Tuesday, May 31, 2005

The Carnival of Bad History

Speaking of blog carnivals, the Carnival of Bad History has been posted at Science and Politics. It's a lot like the Skeptics' Circle, only it concentrates on history and how people distort, mangle, and misuse it.

Grand Rounds XXXVI

Grand Rounds XXXVI has been posted at Dr. Sanity. Time again to check out the best of the medical blogosphere, complete with art from the great Leonardo da Vinci.

A blog possessed: How vaccine blogging has taken over

Blogging is odd and fascinating. Sometimes it leads you in directions you never anticipated or intended--and, when it does, it can do so with astonishing speed, sometimes taking you by total surprise. One day, you're blogging about one set of topics, and then a day later you suddenly find your blog dominated by a topic that you neither intended nor foresaw. For example, about one week ago, a reader sent me a link to a post on the Huffington Post that was pushing the usual anti-vaccination rhetoric I hear from activists. That e-mail led me to investigate further and find at least five posts with anti-vaccination rhetoric in the short history of the Huffington Post. Because the Ninth Skeptics' Circle was coming up and I wanted to provide my blog buddy St. Nate (the founder of the Skeptics' Circle) with some good material, I decided to write a rather lengthy post rebutting most of the fallacies in those five articles. I barely finished it in time to submit to the Circle, but finish it I did. I posted it last Wednesday and submitted it to the Skeptics' Circle just under the wire for the deadline.

And, suddenly, I'm an autism blogger.

Since then, I've ended up on an e-mail list from Neurodiversity.com, because of a link I posted to an online petition of theirs. (I don't mind; that's partially what this post is going to be about.) I've also ended up writing more about this issue, being cited by Skeptico and having my posts referenced and posted in the comments section of another anti-vaccination piece on the Huffington Post (something I should have done, but I hadn't realized that this particular article allowed comments, unlike previous ones).

We'll see what happens, but I never intended for this subject to take over Respectful Insolence the way it did. I just thought it would be an interesting piece to submit to the Skeptics' Circle on a subject I knew a bit about. I don't plan on making it a major theme of this blog, when someone like Autism Diva can do it better, but I can't resist one last entry into the fray.

One thing that came up during all this was the question: What's wrong with anti-vaccination activists pushing a link between thimerosal and autism? After all, thimerosal has been removed from all early childhood vaccines other than the flu vaccine (which is not a standard vaccine that is given to all children). If the anti-vaxers were right, we'll soon see the epidemiological link over the next few years, right? Ditto if they're wrong. And it is true, as I pointed out. Indeed, Dr. Gordon and I agree on this; we just don't agree on what the following 5-10 years are likely to show with regard to the epidemiology of such a link. In the meantime, is it such a bad thing to get the mercury out of vaccines?

There's nothing wrong per se (although it probably increased the cost of vaccination for in essence no benefit and left a nice fat juicy opening for the trial lawyers to imply that the fact that the government and vaccine manufacturers have succumbed to activist pressure to remove thimerosal from vaccines proves a link), but there's a price for this removal of thimerosal that anti-vaxers don't like to acknowledge. First, postulating the link when the evidence supporting it was very weak to nonexistent frightened parents, making them unjustifiably suspicious of vaccination and therefore less likely to have their children vaccinated (or, at the very least more resistant to it). Second, suggesting such a link on very weak evidence inflamed the guilt of existing parents, who were told in effect that it was at least partially their fault for their children's autism because they vaccinated their children as advised. Third, the postulating of a probably nonexistent link between mercury and autism opened the doors to the chelation therapy quacks, who use the ineffective treatment of chelation therapy to "remove the mercury" and supposedly "cure" the child of autism, a therapy that is unfortunately spoken of approvingly by some elements of the mainstream media, such as Paul Harvey last Thursday (and that formed the basis of many of the abstracts at the Autism One quackfest in Chicago this weekend). Even if mercury is found to be a major contributor to autism as the epidemiologic evidence comes in over the next five to ten years, it is already known that chelation therapy does not improve autism.

However, there is one more consequence, as pointed out in this open letter to David Kirby, the author of the recent book favorably reporting on those postulating a link between mercury and autism, Evidence of Harm. I got this open letter from the Neurodiversity.com mailing list, and its contents shocked me. The letter tells of a coarsening of the debate through anti-vaccination zealotry, as demonstrated by the advertising campaign for Mr. Kirby's book and the dialog on the message boards on Mr. Kirby's website. An excerpt from the open letter:
I have read many online newsgroup posts (including posts to the EOH list) written by parents of autistic children who do not describe witnessing any specific reaction at the time that shots were administered to their children, but who have become convinced of the vaccine hypothesis due to the publicity efforts of vaccine litigants. These parents are now consumed with guilt that their good-faith decision to vaccinate their children might have had damaging consequences, and rage at those individuals whom they presume misled them and inflicted damage upon their children, whether that guilt and rage are warranted or not.

It is also a legal strategy undertaken with little regard for the potential long-term, stigma-perpetuating impact upon those autistic people and their family members who are not inclined to believe that all autistics are poisoned. I have observed numerous instances in which vocal proponents of the autism=poisoning hypothesis have displayed outright contempt for anyone who might have come to their own conclusions about their and their family members' lives, and I will cite many of these instances in this letter.

For example, here is a comment by Lujene Clark, responding to Kevin Leitch, a British father of an autistic child; she and other EOH list members descended en masse upon Mr. Leitch after a blog entry he had written was mentioned on the list (http://www.kevinleitch.co.uk/wp/?p=146, EOH message 1014):

"...if you remain in denial you don't have to extend yourself or take responsibility to heal your child because it is so much easier to blame 'bad genes' and accept your child's fate. Or worse, try to get your child to accept his "genetic" fate. That is a COP-OUT. Your child deserves better. Get off your lazy bum and start to heal the biomedical problems of your child!!"

When Mr. Leitch stated that he recognized autistic traits in members of his extended family, Mrs. Clark replied,

"it seems apparent from reading your reply there is a history of serious psychiatric illness in your family. My apologies, I would not have attempted to engage in rational discussion had I known you were affected."

Now, this is quite a toxic attitude to have towards disability, towards evidence of the genetic transmission of devalued characteristics, and towards parents who think for themselves.

Indeed it is, and sadly there are several other examples in the letter of nastiness engendered by Mr. Kirby's book and other sources loudly touting a mercury-autism link. It is likely that Mr. Kirby does not support such viciousness, but we don't know for sure because he does not appear to have condemned it. He may not even know of it. Hopefully, this open letter will inform him of what is going on based on his book and provide an impetus for him to condemn such attacks. In any case, this toxic rhetoric towards parents who have the burden of caring for an autistic child reminds me of some of the rhetoric that another bunch of zealots, animal rights activists, sometimes heap upon people who have benefited from animal research. Such a stigmatizing attitude would be bad enough to subject the parents of autistic children to even if the science justified a link between thimerosal and autism. It is utterly inexcusable when the science does not support such a link. Most anti-vaccination activists don't behave this way, but the hysteria engendered by them emboldens the minority who do. When one is utterly certain that one has The Answer, it then starts to make a sort of sense to conclude that parents who do not subscribe to that "answer" and therefore do not treat their children accordingly are either deluded, careless, or even bad parents doing harm to their children and that they therefore deserve contempt. Parents with autistic children have enough problems; they don't need this one added on top of the difficulties they have to deal with every day raising their children.

Takin' care of business

Over the Memorial Day weekend, I tried to do a little spring cleaning on my sidebar. I found some dead links and either removed them or fixed them. I also added a few new blogs and websites, and removed several others that I no longer regularly browsed, as well as a few blogs that hadn't been updated in a long time. The "Essential Orac" section was reorganized, with some posts added and a few others removed. Finally, some new Chicklets were added to the sidebar make subscribing feeds of Respectful Insolence in My Yahoo!, My MSN, and Newsgator easier. Overall, the sidebar should be somewhat shorter, more concise, and (hopefully) better organized.

