A creationist response to antibiotic resistance?

Here's an amusing take on how creationists might deal with the phenomenon of antibiotic resistance. After all, blaming bacterial resistance to antibiotics on something like evolution by natural selection (the selective agent being the antibiotic, of course) just won't do, will it? Instead, better to let the Creationist Patrol deal with it...

(Via Pharyngula.)

Skeptico finds more RFK Jr. quote-mining

I've been slamming RFK Jr. over the last few weeks for shoddy, one-sided research and quote-mining in his infamous Salon.com article from a couple of weeks ago, Deadly Immunity, in which he swallowed whole all the mercury-autism hysteria and postulated dire conspiracies on the part of the CDC and IOM to "cover up" the supposed link. I started the ball rolling by pointing out an example of RFK Jr.'s brand of highly selective quoting, and Skeptico took it further by reading the entire Simpsonwood transcript (warning: link to large PDF file) and showing how selectively it was quoted out of context in order to give an impression of a whitewash.

Well, now, challenged by a commenter on the Institute of Medicine report (warning: link to a large PDF file) to "explain to me how these quotes are taken out of context as the IOM president would like us to believe," Skeptico has waded through the report and done just that. He's shown that RFK Jr. didn't confine his deceptively selective quoting to just the Simpsonwood transcript. He applied the same technique to the IOM report, taking quotes out of context to make them sound conspiratorial, as if scientists were trying to hide something. Naturally, it's enraged and frustrated Skeptico, and I can entirely sympathize with his rant at the end:

OK, that’s it. Enough! The conspiracy believers have taken their best shot – and that was your best shot – and neither document quoted by Kennedy shows any conspiracy or cover-up. And frankly, taking a few out-of-context quotes from a 199 page transcript as proof of a conspiracy is pretty stupid anyway, but when the transcript reveals a group of honest scientists trying, with integrity, to grapple a difficult problem, it gets beyond stupid and is just thoroughly dishonest. It’s pathetic, frankly. If there really was a cover up, wouldn’t they have something better than this?

No more. Don’t bother throwing down a url linking to a huge .pdf with a couple of dodgy quotes in it and expecting me to read it. That’s over now.

Wow. First he wades through the entire Simpsonwood transcript in record time, and now he wades through the entire IOM report in similarly record time. I'm impressed, but somehow have to wonder if he needs to get a bit more of a life.

Just kidding--although the three-day Fourth of July weekend is coming up soon.

I also wonder if that means I'm now going to have to try to wade through more of these transcripts; I've just barely finished the Simpsonwood transcript--and that was two weeks in coming....

A scientific creation story

Although I've been slamming the Huffington Post lately for buying into the mercury-autism scare-mongering wholeheartedly, I can't help but give it credit for publishing a column by Michael Shermer. This week, Shermer gives us a scientific creation story. I can't help but think he's being a bit tongue-in-cheek:

...And God said, Let the waters bring forth abundantly the moving creatures that hath life, the fishes. And God created great whales whose skeletal structure and physiology were homologous with the land mammals he would create later that day. Since this caused confusion in the valley of the shadow of doubt God brought forth abundantly all creatures, great and small, declaring that microevolution was permitted, but not macroevolution. And God said, “Natura non facit saltum”—Nature shall not make leaps. And the evening and morning were the fifth day.

And God created the pongidids and hominids with 98 percent genetic similarity, naming two of them Adam and Eve, who were anatomically fully modern humans. In the book in which God explained how He did all this, in chapter one He said he created Adam and Eve together out of the dust at the same time, but in chapter two He said He created Adam first, then later created Eve out of one of Adam’s ribs. This caused further confusion in the valley of the shadow of doubt, so God created Bible scholars and theologians to argue the point.

And in the ground placed He in abundance teeth, jaws, skulls, and pelvises of transitional fossils from pre-Adamite creatures. One he chose as his special creation He named Lucy. And God realized this was confusing, so he created paleoanthropologists to sort it out. And just as He was finishing up the loose ends of the creation God realized that Adam’s immediate descendants who lived as farmers and herders would not understand inflationary cosmology, global general relativity, quantum mechanics, astrophysics, biochemistry, paleontology, population genetics, and evolutionary theory, so He created creation myths. But there were so many creation stories throughout the land that God realized this too was confusing, so he created anthropologists, folklorists, and mythologists to settle the issue.

Alas, it would appear that some people refuse to listen.

Herbs vs. homeopathy

Last week, I was in the recovery room of the Same Day Surgery Unit, having completed my last case of the day. While I was sitting at the computer entering postoperative orders, I overheard a conversation. A middle-aged woman, who appeared to be a relative of one patient lying in one of the recovery bays, was speaking to the patient's nurse. She was expounding in great length and detail about the herbal and homeopathic remedies that she favored, with the nurse politely listening, but with a slight tightening of her mouth that told me she was probably thinking, " I wish this lady would shut up, already." Then the woman said something that I actually found myself agreeing with, although not for the reason this woman would think:

"Remember, homeopathic remedies and herbal remedies are two completely different things."

Believe it or not, I agree with that. A few herbal remedies might actually have a therapeutic benefit, mainly because some herbs contain pharmacologically active compounds that work like drugs (albeit in amounts that vary markedly from batch to batch, making herbs an unreliable source of active drugs). Indeed, many of our drugs are chemically altered versions of active molecules found in nature, usually in plants. For example, Taxol, a chemotherapy drug used to fight breast cancer and a variety of other tumors, comes from the bark of the Pacific Yew tree, Taxus brevifolia. Another drug, digoxin is derived from the foxglove plant, and the list goes on and on. In marked contrast, homeopathic remedies by their very definition don't contain any active ingredients, at least not at any concentration that could possibly have pharmacologic activity. This makes homeopathic remedies completely worthless, the claims of its advocates that somehow the water used to dilute the solution retains a "memory" of the active ingredient that was diluted out notwithstanding.

Remember, if a "homeopathic remedy" actually contains any active ingredient whatsoever, after all, then by the homeopathic Law of Infinitesimals, it is not really "homeopathic" at all!

The 31st Meeting of the Tangled Bank Society

Join David Winters at Science and Sensibility for the 31st Meeting of the Tangled Bank Society, a gathering of scientific bloggers presenting their findings to their peers:

Welcome to day one of the 31st meeting of the Tangled Bank Society. As you know the Tangled Bank meeting offers a chance for scientists and scientific communicators working in disparate fields to get together and talking about what they are up to, what drives them and what they find interesting Below is a schedule for today's session which is being held in the Winter Lecture Theatre. Each presentation is identified by title which is followed by the author's name and the institution the presenter is representing. As you will note the schedule for today is pretty full so we encourage you to make any comments to presenters in person following their presentation. Enjoy the talks and we hope to see all of you at tomorrow night's banquet!

It's a fine collection of the best science blogging from the last two weeks. My only question is: What's on the schedule for Day #2?

A brief Cablevision rant

Allow me a moment to vent today.

I've come to hate Cablevision.

Oh, I like its high speed Internet access service, Optimum Online. It's blazing fast and generally reliable, albeit a tad on the pricey side, but as a cable TV company Cablevision is the pits. It suffers from all the problems of a monopoly: high prices, piss-poor customer service, and a lack of certain channels that most other cable companies in my area routinely provide as part of basic or enhanced basic packages, such as Turner Classic Movies (available from Cablevision only in the most expensive digital package), BBC America, or Trio.

I was reminded the other day of one of the reasons (well, several, actually) that I hate this company so much. We have two TVs, one in our family room and one upstairs in our bedroom. The cable signal to the TV in our family room has always worked pretty well. In contrast, the the one in our bedroom has been dicey almost from day one, but ever since we switched to digital cable it's always been a problem. Channels pixelate badly, freeze, and the box even turns off and reboots seemingly at random. Often, channels don't even come through at all, and I know it's not the box, because hooking the same box up to our other TV does not result in the same problems. Similarly, rebooting the box repeatedly didn't help. Because we mostly only watched the 11 PM news and Letterman when up there, it didn't bother us too much, mainly because it was usually the premium channels that did this. Besides, both my wife and I work, and taking an afternoon or morning off to wait for the cable guy just never seemed to be worth the pain it would take to get one to come out. Several calls to customer service and going through troubleshooting routines didn't help. I was convinced it was the cable connection, because our other connection worked fine, suggesting that a service call might require major rejiggering of the cable itself. Worse, many months ago, I scheduled a service call to deal with this very problem, and the repair guy never showed up. I was fed up.

Basically we just lived with it, with me occasionally making calls and going through trouble-shooting routines that either didn't work or only marginally (and briefly) helped. A few weeks ago, though, the broadcast channels started doing the same, and the other day, after procrastinating and taking the temporary measure of occasionally hooking the cable directly into the TV (which gained back the broadcast channels but lost the digital channels), I finally got fed up enough to do something about it. I called customer service.

Big mistake.

First off, since the last time I went through this, Cablevision has added an annoying computerized "customer service" system that speaks to you with "artificial intelligence" using a creepily inhuman sounding female voice, much like the system Sprint PCS uses when you call customer service. "She" sounds like a female version of HAL 9000. I hated that system enough, but at least you can get past Sprint's electronic gatekeeper if you use the right phrase or just request a representative. Not so this electronic gatekeeper Cablevision has employed, whom I'm now dubbing "She-HAL 9000" and whose dedication to keeping you the customer from getting through to a real human being rivals the tenacity of Heimdall in guarding the Bifrost Bridge and preventing trespassers from entering Asgard. A horde of enraged frost giants could be trying to get past this electronic fortress wall, and their catapult projectiles would bounce harmlessly back, rebounding on them with devastating power.

But enough of the Norse mythology references, as much as I like them.

"Hello," said She-HAL 9000. "Tell me what your problem is."

"My picture is pixelating and even freezing up."

"Please repeat." I repeated it. "I didn't get that. I'm going to list some complaints. Please repeat the complaint when you hear it." She (it?) listed five or six problems, none of which quite fit my problem. I picked one that was the closest and ran with it.

What followed were 15 minutes of ever increasing frustration. My temper and blood pressure steadily rose as I tried to go through this damnable system. The computer had me reboot the cable box twice. The first time, as I waited for the box to reboot, the she-HAL 9000 "helpfully" kept telling me that it could take "several minutes" for the box to start up. (Thanks, I never would have guessed that myself.) After I rebooted, it asked me if the problem was fixed. I said no. So it went through the same troubleshooting routine again! My answers slowly got louder and more insistent and then finally more laced with profanity. I was beginning to feel like Sysiphus, pushing the stone up the hill, feeling as though I was getting closer to the Holy Grail of finally talking to an actual live human being, only to have it roll down again. Unfortunately, She-HAL 9000 was impervious to my best cussing, which usually resulted in a reply along the lines of "please repeat."

