Greg Laden’s Blog : Paul Ewald: Can we domesticate germs?
May 12, 2008
Evolutionary biologist Paul Ewald drags us into the sewer to discuss germs. Why are some more harmful than others? How could we make the harmful ones benign? Searching for answers, he examines a disgusting, fascinating case: diarrhea.
Signout : Formidable and noisy
May 12, 2008
“What I want you to do,” I said, “is breathe in deep, then blow it all out like you’re blowing out birthday candles.”
He focused his eyes in concentration and blinked a few times, then did as I’d said, aiming for the finger I held in front of him.
I listened to his back with my stethoscope. “Again,” I said. “Again. Again. Good job! Again.”
His mother sat forward in her seat and breathed in sync with her boy, her face softened from the suspicious glare she’d trained on me a moment before. After I’d listened to every part of the kid’s chest, I put my hand up for a high five, which he gave me without prompting. His mother frowned and looked at me. “Well?”
I understood her frustration. It was the fifth time in a month that they’d been in the clinic for the boy’s wheezing. He was now on four asthma medications, and yet according to his mom, his coughing and wheezing were worse than ever. Indeed, I could hear the boy breathe from across the room. But with my stethoscope, I just heard some mild coarseness–no wheezing at all. I had the boy cough, then listened again, and heard the same thing.
I told the mother I heard very little wheezing on my exam, and that perhaps asthma alone was not sufficient explanation for the boy’s problems. I then stepped out to discuss the boy’s case with a supervising clinician, Dr. Mallet.
Dr. Mallet knew the boy well–he had seen this patient for every previous complaint of wheezing and had initiated all of the treatments the boy was taking. I like Dr. Mallet a lot, and think he is a bright and caring physician and an excellent teacher.
But Dr. Mallet heard wheezing. “Yeah, he doesn’t sound great,” he said after listening to the boy’s back. He suggested we start steroids and order a chest x-ray, then left me in the room to complete the paperwork. A moment later, he popped his head back in. “You know, let’s also do a course of antibiotics. This has been going on for an awfully long time.”
Before I gave the mother her stack of requisitions and prescriptions, I asked if I could listen to her boy one more time. Again, I heard no wheezing.
“Huh,” I said.
The following day, Dr. Mallet called me into the x-ray reading room. As it happened, the film showed traces of a pneumonia. The most likely pathophysiological scenario is that the boy had severe asthma that was incompletely controlled for long enough that he eventually developed a post-obstructive bacterial pneumonia. The noisy breathing was probably due in part to off-and-on wheezing and in part to upper respiratory congestion. But what interested me about this interaction wasn’t the pathophysiology.
I’m not an expert clinician, but I know what wheezing sounds like, and I have great hearing. By my three exams, this kid wasn’t wheezing. Sure, it’s possible that my lung exam stinks. But presuming it doesn’t, how is it possible that Dr. Mallet heard such different breath sounds than I did?
A great clinician I worked with in medical school used to say, “When you’re a hammer, everything looks like a nail.” He was talking about something called confirmation bias, which occurs when we selectively look for or “find” information that confirms what we believe to be true. It’s human nature to approach problems with this kind of bias, and even very good doctors have stories about mistakes made because of it.
If my exam really was right, Dr. Mallet “heard” findings of asthma because he had diagnosed the kid with asthma. Still, something made him come back to the room after continuing down his expected diagnostic path.
Even if Dr. Mallet’s findings were guided by his expectations, his plan was not. Although some part of him might have been trying to make this patient fit into a familiar pattern, it was overpowered by his sense that something didn’t fit. His attention to that sense–even in the face of a formidable and noisy bias–helped him make the right decision for this patient. In medicine, human nature demands constant questioning.
I refer you to Jerome Groopman’s excellent book, How Doctors Think, for more on the kinds of errors doctors make, and on ways to avoid them.
Respectful Insolence: A high tech form of the same old “detoxification” woo
May 12, 2008
“Detoxification.”