Over the summer I'll continue fiddling with it until I get it to where I want it to be--at least until I finally decide whether to ditch Blogger for something else or not.

Monday, May 30, 2005

Memorial Day

Today is Memorial Day. It is the day set aside to remember those who have died fighting for our nation in its wars. I was debating about what to post today, when I remembered that, two and a half weeks ago, I happened to be in Bethesda for a conference sponsored by the NIH. Because of my interest in World War II history and because I had a few hours hadn't seen the new World War II Memorial before (which had been dedicated on Memorial Day weekend last year), I decided to take the Metro into Washington and check it out before heading home. As regular readers of this blog know, sometimes I succumb to the temptation to engage in some photoblogging. Today it seems appropriate to post some of the pictures I took of the monument.

From accounts in the press and opposition to the choice of a location for the monument, I had had my doubts about the design, but I have to say that seeing it up close and personal, in the context of all the other monuments in the area and with the nearby Reflecting Pool, I was impressed and moved. Fears that critics voiced that the monument would ruin the sight lines between the Lincoln Memorial and the Washington Monument were unfounded. Lining paths leading to the fountains in the center are a number of bas-relief panels by sculptor Ray Kaskey, and the overall effect was serene. My one disappointment was that some of the pools without fountains appeared rather stagnant, with algae. You'd think they could take better care of the monument, which is only a year old.

The photos (click for larger versions, and go here for more):

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Overall, this seemed to me a fitting memorial to the hundreds of thousands who died in World War II. On this Memorial Day, between the trips to the beach and the barbecues, let us remember the soldiers who have fought and died in all of our wars.

For more, go here.

A sign of the times

In Britain, a cell phone ringtone--"Crazy Frog Axel F," a ring tone based on the sound of a revving Swedish mo-ped--has become a #1 hit, outselling the new single by Coldplay by a four-to-one ratio. Coldplay is reportedly bummed, having hoped to go straight to #1 with their single, "Speed of Sound."

Expect to see more of this, although not among us old farts.

Sunday, May 29, 2005

This is so wrong

Apparently, someone thinks it's a good idea to sell a thong for your cellphone...

PTFrontBackPTLargeImage

I'm sorry, but I just don't understand. I can understand the utility of some device or other to hang a phone from, but why on earth make it look like a thong?

(Via Gizmodo)

More antivaccination puffery on The Huffington Post

A few days ago, I posted a long piece about how antivaccination fallacies are being given wide distribution on the new group celebrity blog, The Huffington Post. I then posted an addendum mentioning for the sake of fairness that at least The Huffington Post allowed one expert to post a rebuttal. Well, as expected, it didn't take long for Dr. Jay Gordon to post his response to the rebuttal. As with his other pieces, it's a relatively content-free post, in which once again Dr. Gordon makes dire insinuations that those who don't believe that the objective evidence supports the contention that mercury in vaccines causes autism are shills for the pharmaceutical industry:
The American Academy of Pediatrics (of which I have been a member for a quarter century) has a very cozy relationship with the vaccine industry. Most authors and speakers in the vaccine controversy have been paid consultants to the vaccine industry. Most of these researchers still accept funds while commenting on the issues.

OK, Dr. Gordon, so you think that the American Academy of Pediatrics is biased because of a "cozy" relationship with the vaccine industry? If that's so, then why has the AAP come out for removing thimerosal from vaccines--as you yourself pointed out, "adamantly" for it. (I'd have to guess that it's mainly it's because of activists like you, not because of the experimental evidence for a link, which has always been very weak at best and is becoming weaker and weaker with each new study. Apparently, the AAP's "cozy" relationship with the pharmaceutical industry didn't stop it from recommending this.) I'd also turn Dr. Gordon's insinuation around and ask him if he's ever accepted funds from any groups advocating that thimerosal in vaccines is a major cause of autism. If he has, then perhaps he would explain to me why his "accepting funds while commenting on the issues" himself" is any different from other doctors doing the same.

But what about researchers on the "other" side of the issue. In Dr. Gordon's view, apparently it's not good for one's objectivity to have a financial interest in one side of the issue. Fair enough; most people would probably agree that a researcher shouldn't have a strong financial interest in one side of a question. (Leave aside for the moment that most scientists who don't have a financial interest in vaccines also have concluded that there is no link between thimerosal in vaccines and autism and not just in this country.) Given that, why, then, does it not seem to bother Dr. Gordon in the least that David Geier and Dr. Mark Geier, whose research he once again singles out to cite approvingly and both of whom make a significant part of their livings providing legal counsel and consulting and expert witness services to parents pursuing legal action for alleged "injuries" due to vaccination? Doesn't that count as a financial conflict of interest? Yet Dr. Gordon thinks their research is "excellent." Or why doesn't it bother him that their work has been criticized for sloppiness and methodological flaws and they've been rebuked for risking patient confidentiality while mining the CDC's database.

Oh, wait. I get it. The Geiers are not in the pockets of the pharmaceutical industry (pharmceutical industry: always bad). They're in the pockets of trial lawyers and antivaccination activists (antivaccination activists: always good). They're on the "right" side; so Dr. Gordon appears willing to overlook their blatant conflict of interest, while at the same time making vague insinuations of a conflict of interest against by claiming that most researchers in the field accept funding from pharmaceutical companies that manufacture vaccines.

It looks as though Dr. Gordon is going to be a regular at The Huffington Post. Unfortunately, that means he'll have a huge platform for pushing his antivaccination misinformation. That means he'll also probably be occasionally providing me with ideas for this blog for some time to come. But I'd give up all that material in an instant if he's stop making exaggerated claims for a link between thimerosal and autism that almost certainly doesn't exist.

I echo the Mad House Madman

A few days ago, the Mad House Madman asked what ever happened to CodeBlueBlog, creator of CSI:Medblogs. I had been wondering the same thing myself, as the blog hadn't been updated since April 20. It used to be one of my favorites and was one of the first I encountered shortly after discovering the medical blogosphere. True, CodeBlue would wander into a bit of conspiracy-mongering from time to time (his posts on Bill Clinton's recent surgery, for example), but CodeBlueBlog was always a good read. (Indeed, I had been meaning to comment on his posts on Mammographic Serfdom for some time now, but somehow never got around to it.) Of course, looking at CodeBlueBlog now, the depressing thing is that, even though the blog hasn't been updated in five or six weeks, he's still averaging only slightly fewer than the same number of hits per day than I do, down from around six times my average in March. Talk about deflating my ego! CodeBlue can leave his blog alone and it takes six weeks for its hit count to fall below mine, which is updated nearly every day, sometimes even three or four times a day.

Oh, well.

However, CodeBlue's mysterious extended absence did get me to thinking about what, if any, obligation a blogger may have to his or her audience if he or she has to discontinue the blog or go on extended hiatus. Consequently, I've come up with a few policies for my blog:
  1. I will post an announcement if I plan on not posting for more than a few days, whether due to vacation, obligations of work (usually impending grant deadlines), or whatever. (Of course, on vacations, if I have Internet access, I will still probably post intermittently every few days. I just can't help myself.)
  2. I will also include in such announcements the date (or an estimate of the date) that regular posting will resume.
  3. If, for whatever reason, I ever decide to discontinue this blog or to go on an extended hiatus (longer than a couple of weeks, which is about the longest I'm ever off for a vacation or would ever need for grant crunchtime), I will announce it and provide an explanation.
  4. If I go more than a week without posting and don't post an announcement, either bad things have happened to my computer or bad things have happened to me.
I wonder if Dr. Charles ever found out what happened to CodeBlue. Perhaps I'll e-mail him myself...