I did. With gusto. (Never mind what cussing like a longshoreman at a computer says about me.)

Finally, after the troubleshooting didn't work again, the machine asked, "Would you like to speak to a customer service representative?"

"YES!" I bellowed.

Finally, a live human being, capable of understanding more than a few preprogrammed phrases! Of course, by this time, I was in such a thoroughly foul mood that, had I been more in control of myself, I would have realized that this could only end badly. Either that, or what was to come probably wouldn't have irritated me nearly as much. Nonetheless, I tried to compose myself and explain my problem, after pithily (I thought, anyway) pointing out to him why Cablevision's new electronic gatekeeper was an object worthy of derision and destruction.

That's when things got off on an even worse foot, when he said, "Well, if you don't want to do what it takes to take care of this..."

If I don't want to do what it takes? If I don't want to do what it takes. I pay this damned company well over $1,000 a year for cable and Internet access, and they expect me to jump through hoops and run the proverbial electronic gauntlet to get service when their crappy product isn't working?

I restrained myself, but it took a Herculean effort. When I got to the end of my explanation, the customer service representative, in his infinite wisdom, sized up the situation, and asked me what model number cable box I had. I told him. "Do you turn your cable box off at night?" He said.

"No. Why do you ask?"

"Well, there's your problem," he said, in a condescending tone.

"There's no way that's the problem," I said, "because I have tried turning off the cable box for extended periods of time and rebooting. I've tried all sorts of permutations, with no effect."

"I'm telling you, that's probably the problem."

"Don't insult my intelligence." I finally muttered, exasperated.

"I'm not insulting your intelligence," he said cooly. "I'm just giving you information about your cable box."

Now I was really pissed. Was he really telling me that (1) despite the fact that I had told him that I've turned this box off many times for hours at a time that doing it again one more time would fix a problem that none of the previous shutdowns did or (2) that Cablevision was using boxes so ridiculously badly designed, so primitive, that they have to be turned off overnight or they cease to work properly until they are? I couldn't tell, but either option painted a very bad picture of the company. It's either moronic customer service or bad equipment (or both). Never mind that the installation guy never mentioned anything of the sort, and there's nothing in the cable box instruction manual saying anything of the sort. I went back and forth with this guy, trying to restrain my temper and avoid losing it. This guy wasn't worth it. Finally, he said dismissively, "I have an appointment aon Friday between 2 and 5 PM. Do you want someone to come out?"

"I'll take it," I growled into the phone, knowing that I would be at work. I didn't care. I could always change the appointment later; Cablevision does have a phone menu option that lets you reschedule already scheduled appointments, as I had found out in previous encounters. It's only to make the first appointment to have someone come out to check it out in the first place that you have run the gauntlet of She-HAL 9000 and then the cable version of David Spade's impassable receptionist, the one who wouldn't let Jesus Himself pass. I will admit, though, that, if I could have reached through the phone, down the line, to the switching station, and to the customer rep's phone, grabbed him by the lapels, and pulled him through to face him, I would have, just so I could cuss him out face to face and give him an eye-gouge, Moe-style. But why bother? Just get the cable guy out to our house and forget the annoying customer service flack.

And, in case you're wondering, out of curiosity, I did do what the David Spade wannabe recommended and turned off the cable box overnight. Guess what?

The picture was even worse in the morning.

A fellow MD scores a takedown!

RangelMD is on a roll. First, he gave Bill Frist the major thrashing that he deserved for his behavior with respect to the Terri Schiavo case, as I mentioned last week.

Now he's joined the fight against the antiscience known as "intelligent design" creationism. It's not often that you see a more dedicated medblogger like RangelMD take on "intelligent design" creationism, but I find it quite heartening to see. (I only say "more dedicated medblogger mainly in comparison to me, because Respectful Insolence is rather like a Frankenblog; it's the medical/science/history/skepticism/silly rants blog, whereas RangelMD tends to stick more closely to medicine and medical science.) A choice excerpt:

Not only are they stuck without any direct evidence of intelligent design (ID) but also proponents of ID don't have a viable theory on exactly how God implemented her design into the universe. Any proposed mechanism paints them into a corner. If the universe was designed at the start and put into motion then God is a metaphysical being and thus beyond our ability to prove or disprove her existence beyond that of a concept. If God directly manipulates her creation on the go then where is the evidence for supernatural activity (i.e. a corporeal event completely unexplainable by conventional science)? If any supernatural manipulation of nature is beyond the ability of science to detect then we are back to square one in which ID is just another philosophy. If we can't directly prove anything about the activities of God then ID proponents must accept the fact that their theory has exactly as much weight as Flying Spaghetti Monsterism!

Nice takedown, and welcome to the fight, Chris. I might have to add an appropriately rephrased version of this paragraph to my Reply to a 14-year-old creationist.

Grand Rounds XL

Grand Rounds XL has been posted at Health Business Blog. It's yet more more medical blogging goodness all gathered into one nice easily digestible package. It should be enough to satisfy even the geekiest docs around here. Check it out.

RINO sightings (not to mention eminent domain)

The very first ever edition of RINO sitings, a forum where secular and moderate conservatives who are being driven away from the Republican Party by the loonier elements of the right wing (creationists, religious fundamentalists, etc.), has been posted at SayUncle. As they say, it's Republican, without all the crazy (well, mostly, anyway; a few of these guys are still quite a bit farther to the right than me). In any case, I joined the RINOs because it is at least attempting to provide a forum for secular moderate conservatives like myself.

One post I do agree with 100% is this attack on the recent Supreme Court ruling on eminent domain. As Barry puts it:

As a practical matter, this means that you've got good title to your property, and the right of ownership, as long as there isn't a politically connected developer in your hometown who'd like to build a Wal-Mart where your family home sits now.

Sadly, unless you live in a state that has stronger protections against eminent domain seizures than the U.S. Constitution (which, given this ruling, is now essentially no protection at all), Barry is not exaggerating.

Besides my belief that property rights are fundamental rights in a democracy, meaning that the government should not be able , this issue also resonates with me because of what happened 24 years ago in my hometown of Detroit. In 1981, General Motors and the cities of Detroit and Hamtramck collaborated to displace 4,200 people from their homes in a neighborhood known as Poletown in order to build a new auto plant. In essence, Detroit and Hamtramck used eminent domain to seize private property to give to another private entity, setting a standard that served as the basis for other governments to justify making similar property transfers to private entities for stadiums and the like. Last year, the Michigan Supreme Court ruled the Poletown seizures unlawful and placed limits on the rights of state and local governments to use eminent domain to seize land, a significant victory against abuse of eminent domain.

Too bad the U.S. Supreme Court couldn't have seen its way to do the same. At least in the Poletown case, the actions of Detroit and Hamtramck, although an example of the abuse of eminent domain, are somewhat understandable. It was the middle of the deep recession of the 1980's, and unemployment rates were in the double digits. Anything that could create badly needed manufacturing jobs was highly tempting, even if the cost was the destruction of an old ethnic neighborhood. The Connecticut case that the Supreme Court ruled on was a land grab to transfer property to wealthy developers for "economic development" and increased tax receipts.

It would appear that the title to your house now means very little if the government decides it would generate more tax revenue as an office park or a hotel.

Mercury and autism: More Huffington Post nonsense

A few days ago, I linked to a great article on the Huffington Post by Michael Shermer defending evolution and pointing out the weaknesses in "intelligent design" creationism. Unfortunately, I spoke too soon. Remember how much I bored you all with my broadsides against the antivaccine paranoia running rampant on the Huffington Post (1, 2, 3, 4)? Well, the paranoia is back with a vengeance (1, 2, 3, 4, 5). I guess that's what I get for not looking for this stuff on the Huffington Post for a week or two and for writing my piece about the Michael Shermer article several days before actually posting it.

I should have expected this, though, after RFK Jr.'s one-sided deceptive screed against the pharmaceutical companies blaming mercury in vaccines for autism and crying coverup, the one that I've been pounding on for the last 10 days or so (1, 2, 3, 4). In fact, I was sort of wondering why our favorite conspiracy-mongering pediatrician from the Huffington Post, Dr. Jay Gordon, hadn't yet weighed in on this issue. I toyed with the idea that perhaps he had been so taken aback by the blog tag team slapdown administered to him by myself and Skeptico (1, 2) for his irritating tendencies to take the irrational position of ignoring out of hand any research funded by pharmaceutical companies simply because they were funded by pharmaceutical companies and to give backhanded "compliments" to the principle investigators of such studies by calling them "honest" while simultaneously insinuating that they're hoplessly biased because of their connections to big pharma without being able to point out any specific flaws in their studies.

No such luck. He's like the Energizer Bunny on this issue. He keeps going and going and going and going....

In his post, No Conflict of Interest, Dr. Gordon not surprisingly swallows whole all the distortions and conspiracy-mongering that RFK Jr. could lay down and completely buys into RFK Jr.'s complaint that ABC News changed a more positive segment to an attack piece at the behest of its pharmaceutical advertiser masters. Quoth he (with Orac's pithy comments):

Mercury in vaccines causes autism and other brain injury. [Orac says: There is no good evidence that mercury in vaccines cause autism. Indeed, the most recent experience from Canada and Denmark strongly supports the contention that it very likely does not. The jury's out on other brain injury, but, based on current evidence, the likelihood of a connection there is also probably low.] The IOM twisted the facts to suit the CDC and the vaccine industry. [Orac says: Care to provide evidence for that assertion that, Dr. Gordon? Certainly RFK Jr. failed to do so and was reduced to twisting facts and misrepresenting the Simpsonwood Conference to make his fallacious case.]

This week, ABC TV (my old employer) twisted the editing and commentary to weaken Mr. Kennedy's interview. [Orac says: Care to provide evidence that it was intentional "twisting" and "editing" designed to "weaken" his interview? Of course, Orac can't help but savor the utterly delicious irony of RFK Jr., who proved himself to be a master at selective quoting in the service of making the Simpsonwood Conference seem ominous and conspiratorial, now complaining about his supposedly being selectively quoted by ABC News!] For ABC TV, hundreds of millions of dollars in ad revenue are at stake and they were irresponsible with the lives and health of children at risk. They should be ashamed of themselves. [Orac says: I have two words for you, Dr. Gordon: Vioxx and Merck. Gee, the mighty pharmaceutical company didn't seem able to stop the barrage of negative publicity from the press on that story. Yep, the fear of losing advertising revenue really shut 'em up that time. Even in the absence of that example, perhaps you could show us some hard evidence, rather than speculation, that ABC News altered its story for fear of losing pharmaceutical company revenue. Just a little evidence? Even a tiny bit? You can do that for a fellow M.D., can't you?]