Whenever I hear that term, I’m at least 90% certain that I’m dealing with seriously unscientific woo. The reason should be obvious to longtime readers of this blog or to anyone who has followed “alternative medicine” for a while, because “detoxification” is a mainstay of “alternative” treatments and quackery for such a wide variety of diseases and conditions. Of course, toxins are indeed a bad thing, and we close-minded reductionist “allopathic” physicians do indeed use detoxification when appropriate. What differentiates us from “alternative” medicine practitioners is that we have this extremely annoying tendency (annoying to alties, that is) to want to know exactly what toxins we are dealing with, to verify that they are present in concentrations that can cause problems or damage before instituting any sort of treatment for them, and then to tailor our therapies to remove the specific toxins causing symptoms and to verify that we are successful. Not so for the “detoxification” as practiced by so-called “complementary and alternative medicine” (CAM) practitioners. CAM “detoxification” most often does not specify which “toxins” are being “detoxified,” or when it does it is intentionally vague about them. Occasionally, they will get specific (mercury as a cause for autism), but the problem with specifying a “toxin” as a cause for a disease is that doing so allows for falsification; it also allows scientists who know something about the disease to assess the specific toxin as a cause for a disease for biological plausibility. Not surprisingly, rarely is the mechanism biologically plausible.
The concept of “detoxification” in alternative medicine also leads to a number of bizarre and sometimes dangerous treatments. For example, there is chelation therapy for all manner of conditions, such as atherosclerotic coronary artery disease and autism; there have been deaths, even the death of a child, from this nonsense. Then there is all manner of “detoxification” for cancer patients, which can include coffee enemas, combinations of enemas and various juices, or all manner of combinations of fasts and purges. Perhaps the ultimate “detoxification” regimen is the Gonzalez regimen for pancreatic cancer, which involves taking over 100 supplements and multiple enemas a day. Truly, “detoxification,” at least as practices in alt-med circles, is far more of a religious concept akin to self-purification of unspecified evils than anything else.
No doubt the person who has thought up what I’m about to write about would, were he to see this post, think that my introduction is horribly unfair, but I don’t think so. As you will see, the only difference between this form of “detoxification” and traditional alt-med forms of detoxification is high tech. The rationales are in essence the same. What am I talking about? A pediatrician in Pittsburgh named Dr. Scott Faber is planning on treating autism by placing children in an “Environmental Pediatric Room,” which is in reality planned to be a clean room, at a cost of $500,000 to construct and $1,000,000 a year in operating costs:
With childhood autism cases skyrocketing and no cure in sight, doctors at the Children’s Institute in Squirrel Hill are planning on a Hail Mary pass approach to the mysterious disorder — housing young patients for weeks at a time in a pollutant-free “clean room,” in an attempt to detoxify their bodies.
No cause for autism has been found, and debates rage as to whether the brain development disorder is purely genetic or caused in part by environmental factors, including air and food-borne chemicals.
With roots in autism treatment theories that until now have lived mostly on the Internet, the pediatric clean room plan would be the first of its kind in a mainstream American hospital environment.
The Children Institute’s Scott Faber, a pediatrician with several hundred autistic patients and a waiting list six months long, is one of the believers in toxic causes, and the institute is trying to back him with a multimillion dollar test of the novel theory.
Under the plans — developed with help from Duquesne University — autistic patients would live for more than six weeks in a 1,000-square-foot room kept mostly free of harmful chemicals and pollutants, using special air-filtering systems, ultraviolet lights and air locks on doorways.
Furniture, paints, toys and floor coverings would be designed to be toxin-free, and food, clothing and water organic and clean. Doctors would seek to rid patients’ bodies of chemicals and boost their immune systems through natural means such as nutritional supplements and dietary changes.
Basically, it would be pushing a “reset” button on the child’s body, with the hope of wiping autistic symptoms away.
“What we would like to do is have kids live in this wonderful environment where they are exposed to almost none of the Industrial Revolution. And we wonder, if the chemicals come out and the heavy metals come out, will the children start improving?” Dr. Faber said.
Yep, this is the same old woo dressed up in high tech clothing. It sounds like typical “detoxification” diets and supplements with the addition of this special room. As with all detoxification woo, the specific toxins are not really specified. Dr. Faber, it is known, is a booster of the concept that “heavy metal buildup” is a major contributor to autism and a purveyor of some fairly typical (and dubious) “biomedical” interventions for autism. For example, here he is being interviewed in response to Dr. Raymond Palmer’s awful (from a scientific standpoint) paper linking autism to proximity to coal-burning powerplants in Texas:
Dr. Scott Faber, a neurodevelopmental pediatrician at Pittsburgh’s Children’s Institute, said most autism cases appear to be caused by some type of environmental impact while babies are still in the womb.
“These kids have a genetic predisposition to not handling an environmental exposure,” Faber said. “That exposure can be one of the chemicals in the environment. It can be heavy metals that are released into the air.”
And here Dr. Faber is again:
Dr. Scott Faber, a specialist in neurodevelopmental disabilities and behavioral pediatrics at the Children’s Institute in Pittsburgh, said there is emerging evidence that heavy metal build-up in the body can cause the neurological impairment seen in autism.