Saturday, May 28, 2005

Needlestick

Alan, a.k.a. Gruntdoc, my favorite ER doc blogger, has an interesting post today regarding getting a needlestick injury. As he points out, it's an occupational hazard of being a doctor, although some specialties (emergency medicine and procedure-oriented specialties like surgery) have a much higher risk than others (psychiatry, radiation oncology, non-interventionalist radiologists, for example). I can totally sympathize with his first thoughts:
The first thought that flew into my mind: "Crap! I'm better than that." Really, I was terrifically disappointed in myself, and angry I'd made the rookie mistake of not watching the needle in my hand. I handle needles for a living, and they never get me, they get the patient, as intended. That's how it's Supposed To Be.

Indeed.

Needlesticks are almost inevitable if you're a surgeon. All you can do is to try to take every precaution and keep them to a minimum. However, sooner or later, it will happen. Gruntdoc's post took me back to the worst blood exposure incident I ever suffered, one that still haunts me to this day. Fortunately, given that it was 11 years ago and I've had multiple negative hepatitis B and HIV tests since then, I know I'm no worse for it. I was the senior resident on the trauma service, and a man had come in after a fall from a balcony of about 25-30 feet. He had multiple broken ribs, severe head trauma, and a fractured pelvis. It's unclear what he was doing there or what led to the fall, but he did reek of alcohol. In any case, we had done a diagnostic peritoneal lavage to rule out intraabdominal bleeding (these days, we would have done a quick ultrasound or even spiral CT), and we were working on him, getting ready to take him for a head CT. Over about five minutes, his blood pressure fell to zero and we were unable to get a pulse. It was clear that he was going down. It was decided by the trauma attending that we would do a bedside thoracotomy. Now, for blunt trauma (as opposed to penetrating trauma like gunshot wounds or stabbings), the success rate for bedside/ER thoracotomies is very close to zero, which is why we generally don't do them anymore for blunt trauma. When a patient with extensive blunt trauma loses his vital signs, that's usually all she wrote. It's rare to be able to bring him back, no matter what you do. In retrospect, therefore, it probably wasn't the correct thing to do, as it had such an incredibly small chance of making any difference in this man's outcome. But the attending was new and wanted to "do everything." An older, more experienced attending almost certainly would have simply coded the patient for a while and, if there were no immediate response to our interventions, called the code.

So, I got ready to do the procedure with the intern, and the intern asked if he could do the incision. Fool that I was (this was not one of our more stellar interns, to say the least) or in the heat of the moment, I said yes. And so it began.

The intern made the skin incision, and then, while I was repositioning a retractor, telling him to hold on a second to let me get better exposure, he ignored me and carried the incision deeper--right across the side of my index finger.

I was stunned. I stared at the slice in my glove, the cleanly severed latex edges flapping to reveal the cleanly severed skin beneath. Blood was pooling within the finger of the glove, darkening my finger and slowly leaking out of the gash to mingle with the patient's blood already there. After a couple of seconds, I regained my composure enough to utter a few choice profanities at the clueless intern and throwing him out of the procedure. (Crap! I'm better than that. I should have kept a better eye on the intern--especially this intern. Or I never should have let him do this in the first place!) I quickly regained my composure and continued the futile procedure. When the attending saw what happened, he gloved and gowned up to take over, allowing me to run off to wash out the incision. It was pretty deep, but fortunately, as far as I could tell, not deep enough to damage any nerves or tendons. Sensation distal to the injury was intact, and there were no deficits in my ability to move my finger that might indicate an injury to a tendon. While I was doing that, our attending finally bowed before reality and called the code.

I was royally pissed at the intern, who in his hurry hadn't listened. (Lest you think I was being unduly hard on him, the main reason this intern was not one of our more stellar interns was his recurrent and obnoxious inability or refusal to listen and follow instructions.) I was also really furious at myself, as I should have known better than to let this clown near a knife in an emergency situation. But I was scared too. Even though the odds of getting infected from a single blood exposure incident are very small, I still couldn't help but see visions of my young life being snuffed out prematurely and in a most unpleasant fashion, all because of a stupid mistake. Making the fear level higher, the patient didn't look like the most reputable character in the world, and we later found out that he had a history of polysubstance abuse. I ended up getting a shot of gamma globulin, and sweating it out. Fortunately, much to my relief, his HIV and hepatitis B tests turned out negative (and I found out that I still had a strong antibody titer for hepatitis B from my previous vaccine, anyway). Six months later, my repeat HIV test remained negative, and, in the 11 years since then, I haven't developed hepatitis (there were no tests for hepatitis C back then).

Since then, I've had a couple of more needlestick incidents, despite my best efforts. One of them happened while I was, of all things, aspirating a breast cyst in a nice little old lady. Ironically, in my opinion, the "safety" needles that are used in our hospital now are so cumbersome that I honestly believe they make it more likely I will accidentally stick myself. Ditto the "safety scalpels" (which I've dubbed "Playskool knives"), but that may be a topic for another post. Fortunately, it's been around four or five years since I last had a needlestick incident, and I hope to extend that streak to the rest of my career.

I was going to come up with a pithy ending to the description of this incident, but Gruntdoc summed it up better than what I can come up with right now:
Mortality sucks. Mortality through stupidity would be unforgivable, for me, and I resolve to not make any more stupid mistakes.
I couldn't have said it better myself. If I could, I would have.

The Cult of Apple revisited

Heh. But at least our cult is a force for good...

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Friday, May 27, 2005

Oh my...

It's stupid stuff like this that gives me migraines:

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It boggles the mind. Repeat after me, people: "Evolution is not incompatible with Christianity." Fortunately, the way I learned of this was through Right Thoughts, yet more evidence that not all conservatives buy into the rejection of science that all too many fundamentalists and "intelligent design" creationism apologists are pushing. Unfortunately, it is the fundamentalists who have taken over the Republican Party, and it doesn't look as though they're going to be ousted any time soon. Their anti-science viewpoint is one of the reasons I no longer identify myself as a Republican.

The Carnival of Comedy #5

The Carnival of Comedy #5 has been posted at IMAO. It's a nice bit of light-hearted reading to get you in the mood for the long weekend.

Nice resource on the scientific evaluation of alternative medicine

Professor Thomas J. Wheeler, of the Department of Biochemistry and Molecular Biology at the University of Louisville School of Medicine, has made the classroom handouts and reading lists for his course, A Scientific Look at Alternative Medicine, available online. It's a nice resource for anyone interested in a critical look at alt-med claims, and I can only give Paul at Confessions of a Quackbuster his well-deserved props for having found it.

I wish more medical schools and universities would offer courses like this, and hopefully Professor Wheeler will expand on this resource in the future.

