained?).

    Plus if they wish to eat anything that was not modified by selective breeding they just need to forage in the wilderness. The fact there are seedless oranges, bananas, and grapes is evidence that humans had a hand in their development and further propagation. The same goes with corn, other grains and just about any fruit and veg one sees in their grocery store.

  2. DavidCT says:

    I agree it has to be Dr. Mark not Dr. Steve.

    Ben Stein may have a point. Think of all the science and technology behind making a motion picture. What did we get? “Expelled”. Evil science at it again.

    Mr. Stein is just a shining example of how intelligence is no protection against becoming seriously deluded.

  3. overshoot says:

    Jenner and credit where due:

    No, it didn’t really start with Jenner. Good work, but non-European societies were doing quite well with cutaneous variolation for a long time before he drew breath. Of course, they were working with pragmatic protocols that didn’t pass theoretical muster in Europe; the much wiser European physicians knew that to be really effective the infectious matter had to be driven deep into the tissues and reach the bloodstream. The fact that patients treated in this fashion didn’t do well wasn’t their problem apparently.

    Give Jenner his due: he found a better alternative to using smallpox as an immunizer. He also actually tested his treatment to see if it worked. However, that was less remarkable in a global context than in a European one at the time.

  4. I posted this for Mark and forgot to change the author name. It’s fixed now – this was written by Mark Crislip.

  5. Harriet Hall says:

    Mark has beautifully described the greatest success of modern medicine: preventing and treating infectious disease. Isn’t it incredible that some people still question the germ theory of disease? I recently had a long e-mail interchange with one of those people, which I wrote about in an article that will be appearing soon in Skeptic magazine. In brief, she is a raw food devotee who believes all disease is due to toxemia from improper diet and lifestyle. She gets her information from 19th century and early 20th century sources. She denies that smallpox has been eradicated and says the same symptoms are being called chickenpox today. I tried in vain to tell her that we could distinguish the two viruses with an electron microscope, and that we even know the genome of smallpox; but she still believes her sources that tell her we’re only seeing cellular debris. Totally impervious to fact and logic. Sad.

  6. goodguyseatpie says:

    Is there any way that the administrator of this site can truncate the posts for RSS and other feed viewing? These are articles are great, but when they are released, they take up the entire page and I start to miss my other feeds.

    Thanks!

  7. DBonez says:

    What an outstanding post and should serve as a powerful reminder to be thankful to science and scientists for our luxurious, prosperous existence. We are afforded a lot time and freedom these days to complain about things that are built on the foundation of past failures and successes and lots of research and development.

    We have the opportunity to complain about what’s posted on a blog because the 10,000,000 transistors in our CPUs switch in flawless synchronicity, billions-of-times-per-second for decades with only the occasional glitch. Sure, I get pissed too when I get a blue-screen-of-death or lose a document, but that’s life.

    We are fortunate to whine about the placement of cup holders as we spill coffee on our heated, leather seats in our ultra safe, super reliable, luxury cars. I know, I’ve seen them being towed to the shop and they don’t look so cool then.

    We have the audacity to snivel about airline food or ticket lines when we fly on ultra complex yet ultra safe commercial jets that flawlessly transport millions of people per year without incident. Of course, there’s no such thing as a fender-bender at 30K feet and 500mph.

    And we have the laughable luxury to even contemplate things so ridiculous and unprovable as homeopathy, acupuncture, and CAM only because we live long, healthy lives thanks to the real doctors and real scientists doing real, provable, repeatable scientific work. Naturally, science isn’t perfect and doesn’t have all the answers, but it’s pretty damn good and works great every time it’s applied right (whether or not you like the results).

    We should think of this post the next time we see a post-polio person walking with leg braces and crutches and then think of the younger generations, spared the agony of this disease thanks to vaccinations, that have benefited from industrialized science and the scientific method.

  8. dhawk says:

    I must disagree with goodguyseatpie. I love being able to read the entire post in my feed reader, and not have to open up a new page (unless I want to comment). Don’t change it.