Faber and Hewitson, the researcher with Magee’s Pittsburgh Development Center, each said there may be a connection between mercury exposure in the womb and autism.
I’ll give Dr. Faber credit in that he at least rejects the hypothesis that mercury in vaccines is a cause for the “autism epidemic,” but he nonetheless still seems to be a true believer in blaming mercury and other unspecified “heavy metals” for autism. Of course, even if mercury were a major contributor to autism, he is short on rationale as to why placing autistic children in a clean room would do anything to help them. First off, he seems to think that mercury exposure in the womb is important. If that were indeed the case, then wouldn’t putting children in a clean room be a little late? Wouldn’t he have to lock future mommies up in his clean room for nine months, just to be sure?
This whole concept of using “clean rooms” for treating autism is not Dr. Faber’s idea, however. It’s apparently based on ideas promulgated by a nutritionist named Karen Slimak, who appears to be heavily into dietary and detoxification woo for treating autism combined with extreme environmental control. Like many purveyors of dubious remedies, she has not published a single report in a peer-reviewed biomedical journal describing her use of clean rooms to treat autistic children (or even about her treatment or about any aspect of autism), opting instead for bypassing peer review and going straight to the Internet. Also typical for such “studies,” there is no blinding, no randomization, no real control group, and only vaguely described methodology, which makes its rsults virtually uninterpretable. Indeed, her “study” is mighty thin gruel to spend several million dollars on. Even Dr. Faber seems to realize that:
Dr. Faber noted that Ms. Slimak’s clean room work — like much of the research on toxicity in autism — “hasn’t been written for the main [scientific] literature” but instead has been written mostly for the Internet. The Children’s Institute plan would be taking what is arguably a fringe movement into the mainstream: It would be the first autism treatment of this kind staged in an American hospital setting. It will be matched with scientific analysis, sensors and video cameras to study the real impacts of detoxification. The data and findings will be shared openly, he said.
How lovely. Of course, a more reasonable and scientific manner to test Slimak’s methodology would be to collaborate with her and demand scientific rigor: you know, little things like randomization, double-blinding (admittedly difficult with a clean room, but not impossible), and the use of real control groups in the clinical trial. Of course, if Slimak hasn’t published her work in the peer-reviewed literature, I doubt she’d be too interested in that. Come to think of it, I couldn’t find a single scientific paper in the peer-reviewed biomedical literature about autism by Dr. Faber either.
Leaving the issue of how weak Ms. Slimak’s work is, though, Dr. Faber sounds as though he plans on doing clinical research with this clean room. It’s thus only reaosnable to wonder whether he will use methodology that would have a hope of actually answering the question of whether or not the clean room is having an effect. The methodology he describes certainly doesn’t sound as though it will be anywhere rigorous enough. Once again, I hear nothing about blinding, nothing about a control group, nothing about randomization or case matching. Moreover, if he only plans on putting one child in the room at a time, it would take him a hell of a long time to accumulate any meaningful data even if he had devised a scientifically rigorous methodology to test the hypothesis that “detoxification” using a clean room and special diet does anything at all for autistic symptoms. (He doesn’t.) Indeed, his methodology seems custom-made to produce the same old false positives that so many “biomedical” intervention studies are prone to produce.
There are also many logistical challenges that make me wonder. Clean rooms are very difficult to maintain. There’s a reason that workers in real clean rooms wear synthetic full-body suits; the human body sheds dead cells, hair, and all manner of particulates. Similarly, any “natural” fibers or toys would be difficult to fabricate in such a way that they, too, don’t throw off all sorts of particulates. The end result will likely be a hellacious time trying to keep the air filters from constantly clogging, particularly if the parents are staying and staff is coming in and out. All in all, it sounds like a very long run for a very short slide.
So what’s the problem, you ask? After all, assuming the dietary manipulations aren’t too extreme, this intervention should be harmless. At least that’s what Elliot Frank, the chairman of Pittsburgh’s Advisory Board on Autism and Related Disorders, argues:
Even if it does not work, patients will be in a safe and professional environment, benefiting from passive treatments such as nutrition and clean air.
Among parents of children with autism, Mr. Frank said, “some will say, ‘Come on, who are you kidding?’ But a significant portion of parents will feel good about this and watch this with incredible interest. Others will watch and say, ‘Hmm, let’s see what happens.’ “
Indeed, “empowerment” seems to be what it’s all about, more than anything else:
“We know that the data for this is just emerging, but we feel it’s a very safe intervention, and it’s empowering for families and very reasonable,” he said.
