Wednesday, November 30, 2005

Carnival barking

I can't believe I did it.

I can't believe I forgot to plug Grand Rounds yesterday.

Ah, well, time to make up for lost time...

Grand Rounds, vol. 2, no. 10 has been posted over at Over My Med Body. (Great blog name.)

And, for all you scientifically-inclined readers, Tangled Bank #42 (you know, the Answer to the great question of Life, the Universe, and Everything) has been posted at Dogged Blog (Another great blog name).

Also, Medgadget is now open for nominations for the best medical blogs of 2005, with a variety of categories for which you can make nominations. Voting will begin in January.

More rebuttals of HIV/AIDS "skeptics"

As regulars may recall, about a week and a half ago, I got a little riled up at having my honesty questioned by a certain blogger who doesn't think that HIV causes AIDS. This same blogger, Dean Esmay, has been commenting fairly extensively over the last couple of months about Eliza Jane Scovill, an unfortunate child who died tragically, collapsing suddenly after an upper respiratory infection and an ear infection. At autopsy, the coroner found, among other things, Pneumocystis carinii pneumonia and HIV encephalopathy, leading him to conclude that Eliza Jane died of complications due to AIDS.

It's a tragedy any time a child dies of AIDS or any other disease, but this case would not have garnered any press attention had it not been for the fact that Eliza Jane's mother, Christine Maggiore, happens to be a very high profile member of a movement that professes "skepticism" (more like outright denial, actually) that HIV causes AIDS, despite the overwhelming scientific, epidemiologic, and clinical evidence to the contrary. Based on her belief, she had refused to take antiretroviral drugs or to have Eliza Jane tested for HIV. Although I have no reason to believe that she was anything other than a loving mother otherwise and no mother should have to suffer such a horrible loss, she was tragically incorrect in her decision. Dean Esmay, of course, vigorously defended her to the hilt.

What prompted my initial response was a "pathologist" report by one Dr. Mohommed Al-Bayati that purported to "rebut" the L. A. County Coroner's conclusions regarding this unfortunate child's death. Actually, it wasn't exactly the report itself, but rather it was Dean's mention of me (and others who had spoken out against the dangerous pseudoscientific myth that HIV doesn't cause AIDS) as he trumpeted the report as "proof" that Eliza Jane didn't have AIDS and lambasted the coroner and the L. A. Times for a "political diagnosis in order to grandstand." (Oddly enough, he never explained why the coroner, much less the L. A. Times, would want to "grandstand" over this case.) Oh, and Dean implied that I was dishonest and accused me of "lynch mob prejudice." Annoyed, I wrote a long and rather detailed (not to mention occasionally sarcastic) rebuttal of Dr. Al-Bayati's report, a rebuttal that Dean never bothered to respond to, although I knew he knew about it from the comments in his own blog. (Maybe the verbiage and admittedly excessively technical jargon scared him off. If so, good.)

Now, two other health care professionals have weighed in on this tragic case, and they both agree with me.

First up is Trent McBride, a pathology resident who blogs at Catallarchy. He has now presented an excellent explanation of why the Al-Bayati report is full of holes. He's also a lot less--shall we say?--vociferous than I was, but he nonetheless takes down Dr. Al-Bayati's claims with a calm, polite demeanor that's devastating. Given the way that Dr. Al-Bayati appealed to the definition of pneumonia from a single pathology textbook ad nauseam to claim that Eliza Jane couldn't have PCP because she didn't have "pneumonia," I particularly like the way that Trent turned the tables on him and quoted him back several definitions from pathology textbooks that totally support the conclusion that the findings in Eliza Jane's lungs were entirely consistent with--nay, even pathognomonic of--PCP pneumonia. Trent also found another feature that I missed and am now kicking myself for not having picked up on. Remember how I went on about how the steatosis of the liver (fatty infiltrate) described on the autopsy was not consistent with acute liver injury from amoxicillin-clavulanate? Trent agrees, but he also found a tidbit that I should have looked up. It turns out that steatosis is very common in pediatric AIDS patients. It was originally thought that this AIDS-associated steatosis was due to antiretroviral drugs used to treat AIDS, but Trent found a study that shows it's quite common in patients before they've ever been treated. True, steatosis is not in any way specific for AIDS, but it is entirely consistent with AIDS. Excellent work, Trent.

But that's not all. Nick Bennett, an MB/Ph.D. (he's British, hence the M.B. Chir instead of MD) is a pediatrics resident whose Ph.D. thesis concerned the molecular biology of HIV. He runs a blog called AIDS Myth, in which he routinely rebuts the distortions and selective evidence use of the HIV/AIDS "dissidents." (Now that I've plugged his blog, I just hope he updates it more often.) Dr. Bennett was also kind enough to e-mail me a PDF file containing his point-by-point rebuttal of Dr. Al-Bayati's report, and Trent was kind enough to host it for us at Catallarchy. You can download the PDF of Dr. Bennett's response to Dr. Al-Bayati here or here.

Dr. Bennett covers a lot of the same ground as Trent and I did. He nicely takes apart Al-Bayati's attribution of Eliza Jane's collapse to an anaphylactic (allergic) reaction to amoxicillin on clinical grounds. He points out that multinucleated giant cells in inflammatory lesions in the brain without granulomas are very characteristic of HIV encephalitis, even if it hasn't manifested symptoms yet. He says basically the same thing as Trent and me with regards to Al-Bayati's bogus attempt to blame parvovirus for the Eliza Jane's anemia. All of this is different in emphasis and better on some details, but Dr. Bennett's unique contribution to debunking Dr. Al-Bayati's report comes from his perspective as a pediatrician. Using that experience, Dr. Bennett does something that I (and I daresay Trent) probably never would have thought to do (neither of us being pediatricians or primary care doctors). He takes a much closer look at Eliza Jane's growth curves:
I note that Al-Bayati says that EJ’s weight is within the normal range for a child of her age. She is according to him within the 5th centile for her age, but a proper growth chart plot shows that she in fact suffered from a striking failure to thrive from the age of approximately one year. Although she did indeed gain 22 pounds during her life, a child born at 7lbs of weight is expected to weigh 4 pounds more than she did at the age of her death (a difference of around 15% of her actual body mass). In addition, it is clear that this final weight is an aberration from her normal growth curve, as if she had continued along her past track she should have only weighed 26-27lbs at the time of death. The extra 2 lbs (around 900 ml equivalent) is perhaps accounted for by the additional fluid found within and surrounding her organs at the time of death. As such, it appears more likely that the fluid accumulated over time, rather than as a result of simply moving out of the vascular spaces, as if that would have happened her total mass would remain unchanged. Alternatively it may simply be a result of the fluid boluses given to her during resuscitation – without being able to see the actual medical notes I can’t say either way. A significant resuscitation of 40ml/kg would account for around half of that additional volume.
He concludes:
As such, it would appear to me that EJ had some form of significant clinical problem for the 2 and a half years prior to her death, regardless of her status regarding other childhood illnesses (which by all accounts was unremarkable). Her weight is in lower centiles by my reckoning than what Al-Bayati states, but that may simply be a result of using different growth charts or rounding-up to the nearest line. These charts are the current (2002) versions from the CDC website, accessed Nov 2005. The lowest line is the 3rd centile, which EJ generally remains below. In basic terms, if around 100 kids of the same age were lined up, EJ would have been the smallest.

There is a possibility of a metabolic disorder resulting in failure to thrive, but since she did so well for the first 12 months of her live, I don’t consider that a real possibility. Regardless of cause, aged 3.5 years she weighed only as much as a 2.5 year old would normally weigh (and remember, she was born smack in the middle of the spread, at 7 lbs).
He further concludes that there is good evidence that her failure to thrive and fluid accumulation may have been due to nephrotic syndrome due to Minimal Change Disease, a kidney disease that shows little or no change in the kidney structure on biopsy and can be precipitated by HIV infection. Whether he's right or not about this (this is clearly more speculative than his points about parvovirus, amoxicillin allergies, etc.), he makes a compelling case, and that diagnosis as a cause of EJ's generalized edema is one I never would have thought of. Also, if the data regarding Eliza Jane's weights at various ages are correct, Dr. Bennett's analysis also casts doubt on the HIV denialist claims that Eliza Jane was "perfectly healthy" all her life. She may have seemed healthy, but if there was indeed a failure to grow it should have tipped off her pediatricians that something might be wrong. But you really should read all of Dr. Bennett's analysis. It's quite accessible to the lay person.

So how did Dean react to Trent's rebuttal of Dr. Al-Bayati's report?

He repeated the same canard about Pneumocystis being 100% ubiquitous, which Trent rebutted and ignored all the substantive criticisms of the report that Trent and I had made. And then he called me dishonest again.

And how did I react to Dean's impugning my honesty a second time?

I laughed. (Never let it be said that I don't learn from experience to consider the source.)