    @goodguyseatpie, use Google Reader, it’s great.

  9. overshoot says:

    Harriet:

    I tried in vain to tell her that we could distinguish the two viruses with an electron microscope, and that we even know the genome of smallpox; but she still believes her sources that tell her we’re only seeing cellular debris.

    When confronting the germ theory deniers, I find it much easier to ask them how to induce specific diseases. For instance, how does one (per their beliefs) induce plaugue in prairie dogs? How does one induce measles?

    It can’t be all that hard to induce measles, after all — it used to be something that everyone had by puberty. So how do we do it?

    If nothing else, this approach is good for temporary abatement of symptoms!

  10. Harriet Hall says:

    overshoot,

    I tried arguments very similar to that. She had a rationalization for everything. She would say the prairie dogs don’t really have plague. If they are sick it is probably because they didn’t eat right. Anyway, the people who do those experiments are prejudiced and are not doing real science and you can’t trust anything they say because they’re trying to keep people sick so doctors and Big Pharma can get rich. Etc. etc. Different diseases seem different because they’re different expressions of the body eliminating toxins. Illness is really a healthy defense mechanism. She is convinced that Koch’s postulates have never been fulfilled for any germ.

    She is convinced the Black Plague was due to people not eating right. I tried to pin her down on why the plague stopped when it did, because presumably people hadn’t changed their eating habits. I never did get a precise answer but she was firmly convinced that it stopped for natural reasons having nothing whatsoever to do with germs.

    You can’t reason someone out of something they didn’t reason themselves into in the first place.

  11. pec says:

    It is so true that these simple discoveries have extended our lives and freed humanity from so much misery and illness. It also true that we can credit science with these discoveries.

    And it is also true that the days of great progress in medical science seem to be far behind us. As you say, the momentous breakthroughs were a century or two ago.

    What has happened to medical progress? It isn’t simple anymore, and the ever increasing complexity does not seem to have much of a payoff.

    And that’s why I question some of the mainstream assumptions that I believe have been blocking progress. CAM is still very young and experienced. You can’t expect it to make miraculous discoveries over night, when mainstream medical science is proceeding at a sloth’s pace, if at all.

    We need more CAM research funding, not less.

    (And if Stein really made those comments about science he is a fool.)

  12. pec says:

    oops: “CAM is still very young and INexperienced”

  13. Mark Crislip says:

    When I was a fellow in 1984 the average AIDS patient died in 9 months.

    Now they are expected to live an almost normal life.

    We went from no knowlege at all to an astounding understanding of the disease, its epidemiology and treatment in what I think of as a short time. I

    My world is nothing but incredible payoffs, but I work in acute care medicine.

    In the same time the only breakthoughs in CAM come from 10 year olds.

  14. Harriet Hall says:

    pec

    CAM is young? I thought some of it was “ancient wisdom.” I guess what you mean is that it hasn’t even tried to do real science until fairly recently. The NCCAM has been pouring our tax dollars into CAM research for a decade now and hasn’t found anything worthwhile.

    I would be more inclined to support CAM research if it had EVER made a significant discovery that was adopted by mainstream medicine. I can’t think of a single one. Can you?

    And I think you’re dead wrong about the lack of progress today. You seem to be making the same fallacious argument that was made in the book “The End of Science.” Progress is continual. We have just developed the first vaccine to prevent a type of cancer. Twenty years ago AIDS was a death sentence but today we can keep most HIV positive patients alive and reasonably healthy. It wasn’t until 1956 that we even knew how many chromosomes were in a human cell, and now the entire human genome has been mapped. Molecular biology, stem cell research, personal genetic profiles, basic science research – all these things have great promise and “miracles” in store for us in the near future.

    I, for one, would much rather be treated with the scientific medicine of 2008 than with the scientific medicine of 1970 or even 1990. And I’d like it even better if I could somehow travel 20 years into the future and benefit from the advances I’m sure we will see over the next 20 years.