So, you may ask, what is wrong with all this? I see several things. Again, assuming the dietary manipulations aren’t too far out there, this clean room treatment probably isn’t unsafe. However, it is research, which brings up a number of ethical problems. First, I assume that the parents will be paying for this intervention, given that insurance companies are highly unlikely to. One of the cardinal principles of research is that patients should not be required to pay for experimental therapies, which is what this most definitely is: an experimental therapy without a good scientific rationale or good preclinical or clinical evidence to support its use, but an experimental therapy nonetheless. I highly doubt that the Children’s Institute is going to offer this for free. Indeed, I wonder whether the hospital will make a profit on this treatment. If so, that would make it even more ethically dubious. Second is informed consent. Does Dr. Farber tell parents just how weak the supporting evidence for this therapy is? Somehow I doubt it. Then there’s the issue of research design, which appears to be totally inadequate to evaluate whether or not Dr. Farber’s hypothesis is actually true or whether this therapy is anything more than yet another expensive and elaborate placebo. Taken as a whole, this whole project just reeks of pseudoscience and questionable medical ethics.
But perhaps the worst aspect of this “treatment” is the wasted money and lost opportunity. At least $3.5 million will apparently be dedicated to this project. Surely a lot more could have been done with that money to help autistic children who are patients at Dr. Faber’s hospital. As the project appears to be formulated right now, to me it looks like nothing more than throwing money away on an expensive, “science-y”-sounding project with an at best highly questionable hypothesis behind it with almost zero possibility of producing scientifically useful results for numbers of patients in the single digits each year. In other words, unless I’m missing something, it strikes me as nothing more than a huge boondoggle designed to lure parents of autistic children to an expensive, cumbersome, and almost certainly useless therapy. I thought I had seen it all when it comes to bad clinical science and bizarre treatments for autism, but Dr. Faber has shown me that I was clearly wrong about this. He’s also made me wonder just what sort of strangeness I will encounter next.
I’m not sure I look forward to that answer.
A Good Poop : This is why they post all of those warnings on roller coaster line entrance signs
May 12, 2008
Thakur D, Pocha M. Pneumothorax after a roller coaster ride. Arch Dis Child. 2007 May;91(5):421. No abstract available.
So riding a roller coaster can potentially cause your lung to deflate like a balloon. Now that’s a ride!
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Roldan-Valadez E, Facha MT, Martinez-Lopez M, Herrera-Mora P. Subdural hematoma in a teenager related to roller-coaster ride. Eur J Paediatr Neurol. 2007 Jul;10(4):194-6. Epub 2007 Sep 1.
A subdural hematoma occurs when veins in your brain rupture for some reason (usually a head injury), resulting in blood pooling underneath your skull. The pressure created by the pooling blood can deform your brain.
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Schievink WI, Ebersold MJ, Atkinson JL. Roller-coaster headache due to spinal cerebrospinal fluid leak. Lancet. 1996 May 18;347(9012):1409. No abstract available.
A fluid leak sounds like a car problem and not a person problem. Ick.
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Pelletier AR, Gilchrist J. Roller coaster related fatalities, United States, 1994–2004. Inj Prev. 2007 Oct;11(5):309-12.
Approximately four people die every year in the United States due to a roller coaster-related injury. Given the abject stupidity of a good portion of humanity, I honestly figured it would be worse than that.
Effect Measure : Now keeping us safe is illegal, too
May 12, 2008
The subject of a recent post, rabies, put us in mind of another rare, invariably fatal neurodegenerative disease, Creutzfeld-Jakob Disease (CJD). There is now pretty good evidence that the outbreak of CJD in Europe since the 1990s is caused by the same agent that causes Bovine Spongiform Encephalopathy (BSE), also known as mad cow disease. The incriminated transmissible material is an unconventional agent, an infectious protein (now called a prion). When a prion from a BSE case in cattle is consumed it causes a disease very like CJD in humans. Technically it is called new variant CJD (nvCJD). The BSE prion is thought to stem from feeding cattle other cattle via feed, a practice which is now outlawed. As a result BSE is decreasing in Europe, where extensive testing of cattle is done prior to letting the meat into the chain of commerce. Only a few cases of BSE have been detected in the US, where allegedly stringent controls have been instituted to prevent BSE from occurring. But only a tiny fraction of US cattle is tested and the cattle industry has strenuously resisted any calls for better coverage. You would think that an enterprising meatpacker would test their own products and market it as safe, thus gaining a competitive advantage, especially in export markets highly sensitive to the BSE problem, like Japan. You would be wrong. Not because it isn’t a good idea but because the US Department of Agriculture (USDA) forbids the practice. We’ve discussed it three times here in the context of a Kansas company trying to test its own cattle and being told it cannot.