Oddly enough, though, Dean seemed the most annoyed by a throw-away comment I had made about how he liked to argue from authority a lot and tended to wave Dr. Duesberg's credentials around like "a talisman to ward off attacks against his pseudoscientific posturing." (OK, perhaps that was a bit more of a rhetorical flourish than I needed to use; but give me a break; I was on a roll.) Quoth Dean in the comments:
I tried reading Orac’s response, by the way, but it was so full of false accusations that I couldn’t get through it. The man argues first and foremost through attacks on others’ credibility. I do not, for example, “wave credentials” at anybody, not for my friends or detractors. I note only that credentials do matter, and that in any area of science, a qualified scientist should be respected as having the right to a dissent, even if it’s a minority position, AND, that one shouldn’t treat qualified scientists as kooks or people who can be dismissed with an airy wave of the hand. That is all I have ever said on the subject of credentials; Orac’s dishonesty in this leads me to the (admittedly ad hominem) conclusion that he can’t be trusted to be honest on anything else.
Of course, notice (as Joseph did) that Dean neglected to point out a single instance of a "false accusation." Surely if I'm that dishonest, it should have been child's play to point one example of my "dishonesty" out. Second, he characterizes my debunking of Dr. Al-Bayati's nonsense as being primarily an ad hominem attack, when in reality I spent about one paragraph on Dr. Al-Bayati's credentials (or lack thereof, actually) and many long paragraphs addressing the meat of his report. Truth be told, I had learned some unflattering things about Dr. Al-Bayati's previous work that I could have pointed out but intentionally refrained from doing so in order to focus on the report itself. (I will not go into them here, either.) If all you knew about what I wrote is what Dean said, you'd have thought that all I did was to trash Dr. Al-Bayati, when in fact questioning his credentials was a small part of what I wrote.

But the funniest thing of all is that, a couple of comments before his broadside at me, Dean had confirmed exactly what I said about his penchant for arguing from authority. How? He had waved Dr. Al-Bayati's credentials about (metaphorically speaking), of course! But that wasn't enough. He had also pointed out an endorsement of Dr. Al-Bayati's report by Andrew Maniotis, Ph.D., someone whom Dean termed a "Professor of Pathology at the University of Illinois at Chicago." Well, not exactly a Professor, Dean (at least not a full Professor), but rather an Assistant Professor and a Ph.D. researcher. (To be fair, I did notice that his department web page hasn't been updated in a long time, making it possible that, since he finished his postdoc in 1997, he may have recently been promoted to Associate Professor). Also, Maniotis is not a pathologist, although most people, probably including Dean, wouldn't realize that from his title. (Most people just aren't aware that most academic pathology departments have Ph.D. basic science researchers on their faculties who are not pathologists but are professors of pathology; just because someone has the title of Professor of Pathology does not necessarily mean that person is a pathologist.) None of this, a priori, means he is wrong, but he's probably no more qualified to comment authoritatively on HIV than Dr. Al-Bayati. Also, Dr. Maniotis has just as much of a bias as Dean, Dr. Al-Bayati, or Christine Maggiore as shown by--surprise! surprise!--the fact that he just happens to have signed on to a letter by the Perth Group, to be on the Board of Advisors (with Dr. Al-Bayati) of the HIV/AIDS "dissident" group Alive and Well (founded by Christine Maggiore), and to have been characterized by Dean himself as thinking that "the HIV/AIDS theory is hogwash." (To be fair, though, I will give Dr. Maniotis props for doing what sounds like some rather interesting research on vasculogenic mimickry in melanoma and chromatin structure in cancer cells. I may even look up a couple of his articles to see what he's up to.)

In any case, I'm sure Dean is incapable of seeing the irony in his own statements and how his own response simply confirmed my assessment of him.

Tuesday, November 29, 2005

My ears are bleeding

Listen to this.

But only if you have as strong constitution and a high tolerance for bad music. It seems to be a weird right-wing mutant cross of Billy Joel's We Didn't Start the Fire, coupled with Cheap Trick-esque flourishes (I half expected to hear them screaming "We're all alright, we're all alright, we're all alright, we're all alright" the way Rick Nielsen and Robin Zander did in the the version of Surrender featured on At Budokan). Worse, it's all coupled to a truly annoying "anthemic" chorus consisting of three words, all executed by a band that sounds like a cross between Loverboy and a high school Green Day wannabe garage band with middling talent and even less originality. At first I thought that it had to be some sort of parody, but it doesn't seem to be. These guys seem as though they're playing it straight.

And the lyrics. Holy crap. On the other side of the political spectrum, you may recall that I lambasted the Stones' recent song Sweet Neo Con for some truly inane lyrics, but this one makes Sweet Neo Con look like The Clash's political masterworks Clampdown, The Guns of Brixton, or (White Man) In Hammersmith Palais. Geez, if you're going to try to write conservative political rock, at least get that cuddly reactionary heavy metal rocker and bow hunter Ted Nugent. True, the lyrics would then be even more inane (if that's possible), but at least the Motor City Madman knows how to write songs that really rock. Oh, and lose the Bush cheerleading. Bush is not a real conservative, anyway. Just look at the growth in federal spending and the budget deficit under his term thus far if you don't believe me.

The sad thing is, I'm guessing that this song will go into heavy rotation on Rush Limbaugh's and Sean Hannity's shows as lead-ins and lead-outs, if it hasn't already.

Speaking of The Clash, though, have I ever mentioned how much I like them? In fact, they would easily make my top five favorite bands ever, if not my top three or two. (Of course, my favorite performer remains David Bowie; so that's the only reason The Clash could never make number one.) One of my fondest concert memories was seeing The Clash live in Detroit in the summer of 1982 at the Grand Circus Theater, where I got to experience why they were billed at the time as "the only band that matters." We had fifth row seats, and that concert ranks as one of the best, most intense shows I've ever seen. Near the end of the show, the roadies lost control of the stage, and a number of fans got up on the stage and started dancing, stage diving, and trying to sing with Joe and Mick. As fast as the roadies tossed them back into the mosh pit, new ones would appear. it was wild. (I stayed safely back several rows, preferring to avoid injury.) The only experience that could have been better would have been to have seen them in 1979 when they first toured America or (even better) in 1977 in the U.K. when they first broke (which, unfortunately, was before I discovered the joys of punk rock).

That's the reason why, when I saw the results of this silly little Internet quiz that I couldn't resist taking, I had to post it, even if there are a few who think it's a waste of time when I do these things (hopefully the commentary will make up for it):

you are Joe Strummer!
Joe Strummer... you've been through the cleansing fire of punk, only to pick up a few venereal diseases along the way. You're more of an optimist when it comes to fucked-up genius. But you can write wicked-deadly riffs and lyrics.


And Joe continued to make some top-notch music after The Clash broke up, both on his own, with the Pogues, and later with the Mescaleros. That's why it was a real shame when he died suddenly three years ago at the much too young age of 50.

You know, now that I think of it, even mentioning The Clash in the same post as these "Right Brothers" is an insult to the memory of Joe Strummer.

Forgive me, Joe, wherever you are.

Monday, November 28, 2005

Fostering scientific innovation, part 1: Impediments to innovation

Folks, I have to make a brief announcement here. I spent the entire weekend working on a grant that's due in a few days. Posts over the weekend (with the exception of Friday's post) were mainly excuses to procrastinate a bit when my brain started hurting from too much writing. I found myself last night wondering what, if anything, I would have time to write for today. I had planned on doing another part in my series about the Art of Medicine in Ancient Egypt, but fortunately for my career (although unfortunately for my blog) I was a good boy on Sunday. I spent it trying to pound the grant application into suitable shape for submission, and, by the time I couldn't stand it any more, it was after 1 AM, no time for composing a substantive post. (I should have saved Saturday's post about David Irving for today. The news and commentary would have kept for two days.)

What's worse is that I've always tried to post something substantive on Mondays. I'd feel as if I let you, my readers, down if I didn't post something. (Of course, you realize that this means I have little compunction about not posting substance on other days. It also means that blogging will be relatively light this week. Oh, I'll probably post something every day other than silly Internet quizzes, but chances are that the posts will be much shorter than you're used to. Don't worry, though, I won't turn into an Instapundit-style blogger. In any case, I'll try to make it up to you next week...)

Then I remembered this post. I wrote it back in June and had been meaning to post it since then as a starting point for an occasional series on scientific innovation, what hinders it, and what fosters it. The starting point was a meeting in Philadelphia.

So here goes:

I was sitting in the main hall at the Pennsylvania Convention Center, taking in the morning session of the U.S. Department of Defense Era of Hope Breast Cancer Research Program Meeting, when I browsed through the program, looking to see what the upcoming keynote speech would be about. Usually, keynote speeches at these conferences are given by distinguished scientists who have made a major contribution to the field, heavy hitters, if you will. This time, instead of seeing someone like Judah Folkman (who was the first to truly appreciate the potential for antiangiogenic therapy) Max Wicha (a major innovator who popularized the concept of breast cancer stem cells) Dennis Slamon (whose work led to the development of Herceptin, which has been a major advance in the therapy of breast cancer that overexpresses Her-2/neu), Gregory Hannon (a major force in double-stranded RNA-induced gene silencing at a young age), or others, the Army chose something different.

I must confess, when I saw the name of a Harvard Business School Professor Rosabeth Moss Kanter, who was billed as an expert on "creativity" and "innovation" in business, my first thought was "What the hell?" My second thought was that now would be a fine time to head to the Dunkin' Donuts on the first floor of the Convention Center for some fine caffeine and sugar to help me maintain consciousness and attention for the rest of the 13 hour day. My third thought was whether there this might not be a bad time to plant myself in one of the squishy chairs they had in the main hall and catch a quick nap before the real sessions resumed.

But I stayed.

I'm not sure if it was because of inertia or because my curiosity was piqued. I learned in the introduction that Professor Kanter is an advisor for the Army in how to design its research grant programs to promote innovation. She was also a dynamic speaker who can hold an audience's attention, although there were a few moments when she reminded me a bit of Chris Farley's motivational speaker Matt Foley, the one who used to warn his audiences, "You're gonna end up eating a steady diet of government cheese, and living in a van down by the river!"