Yes, once again, Dr. Gordon insinuates conflicts of interest and dire conspiracies without showing the least bit of evidence. Of course, the funniest line in Dr. Gordon's post is this one: "David Kirby's book, Evidence of Harm is meticulously-researched and a great read." Just ask Autism Diva, Aubrey Noelle Simola, Dr. Michael Fitzpatrick, or Kevin Leitch (1, 2) about how "meticulously researched" it is. A lot of references and a nice index do not necessarily indicate "meticulous research," just voluminous research. It is quite possible to do a ton of research and come up with an utterly incorrect conclusion if you berry-pick the data and ignore data that does not support your thesis, as certain political pundits have proven time and time again.

Speaking of David Kirby, though, he's also now over at the Huffington Post blog bellicosely braying, Bring It On to his "naysayers," gloating, and taking credit for getting this whole media firestorm started in the first place:

We have just witnessed the biggest week ever in the history of reporting on this high-stakes debate and, naturally, I could not be happier. A nationwide discussion about thimerosal and autism was my primary goal in writing “Evidence of Harm: Mercury in Vaccines and the Autism Epidemic,” and at long last the conversation has begun.

At least Kirby finally admitted his bias openly.

In any case, Kirby also boasts of his media appearances on Don Imus' show, the Montel Williams Show, and MSNBC's Connected, bragging about how difficult it has been for him to find someone willing to "debate" him on the issue in a public forum. He's being disingenuous, of course, as this is a very old tactic frequently used by purveyors of dubious science. Although orders of magnitude more dubious than the science behind the mercury-autism link (which is why I make this comparison with a bit of trepidation), "intelligent design" creationism does provide some guidance here. Creationists have long "challenged" scientists to "debates" on evolution and then used the absence of takers as "proof" that scientists are "afraid" to debate them. Besides the fact that such debates are almost always held in venues sympathetic to the pseudoscience (which is very relevant to the case at hand, given that Don Imus, who has been pushing the mercury/autism link on his radio show, will likely host the proposed debate), creationists know that just standing on the same stage or sitting in the same TV or radio studio with a serious scientist automatically gives the impression that they have something scientifically valid to say and that there is a real controversy. Scientists have been arguing amongst themselves for years whether or not it helps or hurts the case for evolution and against ID in the public's mind if they formally "debate" creationists in public forums. Many of the same arguments for and against "debate" apply to David Kirby's challenge. Scientists have learned the hard way that advocates of dubious science like David Kirby and RFK Jr. are often quite good at media-friendly sound bites, whereas debunking those sound bites often requires lengthier (and therefore less glib) responses. As Lenny Flank puts it in reference to creationism:

For this reason, the "debate" is one of the ICR's [Institute for Creation Research] primary tools. . . Nearly all of their opponents make the fatal mistake of underestimating them. . . They [ICR debaters] are highly educated people who possess enormous personal appeal and charisma. They are also highly skilled orators and polished debaters. . . As master showmen, however, they are very capable of turning an unprepared scientific opponent into the equivalent of a blithering idiot.

I don't know if David Kirby falls into the above category as far as his public speaking and debating skills go, but any vaccine scientist who contemplates accepting his challenge to debate would do well to heed Lenny's warning, particularly since the proposed venue (Imus in the Morning) will be so hostile. (At least Imus is on vacation until July 11.) If I were the pharmaceutical executive who, according to Kirby, has accepted his challenge, I'd insist on a change of venue to a show with a more neutral host.

Finally, there was one useful link in Dr. Gordon's post to demonstrate yet again RFK Jr.'s disingenuousness, a fawning Scarborough Country interview. Check out this quote:

Thimerosal is a preservative that was put in vaccines back in the 1930s. Almost immediately after it was put in, autism cases began to appear. Autism had never been known before. It was unknown to science. Then the vaccines were increased in 1989 by the CDC and by a couple of other government agencies.

I've already dealt with this utterly idiotic "correlation does not necessarily indicate causation" canard before, as well as the myth that autism didn't exist before thimerosal-containing vaccines were introduced in the 1930's. Shall I repeat myself? Yes I shall:

No, the reason the disease was "unknown" until 1943 was because it was not described as a specific condition by Dr. Leo Kanner until 1943, after which Dr. Hans Asperger described a similar condition that now bears his name in 1944. Before that, although Dr. Eugen Bleuler had coined the term "autism" in 1911, no specific diagnostic criteria existed for the disease. Even for decades after 1943 autism was not infrequently confused with mental retardation or schizophrenia, and over the last two decades the diagnostic criteria for autism and autism spectum disorders have been widened.

To which I now shall add: It goes back way further than that. There are published accounts of behavior that resembles autism in the 18th century. In the 18th and 19th century, there were many accounts of idiot savants, many of whom were likely autistic or had Asperger's. There are even some who speculate that Sir Isaac Newton may have had Asperger's, although I'm not sure I entirely buy their argument. Does RFK Jr. really mean to argue that autism and ASDs just popped up almost overnight a few years after mercury was introduced into vaccines? These diseases most definitely did not. They've probably been around as long as humans have been around; it's just that before the mid 20th century sufferers of these diseases were relegated to insane asylums, lumped together with the mentally retarded and schizophrenics, used as entertainment in freak shows, or simply labeled as "odd" or even "mad." RFK Jr. only shoots himself in the foot and makes himself look a fool by constantly repeating such an easily debunked canard.

RFK Jr. even repeated his misrepresentation of the Simpsonwood Meeting:

And we now have the transcripts of the secret meeting that they did in Simpsonwood, Georgia, in the year 2000.

And it's the most horrifying thing that you can read, Joe. There are scientists there from the government who are saying — who are reading the reports and saying, this is undeniable. There's no way we can ever deny this. I am not going to give this to my children, but now let's hide this from the American people. And it's that clear. And this is what I write about. It's this language that I write about in the "Rolling Stone" and the "Salon" piece that is so shocking, where we have the guys who are supposed to be protecting Americans` health who are actually conspiring to keep this stuff in the vaccines.

RFK Jr., meet Skeptico and Majikthise. Majikthise and Skeptico, meet RFK, Jr. You should all have a lot to talk about, such as what really happened at Simpsonwood, rather than RFK Jr.'s paranoid account. Finally, RFK Jr. stated that he was going to write an article that would go through "all the science" around the thimerosal/autism issue. I assume it's this article (which I haven't had time to read yet, given that it's 66 pages long). Fortunately, Skeptico and Autism Diva have had time to look at it and begin the necessary deconstruction. It looks as though RFK Jr.'s probably going to be the gift to skeptical bloggers that keeps on giving, requiring periodic debunkings.

Unfortunately, I'm becoming more concerned than ever that we are entering a time when good science is too easily cast aside and ignored. As a a surprisingly good recent New York Times article about thimerosal/autism controversy stated:

Yet despite all evidence to the contrary, the number of parents who blame thimerosal for their children's autism has only increased. And in recent months, these parents have used their numbers, their passion and their organizing skills to become a potent national force. The issue has become one of the most fractious and divisive in pediatric medicine.

"This is like nothing I've ever seen before," Dr. Melinda Wharton, deputy director of the National Immunization Program, told a gathering of immunization officials in Washington in March. "It's an era where it appears that science isn't enough."

Indeed it is, and, sadly, not just for the issue of whether thimerosal in vaccines causes autism. This dubious and excessive focus on mercury as a cause of autism frightens parents unnecessarily about the safety of vaccination and drops a load of guilt parents with autistic children who did vaccinate their children, making them wonder if they caused their children's condition. Worse, it wastes scientists' and legislators' time and effort and diverts money from research that might actually get us closer to understanding the pathogenesis of this disease and offering real hope to parents with ASDs.

And on the seventh day, the Hitler zombie rested (I hope)

The Hitler zombie's been a busy undead Führer the last three weeks (1, 2, 3, 4), and it's time (I hope) for him to go back into his coffin for a while, assuming the politicians and pundits so enamored of letting him out don't open the casket again. But, before I nail the lid shut on this undead eater of politicians' brains, I thought it was worth briefly answering one question that was asked in the comments of his last appearance:

But again I ask, to whom should he [Durbin] compare the treatment of prisoners at Guantanamo?

A fair question, and here's my answer:

A more appropriate comparison for the abuses at Gitmo would be "banana republic" authoritarian regimes like Manuel Noriega's, Fidel Castro's, or regimes like those of our erstwhile "allies" Pakistan or Egypt. Even these would still be somewhat overblown comparisons, but they wouldn't be nearly as ridiculously overblown.

Now that I've answered that, something else came to mind. The Hitler zombie is such a great device, that I'm sure I'll have reason to open the coffin and let him out again from time to time. Given that, I thought it would be cool to have an actual picture of a Hitler zombie to use as a graphic. I did a Google picture search, but all I could find were the pictures I've posted here. I rather like the Robot Brain vs. Hitler's Corpse graphic, but I don't think the zombie Hitler should be carrying a gun. His weapon is his ability to eat the brains of politicians and pundits; he needs no other.

So, if anyone knows where any good Hitler zombie pictures can be found (or pictures that could be easily altered to become Hitler zombie pictures), let me know. Who knows? If I get a chance, I may even have a little fun with Photoshop, although I'm not that talented with it. Of course, if anyone out there is really creative, I would be more than grateful to see your creation.
For now, though, it's time for the Hitler zombie to go back to his unnatural sleep for a while (hopefully a long while). There he will stay in his underground resting place. There's no doubt that he will return again someday, but for now, he is satiated. Until someone like Charlie Rangel, Rick Santorum, Dick Durbin, or anyone else revives him, let's be grateful for a break from the hyperbole. But, believe me, the shambling, rotting corpse of the deceased Führer will be ready and waiting--as always.

ADDENDUM: Argh! Josh Rosenau has pointed out another victim of the brain-eating Hitler zombie, Rachael Lea Hunter, a candidate for Supreme Court Justice in North Carolina. Apparently the undead Führer somehow managed to grab a little snack on the side while I wasn't looking. I'll have to keep a closer eye on the sneaky little bastard!