Our first visit to this ridiculous episode was over three years ago, January 2007. A second case of BSE originating in an 8 year old Canadian dairy cow had just been discovered but the US was planning to resume importing Canadian beef anyway after a brief interruption after another Canadian imported case. As a result Japan banned US beef because the US refused to require all cattle under the age of 30 months to be tested. A small packing house, Creekstone Farms, wanted to test all its cattle so it could export to Japan. It was told by the USDA it couldn’t. Creekstone had to lay off 150 workers and reduce the other 650 workers to a 32 hour workweek. Creekstone is located in Arkansas City, Kansas, a town of only 12,000, and is its main employer. The USDA’s reasoning is that the test in young cattle would not guarantee safety and thus the testing would be unfair marketing. As if the USDA cares about unfair marketing when it doesn’t affect the big meat packers, whom it consistently protects and shields.
If refusing to allow a company to test its cattle when it is required by a foreign government sounds stupid to you, you aren’t alone. It sounded stupid to a federal judge, too, who in April 2007 told the USDA it couldn’t prevent companies from doing what was obviously a sound business decision. But he put the decision to allow testing on hold pending government appeal. At the bidding of the meat industry the government did appeal and now their lawyers are arguing the case:
Creekstone Farms Premium Beef LLC, the Kansas-based meat producer, shouldn’t be allowed to test beef for mad-cow disease on its own because it could hurt the U.S. cattle industry, a government lawyer told an appeals court.
“They are creating a false assurance” because the test Creekstone wants to use can’t show that meat is completely free of bovine spongiform encephalopathy, or mad-cow disease, Justice Department attorney Eric Fleisig-Greene told the court at a hearing today in Washington.
“The test is not only unnecessary, but it has no value whatsoever,” Fleisig-Greene told the three-judge panel, adding that a “false positive” from the company’s testing would hurt the entire U.S. cattle industry. (Bloomberg)
Let’s think about this argument for a moment. Either the test is accurate or it isn’t. Suppose it isn’t. It could be wrong in either or both of two ways. It could produce false positives, that is, say cattle is diseased when it isn’t. That is relatively easy to check by a pathologic examination of the animal. It is of no particular value to Creekstone to show it’s cattle are diseased when they aren’t so there is no incentive to make the test come out that way either. Or it could produce false negatives, saying the cattle are healthy when they aren’t. But the USDA has already said US cattle are healthy, staunchly maintaining there is a very, very low risk of BSE in the US, hence the paucity of testing even older cattle. So an alleged negative test only ratifies what the USDA maintains as an official position. If there is no assurance it is true (how else could there be a false negative?) then the USDA is the one that is offering false assurances. Creekstone Farms would only be offering false assurances to the Japanese under the USDA scenario. The USDA would then be offering false assurances to the entire US population.
The threat that a positive test (real or not) could hurt the entire US cattle industry is what this is all about. This is an administration that claims to have kept us safe. It is Orwellian Newspeak at its finest.
What’s my beef? I’m mad as hell. 253 more days of this utter bullshit.
Dr. Joan Bushwell’s Chimpanzee Refuge : Florida, vanity, and lying healthcare dispensers
May 12, 2008
If there’s one part of the country that may be as obsessed with its collective personal appearance as Los Angeles, it’s Florida — specifically its larger cities and metropolitan areas, especially those in the state’s southern coastal areas: Miami-Fort Lauderdale-West Palm Beach, Tampa-St, Petersburg, Naples, Fort Myers, and others.
In L.A., people at least have the excuse of needing to look New and Improved owing to anticipated, incipient, or extant acting careers. In Florida people just want to look good for the hell of it, and more specifically don’t want to look old even though the median age is (reaching into my ass here) about 87.3.
I live in the Sarasota-Bradenton mini-coglomerate, which numbers about 650,000 people, among them Stephen King, Paul Reubens (a.k.a. Pee Wee Herman), Jerry Springer, and Martina Navratilova. It’s not the sprawling hell that Broward County, where I held my first Florida address, has become, and it retains a more of an “old Florida” feel than strip-mall- and golf-course-covered South Florida does. But make no mistake — it has its fair share of eight-lane thoroughfares, magnificently inconsiderate drivers, and ugly condominiums, with the influx of humanity trickling off recently as a result not of carefully managed growth but of a cratering housing market.