The introduction to his course gives a nice summary of the characteristics of alt-med claims (some of which I've annotated with my own comments in parentheses):

SOME CHARACTERISTICS OF PSEUDOSCIENTIFIC HEALTH CLAIMS
  • Nonfalsifiable or irrefutable hypotheses. (This is almost essential to not just quackery but pseudoscience in general, like "intelligent design" creationism.)
  • Attribute failure to reproduce results to: (1) Failure to perform procedures properly; (2) bias; (3) incorrect attitude. (This is one that I hear again and again in misc.health.alternative. Alties will claim that scientists are biased, that they approach the idea with a "skeptical" attitude--which in my book is entirely appropriate. Scientists should approach such claims with a skeptical attitude.)
  • Unwilling to examine the phenomena closely with carefully controlled experiments. (This one is common in all pseudoscience as well. It's particularly common for paranormal phenomenon, but devotees of several altie techniques, like "psychic surgery" or many of the traditional Chinese medicine techniques that rely on Qi, which is basically an vaguely defined "life force" also fall under this rubric, as do quacks like Hulda Clark. How on earth does one measure quantitatively Qi, by the way?)
  • Reliance on anecdotal evidence, or on data from flawed studies (poor controls, insufficient sample size, etc.). (This is a big one. Alties will use testimonials to sell their product or berry pick very small studies that seem to show an effect and ignore all the others that do not, as chelationists frequently do.)
  • Anecdotal evidence can be very persuasive - especially if it concerns yourself. (True, although in most cases, even the anecdotes are questionable, based on insufficient diagnostic testing, insufficient followup, and neglecting the contribution of previous conventional medical treatments. Often the reason the anecdotes seem convincing because most people do not understand the disease for which the testimonial is being given.)
  • Argument from authority rather than evidence - endorsements by doctors, panels, etc. (There's not necessarily anything inherently wrong with arguing from authority if the authority is truly an authority and if the evidence supports it. However, the "authorities" these guys argue from are usually highly questionable at best.)
  • Selection of only supportive data, or deletion or changing of unfavorable data. (A favorite. However, in fairness, I will point out that, unfortunately, scientists aren't always above selection of only supportive data to make their case. Other scientists will usually call them on it, though. However, unlike the case with alties, scientists who are caught deleting or changing unfavorable data will suffer severe consequences in their career, their ability to be published, and their ability to obtain funding to support their research. Not so with alties.)
  • Confuses correlation with causality. (Chapters of books have been written on this. Repeat after me, everyone, "Correlation does not necessarily mean causality. The antivaccination zealots who claim mercury in vaccines causes autism are prime examples of this pseudoscientific fallacy.)
  • "Special pleading" - less stringent rules of evidence should be applied to its claims. (I've seen this one before. Typical is the claim by some alties that there are "different ways of understanding" or "different ways of knowing" other than science. Of course, these "different ways" are almost always less stringent and biased in favor of the "alternative" treatment being discussed. It makes me want to barf when I hear this one.)
  • Claim to be too busy healing patients to pursue verification through research. (A great excuse if you can get away with it. I wish I could use this one four years from now, the next time I have to renew my grant. Oh, I'm sorry, Dr. Study Section Director, I was too busy taking care of patients to pursue the research. Somehow I doubt they'd be very sympathetic. This excuse is a cop-out used by alties who are clearly not interested in proving or disproving their claims using empiric evidence.)
  • Lack of acceptable confirmation of diagnosis before treatment and/or proper followup to confirm healing. (Another big one. When you see "hair analysis" or "live blood cell analysis" used to diagnose cancer or other medical conditions and then to "monitor" response to treatment and "prove" that it's been cured by altie treatments, you're definitely dealing with a quack." Another example is Hulda Clark's "Syncrometer," which purports to diagnose the presence of toxic compounds by changes in skin resistance.)
  • Subjective evaluations or measurements. (See above.)
  • Use of pseudomedical jargon: "detoxify," "rejuvenate," "energy," etc. - entities which cannot be measured. (Another favorite pseudomedical piece of jargon among alties is "strengthens the immune system." How many times have you heard the claim that some altie therapy or other "strengthens the immune system"? More times than you can count? Me too. Too bad it's a meaningless claim, as they never get specific. For example, does the therapy improve T-cell function? What is the evidence that it does? Does it improve antibody response? You'll never get a specific answer with evidence to back it up.)
  • Proposes a single underlying cause for diverse diseases or conditions. (Hulda Clark is guilty of this in her Cure for All Diseases claims, in which she attributes all cancer to an intestinal fluke. Another example is the Gerson therapy, which attributes all cancer to a deficiency in pancreatic enzymes.)
  • Supported through myth and legend: if idea has been around so long, must contain some truth. (Traditional Chinese medicine is a prime example of this. Yes, a few of the herbs they use have medicinal value, but that does not mean the whole package is correct. As for the claim that the fact that an idea has been around a long time must mean it contains some truth, consider this: For thousands of years, people thought that the earth was flat and then, after scientists realized that it wasn't, for hundreds of years after that people believed that the sun revolved around the earth. Just because an idea has been accepted a long time does not necessarily mean it is true.)
  • Charge opponents with being close-minded. (See The Galileo Gambit, by yours truly.)
  • Charge persecution of unorthodox and revolutionary ideas: "They laughed at..." (See The Galileo Gambit again, by yours truly.)
  • Appeals to vanity of patients: "think for yourself." (Indeed. What's the matter with you? Are you going to let doctors and so-called "experts" tell you how to think? Well, are you?... That's sarcasm, by the way.)
  • Exaggerated or false advertising claims. (Just listen to infomercials and many radio commercials to see this one.)
  • Bogus credentials of practitioners (e.g., degrees from unaccredited institutions). (There are too many examples of this to list.)
  • Use of secret formulas. (If they won't tell you what's in it, be very suspicious about putting it into your body.)
The above are a very good primer on the warning signs of pseudoscientific quackery. I'm going to download all his course notes and check them over. I recommend that you do too.

Thursday, May 26, 2005

It never ends

After all this autism/mercury/chelation blogging, what do I hear on the radio five minutes ago as I was typing away on grant reports in my office? Paul Harvey giving a credulous glowing report from parents who claim that chelation therapy "cures" autism!

Arrrrrggghhhhh!

Sorry. I had to take two minutes to vent. Back to work...

(You know, it occurs to me that I probably just revealed what an old fart I'm becoming that I regularly listen to a radio station that broadcasts Paul Harvey's reports...)

Give me that old time skepticism!

After seven editions away, the Skeptics' Circle has come home to its founder's blog, and St. Nate has brought it back to its roots, which, in this case, is a good thing. Consequently, the Ninth Edition of the Skeptics' Circle is filled with great skeptical blogging that would do the Amazing Randi proud. Check it out.

And look for the next edition to appear at Skeptico two weeks from now. Be sure to show Richard some love and send him examples of your best skeptical blogging to rrockley AT pacbell DOT net.

More vaccine blogging

As you can see by scrolling down this page, I posted a rather lengthy article yesterday about anti-vaccination "skepticism" on The Huffington Post. Coincidentally, Skeptico also posted a nice article on the very same day about Mercury in vaccines and chelation therapy. Through this article, I found a rather interesting blog, Autism Diva. It's a lovely counterpoint to most of the stuff on the Internet about autism in that it approaches the subject from a skeptical viewpoint and doesn't push all sorts of unproven altie therapies for autism. There's one post on the blog that gives an idea how much pseudoscientific quackery like chelation therapy for autism can cost the unfortunate parents of autistic children and another nice withering piece about the uselessness of chelation therapy for autism:
Autism Diva believes the whole chelation "cult" appears to be in some kind of trance wherein everyone agrees that chelation cures the kids, any improvement they make is always attributed to chelation. If it is a cultlike atmosphere, ones who don't see improvement will be afraid or too ashamed to speak up and say it isn't working for fear of being marked as apostates. Everyone in the "cult" sees the emperor fully clothed.
Amen.

She also has a nicely snarky piece on the Autism One conference in Chicago (which starts today), which features talks claiming that fermented foods can cure autism and that you can use "vibrational medicine" to treat autism, among other claims. The fact that David Kirby, author of Evidence of Harm, is the keynote speaker probably should tell you all you need to know about this conference. If that's not enough, Mark and David Geier are featured speakers, as is Dr. Andrew Wakefield, the investigator whose study claiming to find a link between MMR and autism was renounced by 10 its other co-authors as not showing any such link. If that doesn't convince you, then look at the list of abstracts. There are a couple of abstracts that look as though they might be legitimate science, but the vast majority do not. There's a whole lot of abstracts on mercury causing autism, treating autism with zinc, lowering your "toxic load" (a favorite altie term), etc.