She started by describing how large organizations put up roadblocks to new ideas, and immediately I could see she knew what she was talking about. Here are some of the common stumbling blocks to innovation, most of which you'll probably recognize (I'm not listing them all):
  1. "Simplify" (also known as the "PowerPoint disease." Managers and others in organizations are always wanting ideas presented to them in the simplest bite-sized form, complete with bullet points. Innovative ideas don't always fit into such constraints. If they do, they may not be all that innovative.
  2. "We want new ideas, but don't want to be 'first.'" Being first with an innovative idea is risky; what if it doesn't work? Of course, it never seems to enter their minds that an idea is not truly innovative if you're the second person to pursue it.
  3. "We want new ideas, just not those new ideas." How many times have you encountered this attitude? I'm not sure what "new" ideas managers have in mind. Probably
  4. Free thinkers are disruptive to organizations. Indeed they are, because they question the status quo and how things have always been done. They also propose ideas whose potential more conventional thinkers don't see the value of and only see as causing difficulties. Change is difficult.
In fact, I think #4 is probably the most significant impediment to true innovation. You might think that universities would be less prone to it than private industry. I would have too, given that medical schools with a heavy research commitment tend to be made up of individual investigators doing their own individual projects, perhaps collaborating with a few of their peers. If the investigators can get outside funding, it's unlikely that anyone in the medical school is going to tell them they can't pursue their ideas.

Unfortunately, it's not quite that simple. For one thing, for junior faculty like me, the Chairperson and Division Chief decide how much and how long they will support us as we struggle to obtain NIH funding to become independent investigators. If they don't like what we're working on, we could find our "protected" research time not so protected any more. Either that, or we might find difficulty getting institutional resources to help us out. If your innovative project involves animal research, IACUC (the committee that reviews all animal protocols to make sure they are scientifically valid and do not inflict excessive pain on the animals) may throw stumbling blocks up. If your innovative project involves human subjects, the Institutional Review Board (IRB) will put up major stumbling blocks, failing to see the potential value or exaggerating the risks. (Don't get me wrong; the very purpose of the IRB is to protect human subjects. However, if they fail to see any value in your work because they don't see the innovation, they will incorrectly rate the potential benefits lower than they should, leading to a perceived risk-benefit ratio that does not favor your project.)

Of course, let's not forget that universities, like any large institution, build up a self-perpetuating and self-protecting bureaucracy that abhors changes in operating procedure. Don't even get me started on that. I could tell you tales of dealing with the Grant Office that...well, never mind.

But what to do?

Well, that's the topic for the next post in this series, when I get around to it (and assuming I can still find my notes from this talk).

RINO Sightings, NSFW Edition

The latest RINO Sightings has been posted.

Don Surber sounds like my kind of conservative:
Yes, thank you for the imbalanced budget, Republicans.

Yes, thank you for Intelligent Design, Republicans.

And finally, thank you for Bill Frist. He'll make a fine president: The ethics of Nixon, the brains of Ford.
I couldn't have said it better myself, except that I think Ford looks better by comparison to Frist. The jury's out on how Frist will compare to Nixon.

Saturday, November 26, 2005

Busted for cheating...

File under: Strange But True and Amusing Justice.

A woman's parrot tipped her off to her husband's infidelity:
Freiburg, Germany (AHN) - A cheating husband was exposed after his wife's parrot imitated him calling out another woman’s name.

Frank Ficker, 50 was having an affair with a woman named Uta. His romantic trysts were observed and apparently “recorded” by the family’s pet parrot, Hugo.

Petra Ficker, 50, says, "Hugo always liked to mimic Frank and he could do his voice perfectly.” The parrot could “do” Frank asking who’s at the door, yelling at the nephews, however one day Petra heard Hugo “doing” something she never heard Frank “do”.

“I heard him doing Frank's voice, but saying ‘Uta, Uta’,” says Petra.
I'm guessing Frank will be a bit more careful in the future about who (or what) is around him when he's having an adulterous tryst.

More Schadenfreude: David Irving now admitting that there were gas chambers?

Yesterday's festivities left me with a distinctly depressed feeling. Oh, I was rather amused that JB Handley would think me worth spending the few bucks it took to buy up the domain and redirect it to his own anti-mercury website, but the reaction of at least two of JB's supporters to my shining a little light on their hero's little trick was depressingly similar to tactics that I had seen during my Usenet days again and again. (Ask one of my commenters, The Probe, if you really want to know how nasty things could get--and can still get--there.) In any case, my purpose has been served, and JB's deception revealed. That's enough for me.

Moving on to other topics, lightening my spirit this morning was this story about the notorious Holocaust denier David Irving:
A lawyer for British historian David Irving said on the eve of a court hearing that Irving admitted past statements could be interpreted as denying the existence of Nazi gas chambers - but now acknowledges they existed.

Prosecutors charged Irving earlier this week under an Austrian law that makes denying the Holocaust a crime.

The charges stem from two speeches Irving delivered in Austria in 1989 in which he allegedly denied the existence of gas chambers. If convicted, he faces up to 10 years in prison.

Irving has changed his views on gas chambers in recent years, his attorney, Elmar Kresbach said.
The History News Network has also referenced a Guardian story on the issue, which gives a little more background:
In the past, Irving has claimed that Adolf Hitler knew nothing about the systematic slaughter of 6 million Jews, and has been quoted as saying there was ``not one shred of evidence'' the Nazis carried out their ``Final Solution'' to exterminate the Jewish population on such a massive scale.

He is the author of nearly 30 books, including ``Hitler's War,'' which challenges the extent of the Holocaust.

Kresbach said Irving is now ``correcting himself,'' adding the historian now ``sees himself as somebody who can influence marginal groups who have difficulty believing in the Third Reich.''

He said he will argue at a custody hearing Friday that Irving should be released on bail.

No trial date has yet been announced. In Austria, suspected violations of the law banning attempts to publicly diminish, deny or justify the Holocaust are heard by an eight-person jury and three judges.
Before I comment, let me just reiterate how much I detest laws against Holocaust denial. They are an abomination against free speech. Worse, they give the vilest scum, Holocaust deniers, a plausible-sounding reason (plausible, at least, to people who don't know much about the Holocaust, which is most people) to don the mantle of free speech martyrs. I can see the purpose of these laws decades ago, when there was a real danger that Nazi-ism might rise again and Germany and Austria no doubt wanted to show the world that they would not allow this to happen. These days, however, such laws do more harm than good.

Nonetheless, once again it is hard not to feel yet a bit more schadenfreude to see David Irving suddenly backpedaling, now that he's in jail, and pleading that his writings and speeches given over three decades were all just some sort of misunderstanding, that he believes there really, truly were gas chambers. (A better question to ask him is whether he's willing to retract his previous statement that he believed the death toll of the Holocaust to have been exaggerated by roughly a factor of ten.) In actuality, Irving's splitting hairs here. One of the techniques of Holocaust deniers is to admit the existence of gas chambers in the camps, but then to claim that the cyanide was used to fumigate clothing, not to kill Jews and other enemies of the Nazi state. Alternatively, another technique is to claim that diesel exhaust can't kill. (It is not widely known among the general public that many Nazi gas chambers used exhaust from diesel engines, rather than cyanide.) Irving has always conceded that gas chambers existed; he has in actuality denied that homocidal gas chambers existed or were used to kill Jews.

In fact, a story this morning shows that Irving is willing to plead guilty in the hopes of leniency:
He [Irving] is to be tried under a 1947 Austrian law banning Nazi revivalism and criminalising belittling or justifying the crimes of the Third Reich. No trial date has been set. The case should be heard in January. Irving faces a jail term of one to 10 years if found guilty.

Mr Irving has 10 days to appeal against the indictment but is not likely to lodge an appeal. His strategy is to plead guilty before a jury trial, but to declare his remorse and insist that he has revised his views on the Third Reich in the years since he made the Austrian speeches in 1989. "This might be a big case, but it's not very difficult," his lawyer, Elmar Kresbach, told the Guardian yesterday. "There are the transcripts of his speeches, there is a newspaper interview that he gave [in 1989]. It's pretty black and white.

"But Irving told me that he has changed his views after researching in the Russian archives in the 1990s. He said, 'I've repented. I've no intention of repeating these views. That would be historically stupid and I'm not a stupid man.'

"He said, 'I fully accept this, it's a fact. The discussion on Auschwitz, the gas chambers and the Holocaust is finished ... it's useless to dispute it'."
The problem with this defense is, of course, that his "revelation" that the Holocaust did indeed happen must have come quite recently. Just reading his website shows that as recently as early 2005 Irving was still denying the gas chambers at Auschwitz.

If David Irving's gambit works, and he's given a lenient sentence, look for him to go back to his old ways as soon as he's released. Even if that happens, though, no doubt he will be diminished--perhaps fatally so, as far as being a leader in the Holocaust denial movement goes--in the eyes of his admirers. After all, for his "I repent" gambit to have a chance of working, Irving is going to be forced to state in unequivocal terms in open court that homicidal gas chambers did exist in Nazi death camps. Such an admission won't endear him to the hard core neo-Nazis and Holocaust deniers upon whom he's been relying to support him through the purchase of his books and attendance at his speeches.

Posts on this issue:
  1. Schadenfreude
  2. More schadenfreude: David Irving now admitting that there were gas chambers?
  3. David Irving to stand trial in Austria

Friday, November 25, 2005

Comment moderation has been temporarily turned on

I didn't want to do it.