    Based on past experience and plausibility, I’d bet good money that very few of those advances will come from CAM, even if we were to devote half of our research funds to CAM research.

  15. Joe says:

    pec, what do you mean by “CAM is still very young and INexperienced”? Specifically, many proponents of CAM (e.g., Chinese med. and ayurvedic med. herbals) claim thousands of years of success. Others, homeopathy and subluxations, claim a few hundred years. What do yuo mean y young?

  16. weing says:

    I got a better idea. Why not devote all our money into CAM research for the next 10 years. Then when we want state of the art medical care, we could go to Mexico or some other third world country that didn’t follow us into this stupidity.

  17. HCN says:

    Reading suggestion for pec:
    http://www.amazon.com/Quack-Medical-Museum-Questionable-Devices/dp/1891661108/

    By the way, I will finish some cancer prevention for my daughter tomorrow: she gets her last of the HPV vaccine series.

    (and I am still getting “Page Not Found” for neurologicablog)

  18. durvit says:

    I can’t believe that Dana Ullman hasn’t done a drive-by to tell you, in no uncertain terms, that although people died with cholera when treated with conventional medicine, almost no cholera mortalities happened at the London Homeopathy Hospital.

    I keep meaning to go and look at the books and documents that they refer to but it is tricky when your sources are an unpublished book and a webpage with no links to direct sources…

  19. pec says:

    “CAM is young? I thought some of it was “ancient wisdom.””

    Some of the ideas are compatible with ancient wisdom, but scientific research on CAM ideas is relatively new, partly because it lacked the advantage of drug company funding.

  20. pec says:

    “Molecular biology, stem cell research, personal genetic profiles, basic science research – all these things have great promise and “miracles” in store for us in the near future.”

    I know that detailed knowledge has been increasing, mostly thanks to the constant improvements in computer technology. But promising miracles in the near future is very different from delivering. Arguments based on promises and wishful thinking are not very scientific.

  21. pec says:

    “Twenty years ago AIDS was a death sentence but today we can keep most HIV positive patients alive and reasonably healthy.”

    Notice how you shifted from “AIDS” to “HIV” hoping no one would notice. Lots of people are diagnosed with HIV now and you don’t know how many would have progressed to AIDS, or when, without treatment. And those drugs are horrible.

  22. Joe says:

    @ durvit, Ullman does that.

    http://forums.randi.org/showthread.php?t=95788 scroll down to entry #30: “http://www.accampbell.uklinux.net/ho…chapter06.html

    Selection bias (the population from which homeopathic patients are drawn is very different in character from the general population) seems the most likely explanation. Only 61 cases out of tens of thousands of cases showed up at the homeopathic hospital. Nobody with a lick of understanding would suggest that their results could be extrapolated/generalized to a broader population (or even back to the ‘population of persons who would choose to attend a homeopathic hospital’).

    Linda”

  23. daedalus2u says:

    Better outcomes at a homeopathic hospital may simply be an artifact of where they get their water from. If the source was non-contaminated patients would likely do better than if the source was contaminated.

  24. pec wrote: “Notice how you shifted from “AIDS” to “HIV” hoping no one would notice. Lots of people are diagnosed with HIV now and you don’t know how many would have progressed to AIDS, or when, without treatment. And those drugs are horrible.”

    This is rubbish. We have very good data on HIV and its progression to clinical AIDS. The anti-retroviral cocktail now being given delays progression from HIV to AIDS and prolongs survival of AIDS. This data is absolutely unequivocal. Only a hopeless ideologue can deny it.

    http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102245788.html
    http://annonc.oxfordjournals.org/cgi/content/abstract/17/6/914
    http://www.hivandhepatitis.com/recent/2007/041707_c.html

  25. nitpicking says:

    Pec, some cancers are completely curable now. That was simply not true even 30 years ago. They can replace hips, knees and shoulders with prosthetics now–do you think that was possible in the Nineteenth Century? Hell, there are pills for baldness and erectile disfunction that my father’s generation would have KILLED for.

    In other words: you are simply incorrect about medical progress.

