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Medicine in the Magic Kingdom of Cascadia

Beautiful Cascadia, where science goes to die.

Beautiful Cascadia, where science goes to die.

When the Pacific NW secedes from the Union it is to be part of a new country, Cascadia. The capital would be Portlandia, I suppose. Somehow, I think not. But when I watch the devolution of health care in Oregon, I think back to The Onion (?) when they reported that the United Kingdom was to be sold to Disney, being renamed as “The United Magic Kingdom.”

That is health care in Oregon due the steady insinuation of naturopathy and other pseudomedicine into real health care.

Oregon Health and Pseudoscience University

Growing up my alma mater was the University of Oregon Medical School. Since then it has undergone two name changes, first to Oregon Health Sciences University and then to the current Oregon Health & Sciences University (OHSU)—with, it should be noted, an ampersand. Not an ‘and’.

Perhaps they need one more name change, since they are not always that interested in the “Science” part of their name.

Some background is needed.

Portland has a trifecta of pseudoscience schools: Naturopathic (National College of Natural Medicine), Chiropractic (University of Western States) and ‘Oriental’ (Oregon College of Oriental Medicine).

Lucky us.

As an aside my kids let me know that the word ‘Oriental’ as used to describe people from the East, the term I grew up using, is persona non grata. I understand the reasoning. The proper term, they tell me, is Asian. So I have a mental cringe every time I see the name “Oregon College of Oriental Medicine”.

All three schools are steeped in pseudoscience and pseudomedicine, removed from known reality. As examples, the naturopathic school teaches homeopathy (and more), the chiropractic school teaches the subluxation complex, and the ‘Oriental’ (cringe) school teaches acupuncture. Reading the curricula of the schools suggests that there is no pseudomedical stone left unturned. (more…)

Posted in: Naturopathy, Politics and Regulation, Public Health

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Vaccine Whistleblower: BS Hooker and William Thompson try to talk about epidemiology

Vaccine Whistleblower – a highly edited misrepresentation of the facts

Vaccine Whistleblower” – a highly edited misrepresentation of the facts.

Here we go again with the whole “CDC Whistleblower” thing, this time with a book about the recorded conversations between Brian J. Hooker and William Thompson. Well, not the whole conversations, of course. If they were to release the whole conversations, we might get the truth, and the truth always gets in the way of the antivax crowd. Instead, we get an edited transcript of the conversations between those two in which, according to them and the book’s editors and authors, there is some sort of massive cover-up at all levels of science, government, and public health. What’s the cover-up? As usual, vaccines are evil and whatnot.

I’m not going to review the whole book for you because Dr. Gorski has already done so, and Dorit Reiss has discussed the legal aspects of what is discussed in the book. You can go read his review and/or Prof. Reiss’ analysis and then come back, or stay here and read what I have to say about the failed attempts at epidemiology from both BS Hooker and Thompson.

Let’s start by reviewing BS Hooker’s credentials. He is a bioengineer and chemical engineer, not an epidemiologist, despite what the author of the book wants you to believe:

With the publication of Kevin Barry’s Vaccine Whistleblower: Exposing Autism Research Fraud at the CDC, any claims of credibility for the CDC’s science has collapsed. Barry built his book upon four legally taped conversations between CDC senior vaccine safety scientist Dr. William Thompson and Simpson College professor and epidemiologist, Dr. Brian Hooker.

Later in the book, in the transcript of one of the conversations between BS Hooker and Thompson, BS gets a list of things he needs to do to earn an “honorary” degree in epidemiology. Among those things was to look at some of the earlier studies that Thompson had coauthored. And BS did. He would go on to write a flawed paper that I critiqued here and ended up being retracted, as I told you about here. That paper alone should tell you everything you need to know about BS Hooker’s epidemiological understanding, but the transcripts given to us by his camp in the form of the book really reveal his ignorance.

So let’s go through the calls we have transcripts for and pick at the epidemiological and biostatistical missteps that Thompson suggests for BS Hooker. (more…)

Posted in: Politics and Regulation, Public Health, Vaccines

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Vaccine Whistleblower: An antivaccine “exposé” full of sound and fury, signifying nothing

Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

– Shakespeare’s Macbeth, Act 5, Scene 5

 

"Vaccine Whistleblower"? More like the next Andrew Wakefield in the making.

“Vaccine Whistleblower”? More like the next Andrew Wakefield in the making, albeit a shy, really pissed off Andrew Wakefield.