Tom Cruise in meltdown

I think that Scientology has finally affected Cruise's brain, perhaps irreparably. I really do. Want evidence? Read this hilarious transcript of Tom Cruise's interview with Matt Lauer last week. He calls psychiatry a "pseudoscience" and tries to justify his statement that Brooke Shields shouldn't have used antidepressants to treat her postpartum depression. Repeatedly claiming that he "knows the history of psychiatry," Cruise fallaciously concludes that, just because there have been abuses in the history of psychiatry that it is all bad. Here is one amusing excerpt:

TOM CRUISE: But what happens, the antidepressant, all it does is mask the problem. There's ways of vitamins and through exercise and various things. I'm not saying that that isn't real. That's not what I'm saying. That's an alteration of what-- what I'm saying. I'm saying that drugs aren't the answer, these drugs are very dangerous. They're mind-altering, anti-psychotic drugs. And there are ways of doing it without that so that we don't end up in a brave new world. // the thing that I'm saying about Brooke is that there's misinformation, okay. And she doesn't understand the history of psychiatry. She-- she doesn't understand in the same way that you don't understand it, Matt.

MATT LAUER: But a little bit what you're saying Tom is, you say you want people to do well. But you want them do to well by taking the road that you approve of, as opposed to a road that may work for them.

TOM CRUISE: No, no, I'm not.

MATT LAUER: Well, if antidepressants work for Brooke Shields, why isn't that okay?

TOM CRUISE: I-- I disagree with it. And I think that there's a higher and better quality of life. And I think that promoting for me personally, see, you're saying what, I can't discuss what I wanna discuss?

I just wish Lauer had asked Cruise to justify the utterly ridiculous pseudoscience behind Scientology, such as the "E-meter" that its adherents use to diagnose the "mental and spiritual condition" of the test subject. Naturally, the conclusion is always that the subject needs more "auditing" (Scientology's "diagnosis and therapy" for such problems) at a cost of thousands of dollars. And this ridiculous pseudoscience is not without other costs. For example, there is the case of Jeremy Perkins, a schizophrenic many of whose family were members of the Church of Scientology and who was left untreated. He ended up stabbing his mother 77 times. Apparently Tom's ability to recognize pseudoscience when he sees it isn't quite as fine-tuned as he seems to think it is.

Of course, The Onion, as usual, got it just right a few years back when writing about John Travolta's Scientology beliefs...

On the uselessness of chelation therapy for autism

In my recent blog frenzy (1, 2, 3, 4) about thimerosal in vaccines and autism brought to the forefront by RFK Jr.'s deceptive and biased article, Deadly Immunity, a fair number of comments and e-mails came up about whether chelation therapy is useful in treating autism. In this regard, there is no evidence whatsoever that it does any good or improves the symptoms of autism. However, there are parents out there who are utterly convinced that it helped their child enormously. Such cases are hard to deal with for the simple reason that no matter how much you point out that it is mechanistically implausible for chelation therapy should help autism or ASDs and that there is no evidence that it does anything good whatsoever for these neurodevelopmental disorders, they tend to remain utterly convinced that it helped their children. And, because the nature of medicine and science is such that impossible ever to prove a negative, you can never rule out 100% that chelation may have helped in this one case, chelation therapy lives on, and the quacks continue to profit off of preying upon the hopes of desperate parents who want to do something to help their children.

As dubious as intravenous chelation therapy is for autism, though, there is a newer form of "chelation therapy" that is even more dubious. That is the so-called "transdermal" chelation therapy championed by Dr. Rashid Buttar (what an utterly appropriate name, given that it's been called the "Buttar treatment," and the cream could be said to look a bit like butter). Dr. Buttar claims that TD-DPMS can do wonders for autism. Unfortunately, he presents no data. He can't even present pharmacokinetic data to show that the active chelating agent is actually absorbed through the skin in sufficient quantities to chelate anything. Yet he treats children with it.

Fortunately, Kevin Leitch is on the case, writing this fantastically sarcastic letter to Dr. Rashid Buttar. Money quote:

Such an important scientist as yourself must surely have peers flocking to review your work. As such an august scientist you are no doubt aware of the most basic scientific precept of subjecting your scientific work for review so that others may critically appraise your work and replicate it. I was surprised therefore to discover that a search of www.pubmed.gov – the site that lists all scientific articles in peer-reviewed scientific literature – and found nothing when searching for ‘Rashid Buttar’. Did you submit your thesis under a pseudonym perhaps? I’m positive this must be an oversight and that the safety and efficacy of a product that you regularly use on children has been regularly tested and re-tested by both yourself and your peers as to do otherwise is tantamount to admitting one is afraid to submit one’s work for peer review – I’m certain that can’t be the case for you!

Alas, such is not the case. Perhaps Dr. Buttar will use the "too busy taking care of patients to get published" excuse that alties frequently use. I wish I could get away with that one when I come up for my yearly review. Somehow, I don't think my division chief would buy it.

The Onion does it again!

Imagine, if you will, The Onion as it will appear fifty-one years from now. I'm just bummed that much of the Midwest will be radioactive ruin then and Haliburton will get the contract to rebuild it.

And wouldn't you like it if your horoscope looked like this? Sure, it's just as much a bogus pile of B.S. as horoscopes are now, but at least it has way cooler signs. So, what's your sign? Asimov, Zelazny, or Bester?

Maybe there's hope for the Huffington Post after all

In the cause of going back to blogging about topics less controversial than the alleged thimerosal-autism connection or dubious Nazi analogies and the people who love them, I note that there is actually a nice article by Michael Shermer on intelligent design at the Huffington Post. An excerpt:

Since the U.S. Constitution prohibits public schools from promoting any particular brand of religion, this has led to the oxymoronic movement known as “Intelligent Design” (ID) where ID (aka God) miraculously intervenes just in the places where science has yet to offer a comprehensive explanation for a particular phenomenon. ID used to control the weather, but now that we have a science of meteorology He has moved on to more obdurate problems, such as the origins of DNA or the evolution of cellular structures such as the flagellum. Once these problems are mastered then ID will presumably find even more intractable conundrums. Thus, IDers would have us teach students that when science cannot fully explain something we should look no further and declare that “ID did it.” I fail to see how this is science. “ID did it” makes for a rather short lab lecture.

By contrast, a scientist would want to know how ID did it. Did ID use known principles of chemical bonding and self-organization to create the first DNA molecule? If so, then ID appears indistinguishable from nature. Is this the God IDers worship? No. IDers want a supernatural God who uses unknown forces to create life. But what will IDers do when science discovers those forces? If they join in the research on them then they will be doing science. If they continue to eschew all attempts to provide a naturalistic explanation for the natural phenomena under question, IDers will have abandoned science altogether. This is, in fact, what they have done.

Isn't this what I've been saying all along? If God did create it all, that would not change the desire of real scientists to figure out as much as they can understand about how He did it.

Wow, and I thought I was annoyed at Bill Frist

But my annoyance about his playing politics with the Terri Schiavo case is nothing compared to that of RangelMD, who calls for the State of Tennessee either to revoke or suspend his medical license for his rendering a medical opinion on Schiavo's state without ever having actually examined her and using the authority of being a physician to persuade Congress to pass an ill-advised law allowing the Schiavo's parents to bypass Florida State courts and go straight to Federal courts.

He has a point, though. Frist was shamelessly playing on the fact that he is a surgeon to play politics with a tragic case. Although it probably doesn't rise to the level of an offense worthy of the revocation of his medical licensure, his behavior in the Schiavo controversy (among other things) makes me hope that Frist never gets close to the Presidency.

I fought the Hitler zombie, and the Hitler zombie won...maybe

It would be no fun at all to write this blog if everyone always agreed with me. (Of course, it would be even less fun if everyone violently disagreed with me and, as some of the antivaxers did, angrily and gleefully wished that I should have an autistic child, but that's another issue.) In any case, every so often I'll post something that produces a reaction that surprises me. So it was as I was looking over some of the comments on yesterday's post about Dick Durbin's recent use of the Nazi analogy. Given my history of going after such analogies, I thought it might be a nice diversion from vaccines to comment on it. Silly me. I had expected a more mixed response, but that's not what I got. Instead, the response was overwhelmingly negative. Consequently, I thought this would be a good time to do an "aggregate" response to the commentary. At the risk of angering a few loyal readers, I'll share two thoughts that came to mind:

1. A few people didn't read what I actually wrote or read it through the prism of their biases.
   
2. In my haste to get the article posted, I didn't make my point as cogently as I'm normally capable of doing, leading to an impression I hadn't planned on making.
   

In reality, I think it was a combination of #1 and #2. You can decide for yourself which of the two predominates. Personally, I like to think it was more #1, but then, hard as it is to believe sometimes, actual humility overtakes me and I have to admit that it could well be #2. On the other hand, it could also be that I've become enamored of the concept of a Hitler zombie eating people's brains a little too much, so much so that I like to bring out the shambling corpse with the Swastika and the Charlie Chaplin mustache a little more often than he's needed. Who knows? (Come on, admit it, though. Don't you think that the Hitler zombie is a really cool writing device to use to take down idiots who make such silly Nazi/Hitler analogies, like Rick Santorum and Charlie Rangel?)

I was puzzled by the reaction because what was being said was not that far off from what I said in my post. I agree 100% that the main problem is the way that Durbin's remarks have been reported and spun throughout the right wing blogosphere and talk radio. Indeed, I characterized the response as "way out of proportion to the actual offense" and described the right wing as "really out for blood." I even provided a link to an article by a conservative who was critical of the right wing nutcases who were out for Durbin's blood and a direct link to the text of Durbin's remarks, so that people could judge for themselves. As for the comment that Durbin never actually compared anyone to Hitler, I respond that that's a distinction without a meaningful difference. Whenever you invoke the Nazi regime, you invoke Hitler. Hitler, the Nazi regime, the Holocaust, they're all part of the same vile package. There's no easy way around it, because Hitler was the absolute dictator of the regime and no major policy the Nazi regime undertook happened without his order or at least tacit approval. Indeed, the equivalence of references to Hitler and the Nazis in practical terms, as far as rhetoric goes, is implicitly understood, which is why Godwin's Law is about Hitler and the Nazis, not just Hitler.

