Back in 2009 I wrote a story entitled, “The New Plague”, about my experiences as a pediatrician with the frightening trend of parental vaccine refusal in New York City. In that post I discussed some of the complex social factors contributing to this phenomenon, and some of the common vaccine myths to which many parents fall prey. I recommend that you read that post, as it is (unfortunately) as timely today as it was then. Now I’m a pediatrician in Amherst, Massachusetts, and I find it necessary to revisit this dangerous trend in parenting.
As I described in my previous post on the subject, my old practice was at an interesting crossroads of several communities that seemed to perfectly embody the socioeconomic and cultural characteristics commonly found in communities with high rates of parental vaccine refusal. Ironically, these tend to include people who are educated and socially privileged; those empowered to question authority. In 2010, I left New York City and moved to Western Massachusetts to take a job at Baystate Children’s Hospital in Springfield. There I was in charge of the teaching clinic where pediatric residents are trained in the outpatient care of children. The children we took care of in Springfield comprised a very high-risk, underprivileged population. Our patients were significantly below the poverty level, with high rates of developmental and educational disability, a high teen pregnancy rate, and high rates of domestic violence, drug use, and gang involvement. Children who were not up to date with their vaccinations were behind because of poor continuity of care, with many missed appointments and gaps in follow-up. I now work at a private practice further north in the Pioneer Valley of Central Massachusetts. Here, my experiences with vaccine lapses are starkly different. Now, when I encounter a child who is not fully vaccinated or is completely unvaccinated, it is the result of a parental decision. A very flawed, dangerous, and misinformed parental decision.
Dug the Dog strikes again, as he did three weeks ago. I had a couple of ideas for a post this week, but none of them were time-sensitive or timely. Then, over the weekend, I saw a post on the antivaccine crank blog Age of Autism by Dan “Where are the Autistic Amish” Olmsted entitled Weekly Wrap: Another Medical Practice with a Sane Vaccine Schedule – and No Autism. Given the tendency towards a—shall we say?—lack of accuracy of Olmsted’s previous reporting, it’s no surprise that he’d latch on to this study. I’m also seeing it appear around other antivaccine websites. I had gotten wind of it late last week, a few of my readers having sent it to me but hadn’t decided yet whether to blog about it. Then it appeared on AoA. Thanks, Dan.
So let’s see how this study is being spun by the antivaccine movement:
When we at Age of Autism talk about ending the epidemic, the “to do” list seems almost overwhelming – funding a vax-unvaxed study, getting mercury out of flu shots, proving the HepB shot is nuts, wresting control of the agenda from pharma, fixing Vaccine Court (this time in the good sense of “fix”), establishing that biomedical treatments help kids recover, and on and on.
But there’s a shortcut to all this, and it goes straight through pediatricians’ offices. The evidence is growing that where a sane alternative to the CDC’s bloated vaccine schedule is offered, and other reasonable changes adopted, autism is either non-existent or so infrequent that it doesn’t constitute an epidemic at all.
The latest example comes from Lynchburg, Va., and the pediatric practice of Dr. Elizabeth Mumper. She noticed a frightening rise in autism in the 1990s. Concerned that vaccines and other medical interventions might be playing a role – concerned in other words that SHE was playing a role — Mumper changed course.
Fewer vaccines. Fewer antibiotics. No Tylenol. Breast-feeding. Probiotics. Good, pesticide free diets.
Since then, hundreds more children have been seen in her practice, Advocates For Children. But no more autism.
A recently published epidemiological study in JAMA Pediatrics looked at the association between induction and enhancement of labor and the risk of autism. The researchers found a positive association, especially with males. The study has been variously reported in the popular press with causal interpretations not justified by the data.
The study itself is very robust – the authors looked at 625,042 live births, including 5,500 children with a diagnosis of autism. They found:
Compared with children born to mothers who received neither labor induction nor augmentation, children born to mothers who were induced and augmented, induced only, or augmented only experienced increased odds of autism after controlling for potential confounders related to socioeconomic status, maternal health, pregnancy-related events and conditions, and birth year. The observed associations between labor induction/augmentation were particularly pronounced in male children.
Although this is a large study, it is one study, and so the correlation needs to be independently confirmed. But if we assume the correlation is accurate, the next question is – what is the arrow of causation? Observational studies can only indicate an association. By themselves they cannot prove causation, although multiple observational studies may be able to triangulate to the most likely causal interpretation. (more…)
Conservative Christians are calling for banning oral and anal sex between consenting adults, claiming that the practices allow for the spread of disease. Radio host Brian Fischer says that a rise in head, neck and throat cancers “among millennials” is a direct result of the influence of “Bill Clinton and Monica Lewinsky.” He compares oral sex and homosexual sex to drug trafficking, pedophilia and bestiality. He hasn’t decided how offenders should be punished but he suggests either issuing summonses like parking tickets or putting them into programs akin to drug rehab. He says Liz Cheney (the daughter of former Vice President Cheney) is “not a patriot” because she may support gay marriage.