I don’t review books that often. The reason is simple. My posts for this blog sometimes take as much as a several hours to write (particularly my more “epic” ones that surpass 5,000 words), and I usually don’t have the time to add several more hours to the task by reading an entire book. Also, by the time I’ve read a book I might want to review, weeks—or even months—have often passed, and a review is no longer of much interest to our readers anyway. Fortunately, Harriet does an admirable job of reviewing books for us.

Today, I’m making an exception for a book hot off the presses. The main reason is curiosity, because the book is about a topic that I’ve blogged about three times here and several times more for my not-so-super-secret other blog, and I really wanted to find out more about what was going on. I didn’t expect to find out what really happened, because I knew from the beginning that the book, Vaccine Whistleblower: Exposing Research Fraud at the CDC by an antivaccine lawyer named Kevin Barry, would be highly biased. However, as I found out a few weeks ago, the book promised four complete transcripts of telephone conversations between the “CDC whistleblower,” a Centers for Disease Control and Prevention (CDC) psychologist named William W. Thompson who has been a co-investigator on important CDC studies since the late 1990s.

Given my rather public skepticism about the particulars of Thompson’s story, I was quite surprised when my request to Barry’s publicist for a review copy of Vaccine Whistleblower was enthusiastically answered in the affirmative, thus giving me time to read the e-book before it was released. I also sent a copy of the book to a law professor familiar with the saga, Dorit Reiss, to write a legal perspective (also being published on SBM today) which is why I will say little about this aspect of the book in my discussion. In addition, René Najera has examined the book from a statisticians’ standpoint.
(more…)

Posted in: Book & movie reviews, Politics and Regulation, Public Health, Vaccines

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Review of Vaccine Whistleblower: A Legal Perspective 

"Vaccine Whistleblower"? More like the next Andrew Wakefield in the making.

“Vaccine Whistleblower”? More like the next Andrew Wakefield in the making.

This post addresses some legal issues raised in the Vaccine Whistleblower book. The first part explains whistleblower protections and how Dr. Thompson’s allegations fit into them. The second part addresses Dr. Thompson’s suggestion of an independent research agency. The third part explains why the book’s claim that school mandates violate international human rights is incorrect.

A note on the book: Chapters 1 is an executive summary of Chapters 2-5, the interview transcripts; Chapters 6-12 are the author Kevin Barry’s thoughts on what should be done. (Note that Dr. Gorski has also discussed this book from the perspective of the science.)

Prologue: to set the scene

The “Vaccine Whistleblower Book” has four transcripts of telephone conversations between William Thompson and Brian Hooker, recorded between May 1, 2014 and July 28, 2014.

Hooker has elsewhere stated that these conversations were only four of over thirty conversations between Thompson and Hooker. Hooker asserts these conversations began in November, 2013, and that Thompson initiated the conversations. It is not clear if these four recorded conversations were the only ones during that time frame, or what was discussed in the non-recorded conversations.

William Thompson was a co-author on a number of vaccine-safety studies published by the CDC. The most salient one for this discussion is (hereinafter DeStefano 2004):

DeStefano F, Bhasin TK, Thompson WW, Yeargin-Allsopp M, Boyle C. Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan Atlanta. Pediatrics. 2004 Feb;113(2):259-66. PMID 14754936

It is not clear why Thompson became concerned enough to reach out in 2013 about a paper that had been published almost a decade previously.

(more…)

Posted in: Politics and Regulation, Public Health, Vaccines

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Coca-Cola Science

COKE-1-tmagArticle

Science functions best when it is free from any bias or conflict of interest. All those engaged in the process should value what is actually true more than anything else. Unfortunately, there are many sources of bias in science.

Researchers may want their pet theory to be supported. Journal editors want to publish research that will have a high impact. And of course, corporations would prefer that the results of scientific research favor their products and services. A recent round of editorials accuses the Coca-Cola company of trying to put its thumb on the scale of science in order to deflect attention away from sugary drinks as a source of obesity and overweight. What are they doing and what does the science actually say?

Promoting uncertainty

According to The New York Times:

The beverage giant has teamed up with influential scientists who are advancing this message in medical journals, at conferences and through social media. To help the scientists get the word out, Coke has provided financial and logistical support to a new nonprofit organization called the Global Energy Balance Network, which promotes the argument that weight-conscious Americans are overly fixated on how much they eat and drink while not paying enough attention to exercise.

(more…)

Posted in: Public Health

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It’s time for pharmacies to stop selling sugar pills

Some of these products contain no medicine at all.