I really didn't, but an anonymous commenter left me little choice.

Unfortunately, in response to my post revealing that I'd been punked (as Ginger put it) by J. B. Handley, an anonymous commenter, apparently unhappy that I had revealed J. B.'s little deception, started flooding this blog with comments that no blogger could permit, because they bordered on the kind of cyberstalking that I haven't seen since Usenet. So, sad to say, comment moderation has been temporarily turned on, meaning that, for now, comments will have to be approved by me before they appear. I'm sorry about this, everyone. Hopefully I won't need to leave moderation turned on for very long.

Please don't let moderation stop you, though. As you can see, I didn't delete Mr. Best's very hostile comment. I'll probably even approve comments by J. B. himself if he happens to show up to justify his actions, assuming he doesn't pull the same fast one the anonymous commenter did. (Anonymous comments will still be OK.) I haven't decided yet whether I will announce it in a separate post when I decide to turn moderation off again, because such an announcement might be noted and draw these nasties back.

Internet squatter: J. B. Handley

I hadn't been planning on posting today. Instead I had been intending to devote today solely to finishing up a pesky grant application that's nearing completion but needs a lot of polishing. Unfortunately, something came up. I tell ya, I sleep in a bit on a day off before taking on the task of trying to finish a grant, wake up to check my e-mail, and what do I find?

A reader (whom I wish to thank publicly and profusely) tipping me off to a dirty trick, that's what. This reader, apparently, mistakenly typed "" into her browser and found herself redirected to the Generation Rescue website, you remember, the site that states:
Generation Rescue believes that childhood neurological disorders such as autism, Asperger's, ADHD/ADD, speech delay, sensory integration disorder, and many other developmental delays are all misdiagnoses for mercury poisoning.

I was actually somewhat surprised to learn of this little bit of tricky cybersquatting, mainly because less than a month ago I had stated in a post that I was thinking of moving over to a new blogging platform and hoped to do so before my first blogiversary. Around that same time, I had checked to see if the domain name was available (knowing that my blog had been around long enough and had become prominent enough that it's possible someone else may have gotten there first). Foolishly enough, however, I didn't go ahead and purchase it at the time, indecision being the order of the day (as it has been with regards to my radically redesigning my template or dumping Blogger). In any case, I knew instantly that whoever had pulled this trick must have done so quite recently. A little WHOIS search of the public registry of who owns this domain name was all it took to turn up the person who had registered the domain: = [ ]

JB Handley

Registrar Name....: REGISTER.COM INC.
Registrar Whois...:
Registrar Homepage:
Domain Name:
Created on..............: Thu Nov 03 2005
Expires on..............: Mon Nov 03 2008
Record last updated on..: Thu Nov 03 2005
Administrative Contact:
JB Handley

Technical Contact:
Domain Registrar
575 8th Avenue
New York NY 10018
Phone: 1-902-7492701

DNS Servers:
Register your domain name at

Well, well, well. Given where now directs surfers to, this shouldn't come as any surprise, should it? After all, J. B. Handley of Generation Rescue has shown up here before in the comments, as you may recall, rather unhappy with some of my posts.

I couldn't help but note that my post stating that I was thinking of moving to another blogging platform was made on October 28. Then, on November 3, J. B. Handley registered in his name and redirected all traffic to it to his Generation Rescue website. Apparently, J. B. is no longer content just to comment here occasionally when I point out that the evidence does not support his contention that mercury causes autism. Apparently, now he feels the need to trick people looking for my blog. This is particularly odd, given that, in the month or two prior to November 3, I hadn't really written much at all about this topic. Not much was going on, and I had for the the time being moved on to other topics until quite recently.

In any case, the timing seems a little too convenient to be entirely coincidental, doesn't it?

I did a little more digging. Who else, I asked, has irritated J. B. Handley by insisting on sound science and pointing out that clinical and basic scientific data do not support his conspiracy-mongering? Well, there's Autism Diva, of course. So I looked up Yep, you guessed it. J. B. Handley bought that domain too: = [ ]

JB Handley

Registrar Name....: REGISTER.COM INC.
Registrar Whois...:
Registrar Homepage:
Domain Name:
Created on..............: Tue Nov 01 2005
Expires on..............: Mon Nov 01 2010
Record last updated on..: Thu Nov 03 2005
Administrative Contact:
JB Handley
Phone: 1-

Technical Contact:
Domain Registrar
575 8th Avenue
New York NY 10018
Phone: 1-902-7492701

DNS Servers:
Register your domain name at

He redirected traffic to to the Generation Rescue site as well.

Let's see. Is there anyone else? Well, there's (which, unfortunately, seems to be "on permanent hiatus," for reasons that I do not know). Guess what, though? J. B. Handley also bought and also redirected traffic to it to his own website.

I wonder what other domain names J. B. Handley has bought up in order to trick unwary surfers by directing them to Generation Rescue? Does anyone know a way to find out?

Tricks like this have traditionally been the province of spammers and Internet squatters, who buy up domain names that they believe a company or (or, relatively frequently, a political candidate) will want and then extort lots of money if that company or candidate wants to buy the domain name from them. Other uses of this tactic have been to set up attack or parody websites of the intended target that visitors end up at by mistake. One further variation is to buy up domain names that you would get with common typos of the target website. Personally, I highly doubt that Mr. Handley is after money from me, Autism Diva, or any other blogger that he doesn't like. More likely, he just wants to direct readers looking for blogs that try to counter his mercury scaremongering to his own website. And, of course, he probably wants to prevent me from using myself if and when I ever finally decide to move my blog to a different platform and/or get my own host (something I may never do, for the simple reason that Blogger, despite its many flaws, remains the best deal in town because it's free). Never mind that the mercury/autism controversy probably makes up way less than 5% of what I write about(if even that). No doubt J. B. had quite the self-satisfied chuckle when he did this and considers himself quite clever, but that Mr. Handley would stoop to such childish pranks for so little potential gain speaks volumes about him

Of course, scummy does not necessarily constitute illegal, and, of course, Mr. Handley did nothing illegal in purchasing these domains. Unfortunately, I probably have no recourse, other than to publicize his trick. I guess I have only myself to blame. I had been thinking of purchasing for several months but never quite got around to it. Consequently, my farting around allowed an Internet vulture like Mr. Handley snatch the domain name up first and use it for his own nefarious purposes. I wonder what some of Handley's admirers would say about his behavior in this.

Probably nothing.

I would, however, point out to Handley's supporters that you do have to wonder about someone who pulls a trick like this. Ask yourself: If Handley is willing to use a little deception in little things like this, doesn't it make you wonder about his behavior in larger things? At the very least, what he has done is petty and childish.

The really funny thing about this is that Handley's little prank was probably totally unnecessary, at least as far as preventing me from using goes. I'm probably going to stick with Blogger for at least a few more months, just with a different, far spiffier, template that I'm (very slowly) working on and hope to unveil by my blogiversary (assuming I can figure out how to work its many bugs out by then). Given that, I guess I can take satisfaction that I caused Mr. Handley to waste a small amount of his money registering that domain name and noting that he'd have to waste quite a bit more to keep me from using the same name with different extensions (.org, .info, .net, etc.). If I either fail to find a more productive hobby or my job fails to be all-consuming and I happen to be still blogging three years from now, it will be satisfying to think that Mr. Handley will have to waste even more money if he still wants to keep that domain name from me.

True, it's not very much in the grand scheme of things, but it does still make me chuckle just a little bit.

ADDENDUM: Sadly, the behavior of at least two commenters has left me little choice but to turn comment moderation on temporarily. More details here. Sorry, everyone. I'll try to turn it off as soon as it's feasible, because I really hate to interrupt the flow of comments due to delays in approving them.

Thursday, November 24, 2005

Happy Thanksgiving

Happy Thanksgiving to all. Because I'm fortunate enough not to be on call today, I'm taking the day off in order to partake in the American tradition of stuffing oneself until one is no longer able to move (or stay awake) and to express thanks for all the good things in my life. My only regret is that I can't be in Chicago, where my family is gathering.

Until tomorrow (or Saturday, if I overindulge), contemplate these words: "As God is my witness, I thought turkeys could fly..."

(More on this Thanksgiving classic here and here.)

Wednesday, November 23, 2005

Please excuse my while I vomit... (Part 2)

Here's a quickie.

Remember the Gaede twins? You know, the cute 13-year-0ld blonde-haired, blue-eyed, all "Aryan" Mary-Kate and Ashley of the white supremacist set who've become all the rage in white racist and neo-Nazi circles with their lame folk ballads espousing "white pride, " songs like Aryan Man Awake and wrote a song praising Rudolf Hoess? The ones who play a video game called "Ethnic Cleansing" and like to wear smiley face Hitler T-shirts?

They're baaaack. (Actually, unfortunately, they never went anywhere.)

It appears that they almost managed to be featured in Teen People without their vile racist beliefs being mentioned:
Teen People nixed a story about Hitler-loving teenybopper twins Prussian Blue - amid outrage that the glossy had promised to avoid the words "hate," "supremacist" and "Nazi" in its piece on the racist singing sisters.

A Web-based teaser for the February story originally called the hatemongering duo "aspiring musicians" and compared them to wide-eyed sensations Mary-Kate and Ashley Olsen.

The only hint that 13-year-old Lynx and Lamb Gaede praise Hitler, call the Holocaust an "exaggeration" and count former Ku Klux Klan leader David Duke among their fans was a watered-down description of their message as "white pride."