However, the intentionally overblown reaction of pundits like Rush Limbaugh, Bill O'Reilly, and Mark Levin, and opportunistic right wingers like Newt Gingrich does not excuse Durbin. Durbin's a big boy, and the reaction should not have come as a surprise to him. As a seasoned politician who's been in a few nasty campaigns himself, Durbin should have been able to predict what the right wing echo chamber's reaction to his comparison of our excesses at Guantanamo to those of totalitarian regimes like the Nazis or Pol Pot would be. In fact, part of what angers me about Durbin's use of the Nazi analogy is that he was making such good points up until then. His comparison of our policies to the mistake of interning Japanese-Americans during World War II was particularly effective, as was his emphasis that we do not have to sacrifice our American ideals to win the war on terror. He didn't need to drop the H-bomb (much less add the Stalin-bomb and Pol Pot bombs) to be effective in making his point. He really didn't. But drop it he did, and by dropping it he foolishly gave the right wing an easy opening to drown out the substance of his criticisms of how the U.S. has been conducting the war on terror in general (and how it has been running Guantanamo Bay in particular) with hyperbolic distortions, false claims of treachery, and comparing Guantanamo Bay to a death camp. Now he's been forced to apologize, and the neocons will count it as a "victory."

But the above complaints are matters of Durbin screwing up political tactics, a critique that I could have made even if I didn't find his use of the Nazi analogy offensive and foolish. One commenter asked me what it was that I found offensive about Durbin's use of the Nazi analogy. That's a fair question, and perhaps my mistake is that I didn't expand upon it in the original post. Basically, it's a matter of degree. Yes, the Nazi regime (and the Stalin and the Pol Pot regimes) did things similar to what the FBI agent's report said we did to prisoners, such as leaving them chained for 24 hours or more in the fetal position, or in excessively hot or cold conditions, and mentally abusing them. (They probably would indeed have subjected prisoners to loud rap music, had such music existed then.) But they also did so much more to their prisoners. The Nazis, for example, intentionally exterminated millions, systematically building up a machinery of death camps with gas chambers in the service of eliminating the Jews and those whom they considered their racial enemies. In their camps, they intentionally starved and worked their prisoners to death. They performed brutal medical experiments on them, all in the name of "racial hygeine" or "race science." It is because their crimes were so great that they have become synonymous with more than just authoritarian regimes and thuggish interrogation techniques; they have become synonymous with evil. The Soviet regime ran a string of gulags in which millions died. Pol Pot's regime used similar tactics, starving and working Cambodians until they died of malnutrition or malaria, as well as carrying out brutal purges:

Purge after purge of high and low Khmer Rouge followed. They increasingly filled the cells of the major security facility in Phnom Penh, Tuol Sleng, with communist officials and cadre. Pol Pot's gang had these people tortured until they fingered collaborators among higher-ups, who were then executed. Confessions were the aim of most torture, and the gang would even arrest, with all the lethal consequences, interrogators who were so crude as to kill their victims before getting a confession.

On the suffering of the tortured, one such interrogator reported. "I questioned this bitch who came back from France; my activity was that I set fire to her ass until it became a burned-out mess, then beat her to the point that she was so turned around I couldn't get any answer out of her; the enemy then croaked, ending her answers..."

The sheer pile of confessions forced from tortured lips must have further stimulated paranoia at the top. The recorded number of prisoners admitted to Tuol Sleng was about 20,000, suggesting how many were tortured and made such confessions. Only fourteen of them survived this imprisonment--fourteen. And this was only one such torture/execution chamber, albeit the main one in the country.

I'm sorry, but even the worst abuses at Guantanamo Bay are similar to those of Hitler, Pol Pot, and Stalin only in the same way that a firecracker is similar to a thermonuclear device. Both are explosive devices, but they are so many orders of magnitude different in force that comparisons between the two should be undertaken with a great deal of care. Comparing Guantanamo Bay to such brutality not only grossly exaggerates how serious the abuses at Guantanamo Bay are beyond reason but also, as was suggested as one reason for my disgust, "waters down our collective memory about these horrors." It's also so inflammatory that it instantly incinerates whatever other points a speaker is trying to make, no matter how thoughtful or reasonable. As Marc at Spinning Clio has put it, "once the Führer enters the room, the debate has probably 'Jumped-the-Shark.'" It certainly did in this case, as no one paid attention to the rest of what Durbin said, particulary this, which I agree with:

The issue debated in the press today misses the point. The issue is not about closing Guantanamo Bay. It is not a question of the address of these prisoners. It is a question of how we treat these prisoners. To close down Guantanamo and ship these prisoners off to undisclosed locations in other countries, beyond the reach of publicity, beyond the reach of any surveillance, is to give up on the most basic and fundamental commitment to justice and fairness, a commitment we made when we signed the Geneva Convention and said the United States accepts it as the law of the land, a commitment which we have made over and over again when it comes to the issue of torture. To criticize the rest of the world for using torture and to turn a blind eye to what we are doing in this war is wrong, and it is not American.

Too bad no one was listening anymore after he dropped the H-bomb. His opponents were sharpening their knives and firing up the attack machine, and those who might have been predisposed to agree with him heard only sound bites. If you're going to make comparisons to Nazis, the bare minimum criteria should be that the crimes are at least somewhere on the same order of magnitude, unless you're going to do a lot of careful qualification, something political speeches are quite unsuited for.

Is argumentum ad Nazium always a fallacy? No, but in most cases as used by most pundits, it is. But because it is so toxic, to avoid being a fallacy, it should be done with extreme care and only rarely, as I've explained before. David Neiwert has accomplished this in his two famous series (and here) but, unfortunately Dick Durbin did not. He came close but couldn't quite manage it, and it would have been better for him and his message if he had not even tried. It just goes to show that no matter how fast on your feet (rhetorically speaking) you think you are or how thoughtful you think you are, you use the Hitler zombie at your own great peril. Just when you think you've successfully sent him against your opponent, you'll turn around and find yourself staring into a rotting maw with a funny little mustache getting ready to take a bite out of your skull.

The Skeptics' Circle XI

The Eleventh Edition of the Skeptics' Circle has been posted at Anne's Antiquackery and Science Blog. It's the first time we've had a blogger whose first language isn't English host, and she's done a fine job of rounding up the best skeptical blogging from the last couple of weeks.

In honor of the Circle, I thought I would also point out this article about one of the most famous skeptics of all, The Amazing Randi, and skepticism in general. It makes the rather interesting point that the the targets most in need of a good skeptical debunking today are harder to take care of than they were in the past, because they require science, rather than demonstrating sleight of hand or hidden tricks, to debunk, and it's hard to explain good science to the general population. Consider this excerpt:

To us, Uri Geller seemed small-time: The enemies we had in mind were fundamentalist ideologues, like the ones on the Kansas school board who have tried to demote evolution in the science curriculum.

That's the conundrum of the modern skeptics movement: Intelligent Design theorists and deniers of global warming may very well be phonies and scoundrels, but no one is going to debunk them in the classic sense. You can't reveal their hidden microphones or mimic their tricks with sleight of hand. Intelligent Design, after all, is an attempt to recast (even to "rebunk") Creationism in scientific terms. The best weapon against it isn't dramatic exposé, but scientific argument. So a change in tactics makes sense for the movement.

Still, the fervent response to Randi's tirade suggests a deep-seated nostalgia for old-fashioned debunking. In the end, it's just more fun to see a fake like Geller squirm than it is to hear a science lecture. Supernatural scammers may not be the most dangerous opponents of reason, but why not knock a few off every now and again to rally the troops?

Indeed.

And that's what the Skeptics' Circle is good at, although it's also great for exposing the false science that is "intelligent design" creationism and phonies promoting bogus "alternative" medicine "cures." So head on over and enjoy the debunking. Oh, and don't forget to enjoy this clip of Randi and Johnny Carson conspiring to reveal Uri Geller for the fraud he is on the Tonight Show by having arranged for the props and then not allowed Uri or any of his people to have any access to them before the taping of the show. It's an oldie but goodie.

The IOM slaps down RFK Jr.

Dr. Harvey Fineberg, President of the Institute of Medicine of the National Acadamies, has slapped down RFK Jr.'s shoddy paranoia piece in this letter. In it, he points out even more of the selective and deceptive quoting RFK Jr. engaged in and pointed out other factual errors and distortions.

Orac sez: Read it!

Also, Rolling Stone has "updated" RFK Jr.'s article to "correct several inaccuracies":

NOTE: This story has been updated to correct several inaccuracies in the original, published version. As originally reported, American preschoolers received only three vaccinations before 1989, but the article failed to note that they were innoculated a total of eleven times with those vaccines, including boosters. The article also misstated the level of ethylmercury received by infants injected with all their shots by the age of six months. It was 187 micrograms - an amount forty percent, not 187 times, greater than the EPA's limit for daily exposure to methylmercury. Finally, because of an editing error, the article misstated the contents of the rotavirus vaccine approved by the CDC. It did not contain thimerosal. Salon and Rolling Stone regret the errors.

I'll bet they do. One only hopes they are starting to regret having published such a trashy piece of "investigative journalism."

Hat tip to Autism Diva.

Catblogging taken too far

You knew it had to happen sooner or later: A cat hosting the Carnival of the Vanities.

As someone who favors dogs myself, I'm disappointed that it wasn't a dog who first broke the species barrier in blog carnival hosting.

Skeptico gives RFK Jr. the RFK Jr. treatment

Bad Skeptico!

Naughty, bad Skeptico!

How could you do something as unfair as giving RFK Jr. a taste of his own medicine in describing a speech he gave earlier this year at the Ramtha School of Enlightenment?

I'm only sorry I didn't think of it first.

The Hitler zombie wants more brains to eat

I've been wanting to write about Senator Dick Durbin's ill-considered use of argumentum ad Nazium last week in the light of my previous posts (here and here) on the the use of questionable Nazi analogies for political purposes. However, mercury/vaccine blogging took over and got in the way. It's time for a vaccine blogging break, at least as far as longer posts go (barring new developments, of course). I'm a bit burned out on it.

In any case, there's not much for me to add about the Durbin quote at this late date, given that fellow RINO John Cole at Balloon Juice handled the issue quite pretty well. Yes, Senator Durbin's remarks were over the top, although he did try to make a valid point on how the interrogation tactics at Gitmo resemble those of repressive regimes more than I'd like to admit; it's just that he botched his point. He also seemed unable make a coherent case afterward when the right wing pundits started attacking him as having called our soldiers Nazis. Even so, Durbin certainly made a more valid point than, say Rick Santorum or Charlie Rangel did when they dropped the H-bomb). However, the reaction of the right to Durbin's turn at exhuming Hitler's corpse (not to mention Stalin's and Pol Pot's corpses) in the service of his political agenda is way out of proportion to the actual offense. They're really out for blood this time.

