Posts Tagged Infectious disease

SCAM Cell Therapies

Surprisingly, the best youth is in the chump.

Pictured: Stem cells.  Surprisingly, the best youth is in the chump.

Injecting animal cells into humans for therapeutic reasons has a long history. The most infamous was John Brinkley who injected goat testicles into 16,000 men in the 1920s and 30s to treat impotence. Harriet wrote a review of Charlatan: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam, which covers the topic. I wonder who would get the title today. Chopra…Gesundheit.

I had thought this therapy was consigned to the sharps container of history. Of course not. No SCAM ever fades away.

As part of my ID reading I came across the headline “Q Fever Outbreak Among Travelers to Germany Who Received Live Cell Therapy — United States and Canada, 2014.”

It surpasses the classic “Notes from the Field: Campylobacter jejuni Infections Associated with Sheep Castration — Wyoming, 2011” for foolishness, where:

…men reported having used their teeth to castrate some of the lambs.

Really. A most curious way to acquire Campylobacter. But at least the castrators were doing practical, albeit eeewwwwwwww, work. And there is an alternative to teeth, including the Burdizzo Emasculatone, which is:

an elegant little tool especially suited to crushing the spermatic cords of a variety of male mammals. It really helps to make a neat job of what would otherwise be an unpleasantly messy endeavor, and the Burdizzo achieves the goal of bloodless castration admirably.

But I digress and leave to the commenters to make completely inappropriate remarks. Only the SCAM universe can be odder than infectious diseases. (more…)

Posted in: Homeopathy, Humor

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More Lyme ‘Guidelines’

The Lyme tick

The Lyme tick

I noted with understanding that the Doubtful News can’t take it anymore. The relentless tsunami sewage slurry of pseudo-science (who says I can’t alliterate?) has worn her down. She is:

currently experiencing a phase in which I can’t seem to bring myself to promote another ridiculous story in the media about a haunted location, scary sounds from the sky, or the latest outrage fueled by ancient superstition. You might call that… jaded. It’s been over four years now of nearly daily effort to keep track of the weird world of woo. It can wear one down when virtually or literally the same thing appears and reappears over and over as if it hasn’t already been passed around a million times.

I sympathize. I have had a touch of SCAM ennui of late. It is a bit due to the repetitiveness of the SCAMs. I still find the variations on the theme of pseudo-sciences curious. It is like infectious diseases where every case has unique and subtle diversity so no two SCAMs are the same. But there are almost 4,000 clinical trials on acupuncture and I would wager that they all have several of the same half-dozen fatal errors. It is like hand hygiene at work. We have known for, oh what, 160 years, that hand hygiene prevents the spread of disease but people still can’t do it right. We know how to do a good clinical trial but the SCAMsters just can’t seem to figure it out.

The ennui is not the seeming futility of the endeavor. I have always been comfortable with futility, secure, as an example, in the knowledge that someday I will be consumed by the bacteria I spent a career killing. Unless, of course, they get me cremated right away. I keep looking for a motto for the SfSBM; I am attracted to “Sisyphus had it easy.” (more…)

Posted in: Guidelines, Lyme

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Lyme Testimony

The Lyme tick

The Lyme tick

As the saying goes, when you do not have the facts, argue the law. This tried and (?) true approach was successful in New York where a law was passed protecting those who are, shall we say, creative in treating patients with Lyme and ‘chronic’ Lyme.

The bill protects those from investigation of misconduct:

based solely on treatment that is not universally accepted by the medical profession.

The major bone of contention has been extended courses of IV antibiotics for ‘chronic’ Lyme, but there are a wide variety of treatments that may be used by so called “Lyme literate” doctors.

The number of therapies divorced from reality that are offered to Lyme patients is remarkable. I do not know if chronic Lyme patients have greater use of pseudo-medical therapies than other pseudo-diagnoses, but I am impressed by the offerings in a recent review:

Results. More than 30 alternative treatments were identified, which fell into several broad categories: these included oxygen and reactive oxygen therapy; energy and radiation-based therapies; nutritional therapy; chelation and heavy metal therapy; and biological and pharmacological therapies ranging from certain medications without recognized therapeutic effects on Borrelia burgdorgeri to stem cell transplantation. Review of the medical literature did not substantiate efficacy or, in most cases, any rationale for the advertised treatments.