Some of these products contain no medicine at all.

Retail pharmacies have a sugar pill problem. Homeopathic “remedies” may look like conventional medicine when they’re stocked on pharmacy shelves, like the photo above. But unlike conventional medicine, homeopathic products don’t contain any “medicine” at all. They are effectively sugar pills – placebos. Not surprisingly, there is convincing evidence to show that homeopathy is useless as a medical treatment, and fundamentally incompatible with a scientific understanding of medicine, biochemistry and even physics. Questions have been raised about the ethics of selling homeopathy in pharmacies to consumers who may not realize what they’re buying. This growing practice is attracting sharp criticism from other health professions. So why do pharmacies sell them? And what will it take for pharmacies to change? (more…)

Posted in: Ethics, Homeopathy, Politics and Regulation, Public Health

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The uncertainty surrounding mammography continues

Screening mammography

Mammography is a topic that, as a breast surgeon, I can’t get away from. It’s a tool that those of us who treat breast cancer patients have used for over 30 years to detect breast cancer earlier in asymptomatic women and thus decrease their risk of dying of breast cancer through early intervention. We have always known, however, that mammography is an imperfect tool. Oddly enough, its imperfections come from two different directions. On the one hand, in women with dense breasts its sensitivity can be maddeningly low, leading it to miss breast cancers camouflaged by the surrounding dense breast tissue. On the other hand, it can be “too good” in that it can diagnose cancers at a very early stage.

Early detection isn’t always better

While intuitively such early detection would seem to be an unalloyed Good Thing, it isn’t always. Although screening for early cancers appears to improve survival, the phenomenon of lead time bias can mean that detecting a disease early only appears to improve survival even if earlier treatment has no impact whatsoever on the progression of the disease. Teasing out a true improvement in treatment outcomes from lead time bias is not trivial. Part of the reason why early detection might not always lead to improvements in outcome is because of a phenomenon called overdiagnosis. Basically, overdiagnosis is the diagnosis of disease (in this case breast cancer but it is also an issue for other cancers) that would, if left untreated, never endanger the health or life of a patient, either because it never progresses or because it progresses so slowly that the patient will die of something else (old age, even) before the disease ever becomes symptomatic. Estimates of overdiagnosis due to mammography have been reported to be as high as one in five or even one in three. (Remember, the patients in these studies are not patients with a lump or other symptoms, but women whose cancer was detected only through mammography!) Part of the evidence for overdiagnosis includes a 16-fold increase in incidence since 1975 of a breast cancer precursor known as ductal carcinoma in situ, which is almost certainly not due to biology but to the introduction of mass screening programs in the 1980s.

As a result of studies published over the last few years, the efficacy of screening mammography in decreasing breast cancer mortality has been called into question. For instance, in 2012 a study in the New England Journal of Medicine (NEJM) by Archie Bleyer and H. Gilbert Welch found that, while there had been a doubling in the number of cases of early stage breast cancer in the 30 years since mass mammographic screening programs had been instituted, this increase wasn’t associated with a comparable decrease in diagnoses of late stage cancers, as one would expect if early detection was taking early stage cancers out of the “cancer pool” by preventing their progression. That’s not to say that Bleyer and Welch didn’t find that late stage cancer diagnoses decreased, only that they didn’t decrease nearly as much as the diagnosis of early stage cancers increased, and they estimated the rate of overdiagnosis to be 31%. These results are in marked contrast to the promotion of mammography sometimes used by advocacy groups. Last year, the 25 year followup for the Canadian National Breast Screening Study (CNBSS) was published. The CNBSS is a large, randomized clinical trial started in the 1980s to examine the effect of mammographic screening on mortality. The conclusion thus far? That screening with mammography is not associated with a decrease in mortality from breast cancer. Naturally, there was pushback by radiology groups, but their arguments were, in general, not convincing. In any case, mammographic screening resulted in decreases in breast cancer mortality in randomized studies, but those studies were done decades ago, and treatments have improved markedly since, leaving open the question of whether it was the mammographic screening or better adjuvant treatments that caused the decrease in mortality from breast cancer that we have observed over the last 20 years.

Given that it’s been a while since I’ve looked at the topic (other than a dissection of well-meaning but misguided mandatory breast density reporting laws a month ago), I thought now would be a good time to look at some newer evidence in light of the publication of a new study that’s producing familiar headlines, such as “Mammograms may not reduce breast cancer deaths“.