Getting back to the main idea here, plastic surgery and its derivatives are more than alive and well — they’re thundering around town, priapic and beaming ever prepared to give your wallet a nice reaming while returning nothing of value. And some of those derivatives are comically, gloriously dishonest.
A few mornings ago I hit a Whole Foods to collect lunch from the salad bar, a luxury I allow myself once a week. On the way out I snatched a copy of a free magazine I’d never seen before called Natural Awakenings. Given my proclivities for seeking mostly harmless forms of adversity in the name of wasting time, I believe I grabbed this publication because I at some level was confident that within its pages I would find a veritable gold mine of eminently bloggable, undiluted fifth-degree woo.
Holy botched botox, Batman! The ads supporting this amalgam of holistic altie nonsense were worse than I could have imagined. First there was an ad from an M.D. pushing something called prolotherapy, which involves injecting hyperosmolar dextrose into the origins and insertions of tendons and ligaments in order to promote blood flow to these areas and thus speed healing. I’ll deal with this topic in a future post.
Now attuned to what I held in my hands, I flipped ahead a few pages and was confronted by an even more absurd ad — this one yammering about “bioidentical hormones” used to promote weight loss in a “hormone diet” used in conjunction with things called “lipodissolve” and “cold laser.” It didn’t note what hormones are to be eaten, but apparently they’re useful for spot reduction, which has never actually been achieved. The best part? At the bottom of the page was a head shot of the same doctor as the one behind prolotherapy. His name is Mark Vincent Walter and he runs an operation called BodyscultpingMD, ProloMD and the Prolotherapy and Mesotherapy Clinic, which is less than a mile from where I live.
Dr. Walter’s BodyscuptingMD Web site includes the same claims as those in the ad, which reproduces them almost word-for-word. Let’s have some fun and look at these.
First, have a gander at the photo on the front page. Think this woman achieved that look thanks to an intervention by Dr. Walter or that her physique represents the typical end result of one of his treatments?
This passage encapsulates the central dogma of the entire enterprise:
“Nonsurgical Bodysculpting incorporates the latest technology in Lipodissolve, Lipotherapy and Cold Laser to reshape undesirable localizations of fat such as the belly, saddlebags, love handles and double chin without the risks and downtime of liposuction surgery.”
Dr. Walter is thus claiming his techniques allow for “spot reduction,” something that has never been demonstrated to exist in the absence of literally carving or sucking far from people’s “trouble spots.” As one can see by reading through the whole site, what Walter banks on, just like every other lying pitchman in the spot-reduction indwoostry, is people losing weight generally and thus seeing some pounds and ounces disappear from their “trouble spots” as well.
“We are particularly excited about our medical weight loss program that incorporates HCG and other bioidentical hormones as well as vitamins and amino acids to create the optimal environment for successful weight loss and resetting of the hypothalamus. This program builds on the work of Dr. Simeon who pioneered many revolutionary approaches in the field of medical weight loss. In our view this program is an elegant solution to the weight loss conundrum that so many Americans experience. It is absolutely the safest, most effective and most comfortable program available today.”
If you’ve never seen the term “bioidentical hormones,” be aware that it puts those who deploy it on a par with scammers like these and this one. The reason Walter and and his ilk use it lies squarely in the willingness of the general public to put faith in anything sufficiently scientific-sounding. Merely duplicating the chemical structure of a naturally produced hormone does not make it especially safe or useful. For years, the medical world has boasted all sorts of frequently prescribed hormones identical to those made in the body and produced using recombinant technology and other methods (e.g., insulin, erythropoetin, thyroxine, various steroids). This doesn’t mean that you can’t fry yourself on practically any of them, not only through the direct effects on hormone target tissues but by interfering with natural feedback loops and shutting down organs such that the adrenals, thyroid, gonads and others.
A shorter way of making this point is noting that “bioidentical” copperhead snake venom can kill you. It would be fun tho sit this guy down and ask him if he thinks there are no cases on record of athletes and others doing serious and sometimes permanent, even fatal damage to themselves through the use of androgenic hormones that merit the classification “bioidentical.”
Here’s the really funny part. Lower on the front page, Dr. Walter says:
“We avoid Pharmaceuticals and food substitute approaches because these are simply unhealthy and unlikely to be successful in the long term.”
And here he more or less repeats himself:
“We avoid pharmaceutical approaches- not only are the side effects unacceptable but when you discontinue them your weight will rebound.”