"The last thing we need is to celebrate hate in this country," said Brooklyn Borough President Marty Markowitz, who helped lead a Monday demonstration outside the office of Teen People's parent company Time Warner. "I'm absolutely thrilled it's not running."

Time's initial response to the protest was the added mention of the girls' white separatist mom, National Vanguard member April Gaede, in the Web-based teaser.

Hours later, the company yanked the entire project.

"During an editorial review of this assignment, we learned that a junior employee made unauthorized assurances to the mother of the Gaede twins regarding the prohibition of certain words in the story," said Time spokeswoman Ali Zalenko.
Nice try, racist scumbags. (Gee, I wonder if the photoshoot mentioned here was for the Teen People piece.)

It sounds as though this "junior employee" probably didn't know the full depth of the racism, Nazi apologia, and Holocaust denial these girls represent and that they are in essence tools of Erich Gliebe, David Duke, and other white nationalists to appeal to the very demographic that Teen People is marketed to.

If there's one thing to be thankful for tomorrow, it's that people like the Glaede twins, their mother, and the white nationalists who use them as teeny-bopper idols for the up-and-coming hate set remain a fringe group.

May it always be so.

The Twenty-second Meeting of the Skeptics' Circle

EXTRA! EXTRA! Read all about it!

The National Weekly World Inquirer News has published an interview account of the Twenty-second Meeting of the Skeptics' Circle at in a tabloid format:
"It's hard, you know? I won't lie to you now. It's hard." The yeti leans back in his chair, a stylish Swedish contraption made of balsa wood and green canvas. I expected to be in a forest for this interview, but instead my directions brought me to a condo in Greenbelt, Maryland. The yeti met me at the door and gave me a Coke, which I sip in his lounge-themed living room.

"I mean," he continues, "being a mythical creatures isn't what it used to be. But you've got to change with the times, man. Just keep on truckin', you know?" And with those words, the Yeti unloads his furry soul to me.

Go and read the rest!

There's nothing like a plethora of fine skeptical blogging to fire up my appetite for the Thanksgiving feasting that I will be engaging in tomorrow.

Next up is Bora at Circadiana. He's actually hosted the Circle once before back in March on his other blog Science and Politics. With his hosting next week, he will join the (now retired) Founder of the Skeptics' Circle (St. Nate) and me as the only bloggers who have ever hosted the Circle twice. So send him your best skeptical blogging by Wednesday, December 7, and then join us back again at Circadiana on Thursday, December 8!

Hmmm. Come to think of it, I wonder if any of our other previous hosts are interested in joining the Two-Timer's Club. (Wait a minute. That didn't come out quite right.) We have now accumulated quite a stable of hosts who've done a wonderful job in the past hosting; perhaps some of them would like to host again...

In any case, I encourage any bloggers, whether you've hosted before or not, who are interested in hosting an upcoming meeting of the Skeptics' Circle, drop me a line at The updated schedule is here. Guidelines for submissions and hosting are here and here.

How to cut costs in my lab

I've been on a role the last couple of days. However, I must admit, I got a bit carried away with a couple of long screeds. So last night I took a break. Today I'll post something that I had originally written last week to be posted on Friday. The reason it was never posted is because it was pre-empted by my post about David Irving and my taking more time than I should have wasted slapping down Dean Esmay's ridiculous HIV denialism on Monday. On to lighter fare...

Last week, via Science and Politics, I think I might have found a desperately needed way to cut costs in my lab: The MacGyver Project: Genomic DNA Extraction and Gel Electrophoresis Experiments Using Everyday Materials. Such cost cutting measures are critical, because, despite getting my first NIH grant earlier this year, finances are still tight. Oh, they were fine this year, and you'd think I'd be be riding high in hog heaven (scientifically and budgetarily speaking), after finally having attained the Holy Grail of biomedical research funding: the NIH R01. Unfortunately, the lab isn't. First off, the NIH took 22% off the top of all new grants with the rather scary possibility of additional cuts to existing grants if the NIH budget takes a cut in the 2006 budget, as is a distinct possibility. Second, my other grant is due to expire in April, after which money will get much tighter. Third, the university mandates that salaries go up (regardless of employee merit) 4% a year, and the NIH has been consistently raising the mandated rates for postdocs and graduates students every year. In addition, the university has been steadily increasing the amount they charge for fringe benefits and taxes. When I first arrived 6 years ago, it was 26% of salary. Last year, it was 33%, and they plan on increasing it to 34% for 2006. Salaries and fringes keep going up, but the grant provides the same sum every year.

There are only two possible solutions (which may be used in combination, of course): Raise revenues (i. e., get another grant, something I'm working on); or cut expenses. Salaries are pretty much untouchable; so that just leaves supplies.

And that's where the MacGyver Project comes in.

For those of you not familiar with MacGyver, it was a TV show from the late 1980's in which the hero, MacGyver was able to solve problems and defeat his enemies through his cleverness and ability to improvise. His clever solution to problems using the materials at hand, such as using Rosary beads to focus sunlight and trigger a slingshot or using acetic acid and ammonia to produce a smoke screen, became known as MacGyverisms.

So, in the spirit of MacGyver, why waste all that money buying gel electrophoresis boxes at $250 a pop for what is basically a Plexiglass box with a couple of wires and plugs and a tray to run the gel in? What a rip-off! And why waste hundreds of dollars a month on various DNA purification kits, when much cheaper methods will do? I could totally see using Agar Agar obtained from an Asian grocery store (and, conveniently, there is a large such store a mere four miles or so away). Legos with Glad Press 'N' Seal to construct the gel tray? Genius! See the diagram:

Unfortunately, we don't do genomic DNA extractions very often; so this probably wouldn't be much use. What I really need is a good MacGyver method to extract RNA for quantitative reverse transcriptase real time PCR. We do a lot of quantitative RT-PCR in our lab. A lot. One problem with the MacGyver method is that it would be hard to keep RNases from degrading the RNA. DNA is a lot hardier than RNA, which is easily degraded. It would also be nice to have a MacGyver protocol for the extraction of protein for Western blots and nuclear extracts for gel shift assays.

I suppose it would be too much to hope for a MacGyver protocol for cloning, plasmid isolation, and retroviral vector construction--or for the PCR reaction itself. For one thing, you can't do PCR with Taq polymerase or other thermostable DNA polymerases, and the only sort of MacGyver protocol I can think of would involve harvesting the thermophilic bacteria and somehow isolating the enzyme.

Still running a lab on the MacGyver concept sounds as though it would be rather fun. Unfortunately, it would not be practical.

Tuesday, November 22, 2005

Carnival barking

Grand Rounds, Vol. 2, No. 9 has been posted at Code Blog: Tales of a Nurse. Good stuff, as usual.

Also, today is the last chance to get your best skeptical blogging Tom at Mile Zero for a special early Thanksgiving edition, to appear tomorrow, rather than the usual Thursday.

Dr. Buttar has a new protocol

A couple of months ago, there was a minor dust-up here regarding an unfortunate autistic boy who died while undergoing chelation therapy in an altie clinic near Pittsburgh. In my article, I pointed out that the vast majority of the clinical evidence indicates that mercury in vaccines does not cause autism; that there is no convincing (or even suggestive) scientific or clinical evidence that chelation therapy does anything to improve the symptoms of autism; and that giving IV EDTA was dangerous.

A certain commenter infested the comments section of these two posts with impassioned defenses of a certain chelationist by the name of Dr. Rashid Buttar, a man who uses a "transdermal" form of chelation therapy to "treat" autism, posting long (and lame) justifications for why Dr. Buttar can't seem to be bothered to do some very basic tests to demonstrate that his transdermal DMPS (TD-DMPS) actually gets absorbed through the skin into the blood, much less chelates any mercury (as he claims it does), much less "cures" autism. There was a lot of dancing around by this commenter relaying responses from Dr. Buttar when I and others pointed out that, if the DMPS is not absorbed through the skin, then it couldn't possibly chelate anything and further pointed out that, if it doesn't chelate mercury, then, by Dr. Buttar's own belief that chelating mercury can "cure" autism, TD-DMPS couldn't possibly work! At that point, Dr. Buttar changed his tact to claiming he had "empiric" evidence that TD-DMPS helped autistics and emphasizing that DMPS was safer, both in IV form and his "transdermal" form, at one point saying:
It is a "SAFETY" issue I'm talking about....I don't care to prove a damn thing to those people that you have been dueling it out with. The NIH has said our treatment and DMPS specifically is I will take DMPS intravenously to show that it is NOT dangerous. That's why I want the show the world how safe DMPS is. And if it's safe to take intravenously, then it's OBVIOUSLY safer to take it transdermally.
Of course it's "safer" to take it transdermally, given that it's almost certainly not absorbed transdermally. (At least, Dr. Buttar has not produced any evidence that it is.) Earlier, Buttar's defenders had spouted even lamer justifications:
It is well known that whatever is placed on your skin is absorbed. If you swim in a chlorinated pool, the skin will absorb a certain amount chlorine, right? You are concerned that there is no measure for how much DMPS is entering the skin. I say who cares if they have not yet done randomized, double-blind, placebo studies to determine how much DMPS is entering into the bloodstream through the skin? That costs money and why do a big expensive study on a substance that is already approved by the FDA? What they do know is that heavy metals are being removed without any other explanation as to why, other than TD-DMPS.
Buttar did admit to using IV chelation sometimes, but one of his main selling points for his TD-DMPS that makes it attractive to the parents is that it is supposedly "safer." (Again, in my opinion, the very reason it is "safer" is because it is not absorbed and therefore chelates nothing.) Dr. Buttar also seemed to be arguing that IV DMPS was safer compared to IV EDTA. Apparently, however, Dr. Buttar is changing his tune (and his favored treatment) about EDTA. Thanks to a tip from a reader, I've been directed to a link suggesting that Dr. Buttar is now "treating" autism using a new regimen that includes IV EDTA (the chelator that killed Tariq), ozone, and minerals to remove "persistent organics" and asking other parents what they thought of it:
Dr Buttar's office has asked us (after being on TD DMPS for about 11 mos) to come on IV EDTA/ozone protocol over a two month period every two weeks. TD DMPS and TD EDTA will continue on a Mon, Wed, Fri schedule after the IV's