I'm going to add the Autism Diva to my blogroll this weekend when I do a little spring cleaning of the list this holiday weekend.

Forgot about this one yesterday

Reported in the New York Times, eighty years ago today.
John T. Scopes, young Dayton (Tenn.) high school teacher, tonight stands indicted for having taught the theory of evolution to students attending his science classes in violation of a law passed by the Tennessee Legislature and signed by the Governor on March 21, 1925.
The indictment was issued on May 25, 1925. (Via RPM at Evolgen.) Note that the Scopes Monkey Trial did not begin until July 10. Expect the science blogosphere to erupt around the time the 80th anniversary of the trial this summer. Certainly, I plan on commenting on it.

You'd think that eighty years later this wouldn't still be an issue, but you'd be wrong, unfortunately. Look around at how Kansas or Georgia debate the teaching of evolution, and you'd hardly know that eighty years have passed.

Wednesday, May 25, 2005

Rubinstein keeps digging, apparently

Via my Sitemeter logs, I've discovered a blogger named Jody, who has carried out an e-mail correspondence with Professor William D Rubinstein, the history professor who wrote a really badly argued article criticizing evolution, chock full of "intelligent design" creationism canards. He's the same Professor Rubinstein that I lambasted, resulting in an invitation to comment by a blogger named J. Bowen, who had written in essence, a defense of Professor Rubinstein and other evolution "skeptics," which was similarly full of intelligent design canards (although Mr. Bowen does deny being a creationist). Mr. Bowen feels I was unfair with him and that I had used a straw man when calling him a creationist. All I can say in reply is: If Mr. Bowen is truly "not a creationist," as he claims, then I hope that readers knowledgeable about ID fallacies will forgive me for my thinking he is, given that he used some classic ID apologist techniques to "debunk" evolution. If he's not a creationist, he certainly knows how to imitate one almost flawlessly.

But I digress. All I really wanted to say in this post was that Jody's account of his e-mail exchange with Rubinstein gave me a chuckle, and I think it will give you one too.

Antivaccination rhetoric running rampant on the Huffington Post

A couple of weeks ago, Arianna Huffington introduced into the blogosphere with great fanfare a new group blog, The Huffington Post, which was going to be populated by various pundits and celebrities who would blog. To me so far it looks like just a standard political punditry website with a bunch of periodic articles by different people. (Heck, the website doesn't seem to allow comments or Trackbacks.)

So far, I'm not impressed.

Indeed, during its 16 days of existence, Huffington's group blog appears to have already become a repository for anti-vaccination propaganda based on the usual pseudoscientific and fallacious arguments that most antivaccination zealots use. (Tip o' the hat to "chaperonin60," who pointed this out to me.) I've already counted at least five posts "questioning" the efficacy of vaccination or postulating a (probably nonexistent) link between thimerosal in vaccines and autism. They come from three writers. First, there is an article by Janet Grilo, an autism advocate on the Cure Autism Now advocacy group. It's hard to criticize this article that much, because Ms. Grilo is the mother of a child with autism. However, her article blames her son's condition on thimerosal-containing vaccines and mentions "studies" that supposedly prove a link (without actually directly citing any of the studies). As much as I sympathize with parents of autistic children, I also realize that their desperation to do anything to help their child can make them prone to believe all sorts of questionable science and quackery that offer them a cause for their child's plight and a hope that the child might get better. Indeed, autism is one of the most common diseases that quacks prey on, mainly because it has no effective treatment and is so devastating to the child and family. Quacks will offer all sorts of ineffective treatments, particularly chelation therapy (and here), bilking the parents for sometimes as much as hundreds of thousands of dollars. The Institute of Medicine has examined the evidence and affirmed the safety of vaccinations twice, in 2001 and 2004, but that doesn't deter the quacks pushing chelation therapy for autism. Indeed, it feeds their conspiracy mongering, allowing them to claim that the government is prematurely trying to "dismiss" or "suppress" the "real story," and that is to the harm of children with autism and their parents.

Next up in the queue are two articles (and here) by David Kirby, the author of Evidence of Harm. The first one is brief and more or less a plug for a movie, plus a bunch of "questions." The second one is a rant against the CDC, which Kirby accuses of withholding data. He also makes dark unsubstantiated accusations that the CDC covered up data showing a link, approvingly referring to a study by Dr. Mark Geier and David Geier that purports to have found a link between thimerosal and autism using the CDC's own data set. I'm not sure which study he is referring to, but I'm guessing that it is a 2003 study that was rife with methodological errors and inadequate description of statistical methods. Kirby also neglects to mention that Dr. Geier has been a consultant and expert witness in many cases presented to the National Vaccine Injury Compensation Program and that he has also been deemed unqualified to be an expert witness in several cases. David A. Geier, his son, is president of MedCon, a medical–legal consulting firm that helps vaccine injury claimants to obtain money from both the National Vaccine Injury Compensation Program and through civil litigation. Kirby also neglects to mention that, in their zeal to find a link between thimerosal and autism, the Geiers have engaged in data collection irregularities, drawing a rebuke from the CDC and suspension of Dr. Geier's IRB approval from Kaiser-Permanente. Odd that Kirby didn't mention this. Perhaps he thinks this is all part of a nefarious plot by the CDC to discredit the Geiers. Or perhaps he doesn't see anything the least bit questionable about the Geiers' data collection irregularities or their clear conflict of interest in making their livings consulting for and representing parents bringing litigation against the NVICP and thus sees no reason to mention it. Who knows? Of course, anti-vaxers frequently dismiss studies that fail to find a link between mercury in vaccines and autism by pointing out when the investigators have ties to industry. In contrast, they seem blithely unconcerned when two of the leading advocates of a link happen to make their living off of parents trying to get compensation from the NVICP, which is the only reason I mention the Geiers' activities in the legal realm. What's good for the goose is good for the gander.

Personally, though, I'd prefer to get back to the data. Consequently, I'd ask Kirby a few questions of my own, based on known evidence: First, if thimerosal is indeed the cause of the increase in the incidence of autism observed over the last 25 years, as he clearly seems to believe, then why is it that autism rates are still rising, even though thimerosal has been removed from virtually all early childhood vaccines, as shown by a Danish study (also here)? Remember, this is years after thimerosal was ordered removed from childhood vaccines in Denmark in 1992 (vaccines were completely free of thimerosal in that country by 1995)? Similar observations have been reported in California (and here), although there are those who point out that earlier diagnosis of and expanded diagnosis criteria for autism accounts for the majority of the increase. In this country, thimerosal was removed from most vaccines in 2000 and none of the required early childhood vaccines have had thimerosal in them since 2002-2003. Few children under four have received a thimerosal-containing vaccine, and even those that did have received far less thimerosal than older children. However, even correcting for better diagnosis and the broadening of diagnostic criteria (which have definitely contributed the lion's share to increase in the apparent number of new cases of autism), autism rates are probably still rising, just not nearly at the rate that the anti-vaxers claim. In any case, if mercury in vaccines really does act as some sort of environmental "trigger" for autism, wouldn't we expect rates to have started to fall precipitously by now (particularly in Denmark, where it's been 10 years since there was thimerosal in any of its vaccines) or at least leveled off, given the usual age range children show the first symptoms? Second, I'd ask him if, as he seems to believe, a major part of the pathogenesis of autism is mercury from vaccines, then why is it that autistic children do not demonstrate the known symptoms of mercury toxicity, which include visual disturbances, unsteady gait, slurred speech, and numbness in the digits? Third, why is it that no increase in the blood level of mercury to above safe levels is observed in infants who have received thimerosal-containing vaccines and that much of the mercury is rapidly eliminated in the feces? Finally, why is it that there is no correlation between the dose of mercury received and the incidence and/or severity of autism observed? All of these are pretty significant pieces of data casting doubt on a mercury-autism link.