  26. DavidCT says:

    pec is right that one cannot predict the progression of disease just from the detection of the presence of HIV. Before effective treatments about all that was possible was to document the differential progression. Some patients would have their T cell counts drop and have their immune systems start to fall apart. As this happened they would start to develop the infections and other complications associated with progression to AIDS. Treatment was like putting out multiple brush fires until little more could be done.

    With the development of effective anti-retroviral drugs something amazing started to happen. Some of the patients who had moved from HIV status to AIDS started to get better. Virus titers dropped and T cells counts stated to come back. The changes could sometimes be so dramatic that it must have been what it was like to treat patients when antibiotics first arrived.

    This reversal in status was not something being observed “naturally”. What does SCAM (as Dr. Crislip points out you cannot leave out supplements) have to offer? More than 10 years scientific research and hundreds of millions of dollars spent on studying have come up with damn little and that largely by fudging the data. The closer one looks the less there is to find.

  27. David Gorski says:

    Careful, folks, enough of this talk, and you might bring the HIV/AIDS denialists around. They’re one of the most obnoxious, clueless, and dangerous forms of cranks that exist.;-)

  28. David Gorski says:

    Arguments based on promises and wishful thinking are not very scientific.

    Indeed, they are not. Unfortunately, that is pretty much all that alt-med aficionados can offer: arguments based on promises and wishful thinking.

  29. pec says:

    “that is pretty much all that alt-med aficionados can offer: arguments based on promises and wishful thinking.”

    So because you think they’re doing it, you should be allowed to also?

  30. daedalus2u says:

    At the risk of increasing everyone’s perception that I am eccentric (if that is even possible ;) and activating (inappropriately I might add ;) everyone’s quack detectors I suggest (hope?) that we are on the verge of adding a new health factor to the 3 that Dr. Crislip has mentioned, that would be maintaining a proper surface biofilm of commensal autotrophic ammonia oxidizing bacteria on one’s skin.

    Another way to look at it would be as a modification of the importance of clean water. Clean water is only important for avoiding water borne diseases. That is mostly due to clean water for drinking and cooking. Hand washing prior to food preparation is important also, but cleaning off dirt (as opposed to pathogens) has no health benefits in individuals with normal immune systems and intact skin. The obsession that many have with bathing has no health benefits and over time does have health detriments due to disruption of NO/NOx physiology. It does take a while for these adverse effects to develop, so it is easy to not notice them.

    Notice that as seemingly grandiose as my statement may seem to be, I am not castigating researchers, scientists, MDs or any other proponents of EBM and SBM for their non-acceptance of my hypothesis. I am not claiming to be persecuted or ignored or that there is a conspiracy against my ideas. I appreciate that I have not provided sufficient evidence that is sufficiently compelling. I am not claiming that anything in EBM of SBM is wrong, it is simply incomplete.

    As “far out” as my idea is, it did not derive from CAM or SCAM, or any “ancient wisdom” but from observations and mostly from understanding achieved by reading what is in the peer review literature. It derived from a chance occurrence; a friend who was a 5th grade teacher asked me why her horse rolled in the dirt during March. Eventually I realized it was to get the “right” bacteria on its skin to deal with the hydrolysis of urea in sweat (~50% of the solid in sweat is urea) into ammonia. It started with a chance occurrence, but as Pasteur said, “chance favors the prepared mind”. The only way to have a prepared mind is to keep it clear of junk and trash and things that are wrong and unreliable. Unreliable rules and ways of thinking are the most important things to avoid.

    Dr. Novella’s post on the importance of rules is quite appropriate, but he did not emphasize enough the importance of testing one’s own rules to ensure they are reliable. Scientists select our rules so that they give us reliable results, not so that they give us the results that we want. This is the fundamental difference between political rules adopted by politicians to achieve the results they want and scientific rules, adopted by scientists to achieve results that are reliable.

  31. weing says:

    And these people vote too. Boy, we are in trouble.

  32. weing says:

    I didn’t mean you daedalus2u.

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