Every 2 weeks our son will get IV EDTA and ozone (which will be infused in his blood and given via IV) and on the second day he will get minerals. The reason given for ozone is to reduce persistent organics in his system. There is no test being recommended to determine if the child will be a good candidate for ozone. Apparently, some children are seeing good results and Dr Buttar is trying this treatment on older children (greater than 7). Dr Buttar's office has provided some research on ozone done by a MD researcher in NY whom we spoke with. The immediate reaction of this researcher was that there has not been any study with children while ozone therapy is safe and has been used on millions of people in Europe. The researcher was not aware of Dr Buttar or his protocol on children and said that one needs to establish first if ozone therapy is needed.
Oooh boy. "Trying his treatment on older children"? Where to start? To the credit of some of the mothers on the list, they weren't totally buying into this, with one even saying that she "would not want to be first in line" and another saying:
I think IVs of EDTA (or any other chelation agent) are a BAD idea. I wonder what possible rationale he has for this, since I think it is such a bad idea. Besides being the most dangerous form of chelation, IVs are also really expensive, in case they need another strike against them.
Indeed. Once again, I emphasize that there is no evidence that chelating mercury or anything else improves the symptoms of autism. Unfortunately, this same mother was rather credulous about the ozone therapy, suggesting that the first mother instead should purchase her own ozone setup. Then, in a followup, I also became aware of another discussion of new "protocol" on a different discussion group. In this discussion, one mother stated that, for children over 7, Dr. Buttar was recommending an IV drip of DMPS and glutathione, followed by ozone, minerals, and some sort of "pesticide remover" or "environmental detoxifier." Moreover, as the discussion unwound, it was stated that Dr. Buttar charges $2,000 a session plus a charge for supplements, with a total of four visits being required, leading to a complaint by another that "only the rich" can afford his therapy. Another person was unhappy that Dr. Buttar was not planning on making his new protocol public and lamented that he was charging $17,000 to other doctors to take a 7 day course in administering this new protocol. I don't know how accurate this characterization of Buttar's new protocol is or his pricing structure is (it may be a second- or third-hand account), but, if true, it sounds like some serious quackery to me. The reports I've been able to glean from the discussion thus far are conflicting about whether Dr. Buttar now uses IV EDTA or DMPS, but they all appear to agree that he is now using IV chelation of some kind with glutathione, minerals, ozone, and some sort of "environmental detoxifier."

You know, sometimes I think I'm in the wrong business.

One thing that struck me about this new protocol is how much it resembled another form of autism quackery that I wrote about a while ago. Indeed, it appears to be an unholy union of a different form of "oxygenation" therapy other than hyperbaric oxygen "therapy" for autism I used EneMan to poke fun at earlier this month and that favorite dubious therapy of the mercury/autism activists, chelation therapy. Unfortunately, the intravenous injection of ozone hasn't been shown to be effective for any condition that I can find. Ozone therapy may be somewhat useful, as hyperbaric oxygen therapy is useful, in treating chronic wounds, but not much else. Even so, it is not generally used as a treatment for chronic wounds. That doesn't stop a lot of quacks from touting it as a treatment for everything from cancer to AIDS. Here is what happens when ozone is administered intravenously:
When ozone is introduced into blood, it reacts with water in red cells producing hydrogen peroxide. This aqueous decomposition of ozone also produces bactericidal and membrane-damaging free radicals [21]. Ozone used for treatment [24] is prepared by creating an electric spark in a chamber of pure oxygen. The final mixture contains between 0.l and 5.0% ozone, concentrations that are equivalent to from l.0 ppm to 50 ppm ozone in pure oxygen.

Ozone generated this way has a half life of 45 minutes at room temperature, and under ideal conditions of sterility, dryness, and cleanliness, it must be prepared on site each time it is used. A two-hour exposure to 1200 ppm ozone is needed to kill microorganisms on open surfaces and in water [25]. Concentrations of ozone recommended are: for topical treatment of superficial wounds, 70 to 100 ppm; for slow-healing ulcers, between 40 and 70 ppm; and when oxygenating effects are needed to treat diseases associated with hypoxia, from l to 40 ppm [26].
One has to wonder how "ideal" or "sterile" Dr. Buttar's conditions are or why one would want to let loose so many free radicals to damage one's blood cells. In any event, ozone is a highly reactive, oxidative gas with many industrial applications, with OSHA recommended guidelines for safe exposure of less than 0.10 ppm. There is no evidence that it is any good for treating cancer, HIV, or autism. (A PubMed search failed to turn up a single reference that suggested ozone might be good to treat autism.) Indeed, at least as of 1999, ozone was not FDA-approved for the treatment of any condition, and the FDA has even arrested and prosecuted people for selling ozone generators and making claims that it can treat medical conditions:
Proponents of medical ozone generators believe ozone can kill viruses and bacteria in the body. While ozone is used as a germicide in the cleaning of manufacturing equipment, FDA is not aware of any scientific data that supports the safety or effectiveness of ozone generators for treating medical conditions. In fact, the agency believes that at the levels needed to work effectively as a germicide, ozone could be detrimental to human health.

"These devices keep popping up," says Bob Gatling, a biomedical engineer and director of the program operations staff in FDA's Center for Devices and Radiological Health. "We always tell their makers": 'Show us some data,' but no one ever pursues it."
The bottom line is that, as is the case for chelation therapy, there is no scientific evidence that IV ozone, either alone or with chelation therapy, does anything therapeutic for autism. It is rather interesting, however, that, with his inclusion of ozone to rid the body of "persistent organics" and the addition of some new "environmental detoxifier," Dr. Buttar is apparently now broadening his approach to more than just mercury. Perhaps he is starting to realize that the mercury mania that has come to the fore this year is without basis and that he needs to expand to eliminating the vague "toxins" alties are so fond of blaming for various diseases. (Certainly he has never presented any scientifically valid "empiric evidence" that his transdermal therapy does anything other than make his patient's skin greasy, anyway.) Given that he seems to be offering this new "protocol" to older children, many of whom have already been on his TD-DMPS, I can't help but speculate that perhaps, just perhaps, TD-DMPS is not all Buttar claims it is, leading him to come up with a "second line" treatment.

Given that my source of information thus far consists of online discussions, I would love more substantive confirmation. I would also love to ask Dr. Buttar or his defenders these questions:
  1. Is Dr. Buttar indeed using IV chelation therapy, ozone, and and "environmental detoxifier" as a new protocol to "treat" autism, as is being discussed in these groups?
  2. If the answer to #1 is yes, does this mean that perhaps his transdermal chelation wasn't as effective as he has claimed it was in the past?
  3. If the answer to #1 is yes, which chelator is Dr. Buttar using, IV DMPS or EDTA? If EDTA, why, given that Dr. Buttar has in the past pointed out that DMPS is much safer than EDTA?
  4. If the answer to #1 is yes, what is the scientific basis for this new "therapy"? What clinical trial evidence does he have that it does anything to improve the symptoms of autism?
  5. If the answer to #1 is yes, what is the scientific rationale for the addition of ozone? What is the evidence (preclinical and clinical) that ozone has any value in treating autism?
  6. If the answer to #1 is yes, what, exactly, is this "environmental detoxifier" these parents say that Dr. Buttar is now including? (Some sort of "magic mixture," perhaps?) What "toxins," specifically, is this "detoxifier" removing and what is the evidence indicating (1) that these toxins have anything to do with autism and (2) that this "detoxifier" actually removes them?
  7. If the answer to #1 is yes, why isn't there anything on Dr. Buttar's website about this new protocol or anywhere else that I can find other than on these discussion groups?
  8. If the answer to #1 is no, why are these parents posting to various groups fairly detailed accounts stating that Dr. Buttar is now recommending IV chelation therapy, minerals, ozone, and an "environmental detoxifier" to treat their autistic children? Is it all just a misunderstanding?
Inquiring minds want to know!

If these reports are indeed true, it sounds as though Dr. Buttar may be going down the pathway of Dr. Stephen B. Edelson. I have to wonder if some of Dr. Buttar's most vociferous defenders will continue to defend him. At the very least, they should put his feet to the fire and make him answer some questions.

Monday, November 21, 2005

An HIV/AIDS "skeptic" questions my honesty and decency...