Conclusions. Providers of alternative therapies commonly target patients who believe they have Lyme disease. The efficacy of these unconventional treatments for Lyme disease is not supported by scientific evidence, and in many cases they are potentially harmful.


Posted in: Lyme, Politics and Regulation, Science and Medicine

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Conspiracy theories and Ebola virus transmission

Yesterday, I spiffed up a post that some of you might have seen, describing how a particular medical conspiracy theory has dire consequences in terms of promoting non-science-based medical policy. Specifically, I referred to how the myth that there are all sorts of “cures” for deadly and even terminal diseases that are being kept from you by an overweening fascistic FDA’s insistence on its approval process is an important driving force behind ill-advised “right to try” legislation that’s passed in four states and likely to pass in Arizona by referendum tomorrow. I’m not exaggerating, either. If you have the stomach to delve into the deeper, darker recesses of alternative medicine and conspiracy theory websites, you’ll find words far worse than that used to describe the FDA, such as this little gem from everyone’s favorite über-quack Mike Adams basically portraying the FDA as Adolf Hitler. Even more “mainstream” advocates, such as’s Ronald Bailey and Nick Gillespie, are not above using a version of this myth stripped of the worst of its conspiracy mongering for public consumption, claiming that the FDA is killing you.

Unfortunately, this sort of medical conspiracy theory is very common. Like all conspiracy theories, medical conspiracy theories tend to involve “someone” hiding something from the public. I like to refer to this as the fallacy of “secret knowledge.” That “someone” hiding the “secret knowledge” is usually the government, big pharma, or other ill-defined nefarious forces. The “secret knowledge” being hidden comes invariably in one of two flavors. Either “they” are hiding cures for all sorts of diseases that conventional medicine can’t cure, or “they” are hiding evidence of harm due to something in medicine. Although examples of the former are common, such as the “hidden cure for cancer,” it is examples of the latter that seem to be even more common, in particular the myth that vaccines cause autism and all sorts of diseases and conditions, that genetically modified organisms (GMOs) are dangerous, or that radiation from cell phones causes cancer. In these latter examples, invariably the motivation is either financial (big pharma profits), ideological (control, although descriptions of how hiding this knowledge results in control are often sketchy at best), or even some seriously out there claims, such as the sometimes invoked story about how mass vaccination programs are about “population control” or even “depopulation.” Either way, “The Truth” needs to be hidden from the population, lest they panic and revolt.

Posted in: Basic Science, Clinical Trials, Public Health

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Salk’s swansong: renaissance of the injected polio vaccine

Picture a lab scientist. White coat, pensive expression, microscope in hand. Glasses, perhaps. The person you have in mind (providing you are willing to humour a stereotype or two) may have a striking resemblance to Jonas Salk, the archetypal laboratory researcher, born in New York City on Wednesday 28th October 1914 — one hundred years ago today.

The name will be familiar to many. As creator of the inactivated polio vaccine (or IPV), Salk is cemented firmly into the annals of medical history. When his vaccine hit the shelves in 1955, the annual epidemics of poliomyelitis represented a fierce insult to postwar American civility: one particularly devastating bout in 1952 caused over 20,000 cases of paralysis and more than 3,000 deaths, mostly among children. The arrival of IPV was greeted with nationwide celebrations, and Salk was praised as a worker of miracles.

Jonas Salk at the University of Pittsburgh where he developed the first polio vaccine.

Jonas Salk at the University of Pittsburgh where he developed the first polio vaccine.

IPV has been in demand ever since, and its use in several countries has been sufficient to get rid of polio. Until recently, however, Salk’s injected vaccine has largely played second fiddle in eradication efforts. When the Global Polio Eradication Initiative was launched in 1988, it favoured an alternative formulation, Albert Sabin’s oral polio vaccine (OPV), as its weapon of choice.

But the spotlight may be shifting. With the eradication programme preparing for what is hoped to be a final onslaught, IPV is poised to take centre stage once more. Indeed, the World Health Organization recently recommended that all countries introduce at least one dose of Salk’s vaccine into routine immunisation by the end of 2015.