Folks, understand one thing: When a doctor pushing hormones claims to reject “pharmaceutical approaches,” understand that he is a brazen fucking liar. In the quiet, prevarication-happy recesses of his own mind, does he really pretend that exogenous hormones are not simply drugs? I doubt it. But if so, how does this wizard propose that estrogen- and progesterone-based birth-control pills exert their effects? There are a slew of similar examples.
I don’t know if the Web site includes the term “hormone diet,” but the print ad does. This is more undisguised bullshit. Hormones, unlike macronutrients (carbohydrates, proteins, fats), offer no calories whatsoever. If you tried to subsist on them, even a wide variety, you would starve to death. “Hormone diet” is as meaningful as “hashish diet” or “sand diet.” I wonder if any of the same duped yokels who shun certain dairy and poultry products for fear of their being tainted by growth hormone would eagerly go on Dr. Walter’s hormone diet.
As for “lipodissolve,” watch this CBS news segment on the procedure and draw your own conclusions. This procedure, like many provided by huckster-docs, is not aproved or regulated by the U.S. Food and Drug Administration.
One notable advocate of woo-driven hormone regimens is former Three’s Company starlet Suzanne Somers. I’m convinced that Somers is a robot invented by a coalition of jaded but creative engineers bent on exacting revenge on blondes by making them look stupid as hell. See what nonpareil crankbuster Orac has to say about her here and here.
One last thing for now. Walter refers to himself on one of his other sites (I’ll get to that in a later posting) as a specialist in “non-surgical orthopedics.” Forgive my ignorance, but isn’t that sort of like specializing in chemistry-free toxicology, male gynecology, or adult pediatrics?
And so. long after the Ringling family left Sarasota, the circus continues, with the clowns in white coats now outnumbering the traditional, less scary kind.
Respectful Insolence: More of the consequences of not vaccinating…
May 11, 2008
…more outbreaks of vaccine-preventable diseases like pertussis:
Erik Ferry thought little of the sniffles and cough his 12-year-old daughter came down with in February.
But the coughs became more frequent and violent, and the bug hung on for days, then weeks.
Concerned it was more than just a cold, Ferry took his daughter to the doctor, and a dose of antibiotics cleared things up. Only later did he learn that several of the girl’s classmates at the East Bay Waldorf School in El Sobrante had the same symptoms.
And it was only this month that Ferry, who lives in Berkeley, learned that a bout of pertussis, or whooping cough, was sweeping through the school like a bad rumor: Sixteen students have been diagnosed, and health officials suspect many more are infected.
The outbreak was so severe that school officials had to shut down the school to control it. The reason for the outbreak? I think you know the answer to that one already:
Contra Costa Health Services temporarily shut down the private East Bay Waldorf School on Friday in an effort to control the outbreak, which health officials say spread quickly because fewer than half the students at the school are immunized.
Students and staff will be allowed to return to school Monday, Contra Costa Public Health Director Wendel Brunner said, but all parents must prove their children are on antibiotics.
What?
Screw antibiotics! They’re at best a short-term measure. Make sure all the children are immunized against pertussis before they are allowed back! Antibiotics are a short term solution. (I’m also surprised that such lovers of “natural” cures will eschew vaccination but require its children to down three weeks worth of the evil, big pharma tool of antibiotics.) A 50% immunization rate is far too low to sustain herd immunity, leaving the population there vulnerable to outbreaks. Unless immunization rates top 90%, there’s little to stop something like this from happening again:
School and health department officials said they have been trying to control the disease — affecting mostly kindergartners — since the first confirmed case in April. But Ferry said he believes the pertussis started making its way around the school in January, when several students initially got sick.
“Closing a school for an outbreak of pertussis is a very unusual action,” Brunner said. “Normally, we’re able to control pertussis cases in schools without closing the school; however, the situation in the East Bay Waldorf School is different. They have a very low rate of immunization among their students.”
About 98 percent of students at other schools in the county — public and private — have been vaccinated. California law allows parents to opt out of immunizing their children for various reasons.
Waldorf Schools, of course, are well known for being places where parents tend to be very open to “alternative” health practices and antivaccination sentiments. However, they could well be the canary in the coal mine as vaccination rates fall. And what is one of the reasons, arguably the major reason, parents are afraid of vaccines and vaccination rates are falling? Well, I think you know the answer to that one too:
Contra Costa Health Immunization Coordinator Erika Jenssen, parent of an 11-year-old at the school who has been immunized, said some parents cite studies that indicate vaccinations may cause autism as a reason for opting out.