Those of us who want the government to stay the hell out of our bedrooms will gladly ignore such rants, but the health risks of sexual practices are real. Michael Douglas recently shocked the world by announcing that cunnilingus could have caused his throat cancer. He was right, it could have.
HPV causes several kinds of cancer
Most head and neck cancers are caused by tobacco and alcohol, but researchers believe that up to 80% of oropharyngeal cancers are due to HPV (human papilloma virus) infection. The cause can be confirmed by testing biopsy samples for HPV DNA. The incidence of throat cancer caused by HPV is rising rapidly (a 225% increase from 1988 to 2004) and has been attributed to an increase in oral sex. It is estimated that by 2020 HPV will cause more oropharyngeal cancers than cervical cancers in the US. (more…)
As I’ve joked about before, I’m a bit like Dug the Dog from the movie Up whenever a squirrel goes by. In other words, I’m easily distracted by things that interest my primal urge to chase pseudoscience. I originally had a cancer-related topic in mind for this week’s foray into science-based medicine, but then on Friday our favorite group of antivaccine activists over at the antivaccine crank blog Age of Autism induced a squirrel to run in front of me, and the rest is history, at least for the moment. I’ll try to get back to my original topic either as a bonus post later this week or as next week’s post (unlike the topic of today’s post it’s not really particularly time sensitive). In the meantime, I’ll chase this squirrel. Sorry about that. But Dug’s gotta do what Dug’s gotta do. Besides, the topic I had in mind for this week is sufficiently complex that my ultimate post will probably end up being much better if I have a few more days to a week to think about it. At least, that’s what I keep telling myself.
If there’s one thing I’ve learned over the years opposing the antivaccine movement, it’s that these days its “Holy Grail” (well, a “holy grail”) is to have a “vaccinated versus unvaccinated” study performed, or, as it’s frequently abbreviated, a “vaxed verus unvaxed” study. The reason they want such a study so badly is not because they think there’s a scientific question that genuinely cries out for an answer. Rather, they believe it will confirm their fixed, unalterable belief that vaccines are the root of nearly all chronic health conditions children suffer today, particularly autism and autism spectrum disorders. In particular, they believe that a “vaxed versus unvaxed” study would demonstrate once and for all that vaccines are the cause of the “autism epidemic.” Hilariously, a few years back, the antivaccine group Generation Rescue tried to do such a study. It was more an utterly incompetently administered and analyzed telephone survey than anything else, and, ironically, its results actually were just as consistent with the conclusions that vaccines protect against autism as that they predispose to autism. And don’t even get me started on an even more hilariously incompetent vaxed versus unvaxed study by a German antivaccine homeopath (I know; “antivaccine homeopath” is redundant) that antivaccinationists were touting a while back. That took attempts to ape science to depressingly ridiculous extremes.
A correspondent asked for my opinion of a new book by journalist Jennifer Margulis that is apparently getting a lot of attention in some circles: The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line. I got a copy from the library and read it. It was a painful experience. One of the customer reviews on the Amazon website accurately sums up my own reaction:
There is a great need for an incisive look at all sides of modern maternity care in the United States, because — let’s face it — we all know it’s not perfect. This, however, is not that book.
The author is a strong advocate of home birth, water birth, midwives, “embracing the pain to make you stronger,” “parents know better than doctors,” natural = good, and very early potty training. She thinks bathing a newborn is harmful. She questions the need for well baby checkups: she thinks they are mainly a gimmick to sell vaccines. She questions the (science-based) practice of giving newborns vitamin K and prophylactic eye drops. She is against the use of chemicals in general. She reports that Johnson’s Baby Wash contains “a host of unpronounceable chemicals, some of which are known toxins…and carcinogens.” She doesn’t seem to have grasped the basic principle of toxicology that the poison is in the dose. She is against formula, which she says is killing babies, and against disposable diapers because they contain chemicals and petroleum and because they can cause your child to become infertile. Her only evidence for “infertility” is one study showing that disposable diapers raise scrotal temperatures. Indeed, plastic underpants are probably warm.
Editor’s note: This is an extra “bonus” post. Basically, it’s a revised version of a post I did at my not-so-super-secret-other-blog last week. The issue, however, has disturbed me so much that I felt it appropriate to post it to SBM as well. Fear not. There will be a new post by yours truly on Monday.
Sometimes, in the course of blogging, I come across a story that I don’t know what to make of. Sometimes, it’s a quack or a crank taking a seemingly science-based position. Sometimes it’s something out of the ordinary. Other times, it’s a story that’s just weird, such that I strongly suspect that something else is going on but can’t prove it. So it was a few months ago when I came across the story of Alex Spourdalakis, a 14-year-old autistic boy who became a cause célèbre of the antivaccine crank blog Age of Autism.