Unfortunately, the most disappointing two articles of the bunch come from a physician, Dr. Jay Gordon, who posted the first anti-vaccination article a week ago under the title Parents' Right to Choose and then followed it up with another piece entitled Vaccines and Autism: Answers. Although he is clearly not a full-fledged anti-vaxer, Dr. Gordon's website suggests that he is bordering on being altie and maybe even an HIV/AIDS denialist, given that he seems to buy at least partially into the idea that anti-HIV drugs contribute to AIDS and lists a number of "alternative" methods to "strengthen the immune system" (a favorite altie all-purpose "treatment strategy") of AIDS patients. I'll give him some credit that at least he does give his patients most of the recommended vaccines, but in many places in his website he expresses "skepticism" over the safety of vaccines and emphasizes again and again how few cases of the diseases being vaccinated against there are (forgetting, perhaps, the concept of herd immunity and how mobile people throughout the world have become). Unfortunately, though, even though he claims to "rebut" antivaccination activists, he seems to buy at least partially into a standard anti-vaccination line that the mercury in the thimerosal preservative of some vaccines causes autism:
Very few experts agree with the only partially proven hypothesis that vaccines have contributed to the huge increase in autism and related disorders. Vaccines remain a public health triumph but still worry many parents. They worry me, too.
The "only partially proven hypothesis that vaccines have contributed to the huge increase in autism and related disorders"? How about the unproven hypothesis that vaccines have contributed to the huge increase in autism? That would have been more accurate. I'd have given Dr. Gordon the benefit of the doubt based on the contents of his website, which, while a bit on the altie side, is not totally off the wall, if he hadn't hit me with this statement in his other article in the Huffington Post:
The “triggers” to this huge increase (from 1 case/5000 in 1980 to 1/166 in 2005) undoubtedly include mercury. Mercury from vaccines is a very likely culprit and the most recent studies support this. Conflicting analyses do exist. Most of the doctors and researchers involved in denying that vaccines cause autism are recipients of large sums -— millions of dollars in some cases -— from the vaccine industry.
Oh, my.

Dr. Gordon, I had hoped you wouldn't invoke the usual conspiracy theory mongering that anti-vaxers love. I really had, as your website, flaky as some of its contents are, is fairly unremarkable in its medical advice about other areas and downright reasonable in comparison to many of the loony anti-vaxer websites I have had the misfortune of encountering. However, when I see someone so quick to intimate that those who disagree with their beliefs are, in essence, shills for some corporation or other, I know I'm reading someone who is probably well along the path to the Dark Side, even if he has not yet arrived there. To such people, anyone who questions their assertions regarding vaccines must be in the pocket of the pharmaceutical industry. There can be no other explanation. Surely they couldn't have come to their conclusions through science and their own research, at least not according to alties. Other than well-documented examples like the Geiers, I don't automatically assume that researchers who believe there is a link between thimerosal and autism have a financial interest in finding out that there is such a link, and I try hard to evaluate each study on its own merits. (I may or may not succeed, but I try.)

Worse, through the link in his article, Dr. Gordon invokes Professor Boyd Haley, Chairman of the Department of Chemistry at the University of Kentucky, who has become the darling of the anti-vaccination movement and has even gone so far as to refer to autism and ADHD as "mad child disease." This insensitive remark provoked a petition demanding an apology, which Dr. Haley has refused to do, claiming he had said "M.A.D. child" disease (for Mercury-Acquired Disease of children--an extremely insensitive and tasteless acronym even if you take Dr. Boyd at his word that the acronym was the meaning that he had originally intended when he made the statement). He is also an advocate for dental amalgam removal, a favorite altie stalking horse for practically every chronic disease humans suffer from, particularly fibromyalgia and autoimmune diseases. Indeed, he is Chair of the Advisory Committee for Toxic Teeth, an anti-amalgam group. Even worse, an educated layperson has been able to show many of the fallacies of Dr. Haley's claims, particularly the oft-repeated anti-vax claim that vaccines contain 50-100 times the FDA safe dose of mercury. Well, that's not exactly true; older vaccines contained 50-100 times the FDA safe dose for one day (originally developed as a guideline for eating fish, which may contain mercury). As the study I mentioned above shows, even that dose of mercury in vaccines does not raise blood levels above levels considered safe.

The bottom line is that the evidence purporting to show a link between thimerosal and is weak at best to nonexistent at worst. Does that mean a link definitely doesn't exist? No. However, the observation that autism rates are still rising despite the reduction and elimination of thimerosal as a preservative in childhood vaccination is pretty strong epidemiological evidence that there is probably no link or, if such a link exists, it is probably very, very weak. In fact, the only thing I agree with Dr. Gordon on is that in the next few years, as more and more of the present generation of preschoolers who have never received thimerosal-containing vaccinations reach and pass the age range where autism is most frequently diagnosed, doctors and scientists will "break" this case. However, based on the experience in Denmark, I consider it highly unlikely that they will come to the conclusions that Dr. Gordon apparently thinks they will. (In a way, though, I sometimes actually think it would be great if such a neat link were discovered, because then we could anticipate that the rate of diagnosis of new cases of autism will fall precipitously over the next few years. Given the devastation that autism causes to children and their parents and the cost of taking care of these children, who wouldn't want that?)

In reality, though, even if autism rates do continue to rise and further research does continue to fail to demonstrate an epidemiological or biological link between the thimerosal in vaccines and autism, that still probably won't stop anti-vaxers from continuing to blame vaccines for autism. Like Ahab, they've identified their whale and will pursue it to the end, no matter what. Most likely, their explanation for a supposed link between vaccines and autism will simply shift to another area. For example, they still blame MMR vaccines for autism, even though MMR does not and never has contained thimerosal and there is no link other than a discredited study which the majority of authors have now renounced. I'm guessing they'll find other creative ways to blame vaccines for autism. No doubt we'll see articles on the Huffington Post about that, too, when it happens.

ADDENDUM: Earlier today, the Huffington Post printed a rebuttal to David Kirby's and Dr. Jay Gordon's earlier posts by Dr. Marc Strasburg, an adjunct Professor of Epidemiology at UCLA. It's about time. Let's see, five anti-vax posts, and one short rebuttal. Oh well, at least they let someone post something. Now just wait for a flurry of posts attacking Dr. Strasburg's article. Just wait. I hope I'm wrong, but I predict it's coming.

ADDENDUM #2: Apparently more recent posts on the Huffington Post now allow comments.

Tuesday, May 24, 2005

The Commissar gets it right

Not all conservatives drink the "intelligent design" Kool Aid. For example, the Commissar takes the "argument" of "let the students decide" what should be taught to its "logical" conclusion! Sadly, I've seen some course lists that sort of look like the one he describes.

Quoth the Commissar: "The best part is... if this curriculum is all wrong... the kids can figure it out for themselves!! Put it all out there and let the students decide."

Sadly, that's what ID adherents are in essence saying when they say, "Let the students decide."