Another problem, of course, is that the unvaccinated tend to cluster in crunchy places like Waldorf schools, a nidus for infections that can provide a reservoir of disease that can spread to the rest of the community, endangering those who can’t be vaccinated for medical reasons and the small percentage of the vaccinated who did not develop immunity. Contrary to the insinuations of antivaccinationists, who view diseases like pertussis as not a big deal, pertussis is a huge deal, particularly in infants. The WHO estimates that 294,000 infants died of pertussis worldwide, and in the prevaccination era there were on the order of 10,000 deaths a year from pertussis in just the U.S. alone. The usual causes of death from this disease are secondary pneumonia, dehydration, hypoxia, encephalopathy, or cerebral hemorrhage, the last of which occurs because of the paroxysmal coughing, which elevates intracranial pressure. Moreover, up to 25% of children under 4 and 4% of children over four develop a secondary pneumonia, which often requires hospitalization. Even leaving that aside, the unrelenting cough that the disease causes is horrible to behold and even more horrible for a child to endure.
I fear that this is the sort of story that we will be seeing more and more of in the future. I had thought that they had faded into the woodwork, but antivaccinationists are like cockroaches. They never really went away. They were always there, lurking under the floorboards, and now they’ve managed to get celebrity power in the form of D-list celebrity Jenny McCarthy who, despite being dumb as a rock when it comes to science and medicine (and that’s actually an insult to rocks) while she spreads toxic myths about vaccines, nonetheless thinks her University of Google degree gives her the background and knowledge to tell physicians that they don’t know what they’re talking about. They’ve also been lucky enough to be able to take advantage of a confusing ruling in the Hannah Poling case that opens the door for them to spin it into a “concession that vaccines cause autism” when it is nothing of the sort.
Worse, on June 4, led by the ex-comedienne turned antivaccinationist Jenny McCarthy, hordes (or maybe dozens; it remains to be seen) of activists who disingenuously claim they are not “antivaccine” while attributing all manner of toxins and evils to vaccines, will descend upon Washington, D.C. to protest in a “Green Our Vaccines” rally. They’ll likely get national news attention and scare even more parents about vaccine safety. It’s true that the organizers of the march are trying to hide the more–shall we say?–vociferous of the antivaccinationists in their ranks in order to try to maintain the facade that they are not “antivaccine,” but the rabid antivaccinationists will be there nonetheless. They’ll be meeting with their–and your–legislators and doing their best to influence them.
What’s likely to happen next if pro-science forces don’t get their acts together is a sadly predictable phenomenon. The more vaccination rates fall, the more frequently outbreaks like this will occur. The more vaccination rates fall, the more children and adults will become ill with vaccine-preventable diseases. The more vaccination rates fall, the more deaths there will be. If antivaccinationists get their way, maybe even polio could make a comeback.
All of this leaves the question of what to do. What can those who understand the value of vaccines do to counter this well-financed, well-publicized effort? Three years ago, antivaccinationists were the gang that couldn’t shoot straight. Now they’re appearing on Larry King’s and Oprah’s TV shows to spew their fear to the masses. When the number of vaccine-preventable deaths per year skyrockets from the double digits to three, four, or even five digits, you’ll know whom to blame, but it will be too late. As the U.K. experience over the MMR vaccine shows us, it can more than a decade or more for the damage from such campaigns to be repaired.
The Loom : Sex In A Blender: The Microcosm Edition of Bloggingheads
May 10, 2008
As long as I can remember, I’ve been a fan of George Johnson’s writing about science. He has always kept focus on the deep mysteries of existence, even while writing in a deliciously clear style. So it was a real pleasure to talk to him on bloggingheads.tv about my own book, Microcosm. Even though we spent lots of time wondering what E. coli tells us about the universal rules of life itself, we still found time to talk about what it’s like to have sex in a Waring blender. Check it out. (And to all those insomniacs–don’t forget, I’ll be on the radio on Coast to Coast AM tonight at 1 am.)
The Loom : New Scientist: Microcosm is “exciting,” “original,” “powerful”
May 10, 2008
From the new issue: “It is a powerful account of the dynamic, complicated and social world we share with this ordinary yet remarkable bug. Evolution and genetics glitter among the pages, as do the lives and experiments of the scientists who have studied them. Microcosm is exciting, original and wholly persuasive of the beauty and utility of looking at the largest of issues from the smallest perspectives.”
The Loom : Time change for Coast to Coast: 1 am EST Sunday
May 10, 2008
I’ll be talking on Coast to Coast at a slightly less wee-hours time: 1 am on Sunday.