I first noticed the story in early March when perusing AoA and came across a post by Lisa Goes entitled Day 19: Chicago Hospital Locks Down Autistic Patient. In the post was a shocking picture of a large 14-year-old boy in a a hospital bed in four-point restraints. He was naked, except for a sheet covering his genitals. A huge gash was torn in the bedsheet, revealing the black vinyl of the hospital bed beneath. The boy’s name, we were informed, was Alex Spourdalakis. Further down in the post was another, equally shocking, picture of Alex that, according to Goes, showed severe dermatitis on Alex’s back due to the hospital sheets. The photos shocked me for two reasons. First, if the story was as advertised (something always to be doubted about any story posted at AoA), for once I thought that I might be agreeing with Goes and thinking that AoA was actually doing a good thing, as disconcerting as that possibility was to me. Second, however, I was extremely disturbed by the publication of such revealing photos of the boy. Undoubtedly, Alex’s mother must have given permission. What kind of mother posts pictures like that of her son for all the world to see? Then there appeared a Facebook page, Help Support Alex Spourdalakis, which pled for readers to help the Spourdalakis family.
As I said, something just didn’t seem right at the time.
Pennsylvania legislators need to know only one thing about House Bill 612 (licensure of naturopathic “doctors”) to vote against it: As a means of “naturopathic musculoskeletal therapy” the bill would allow naturopaths to “reposition body tissues and organs.”
This is impossible. You cannot “reposition” tissues and organs of the human body by external manipulation.
Why does this tell us everything we need to know about these naturopathic doctors and why they shouldn’t be licensed in Pennsylvania? For one thing, this is no mistake a bill draftsman made in understanding what naturopathic practice includes. House Bill 612 was obviously drafted by naturopaths. That means naturopathic doctors actually believe they can “reposition” your body’s tissues and organs. And that speaks to their poor education and training. They don’t even understand basic anatomy.
For another, it tells us naturopathic doctors reject evidence-based medicine as a standard of practice. There is no evidence that this “repositioning” of organs and tissues is beneficial for any condition or disease, even if they could do it in the first place, which they can’t.
And for yet another, this certainly calls into question their understanding of the disease process and their diagnostic skills. One has to wonder exactly what health problems they think these purportedly out-of-place organs are causing. And how do they go about determining which organs are out of place and where they should go? Or when they have been successfully returned to their proper position? Again, this should raise alarming questions in the legislators’ minds about their education and training. (more…)
A correspondent asked me to look into the GAPS diet. I did. I was sorry: it was a painful experience. What a mishmash of half-truths, pseudoscience, imagination, and untested claims!
GAPS stands for Gut and Psychology Syndrome. It is the invention of Dr. Natasha Campbell-McBride. According to her, a wide variety of health problems can be traced to a single cause: an imbalance of gut microbes. She cites ancient wisdom: Hippocrates said all diseases begin in the gut. She says science confirmed that wisdom when it discovered that 90% of all cells and all genetic material in the human body belongs to the gut flora. She says the modern world poses many dangers for the gut flora, and once it is damaged, the health of the whole body enters a downward slide towards disease. She claims that autism and ADD, OCD, schizophrenia, epilepsy, depression, and numerous other ailments are all digestive disorders. (more…)
As usual, I was impressed with Mark Crislip’s post on Friday in which he discussed the boundaries between science-based medicine and what we sometimes refer to as woo or what Mark often refers to as sCAM. It got me to thinking a bit, which is always a dangerous thing, particularly when such thinking leads to my writing something for my not-so-super-secret other blog (NSSSOB). Of course, this is not my NSSSOB, but that doesn’t make it that much less dangerous. Be that as it may, I started thinking about a gambit I started noticing a few years ago being directed at me by the targets of my logorrheic deconstructions. Actually, I noticed it from the very beginning, when I first started blogging about SBM versus quackery way back in 2004 and even before, back when I was one of a doughty band of pro-science types who waded into the Wild West of online forums known as Usenet, in particular the misc.health.alternative newsgroup.
I happen to be in Washington, DC as I write this. In fact, as I write this I’m here to attend the annual meeting of the American Association for Cancer Research (AACR), the better to soak in all that cancer science goodness and (hopefully) be pumped up to go back and keep trying to do good science and, hopefully, manage to get my lab funded. Of course, the latter task is a really daunting these days, a truly depressing thing to contemplate, given that the current payline for the National Cancer Institute is around the 7th percentile, which makes me worry about how much longer my lab will be open. My self pity aside, Mark got me to thinking about the characteristics of purveyors of non-science-based medicine (i.e., quackery and quackademic medicine) compared to SBM. More precisely, I started thinking about a difference that what Mark calls sCAMmers try to pin on those of us who try to defend SBM against the forces of pseudoscience. To introduce this concept, I think it’s worth going back a few years to a comment I got a long, long time ago on a blog far, far away (i.e., my NSSSOB):
When it comes to autism, you seem to have lost something that I think every physician is well-served to have in abundance: compassion.