The Commissar also gets it right when he lambastes pseudoscientists for whining rather than doing what real scientists do (looking for evidence) when their ideas are not immediately accepted, and he gives the examples of several real scientists whose ideas were rejected at first--until the weight of evidence forced scientists to revise their opinions. I've said more or less the same thing in the past:
...no real scientist claims that the "Theory du Jour" is the "final word." Such thinking is anathema to scientists. Real scientists consider every theory as merely provisionally accepted as the best presently existing explanation for a natural phenomenon. All theories, including evolution, are subject to revision or replacement if new evidence mandates it. Indeed, the greatest joy a scientist can achieve is not to confirm current theory (although that can be satisifying) but rather to challenge and go beyond current theory, filling in its flaws or even overturning it altogether in favor of something new that leads to new understanding and new areas of inquiry. But achieving that is not easy. It takes evidence so compelling and in such quantities that the bulk of scientists are finally forced to admit that present theory can't stand against it, something ID proponents don't seem to understand. If they think ID is a superior explanation for evolution than present day theory, they need to produce the goods to prove it, just as every scientist who has successfully challenged current theory has done before. It is not up to the skeptics to prove ID is not the best explanation for the diversity of life; it is up to its adherents to prove that it is.

Grand Rounds XXXV

Grand Rounds XXXV has been posted at Iatremia: The Chaplin.News, but only after a demand by Dr. Chaplin on Saturday to "submit to me," and then introducing each entry with appropriate quotes, some altered to fit the material. It would appear that many have submitted to Dr. Chaplin, and the result is one of the larger and more varied Grand Rounds I can recall.

Enjoy.

Invitation accepted

Yesterday morning, I was quickly looking through my e-mail before heading off to clinic, when I noticed a message with a Subject header reading "Invitation to comment." The message was from a "J Bowen," someone of whom I had never heard before.

I should have known better. I really should have. I knew no good could come of it, just as no good can come of clicking on a piece of spam. But I did it anyway. I foolishly clicked on the link to the article about which Mr. Bowen apparently wanted me to comment. I instantly regretted it. Contained in the article was more "intelligent design" apologia, this time in response to Dr. Richard Hoppe's critique of the same mind-numbingly bad "criticism" of evolution written by historian Professor William D. Rubinstein that I myself had critiqued, both in the comments of Professor Rubinstein's original article and right here on Respectful Insolence.

Humble guy that I am, I immediately realized that I was probably not being singled out for the "honor" of being asked to comment on Mr. Bowen's article because he was genuinely interested in my opinion about it. Rather, I'm guessing that I was probably "invited" to comment on his piece because (1) I had commented on Professor Rubinstein's article in similarly unflattering terms as Dr. Hoppe had and (2) because Bowen probably thought (mistakenly, I hope) that I would be an easier mark than either PZ Myers, who had also eviscerated Professor Rubinstein's article twice or Dr. Hoppe, who had posted the original article to Panda's Thumb that had gotten Mr. Bowen all worked up. Although I'm a physician with extensive training in molecular biologist, I'm not an evolutionary biologist. Given the shoddy quality of the "rebuttal" Mr. Bowen posted, I'm not surprised that he would naturally seek out whom he perceived to be the weakest target, rather than simply forwarding his permalink to Dr. Hoppe for comment. However he miscalculated. I'm more than sufficient to take care of ID apologia as poorly constructed as that by Mr. Bowen. And I also called him on it by forwarding his request for comment to the target of his wrath (I had to get to clinic and didn't have time to start to address his post until last night).

So what did I see when I made the mistake of clicking on the link provided? Well, this sure wasn't auspicious:
If you should ever see a jackass wearing a mortarboard exiting a biology department, it might well answer to the name "Hoppe." From a post attacking someone who dares to dissent from evolutionary dogma, quoth Richard Hoppe:
Oh, boy.

Whenever I read or hear anything along the lines of "dissent from evolutionary dogma," I know I'm probably dealing with a hard-core creationist of the "intelligent design" variety. Mr. Bowen is a prime example of the "pot calling the kettle black." He's oh-so-self-righteously upset that anyone would use less than perfect decorum criticising an author who publicly posted something so risible that he utterly deserves being called "pig-ignorant" but then sees no problem calling Dr. Hoppe a "jackass wearing a mortarboard." Mr. Bowen then proceeded to use a time-honored ID technique for attacking evolution: quote-mining. In this case, he carefully selected a few paragraphs from the Talk Origins speciation FAQ that put the topic in context and pointed out a few shortcomings with the presently existing reports of speciation, with the clear intent to make it appear that this FAQ "admits" that there are few examples of speciation. Of course, Mr. Bowen neither linked directly to the FAQ, nor did he bother to mention that the FAQ to which he referred lists at least a couple of dozen more examples of observed instances of speciation. He did mention another FAQ from Talk Origins that lists a few more examples, but then dismissed them blithely as having "their flaws" (without, of course, actually listing what any of those flaws are or why he considers them flaws--surprise, surprise), finally concluding with another fine example of a "pot-kettle-black" attack on Dr. Hoppe:
Spend your time researching instead of defending your faith with content-free invective like Hoppe.
No, Mr. Bowen, I suggest that you spend some time learning some basic evolutionary biology, rather than defending your faith with content-free invective. Good places to start are here, and, for information regarding what you incorrectly label as "missing" fossils, here. I could go on more about Bowen's obvious selective quoting, but why bother? PZ, as usual, has beaten me to it, dismantling Bowen's post in more detail and with more gusto. I don't want to belabor the obvious about this ID apologist and the utter speciousness of his "arguments," other than to point out that he invited me to comment on his article. All I can say now is:
Invitation accepted.
Aren't you glad you invited me? No, no, don' t thank me for my trouble.

It was my pleasure.

ADDENDUM 05/24/2005 11:30 PM: Someone told me that the link to Mr. Bowen's article was broken. I tried to access the article and Mr. Bowen's blog to verify whether or not this was true, and, as of this writing, Mr. Bowen's blog is indeed unavailable, at least from here. I keep getting an error message. Blogger bug? Who knows? Anyway, hopefully his article will be up again soon. Articles like that should be read widely to demonstrate the utter speciousness of the usual "criticisms" of evolution made by self-proclaimed "skeptics," most of whom are ID apologists. Also, whatever nastiness has passed between us, I can't help but feel sympathy for a fellow blogger whose blog may have been sabotaged by Blogger's shortcomings. I've been there myself.

Monday, May 23, 2005

Credit where credit is due

Yes, it appears that I'm not the only one ruminating about the strange behaviors cell phones will lead people to. Dr. Charles beat me to it last week and did it without descending into bathroom humor. I did remember seeing his post and being amused; I probably should have mentioned it. Oh, well, better late than never.

An odd place for a telephone booth

I was sitting in my office, working on a yearly summary report for a grant. In such reports, it is customary to report on what you have done the previous year and, most importantly, to paint a glowing picture to the granting agency (in this case, the Army) of how much fantastic progress has been made on the funded project and how well-spent its money had been, so that they continue to fund the remaining years of the project. While I was typing away and cutting and pasting various figures into the document, I felt the call of nature. It's not surprising, given that the verbiage that I was introducing into the report was not unlike one of the end products of answering said call (which is probably why such tasks seem to stimulate certain biological functions in me). I tried to ignore the need for a while, wanting to finish the section I had been working on first, but the urge became steadily more insistent. Biology can only be denied for so long before it has a way of forcing its will to be done.

I headed towards the bathroom nearest my office, thankful that the urge hadn't hit me while I was in the operating room.

Entering the nearest stall, I prepared to do what my colon was demanding of me when, eminating from the stall next to me, I heard it. No, it wasn't the rude noises common to such facilities, nor was it the flush of a toilet. It was this (paraphrased from memory, of course; I don't carry tape recorders into the john with me, at least not routinely):

"Well, I realize that that regimen will really knock him for a loop. He'll be neutropenic for quite a while, and he might even need to be admitted. On the other hand, he's failed first-line therapy, and this is probably your best next option."

I recognized the voice. It was one of our medical oncologists (whom I'll call "Dr. X"). In fact, it was a senior oncologist, one of the best we have in our facility, one whose abilities and compassion I respect enormously. Apparently Dr. X had felt same call that I had. But apparently the call of nature wasn't the only call he had felt the need to answer.