Of note, Orcinus has a stronger condemnation of the right on the whole affair. Unfortunately, he lets Durbin off the hook way too easily. Durbin may have had a point worth making, but he overplayed his hand and deserves a decent fraction of the criticism he's getting.

Yes, it would appear that the Hitler zombie has claimed at least part of another victim's brain, which is probably not surprising. Given the paucity of nourishment devouring the brains of Rick Santorum and Charlie Rangel provided in the recent past, the Hitler zombie was almost certainly still famished. We can only hope that Dick Durbin's brain provided a more substantive snack for the undead Führer, at the very least so that the Hitler zombie won't be looking to feed again soon. We could all use a break from the hyperbole and ill-considered Hitler/Nazi analogies used for political purposes.

Make no mistake, though. It will be back. The Hitler zombie always comes back. Which makes me wonder: Whose brain will it eat next? Howard Dean's? Bill Frist's?

ADDENDUM: It looks like Durbin apologized.

I had thought this issue was settled...

After all the abuse I took for taking RFK Jr. and the mercury-autism activists to task for relying on shoddy science to promote a probably nonexistent link between thimerosal in vaccines and autism, I thought it was time to take a break and deal with a less controversial topic.

How about evolution?

I had thought that this issue was more or less settled, but it appears that the fundamentalists opposed to teaching the science of evolution are still at it. They're still pressuring museums--museums!--not to show IMAX films that refer to evolution. One example is Volcanoes of the Deep Sea. Its crime? It states that life originated in the oceans:

"Volcanos of the Deep Sea" has prompted some radical religious conservatives to blow their own tops.

But oceanographer Richard Lutz, who collaborated on the movie, said the controversy centered on "a reference in the film that life may have originated in the deep sea."

Museum owners downplay evolution as a reason for dumping the films, but there's little doubt that that's the real subtext lurking behind the fear of Museum owners to show these films in areas where there are large concentrations of fundamentalist Christians:

Earlier this year, the Museum of Science and History of Fort Worth, Texas, refused to show the volcano film after a screening for a test audience.

"At the time, we had better choices that scored better in our screening tests," said Margaret Ritsch, the museum's Director of Public Affairs.

She admitted, however, that some people had made comments about the theory of evolution.

Of course they did, and that was almost certainly the reason the Museum caved. It's not enough for these religious zealots simply to hold whatever religious beliefs they want about evolution, even if those beliefs are not consistent with what we know from science. They have to shut down any references to evolution and try to get their religious beliefs taught to other people's children as "science."

(Via fello RINO Right Thoughts, who was even harsher than I was about this. And, just for fun, a link to a fellow conservative-leaning blogger who doesn't drink the creationist Kool Aid either. As a West Virginian, he's all in favor of "dumbing down" his northern neighbors in Dover, where the school board has been trying to get "intelligent design" creationism in the high school curriculum, concluding, "I guess I shouldn't complain- we will take whatever competitive edge West Virginia can get." Finally, of course, there's always the Founder of the RINOs, the Commissar, who weighs in on the right's tendency to promote, or at least tolerate, antievolution antiscience in its ranks.)

Dare I hope?

Yes!

My hometown team the Pistons just pulled it off, beating the San Antonio Spurs in Game 6 of the NBA Finals 95-86.

I thought they were toast after they lost Game 5, given that they'd have to take two at San Antonio to win the championship, but a Detroit repeat is starting to look less unlikely. True, the Pistons are still the underdogs going into Game 7, but there does appear to be hope that they might just take it all.

Simpsonwood redux: Isolation is a state of mind

In the comments of Skeptico's takedown of RFK Jr.'s distorted and one-sided description of the Simpsonwood Conference on the postulated link between thimerosal in vaccines and autism, David Schmitt made my day yesterday. As you may recall, JFK Jr. started his article out with this ominous-sounding introduction:

In June 2000, a group of top government scientists and health officials gathered for a meeting at the isolated Simpsonwood conference center in Norcross, Ga. Convened by the Centers for Disease Control and Prevention, the meeting was held at this Methodist retreat center, nestled in wooded farmland next to the Chattahoochee River, to ensure complete secrecy.

Fortunately, David Schmitt lives not too far from Norcross and Simpsonwood, and was willing to point out yet more support for RFK Jr.'s distortions in the comment section of Skeptico's piece:

And for a visual look at the retreat center "nestled in the wooded farmland next to the Chattahoochee River", look here.

(zoom in and click on the Satellite link)

I live near this place, and it's smack in the middle of the suburban "sprawl" that environmentalists like Kennedy are constantly criticizing.

To me, it looks as though the conference center is located in an area that's pretty densely built up. It also looks as though it's surrounded by multiple subdivisions in suburban Atlanta, complete with the usual cul-de-sacs and winding streets, as any quick search using Google Maps, Mapquest, or Mapblast would have shown. The satellite picture in Google Maps just makes it all that much more obvious.

I guess "isolation" is a state of RFK Jr.'s mind. Of course, the real reason Simpsonwood was chosen was not to "ensure complete secrecy," but rather because a huge computer conference was in Atlanta at the same time, and Simpsonwood was the only facility that had space on such short notice.

On the other hand, to be fair, the Simpsonwood website does have lots of bucolic pictures, with deer and walking trails; so maybe it's similar to some of those large office complexes you often see in outer suburbs that have nice wooded grounds around them but are surrounded on all sides by suburban sprawl. We have many complexes like that around where I live, some of which are corporate facilities. Too bad this didn't come up before my trip to Atlanta three months ago. I might have been able to cruise up there to check the center out for myself.

In any case, I've made my way through more of the Simpsonwood transcript, and I've yet to find evidence of the coverup RFK Jr. insinuated. It also looks as though Majikthise is also making the painful slog through the 11 MB and 286 pages. I look forward to seeing what she has to say.

Grand Rounds XXXIX

Grand Rounds XXXIX has been posted at A Chance to Cut is a Chance to Cure. Given that the inimitable Dr. Bard-Parker is a fellow surgeon, I'd like to try to use my newfound (and almost certainly fleeting) notoriety, as minimal as it is, for good rather than evil and send him some traffic. There's good stuff there, as usual the best of the medical blogosphere from the last week.

The Skeptics' Circle is fast approaching

Time flies. The next edition of the Skeptics' Circle is due to hit the blogosphere on Thursday, June 23. This time around, it's being hosted by Anne at Anne's Anti-Quackery & Science Blog. So, skeptical bloggers, get going. There's a lot of credulity out there to take on out there, with the Schiavo autopsy report having been released and, most of all, this horrendously bad and one-sided article about the supposed link between thimerosal and autism written by RFK, Jr. and posted at Salon.com and Rolling Stone that I've already commented on here (the most infamous of the lot), here, here, and here.

Submission instructions are here.

Skeptico reads the Simpsonwood transcript so that you don't have to (unless you really want to)

I have to hand it to Skeptico. I really do. He's managed to go through the entire 286 page transcript (warning: direct link to big file) of the infamous Simpsonwood Conference in a mere three or four days--over a weekend, yet! Given that it's a big document full of really dull, dry discussion among scientists and that this is June, when many people think of having fun outside on weekends instead of reading hundreds of pages of such tedium, that's a real accomplishment, one I haven't managed yet. (It shames me to admit that, in comparison, I've only gotten about a third of the way through it.)

He's also managed to get me to write one more time about this whole affair, even though I had said that I was going to try not to discuss this particular topic again for a while.

The Simpsonwood Conference was the conference that RFK Jr. opened his article making such dire insinuations about, claiming that it was primarily a strategy meeting to discuss ways to cover up the alleged link between mercury in vaccines and autism. I have discussed before how RFK Jr. used highly selective quoting to make what was in reality a discussion among scientists about the data for and against the hypothesis that thimerosal in vaccines cause autism and determining what studies should be done next seem very dark and conspiratorial when it really was neither. However, for reasons of space (and because there were so few examples of any excerpts that I could find that sounded even slightly conspiratorial), I only cited one example. Now, Skeptico utterly demolishes RFK Jr.'s treatment of this conference. In fact, after reading Skeptico's piece, I've been forced to change my opinion. Before, I just thought that RFK Jr. had simply let his bias and his close contact with Lujene Clark and other mercury-autism activists during the preparation of his article lead him astray. After reading Skeptico's take on the matter, now I reluctantly have to conclude that it is more likely that he was being downright dishonest in his treatment of the entire issue of the Simpsonwood Conference.

But let Skeptico explain it in the money quote from his piece:

When I first read Kennedy’s piece, I was shocked that there had apparently been some kind of cover up about thimerosal. It seemed I would have to re-examine my previous views on the subject as all good skeptics should when new evidence appears. And that was even though I have full knowledge of studies in Denmark and Canada that show autism rates increasing even though thimerosal has been banned in those countries for years. Even though I knew this, the article still sounded convincing. So I can well understand people reading this article and believing it and being livid with the vaccination industry, the CDC and everyone else involved.

But I now know Kennedy’s article is a shockingly dishonest piece of crap from beginning to end. Dishonest and manipulative. He starts with sensationalist language to imply there is something wrong going on, softening up his readers for what comes next. The scene set he, frankly, lies about what happened at the meeting. (Either that or he didn’t read the transcript – your call.) And in the absence of evidence to back up his claim, I suggest Kennedy also made up the bit about the Institute of Medicine whitewashing any embarrassing results. Kennedy wrote his alarmist piece in the knowledge that very few people (in reality – virtually zero) would bother to read the lengthy transcript to find out what actually happened. It’s nothing short of shameful from someone who I had previously believed to have the highest integrity. My only question is, why? Perhaps he’s just losing it, I don’t know.

Contrary to Skeptico's disillusionment with RFK Jr., whom he seems to have respected before this travesty, I never really thought that RFK Jr. ever really "had it" in the first place as an "investigative journalist," although he had never given me this much reason to dismiss him as a hack before. My guess is that RFK Jr. probably didn't bother to read the entire transcript in detail, just the specially berry-picked excerpts. At least, the trusting part of me that wants to give everyone the benefit of the doubt and doesn't want to have to conclude that anyone (much less RFK Jr.) intentionally distorted what was said at the Simpsonwood Conference to serve his agenda would prefer to attribute this level of misrepresentation and manipulativeness to laziness rather than dishonesty. On the other hand, as I discussed here, even a fairly cursory look at his article and the Simpsonwood transcript shows that RFK Jr. did use highly selective quoting to give the incorrect impression that Dr. John Clements, for example, urged a coverup when the full quote in context shows that he did not. Worse, Dr. Clements' in-context words were quoted almost completely even in the excerpts, making it hard to conclude anything other than that RFK Jr. was intentionally quote-mining.