Why is IPV so important to polio eradication plans? What does the injected vaccine offer that the oral one does not? The centenary of Salk’s birth offers a fitting occasion to consider these issues.


Posted in: History, Public Health, Vaccines

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Lemons and Lyme: Bogus tests and dangerous treatments of the Lyme-literati


It’s that time of year when every day I can expect to see at least one patient with a concern about Lyme disease. In Lyme-endemic regions such as Western Massachusetts, where I practice pediatrics, summer brings a steady stream of children to my office with either the classic Lyme rash (erythema chronicum migrans, or ECM), an embedded tick, a history of a tick bite, or non-specific signs or symptoms that may or may not be due to Lyme disease. Sometimes the diagnosis is relatively straightforward. A child is brought in after a parent has pulled off an engorged deer tick, and there is a classic, enlarging ECM rash at the site of the bite. More often the presentation is less clear, requiring detective work and science-based reasoning to make an informed decision and a diagnostic and therapeutic plan based on the best available evidence. Depending on the story, the plan may include immediate treatment without any testing (as in the straightforward case described above), immediate testing without treatment pending test results, or waiting as we watch and see how a rash progresses before doing anything. An example of this latter course of action would be when a patient comes in with a pink swelling at the site of a new tick bite. In this case, it may not be clear if the swelling is a Lyme rash or simply a local reaction to the bite, a much more common occurrence. The classic ECM rash (an enlarging, red, circular, bull’s-eye rash at or near a tick bite) typically develops 1-2 weeks after a tick bite, but can occur anywhere from 3-30 days later. It then expands and darkens over another 1-3 weeks before fading. This classic rash is not the most common rash of Lyme disease, however, as it occurs in only about 30% of cases. Instead, the rash may be uniformly pink or red (or even darker in the center) without the target-like appearance, or may be a linear rash, expanding outward from the tick bite site. In the case of a patient who comes in with a vague, pink swelling within a day few days of a tick bite, we will typically wait and see what happens to the rash. If it is a local reaction, it will likely resolve within another few days. With Lyme disease, the rash will continue to enlarge and declare itself as an ECM rash. Another unclear and not uncommon situation is when a patient comes in with non-specific symptoms such as fatigue, musculoskeletal pains, and headache. If warranted by the history and the physical exam, we may in this case order Lyme testing. This may not give us an answer even if the patient has Lyme disease, because results are often negative in the first few weeks of the disease. In this case, if symptoms persist or evolve, we will repeat the testing in another few weeks at which point true Lyme disease will test positive and can then be treated. The good news is that the treatment of Lyme disease, particularly in the early, localized phase of the disease, is extremely safe and effective with a 14-day course of antibiotics. The testing is also relatively straightforward, with very good sensitivity and specificity when performed correctly. And this is where the bad news comes… (more…)

Posted in: Diagnostic tests & procedures, Science and Medicine

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Measles gets a helping hand

In a recent post I shared a bit of my personal, near-death experience with measles during the US epidemic of 1989-1991. As I describe in that post, I contracted a very serious measles infection at the end of medical school, and was highly infectious when I interviewed for a residency position at Seattle Children’s Hospital. Like others my age who received an ineffective, killed measles vaccine between 1963 and 1967, I had not been adequately protected. The MMR vaccine was not yet available, and no boosters were recommended at the time. Unfortunately, though my measles titers (a test of immunity to measles) were checked when I entered medical school, the school’s student health department failed to notice or respond to the results – I was not immune and did not receive a booster dose at that time, as I should have. That mistake was huge, and could have cost me my life. It also caused me to potentially sicken many vulnerable children during my tour of the hospital, as well as others I may have inadvertently exposed during the window of communicability as I walked the streets of Seattle. The Department of Health had to be called to trace all of my steps and attempt to track down and protect any potential contacts.

Posted in: Epidemiology, Medical Ethics, Politics and Regulation, Public Health, Science and Medicine, Vaccines

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Vaccines work. Period.