"Of course I'd be happy to accept him here, if that's what you'd like. However, if you'd prefer to give him the chemo yourself, you could always transfer him if he got into trouble." A pause, during which I could hear a quiet buzzing that must have been the person he was talking to coming through on his phone. "Yes, I'd say the odds of inducing a remission are probably less than 50%, but he'll progress rapidly if you don't do anything, and even if you don't get a complete remission you could get a strong partial response."

Holy crap! (An appropriate exclamation, given the situation.) Dr. X was having a long and involved conversation on a cell phone about a patient with another physician while sitting on the throne! As I sat there, I could not help but become engrossed (another seemingly appropriate word) in the conversation. He was going into great details about this patient's course of treatment, the likelihood of success, the potential side effects, and how those side effects could be managed. I was getting a serious education in the second-line therapy for non-Hodgkin's lymphoma right there on the commode! At first I thought to myself that this had to be some sort of HIPAA privacy violation, but on second consideration, I realized that no patient-identifiable information was being discussed at this end. (Hopefully the doctor on the other end of the conversation was in his or her office or someplace suitably private.) The conversation was perfectly legal! So engrossed was I that I temporarily forgot my purpose in entering that stall. No problem, though. My colon wouldn't let me forget for long my original purpose.

I completed the task for which I had entered the stall.

Sweet relief, but I was now faced with a dilemma. Dr. X was still continuing his conversation next door, but my task was actually not yet quite complete. One thing remained. The problem is, I realized, that that "one thing" might cause a problem. So, there I stood, having finished wiping, and pondered the question for several seconds: Should I or shouldn't I flush? On the one hand, flushing would very likely be heard by the person on the other end of the line, revealing that Dr. X was in the bathroom while carrying out this conversation. I didn't want to embarrass him if I could help it. On the other hand, the end result of my visit to the commode was rather large and stinky, my having had a pretty big and greasy meal the night before. It really wasn't fair to future users to leave it there unflushed to pollute the rest of the public restroom. Dr. X had decided to have his conversation in the sanctum sanctorum. I couldn't be responsible. However, I could be responsible if I left the disgusting product of my colon behind, unflushed, to gross someone else out and to require them to do what I should have done in the first place. My course was clear. I knew what I had to do.

I hesitated a moment, my hand over the handle, and then flushed.

The sound filled the restroom, loud and reverberating off the walls. It was an unmistakable sound, an emphatic declaration that my business there had concluded. There was no way that Dr. X's conversation partner wouldn't have heard, as the phone couldn't have been more than five or six feet from the sound, separated only by a partition. The sound of rushing water seemed to go on forever. It's fortunate that it did go on so loudly and luxuriantly.

The flush covered my escape.

I darted out of the stall, went right past the sinks, left the restroom, and headed for my lab, where I could wash my hands without the chance of Dr. X seeing me on his way out, although I think he was still otherwise indisposed.

Gentle reader, you might wonder why I behaved in the manner that I did. I ask myself the same question. Why couldn't I have thought of another solution? For instance, I could have refrained from flushing and then simply checked back in a few minutes, after Dr. X had finished both parts of his business, the primary and secondary (I don't know which he would consider primary and which secondary). My office wasn't far away, nor was my laboratory. Such a solution would have worked quite well.

The answer, I think, comes down to annoyance, plus a little embarrassment at having listened in on a private conversation about a patient. Yes, I realize that the embarrassment was irrational, given that I had little choice but to hear the conversation (unless I wished to go to the public restroom one floor down, not a great idea given the urgency of my need), but the annoyance was not. It used to be that, even in a public restroom, one could expect a modicum of privacy to go about one's business with regard to the purpose for which the stall was intended. Little in the way of conversation usually happened there (the exception being large restrooms at stadiums, where people waiting in line will frequently talk), and even there usually not in the stalls. But I think the annoyance was more generalized than that. The younger readers of this blog may not understand this, but I was annoyed at the intrusion. I was annoyed that technology has reached the point such that no place is considered off-limits for conducting business or doing work, a point driven home by this incident.

No place, that is, except the rare locale that doesn't have a signal.

Don't get me wrong. Cell phones are wonderful devices, something so phenomenally and incredibly useful that I no longer see how I could go through life without one. I'm a complete gadget freak in many ways. However, back when I started my residency, pagers were used only by doctors and drug dealers. A few years later, anyone could afford them. A few years after that, cell phones proliferated. I got my first cell phone in 1997, and it was a brick and too expensive to use all that often. Now cell phones are tiny, and you can get plans with huge buckets of nationwide minutes at relatively cheap prices. No wonder almost everyone has one. No wonder Dr. X uses one to take care of business while he's taking care of business, so to speak, given how much he has to do in a day. However, thinking of being so busy that I would feel the need to occupy every minute with productive activity, including my time on the throne, would give me pause.

The great benefit of these devices is that they allow us to be connected almost anywhere, an attribute that is particularly useful in emergencies and especially useful for doctors who take care of a lot of sick patients. Unfortunately, that same interconnectedness is also their curse. For many, there is now no escape from work, no place that can be considered private, no excuse for not answering. For others, there is now no place that is safe from being subjected to the interconnectedness of others. Being subjected to a detailed conversation about a paitent while I was trying to take care of business that, until recently, had been considered private reminded me of that. Twenty years ago, no one would have conceived of having telephone conversations of great import while sitting on the can. Now, no one thinks anything of it. It's bad enough when someone as busy as Dr. X feels so harried that he won't even allow himself a moment's peace, but what about less important uses. I've seen guys walk into the restroom, phone plastered to their ear jabbering away, walk up to the urinal, whip it out, do their business, flush, and put it back in their pants, all without even slowing down their conversation.

Are all these conversations really so important that they can't wait a few minutes? To some extent I can understand why Dr. X, being so unrelentingly busy taking care of his patients, might consider it entirely rational to take advantage of a cell phone's ability to let him to do two things at once even in the strangest of places, but that doesn't mean I have to like it. Technology exists to serve, but unfortunately it's all too easy to let it rule us. All this wonderful technology that wires us and binds us through radio waves to each other can, at times, seem a smothering electronic cocoon that destroys the precious little personal space we have left.

Sunday, May 22, 2005

Yoda's wisdom for the ages

An example of Yoda's wisdom:
Saying, "A disturbance in the Force, I sense" after someone farts, only funny once, it is.
Indeed.

There's more where that came from...

Ease the pain

Apparently, yesterday was morphine's 200th birthday (something I didn't know), and articles on celebrating the occasion pain are here. On the same blog (written by a nurse), there's also a rather amusing post about where her demented patients wanted to go during the night shift and where she suggests they should go.

Movie recommendations

Hmmm. I hadn't expected this result when I took this test, although having SF/Fantasy come in so high is consistent. I would have expected it to come in first, though.


You scored as Mindfuck. Congratulations, you scored Mindfuck. You've probably seen a lot of movies, and have grown to hate mainstream shit. You're looking for the movie that will leave you breathless, and with 21 questions to think about. Check out: Donnie Darko, Being John Malkovich, Pulp Fiction, Memento.

Mindfuck


75%

Sci-Fi/Fantasy


70%

Artistic


65%

Drama/Suspense


60%

Sadistic Humour


50%

Mindless Action Flick


50%

Romantic Comedy


30%

Movie Recommendation.
created with QuizFarm.com


I do like mindfuck movies like Donnie Darko (great movie), Pulp Fiction, Brazil, Dark City (another cool one), and 12 Monkeys. However, I didn't much like Jacob's Ladder (too manipulative and predictable). I haven't seen Being John Malkovich or Memento. Perhaps I should rent them....