But, as I said before and as Skeptico also points out, you don't have to take either of our words for it, although Skeptico made a very compelling case for intentional distortion of the contents of the transcript by RFK Jr and his making an unsubstantiated claim that the CDC paid the Institute of Medicine to "whitewash" any thimerosal/autism link. Fortunately, if you don't believe us, you are perfectly free to download the complete 11 MB PDF file of the transcript and see for yourself, and I highly encourage you to do so, if you have the stomach for it (or a case of insominia that this transcript could help with).

Just be sure to drink a lot of coffee or caffeinated colas before you start reading.

Thimerosal and autism: two questions

The last few days have been hectic ones. Circumstances conspired again to turn me, almost against my will, into a vaccine blogger, leading me to step with both feet into the mercury-autism controversy with this post and this followup, the combination of which have brought more attention to this blog than anything I've ever written before. I honestly didn't expect to make my first big splash in the blogosphere on this topic, but c'est la vie. Fortunately, most of the responses were, surprisingly, less hostile and more supportive than I had feared they would be. However, the sheer hostility of a small minority of responses was amazing. For example, someone calling him or herself "cellis" said something that very much reminds me of the sorts of abuse anyone who points out how weak the evidence for a link between mercury and autism can expect, similar to what Kathleen Seidel wrote about in her open letter to David Kirby. Cellis said:

As for the original creator of this absurd post (and all you other ignorant morons), I just hope you have a child or grandchild with autism in the very near future so that your small minds will be blown away when you finally wake up and realize how they got that way...which, since the rate has now "miraculously" risen to 1 in 150 children, I'm sure someone you care for will be affected very soon...Karma's a bitch. Can't wait to see you eat your very ignorant and uneducated words.

There's more where that came from, some even just overnight. I tell you, it's almost enough to make me go back to blogging about less controversial topics, like, say, creationism (or maybe Terri Schiavo). At least creationists usually offer to pray for me, rather than angrily and gleefully wishing autism on my or other people's children just to "teach us a lesson." It half makes me hope that my joke about wanting an Instalanche doesn't come true. But, before I attempt to move on to other topics, I can't resist one last post. (Whether I succeed in moving on is another issue entirely, but I'm going to try; as I pointed out less than three weeks ago, vaccine hysteria was never intended to be a primary focus of this blog. I'm sure I'll end up coming back to the issue sooner or later, but I need a break. Also, this has delayed the writing of a series of posts I've wanted to do for almost two weeks now.)

I've been trying to think of a way to boil the whole issue down to its utter essence, as one commenter suggested. However, I'm going to do it a little differently than what the commenter had in mind. I think two questions serve that purpose quite nicely:

1. What evidence would convince me that the Geiers and Boyd Haley and all the others who are so convinced that mercury in thimerosal used as a preservative in vaccines is a major cause of or contributor to autism are correct and that my skepticism is ill-founded?
2. What evidence would convince those of you out there who are utterly certain that thimerosal in vaccines either causes or is a major contributor to autism that there is no link between mercury in vaccines and autism?

Pretty simple questions, aren't they? I bet some won't find them that easy to answer. Let's see how intellectually honest I am and mercury-autism advocates are, comparatively speaking.

For my part, I can answer my question fairly easily. There is indeed something short of having an autistic child that could make me "eat my very ignorant and uneducated words," as cellis put it. Thimerosal has been removed from vaccines in the U.S., and the last lot of thimerosal-containing vaccines expired in January 2003. If indeed mercury in vaccines causes autism, then five years from now and ten years from now the rates of new cases of autism should plummet dramatically and unambiguously. That they have not done so in Canada or Denmark, both of which removed thimerosal from their vaccines in the 1990's, suggests that it's highly unlikely that the U. S. will see a major decrease in new autism cases over the next decade. However, I'm willing to start fresh and, for the sake of argument, for the moment take on the attitude that seems to be implied by the willingness of activists to dismiss teh Danish and Canadian data so blithely: namely, that it doesn't matter unless it happens in the U.S. But how much is enough? I propose as quite a reasonable measure that, if autism rates fall by 50% or more in 2010 or even 2015, I will happily admit that I was incorrect in my assessment and rejoice that such a blow has been struck against this condition. If rates fall by less than 50% but still inarguably statistically significant, I will concede that this would be pretty good epidemiological evidence that there might be a connection, although in that case the connecton would clearly not be nearly as strong as the link claimed by some activists, like J.B. Handley, founder of Generation Rescue, whose website states quite bluntly 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."

Given such rigidly dogmatic statements, question #2 takes on more importance. What evidence would convince someone like J. B. Handley to change his mind? I can't imagine what evidence would convince him, or Boyd Haley, or the Geiers. It also leaves the a followup question for those of you out there who are so sure that mercury in vaccines causes autism or is a major contributor to autism: Will you concede that you were incorrect if, in 2010 and 2015, autism rates in the U.S. remain unchanged or have increased? I don't have a lot of hope that you will, given the Canadian and Danish experience, where no decrease in autism rates have been observed several years after removal of thimerosal, but I hope I am wrong.

Simplistic?

Well, yes and no. For obvious reasons, it's impossible ever to do the gold standard study about this issue: a double-blinded randomized control trial comparing vaccination of babies with vaccines containing thimerosal and vaccines not containing it and follow the children prospectively to see if the babies receiving vaccines with thimerosal have a higher rate of autism than those receiving thimerosal-free vaccines. So what's the next best thing? Good epidemiological evidence has a way of trumping all the theoretical concerns, cell culture experiments, and even animal data, and the removal of thimerosal from vaccines two years ago provides an epidemiological experiment that is seldom possible to do with other diseases. It's a golden opportunity to test once and for all the hypothesis that autism is caused primarily by mercury in thimerosal in vaccines. If, after a decade of no thimerosal in vaccines, austism rates do not decline, that would be very strong evidence that mercury in vaccines is not and was not the cause of autism. In such as case, it would be very difficult indeed to say that there is a link between the two.

I'll even go out on a limb a bit here (well, probably not really). My prediction is that, in 2010 and 2015, autism rates will remain roughly the same as they are now or maybe somewhat increased, thanks to the continuing improvements in recognition and diagnosis. My further prediction is that, in 2010 and 2015, in light of the unchanging incidence of autism, the mercury-autism activists will either (1) still be claiming that mercury causes autism, (epidemiological evidence be damned) or (2) have changed their claim to say that it is something else in vaccines that is causing autism.

Anybody want to bet against those predictions? Think I'm being disingenuous? Tell me why.

ADDENDUM: OK, I changed my mind and posted on this issue one more time.

The right and the left converge...here (for the moment, anyway)

I've just noticed that my little screed against the RFK Jr. article on Salon.com on the supposed mercury-thimerosal connection has been linked to from both the left and the right.

From the left: One of my favorite lefty bloggers, Majikthise, has come to the same conclusion that I have, namely that the mercury/autism connection is "totally unsupported by the evidence." She also promises a second post on the allegations of collusion, influence peddling, and coverup. I didn't really deal with these issues in my post, so I await her followup article. Just because I point out that the evidence for thimerosal in vaccines as a cause of autism is very weak does not mean I approve of, for example, Bill Frist's cozier-than-appropriate ties with pharmaceutical companies.

From the right: The Corner on National Review Online has also linked to my article as well, as did the Commons.

All of this suggests to me that this issue can be about good science, not politics.

Finally, a shameless plug: Welcome to Respectful Insolence, all new readers brought here from any site that's linked to my article. Some of you obviously hate my viewpoint (as evidenced by some of the nastiness in the comments), but I'm hoping some of you decide to stay a while and make this a regular stop on your blog-reading rounds. This blog is about a whole lot more than vaccines, as you will find out if you stick around a while.

Triumph takes on Michael Jackson fans

It is Sunday, and I feel like taking a break from vaccine blogging. As I have five kids in my house right now who aren't normally here, I won't have time to look at all your comments until this evening sometime (and I already see there are about 15-20 more than the last time I checked). In the meantime, never let it be said I don't try to provide entertainment...

A couple of weeks ago, I happened actually to be up late on a weeknight (which, barring surgical emergencies needing my attention or grant deadlines, doesn't happen that often anymore). Given that I like Conan O'Brien, I naturally flipped it on as background, and came across my favorite insult comic dog, Triumph, taking on Michael Jackson supporters outside his trial in his usual fashion. It was hilarious. And now it's on the web, right here. Enjoy.

Happy Fathers' Day

I want to join in with everyone else and wish my Dad and every other father out there a Happy Fathers' Day.

Signout rules for partners

Although I'm not on call this weekend, I am going to start a week of being on call tomorrow. When I came across this Letter to My Partners by Ad Libitum, I just had to mention it.

Partners cover for each other routinely, and there is nothing more helpful to a surgeon or internist with sick patients than good partners. If you can't trust your partners to take care of your patients when you are not around as well as you would have taken care of them, then you will always have serious anxiety about taking a weekend off or leaving for a meeting or vacation. Fortunately, this is not a problem in our group, but sometimes I get frustrated with how my partners sign out. Our call is a little different in that we are usually on call for a week at a time, during which time we cover new consults during the week (and everyone covers their own patients unless they are out of town), but during the weekends cover the group's patients. Also, most of our patients are not in the ICU, and often none of them are. We also have residents, who can fill in gaps in our knowledge about the patients as they come up. Consequently, unlike Ad Libitum, for our practice it isn't really necessary or desirable to round together on all the patients, and telephone signout is just fine.

Otherwise, though, Ad Libitum's suggestions constitute sound advice for handling signout.

Swimming through the thimerosal

Whoa. (Another Keanu Reeves moment.)

I had a sneaking suspicion when I posted it that I might have stepped into it yesterday with my cranky little rant. And step into it I did. My article was linked to from Pharyngula, a Daily Kos discussion thread, the Captain's Quarters, the Evidence of Harm discussion boards, and even a Democratic Underground discussion thread (where, depressingly there were quite a few people ranting about how the mercury-autism connection is being "covered up"). Yesterday set all time records for the number of hits in a single day to this blog. It's still strictly small stuff as far as the big bloggers go ("Ptooi! I laugh at your measly 2,100 hits in a day!"), but for me it was big. Any time you take on the mercury/autism crowd, particularly in such a combative fashion, you have to be prepared for some even crankier responses. In retrospect, perhaps I should have been less combative, but sometimes I just have to vent. Strangely enough, though, the negative reactions were actually fewer than I expected and the positive reactions more numerous, and the really strongly negative reactions were way fewer than I had expected.