Dean Esmay, who likes to present himself to his readers as a hard-nosed "skeptic," but is in actuality a rather credulous fellow, at least when it comes to HIV "dissidents" and seemingly not understanding why it's such a bad idea to teach "intelligent design" creationism in the science classroom in public schools, is not happy with me, not happy with me at all. On Saturday, as I was about to sit down to watch the Michigan-Ohio State game, I noticed an influx of referrals here from his blog. Given that I hadn't recalled seeing referrals here from Dean before, I checked it out his blog and, amidst a self-congratulatory tirade against bloggers who considered the Eliza Jane Scovill case a tragic example of what can happen to a child when her parents believe won't accept the science showing that HIV causes AIDS, found this comment regarding the case of Eliza Jane, the daughter of HIV denialist Christine Maggiore, who died in May and whose autopsy showed that she had AIDS-associated pneumonia:
I wonder if the Suicide Girls or Orac Knows will show any class, decency or honesty on the subject now that we know the truth? Or will they keep to their lynch-mob prejudices?
Geez. I don't know what brought this on. I've never questioned Dean's honesty. I do think he's prone to excessive credulity when it comes to HIV "skepticism" and that HIV denialism has the potential to do great harm in terms of controlling the spread of AIDS, but I've never impugned Dean's honesty or decency.

OK, Dean. You can trumpet your pseudoscientific nonsense about HIV and AIDS to your readers all you like. I don't really care. You can say that I'm mistaken. You can imply that I lack class. You can even call me a flaming idiot and moron. I wouldn't really care all that much. You can say I'm butt-ugly and smell bad. Water off a duck's back. But question my honesty or decency, and, dude, the gloves come off, making today a very good day indeed for Orac to direct some of his characteristic Respectful Insolence™ your way.

So what brought on Dean's little tirade against others bloggers (and me apparently as an afterthought)? Christine Maggiore, the HIV-positive mother and high profile HIV/AIDS denialist who refused to take AZT to prevent maternal-fetal transmission of the virus, or even to test her child for HIV, has gotten fellow HIV denialist Dr. Mohammed Al-Bayati to look at the L.A. County Coroner's report for her daughter's autopsy. Not surprisingly, Dr. Al-Bayati is claiming that the coroner got it all wrong and that Eliza Jane didn't die of AIDS-related pneumonia as the report concluded, leading Dean to go into spasms of self-righteous rage and claim "that the L.A. County coroner and the Los Angeles Times were and are guilty of a political diagnosis in order to grandstand."

Well, knock me over with a feather! Who could possibly have seen that one coming? The only thing that surprised me is that it took so long to dig up someone to "refute" the coroner's report.

One thing that struck me right away is that Dean failed to mention other medical bloggers who agreed with my position and said so in their blog, bloggers such as Gordon's Notes, Red State Moron,, or even Dr. Trent McBride, a pathology resident who blogs on Catallarchy and who also pointed out that finding Pneumocystis carinii by silver stain on autopsy histology of the lungs of someone not having AIDS or other significant immunosuppression is exceedingly rare. (I wonder if Dean considers these other bloggers writing on this case to be lacking in honesty as well.) Another thing that struck me is that, in the comments Dean whined about ad hominem attacks against his expert (Dr. Al-Bayati), after having himself launched an ad hominem attack on Richard Bennett (whom, I conceded, had once taken what I considered to be a cheap shot at Dean over an admission Dean had made) and others. No doubt Dean fails to see the irony. Apparently ad hominems are OK only as long as it is Dean--who has on occasion been known to refer to his critics by epithets like "sad little losers"--launching the ad hominem.

Nonetheless, at the risk of my being accused of retreating to the "last refuge of the pseudoscientist" (as Dean himself likes to put it), the ad hominem attack, it is nonetheless necessary to take a brief look at Dr. Al-Bayati before addressing the substance of report itself. (Don't worry, I'll get to the substance soon enough.) Given that Dean seems to like to question the motivations of those who don't buy into his "HIV dissident" line and to argue from authority a lot (he is quite enamored of his friend Peter Duesberg's credentials and those of another prominent AIDS denialist, Harvey Bialy and is not at all shy about waving them in front of him--metaphorically speaking--like a talisman to ward off attacks against his pseudoscientific posturing), I consider it entirely appropriate to examine this particular "expert" and his qualifications and motivations before going on to discuss the contents of his report.

So who is Mohammed Ali Al-Bayati, PhD, DABT, DABVT? He represents himself as a toxicologist and "pathologist." However, most pathologists who deal with HIV are MD's. So what kind of pathologist is he? "DABVT" stands for Diplomate, American Board of Veterinary Toxicology; so basically he's a veterinary pathologist and toxicologist. Whether that means he's qualified to evaluate postmortem findings in AIDS, I don't know. He has a few papers published in the peer-reviewed medical literature, but none of them concern HIV; so his publication history doesn't help me evaluate him. He does, however, have a very obvious and undeniable bias. Dean will no doubt characterize it as an ad hominem attack to point out Dr. Al-Bayati's bias, but it's not at all inappropriate in this case to mention his prominent listing on the infamous Virus Myth website or his book Get All the Facts: HIV Does Not Cause AIDS. Also, Dr. Al-Bayati runs a company called Toxi-Health International, which, according to its website, provides expert witness services and "can evaluate the health effect resulting from acute and chronic exposure" to various agents," including medication reactions, adverse reactions to vaccines (shades of the Geiers!), pesticides, and a variety of other compounds. No doubt Dean will lambaste me for even mentioning such things. Tough. If Dean considers it not to be an ad hominem attack to blithely accuse the L.A. County Coroner and L.A. Times without evidence of making "a political diagnosis in order to grandstand," I consider it acceptable to point out an obvious bias in the source Dean chooses to use to make the case that the autopsy findings were incorrect.

As I've said before, as long as you're not just lobbing insults at your opponent, ad hominem arguments are not always inappropriate, particularly when they point out a clear bias that any person evaluating both sides of an argument should be aware of. However, they are not sufficient. The substance of an argument must be addressed as well. So, without further ado, though, let's get to the meat of the matter, shall we? Unfortunately, Dean provided no link to the original coroner's report (apparently it is not publicly available); so I shall have to rely on Dr. Al-Bayati's characterization of the report. Fortunately, that's enough to sink him.

The first thing I noticed reading Dr. Al-Bayati's report is that it appears not to be intended for a scientific audience. (Perhaps this is why Dean found it so compelling, assuming he actually read the whole thing.) Instead, it is constructed more like a legal document designed to cast "reasonable" doubt on the coroner's conclusion that AIDS-related pneumonia was the cause of Eliza Jane's death, rather than actually putting together a coherent case for an alternate explanation. Without ever having seen the body or any of the raw data from the autopsy, Dr. Al-Bayati dives right in. One particularly egregious example of his style is that he lambastes the coroner for not testing for a certain virus (more about this below), and then confidently concludes that Eliza Jane had that virus and not HIV, even though he couldn't possibly make such a conclusion without the results of the very test that he criticizes the coroner for not having done in the first place! Before I myself dive in, however, let's summarize the autopsy conclusions as Dr. Al-Bayati reports them:
  1. Pneumocystis carinii was found in Eliza Jane's lungs by Gomori methenamine silver staining in association with pink foamy casts in the alveoli. The lungs were also edematous (water-logged).
  2. Eliza Jane was mildly neutropenic (low neutrophil--a type of white blood cell--count) and profoundly anemic (low red blood cell count)
  3. Eliza Jane's brain contained throughout its white matter with relative sparing of cortex a number of variable-sized microglial nodules characterized by multinucleate giant cells associated with moderate pallor and myelination, occasional macrophages, and and angiocentric pattern. These lesions stained positive by immunohistochemistry (IHC) for the HIV core p24 protein, a finding consistent with HIV encephalitis.
  4. There was atrophy of the spleen and thymus
  5. There was enlargement of the liver with fatty infiltrate of the cells (steatosis) and ascites
Dr. Al-Bayati then tries to "refute" each of these findings, using a variety of handwaving techniques and "might have beens" that truly astound. One thing that puzzled me, though, was why he thought it so important to refute the finding that HIV was present at all. After all, if, as Dr. Al-Bayati clearly believes very strongly, HIV does not cause AIDS, then why not just come right out and argue that in his report? Why not just argue that AIDS couldn't possibly have killed Eliza Jane and that the HIV protein detected in her brain was a red herring? Heck, why doesn't Dean just argue that?

But I digress.

Dr. Al-Bayati concedes that P. carinii, an AIDS-defining organism, was present in Eliza Jane's lungs but tries to wave this finding away by pointing out that there was not a "pneumonia" because no inflammation was observed, citing a definition in a pathology textbook (a technique not unlike arguing about technical words using dictionary definitions). He repeats this again and again ad nauseam. He also states that P. carinii is ubiquitous, only causing disease in immunosuppressed patients. There are couple of problems with these arguments. First, immunosuppressed AIDS patients tend not to be able to mount a very effective inflammatory response to infection. Indeed, it has been noted that, in HIV infection, PCP pneumonia provokes fewer inflammatory cells and that PCP is worse in patients immunosuppressed by other causes as their immune system recovers and starts attacking the organism, causing inflammation. (That's one reason why the chest X-ray findings and physical exam findings can be so variable.) The one argument Dr. Al-Bayati makes in this context that isn't totally off the wall is that PCP can occur due to immunosuppression from other causes, and he cites several references that show that PCP can occur in people without HIV if they are immunosuppressed for other reasons. Of course, this line of argument totally begs the question of what the cause of this Eliza Jane's profound immunosuppression was in the first place if it wasn't HIV infection. Second, as Dr. McBride pointed out, for P. carinii to be detected in routine tissue samples at autopsy, there have to be a lot of organisms there. In immunocompetent individuals, there simply aren't enough bugs to show up on silver stain. Given that the HIV protein detected in the brain implicates an obvious cause for the immunosuppression that led to the presence of so much P. carinii in Eliza Jane's lungs, it's hard not to conclude that Eliza Jane had AIDS-associated PCP. Dr. Al-Bayati clearly realized that he had to try to throw doubt on that finding.