Over my blogging “career,” which now stretches back nearly nine years, and my hobby before that of engaging in online “debates” on Usenet newsgroups back before 2004, I developed an interest in the antivaccine movement. Antivaccinationism, “antivax,” or whatever you want to call it, represents a particularly insidious and dangerous form of quackery because it doesn’t just endanger the children whose parents don’t vaccinate them. It also endangers children who are vaccinated, because vaccines are not 100% effective. The best vaccines have effectiveness rates in the 90%-plus range, but that still leaves somewhere up to 10% of children unprotected. Worse, because herd immunity requires in general approximately 90% of the population and above to be vaccinated against a vaccine-preventable disease to put the damper on outbreaks, it doesn’t take much of a degradation of vaccination rates to put a population in danger of outbreaks. That’s why, even though overall vaccine uptake is high in the US, we still see outbreaks, because there are areas with pockets of nonvaccinators and antivaccinationists who drive vaccine uptake down to dangerous levels. We’ve seen this in California and elsewhere. Other countries have observed even more dramatic examples, the most well-known being the way that fear of the MMR vaccine stoked by Andrew Wakefield’s bad science and the fear mongering of the British press led MMR uptake to plummet. The result? Measles came roaring back in the UK and Europe, from having been considered under control in the 1990s to being endemic again by 2008.

As much as I get chastised by concern trolls for saying this, to antivaccinationists it really is all about the vaccines. Always. They blame autism, other neurodevelopmental conditions, and a wide variety of chronic diseases on vaccines, without evidence that there is even a correlation. They even falsely blame sudden infant death syndrome (SIDS) on vaccines, even though there is no evidence of an association and, indeed, existing evidence suggests that vaccines likely have a protective effect against SIDS more than anything else. No matter what happens, no matter what the evidence says, antivaccinationists will always find a way to blame bad things on vaccines, even going so far as to claim at times that shaken baby syndrome is a misdiagnosis for vaccine injury.

One thing, however, that is often forgotten, is that they also do their utmost to downplay the beneficial effects of vaccines. One such tactic is for antivaccinationists to claim that the pertussis vaccine doesn’t work because we are seeing resurgences of pertussis even in the face of high vaccine uptake. For example, another common trope is what I like to refer to as the “vaccines didn’t save us” or the “vaccines don’t work” gambit, in which it is pointed out that the introduction of vaccines doesn’t correlate tightly with drops in mortality from various diseases. Julian Whitaker even used this gambit when he debated Steve Novella. The fundamental flaw in this trope neglects the contribution of better medical care to the survival of more victims of disease, which decreased mortality. If you look at graphs of disease incidence you will see a profound and powerful effect of the introduction of vaccines on specific vaccine-preventable diseases. In other words, vaccines work. (more…)

Posted in: Epidemiology, Public Health, Vaccines

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There have been, in the last 20 years, natural, or perhaps unnatural, experiments that have helped shed light on the efficacy of vaccines.  Many societies, for reason of political unrest, religion, or a lack of understanding of science and medicine have seen the rates of vaccination decline and, with that decline, an increase in the cases of vaccine-preventable diseases.

Infectious disease spread in populations is not simple.  Hygiene, nutrition, access to health care, and education all play a role in the spread of communicable diseases.  Vaccines have been critical in driving the rates of vaccine preventable illnesses to almost zero, but they are not the only intervention in our armamentarium. (more…)

Posted in: Public Health, Vaccines

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A Not-So-Split Decision

For those who battle tirelessly against the never ending onslaught of anti-vaccine propaganda, misinformation, and fear, there was great news the other day from Merck. The pharmaceutical company, and maker of the MMR vaccine against measles, mumps, and rubella, has decided not to resume production of the individual, or “split”, components of the vaccine. A Merck representative made the announcement during a meeting of the CDC Advisory Committee on Immunization Practices (ACIP) on Tuesday. During previous ACIP meetings, science experts on that committee presented compelling arguments against  continued, large scale production of the monovalent components of the MMR vaccine, which were echoed by scientists in Merck’s vaccine division. In a moment, I’ll discuss the arguments against the split vaccine, and why this is so important a decision. First, some background on the issue of splitting the MMR.

Posted in: Science and Medicine, Vaccines

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