Here we go again.
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Posted in: Cancer, Public Health

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The war in California over nonmedical exemptions to school vaccine mandates, part 2

The war in California over nonmedical exemptions to school vaccine mandates, part 2

Last week, in the run-up to the 4th of July holiday weekend, something happened that I truly never expected to see. SB 277 became law in the state of California when Governor Jerry Brown signed it. In a nutshell, beginning with the 2016-17 school year, the new law eliminates nonmedical exemptions to school vaccine mandates. When last I wrote about SB 277 for this blog three weeks ago, I explained why I thought it was unlikely that SB 277 would ever become law, so that California could join West Virginia and Mississippi as the only states that do not permit religious or personal belief exemptions to school vaccine mandates. Basically, it was because California is not Mississippi or West Virginia. It’s a hotbed of antivaccine activism. Although statewide vaccination rates are high, there are a number of areas where antivaccine and vaccine-averse parents have led to low vaccine uptake with resultant outbreaks of vaccine-preventable diseases. Most recently, a large outbreak centered at Disneyland served as the catalyst that made it politically possible for a bill like SB 277 even to be seriously considered by the California legislature. Even so, given that California is home to a number of antivaccine celebrities such as Rob Schneider, Alicia Silverstone, Bill Maher, Charlie Sheen, Mayim Bialik, and Jim Carrey, antivaccine pediatricians such as “Dr. Jay” Gordon and “Dr. Bob” Sears, and many of the activists at the antivaccine crank blogs Age of Autism and The Thinking Moms’ Revolution, I was not optimistic.

I was mistaken in my pessimism, and I’m happy about that. I’m grateful to all those who didn’t see passing this law as an impossible task, such as Senators Richard Pan and Ben Allen, and who worked tirelessly to see it through, as some of our regular readers did. I was also pleasantly surprised that Governor Jerry Brown didn’t betray California children by watering down the bill with a signing statement, as he did three years ago when an earlier bill (AB 2109) was passed to make it more difficult for parents to obtain personal belief exemptions to school vaccine mandates.

So since SB 277 is law in California, what now?
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Posted in: Politics and Regulation, Public Health, Religion, Vaccines

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This stimulant can kill, yet you can legally buy it online. Why?

Caffeine Powder

This stimulant drug is highly toxic and perfectly legal.

If there’s one thing that unites all countries and cultures, it’s our love of caffeine. Whether it’s coffee, tea or other foods, caffeine is the most widely consumed drug in the world — more than alcohol, and more than tobacco: 90% of adults worldwide consume caffeine daily. At doses found in food and beverages, the effects are predictable and the side effects are slight. But natural or not, caffeine is a drug; isolate the pure substance, and the risks change. It would be difficult for most people to drink 16 cups of coffee in a row, but that’s the equivalent of just one teaspoon of caffeine powder. If that doesn’t hospitalize you, a tablespoon of the powder will probably kill you. Yet despite the risks, there are no restrictions on the sale of caffeine powder. You can buy a 1kg bag for $35, which provides the caffeine of about 5,000 cups of coffee. Caffeine powder is freely available to buy because regulators treat it differently – not because of its inherent properties, but because it’s “natural” and sold as a dietary supplement rather than a drug. This is a regulatory double-standard that harms consumers. It’s leaving a body count. And it needs to change: (more…)

Posted in: Herbs & Supplements, Politics and Regulation, Public Health

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FDA & CDC find raw pet food unpalatable

Awww!

Awww!

The FDA recently announced it would send field staff out to collect samples of commercially-manufactured raw dog and cat food. The samples will be analyzed for Salmonella, Listeria monocytogenes and E. coli, all of which have been found in raw pet food, in the animals who eat it, in their feces, on their bodies after eating it, in the areas they inhabit, and on their owner’s bodies. Not surprisingly, this has led to both pet and human infection and illness. If the FDA finds pathogens, it could result in a recall, a press release and Reportable Food Registry Submission. The next day, the CDC joined the effort to curb illness caused by pathogens in raw pet food by posting information on safe handling.

Because of the risk to public health, and the lack of any proven benefit of raw pet food diets, the FDA does not recommend them.

However, we understand that some people prefer to feed these types of diets to their pets.

And why is that? For some of the same reasons humans follow absurd diet fads: the “lone genius” discovery, it’s “natural,” anecdotal evidence, appeal to antiquity, anti-corporate sentiment, and “holistic” practitioner recommendations.

(more…)

Posted in: Herbs & Supplements, Nutrition, Politics and Regulation, Public Health, Veterinary medicine

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