And how does he try to do that? Disputing the findings of an experienced neuropathologist, Dr. Maurice A. Verity of UCLA, who examined the sections of Eliza Jane's brain, Dr. Al-Bayati argues that the brain lesions seen are nonspecific and that the finding of the HIV p24 protein on IHC must have been a false-positive. He points out a paper from 1992 indicating a high level of false positivity of this test in the presence of inflammation. Tellingly, however, despite listing the numbers and types of tissues stained in the study (which included only 3 brains from HIV-positive patients and one brain without HIV), he does not cite the percentage of false positive results reported in the paper, only that it is "common." (I couldn't get the paper online to check myself, because the online archives only go back to 2000.) The problem with this line of argument is that it's not enough just to say that this "might" have been a false positive using references that, being 13 years old, may not even be relevant to how IHC for HIV proteins is done today. He has to show compelling reason that it was, rather than hand-waving and saying that some combination of a viral infection and/or an allergic reaction to amoxicillin caused this (see below). Even Dr. Al-Bayati appears to realize this shortcoming.

And that's where his strangest argument of all comes in.

There's a saying in medicine that, when you hear hoofbeats you don't look for zebras. (A zebra is medical slang for a rare or highly unlikely diagnosis.) Yes, occasionally it you will find a zebra, but the vast majority of the time you will not. Consequently, when one hears hoofbeats from a tragic case of a dead child of an HIV-positive mother who was found to have profound anemia, PCP, and encephalitic lesions with HIV proteins detected in them, by far the most likely diagnosis is AIDS. Indeed, in the differential diagnosis, the first ten diagnoses in the differential would be AIDS, AIDS, AIDS, AIDS, AIDS, AIDS, AIDS, AIDS, AIDS, and then--very far down the line in probabilities--everything else. Given this, it's not surprising that, in his rebuttal, Dr. Al-Bayati hears not one, but at least two zebras approaching.

Which zebras, though? The first one is erythrocytic aplastic crisis due to infection with parvovirus B19 (PVB19, the virus mentioned above), of course! Shouldn't it have been obvious? He bases this speculation on Eliza Jane's anemia, encephalitis, upper respiratory infection, and atrophy of the spleen and thymus. I'll give him props, though. This is a clever gambit, because this particular virus is common enough that a significant percentage of children have been exposed to it, meaning that there's a reasonable probability that antibodies to it would be found if looked for, whether it was this virus that actually caused Eliza Jane's death or not. Let's look at this claim a little more closely.

PVB19 is a parvovirus that is fairly common and can cause upper respiratory infections, erythema infectiosum, arthritis and arthralgias, and transient aplastic crisis. Dr. Al-Bayati makes much of the ability of this virus to cause anemia by transiently suppressing the progenitor cells that develop into red blood cells and blames infection with this virus for Eliza Jane's profound anemia. He also attributes Eliza Jane's encephalitis and bone marrow atrophy to infection with this virus. However, he neglects the observation that PVB19 is rarely much of a problem in healthy individuals. Severe anemia secondary to PVB19 usually only occurs in patients with a pre-existing anemia or pre-existing destruction of red blood cells and who therefore require a high level of reticulocyte production to keep their blood counts up. Conditions in which this can be a problem include chronic hemolytic anemias, sickle cell anemia, thalassemia, acute hemorrhage, and iron deficiency anemia, all of which cause red blood cell loss requiring replacement. Also, severe infections of the bone marrow with PVB19 causing aplastic anemia are rare aside from patients with pre-existing immunosuppression, such as transplant recipients, patients with malignancy, and, of course, patients with HIV. In such patients, PVB19 infection can result in severe, prolonged, recurrent, or even permanent anemia. Dr. Al-Bayati does point out a couple of case reports of a aplastic anemia due to PVB19 in immunocompetent individuals. As far as I can find, there are no decent-sized series reported, however, only a few isolated case reports. This paucity of reports that PVB19 is a fairly rare cause of aplastic anemia in healthy individuals. It is, of course, possible that PVB19 infection caused Eliza Jane's serious anemia (that's where "reasonable doubt" comes in). However, even if it had, given what is known about this strain of parvovirus, a far more likely explanation would be that the virus caused Eliza Jane's anemia because of immunosuppression secondary to her HIV infection. Indeed, case reports even suggest that anemia in AIDS patients due to PVB19 will improve with antiretroviral therapy.

The second zebra is a severe amoxicillin hypersensitivity. (An amoxicillin allergic reaction in and of itself is not a zebra, but it is in the context of this particular case.) Never mind that Eliza Jane had, as was emphasized in the report, never been exposed to antibiotics before and that her clinical course does not seem consistent with a hypersensitivity reaction. Never mind that there was no eosinophilia, no urticaria, or no other stigmata of an allergic reaction mentioned in Dr. Al-Bayati's report (and you can bet that, had any of them been there, he would have mentioned them prominently). Amoxicillin hypersensitivity was also blamed for Eliza Jane's steatosis. It is true that amoxicillin-clavulanate has been associated with hepatocellular, cholestatic, granulomatous, or focal destructive cholangiopathy (all types of liver damage), and references are cited showing this. However, one would think that Dr. Al-Bayati would know that steatosis (a fatty infiltrate of the liver cells) is not the same thing as any of these. Moreover, the pathology report did not state that Eliza Jane's liver had any of the more common manifestations of amoxicillin-clavulanate-induced liver injury, casting further doubt on the antibiotic as the cause. (Drugs more classically associated with steatosis include valproic acid, tetracycline, amiodarone, and aspirin, not amoxicillin-clavulanate. Indeed, a PubMed search on "steatosis" and "amoxicillin" failed to turn up a single reference.) I didn't see any of Dr. Al-Bayati's references supporting his implication that amoxicillin could cause steatosis within a day of exposure. Clearly, the steatosis must have been a pre-existing condition. As for the pulmonary edema and ascites reported, that could be due to allergic reaction, septic shock from an ear infection, cardiopulmonary collapse from whatever cause, or a number of other factors, but in the context of Eliza Jane's HIV infection, rapid deterioriation, and cardiovascular collapse, it fits.

The bottom line is that you can compare these two sets of conclusions about what caused Eliza Jane's death and decide which seems more plausible. The first, the coroner's report, looks at a child of an HIV-positive mother who refused to take AZT during pregnancy, breast-fed her child even though that is known to increase the rate of transmission of HIV, and refused to have her child tested for HIV, a child who collapsed after upper respiratory and ear infections, whose autopsy findings showed HIV encephalitis, P. carinii in the lungs, and severe anemia. Given such findings, it's hard not to conclude that Eliza Jane died of AIDS complications. (Whether or not Dean's contention that the coroner had some sort of horrendous bias or was grandstanding is true, I cannot say, but certainly Dean hasn't provided any compelling evidence that he was.) The second hypothesis, promulgated by an HIV "dissident" with a definite axe to grind, requires us to believe in not just one, but three, highly unlikely occurrences (plus one simply unlikely occurence), namely:
  1. A previously completely healthy girl developed PVB19 infection leading to both encephalitis and aplastic anemia (possible, but highly unlikely, and, even if PVB19 were found, it would be far more likely that it was able to cause anemia because of immunosuppression due to AIDS).
  2. This same girl also developed an acute allergic reaction to amoxicillin that led to cardiovascular collapse and--oh, by the way--also caused steatosis of the liver within a day after starting the drug, the steatosis being something even Dr. Al-Bayati's own references do not seem to support as being likely.
  3. This same otherwise healthy girl had sufficient quantity of P. carinii in her lungs to show up on Gomori methenamine silver staining at her autopsy.
  4. The medical examiner and neuropathologist either botched the staining for the p24 protein (or that it was a false positive) and an experienced neuropathologist didn't know the pitfalls of the diagnosis of HIV encephalitis using brain tissue sections.
A veritable herd of zebras indeed. To believe Dr. Al-Bayati's scenario, you have to believe that at least four very unlikely things happened in the same case, rather than the very likely conclusion (based on the autopsy findings) that AIDS killed Eliza Jane.

Not surprisingly, credulous guy that he is when it comes to anything that supports HIV denialism, Dean does exactly what he accuses Richard Bennett of and "sucks down any codswollop he's fed on this subject and spews it back out on command." No doubt Dean will likely accuse me of the same and/or consider my response to him to be "dishonest" or possibly lacking class. We'll see. Part of the reason I haven't addressed Dean's "skepticism" about AIDS much before is because observing him pontificate on AIDS has taught me that arguing with him on this issue is completely pointless. Quite frankly, even in this instance, it's unlikely that I would have bothered to respond if Dean hadn't annoyed me so much by impugning my honesty.

In the meantime, I plan on submitting this to Grand Rounds this week. (That's about as close to "peer review" as you can get in the blogosphere.) I'm also very interested in what other doctors, scientists, and medbloggers have to say about this. I'm not an AIDS expert, but a lot of the stuff in Dr. Al-Bayati's report is so off the wall that it didn't take much to find the inconsistencies. (And if I, a knowledgeable non-expert, can pick the flaws apart, imagine what a real expert could do.) Nonetheless, if I got something grievously wrong that calls into question my analysis, I'd like my peers to let me know.

ADDENDUM: An update including the opinions of two additional physicians has been posted here. They cover a lot of the same ground, but from different viewpoints and different areas of expertise and, when combined, present a truly devastating rebuttal to Dr. Al-Bayati's "report."