There are too many responses to respond to each individually, but they seemed to fall into categories. Several suggested that I tighten this up and send it to Salon.com. I'm flattered. I assume it would probably be necessary to remove the scatalogical references referring to the article as a big dripping turd, but I could do that. Indeed, I was considering doing just that until I saw some of the letters to the editor that have already shown up at Salon.com. One was from Kathleen Seidel, who runs the website Neurodiversity.com, and you should read the letter in its entirety. As for the others, these guys were just as hard on RFK Jr. as I was. Some examples follow.

Lisa Randall:

What about the Geiers, who claim to have found fantastically high rates of autism among children who received thimerosal? Would that be the same Geiers who had never even heard of SAS, a basic tool of statisticians, before encountering it at the CDC? The same ones who print their "work" in vanity press journals and have been roundly debunked by not only the Institute of Medicine but also the American Academy of Pediatrics and other academic researchers? The father who is a gynecologist-geneticist and the son who runs a consulting business helping people sue doctors?

Thanks, Lisa. I had forgotten about the Geiers' inability to use SAS. That was truly amusing when I found out about it. Let's also not forget their attempt to compromise the confidentiality of patients in the CDC database, either, or that David Geier's company exists mainly to sue vaccine manufacturers and the government.

Kaethe Douglass:

"The fact that Iowa's 700 percent increase in autism began in the 1990s, right after more and more vaccines were added to the children's vaccine schedules, is solid evidence alone," says state Sen. Ken Veenstra. But Veenstra is wrong. That isn't evidence. That isn't anything but coincidence. The 1990s also saw a sharp increase in the use of car seats for children, but no one is blaming them. A 700 percent increase in autism, or any other diagnosis, is much more likely to indicate a growing awareness of a possible diagnosis, rather than an actual increase in patients suffering particular symptoms. And if Veenstra cared to do a little bit of research, he would see that the less specific diagnosis of "mental retardation" dropped as sharply as autism increased.

A good point. I didn't know enough about the numbers to work it into my piece. It's also another nice example of how RFK Jr. confused correlation with causation.

Erin Amerman:

In the past five years, hundreds of studies have been done by independent researchers looking for a correlation between vaccines, thimerosal and neurologic disorders such as autism. The studies have repeatedly failed to find any such link. However, the media neglects to report this and instead latches on to one study performed in 2003 that did find a statistical correlation between thimerosal and autism. This is a grave disservice to the general population, because many fail to understand that the key in determining the validity of a research study is in repeatability of the results. The results of the 2003 study have never been repeated. Additionally, on closer examination, the 2003 study was found to have many design flaws, which call into question the validity of the results....

....The question that remains on the minds of many is that if thimerosal represented no health threat, why did the CDC and the FDA recommend its removal? Simply put, it was removed to appease the public. It is far easier to remove the preservative than it is to risk the health of thousands of children whose well-intentioned parents opt not to get them vaccinated. Why risk the health of these children, and indeed the health of the general population, when the preservative could easily be removed?

Quite correct! We're a rich country. We can afford to replace multiuse vials (the main reason for needing a preservative in vaccines in the first place) with single-use vials. So can Europe, Australia, and much of the rest of the developed world, and if removing the thimerosal in vaccines is necessary to keep parents from abandoning vaccination, regardless of whether the reason the thimerosal scares them is based on fearmongering and weak-to-nonexistent evidence, then I suppose we have to do it. Unfortunately, I don't know about Third World countries, though, where mass vaccination programs are most urgently needed and where there is the least money to pay for them.

These comments already in Salon.com lessened my sense of urgency in retooling my piece. Also, since my home is about to be invaded later this afternoon by an old friend, his wife, and their five kids, I probably won't have time to get to it until next week, if at all, given that I'm going to be on call for our group.

A couple of comments that I saw elsewhere took me to task for supposedly not proving my point that RFK Jr. had very selectively quoted the Simpsonwood transcript, pointing out that I had shown only one example. One reasons I picked only one example are that my piece was too long as it was. Also, part of the reason is that the damned transcript (warning: direct link to bigfile; don't click if you don't have time to let it download) is so long and because there is so little in the transcript that sounds conspiratorial, particularly in context. Try reading it yourself. I've only gotten through part of it, but I'll try to slog through the rest. It's very dull and dry. However, most of that's there is scientists debating the data and potential sources of bias and how to proceed from what was known in 2000. Read it yourself and decide if I was incorrect in my characterization--if you can stay awake while doing it.

One class of comments came from parents of autistic children. Not having an autistic child, there's no way I can truly understand what they're going through. I have a great deal of sympathy for the parents of any child with developmental disorders or other illnesses. Some of them believe chelation therapy helped their child. No matter how many times I repeat the fact that there is no evidence from clinical trials that chelation therapy does anything at all for autistic children and the fact that it is not without risks, it will never convince them. In any case, anecdotal evidence is only useful for formulating hypotheses to generate further research. I have dealt with the issue of alternative medicine testimonials before in relation to breast cancer. Some of what I said there is also applicable to autism and chelation therapy as well. I've also dealt with chelation therapy before in the context of its uselessness for treating cardiovascular disease. As happy as I am that the children of these parents are doing better, I still think it is a big mistake to credit chelation therapy for their improvement. For example, I can provide counterexamples for whom chelation therapy did no good. Finally, I realize what I've said may have sounded dismissive, but it wasn't. It is a natural desire to look for causes for illnesses like autism or for people to blame, and, even with my skepticism, I wouldn't bet the farm that I might not be tempted to take the same path if I were ever to have an autistic child. My take on this issue is here.

One comment that I feel I need to address directly came from Rob Helpy-Chalk:

Why does concern about a thirmisol/autism link automatically make one anti-vaccine and anti-science? Certainly we have seen other cases of drug companies surpressing evidence that one their products is harmful. Do you have to accept every aspect of current medical practice in order to avoid being labeled a quack or the victim of a quack?

I'm afraid you're using a bit of a strawman argument there, Rob. I never said that concern about a thimerosal/autism link makes one "anti-vaccine" or "antiscience." Berry picking data and bad science (even pseudoscience in some cases) to serve an activist agenda, as RFK Jr. did in his Salon.com article, is what makes one anti-science at least. I will concede that not all (or even most) who express concern about thimerosal are antivaccine, but enough of them are and the end effect of their activity is the same: making the parents of autistic children feel guilty for having vaccinated their children and instilling fear in parents about the safety of vaccines, all on the basis of exceedingly weak science. The data from Denmark and Canada are quite clear. Autism rates have not started to decline, despite no thimerosal in vaccines for 10 years. And, contrary to what one DU'er who really didn't like my post thinks, widening of the diagnostic criteria does not account for this lack of a decrease. (This same DU'er also clearly has no clue about the mortality rate of untreated meningitis and how fast these patients can die; although I will concede that RFK Jr.'s article was so sloppy that he didn't mention if these patients had bacterial or viral meningitis, which would have made a difference; using what I know of medicine in 1930, I made the educated guess that it was bacterial meningitis and that the scientists were trying to use thimerosal as an antibiotic.) If the connection between autism and mercury were as strong as advocates claim, the rates of autism in Canada and Denmark should have plummeted dramatically over the last decade regardless. They haven't there, and they probably won't in the U.S. over the coming decade, now that thimerosal has been removed from vaccines. Believe it or not, though, I'd be quite happy if they did, even if it proved me wrong and made me look like an utter fool for what I posted. Who wouldn't want autism rates to fall and find a signficant part of its pathogenesis?

Finally, thanks to Autism Diva, Kristjan Wager, Skeptico, HCN, Jim Laidler, Ali, Soapgun, and Kathleen Seidel for the tactical air support.

ADDENDUM: Two last updates on this issue are posted here and here.

Salon.com flushes its credibility down the toilet

(NOTE ADDED 6/20/05: I've closed this post to comments for now, because the discussion thread is getting way too long and hard to follow. However, never let it be said that I shut down debate in the face of some criticism. Consequently, I have three followup posts here, here, and here and comments are welcome after any of them. Yes, this is also a not-so-subtle way of trying to get you at least to look at my followup articles if you still want to post a comment about this controversy.)


Damn.

I had been tempted to try to let this cup pass, but I couldn't, not after Skeptico, PZ, and several others e-mailed me about this article, seemingly expecting a response. I thought about just chilling out last night, enjoying Game 4 of the NBA Finals, and letting a response wait until next week, but the more I thought about it, the harder it was to wait. Thank heaven for laptops and wireless networking.

Believe it or not, I've been a fairly regular Salon.com reader for at least the three years. Despite its leftward tilt, I've generally enjoyed the writing and features. I've even linked to Salon.com articles and features on occasion. Now I'm going to have to reconsider my opinion of the site. Why? Salon.com has just plopped down on the web the biggest, steamingest, drippiest turd I've ever seen it publish, an article so mindnumbingly one-sided and uncritical that in my eyes it utterly destroys nearly all credibility Salon.com has had as a source of reliable news and comment. Honestly, the editors of Salon.com should hang their heads in shame for publishing this paranoid piece of fear-mongering and trumpeting it as "investigative reporting."

The article to which I refer is, of course, Deadly Immunity (which was a "coinvestigation" by Salon.com and Rolling Stone--a magazine whose attempts at investigative journalism I haven't taken seriously in years). It's a one-sided account by Robert F. Kennedy, Jr. of the supposed link between thimerosal in vaccines and autism that is being promoted by antivaccine activists as an indictment of the government and pharmaceutical companies. For example, the Schaefer Autism Report e-mail list reports that ABC News has cancelled appearances by RFK Jr. on 20/20 and Good Morning America this week. The e-mail invokes the usual conspiracy-mongering, saying, "Our opinion is that they are more concerned about protecting their huge advertising revenues from the pharmaceutical industry than reporting news that could protect pregnant women, infants and children from mercury tainted vaccines." Personally, I suspect it was because ABC News probably figured out that the article was a biased and shoddily researched piece of crap, but then that's just my opinion and hope. Certainly, the newsletter does nothing to dispel my suspicion that this was nothing more than a propaganda piece:

Lujene Clark, co-founder of NoMercury and A-CHAMP (Advocates for Children's Health Affected by Mercury Poisoning), worked extensively with Mr. Kennedy and his office over the past several weeks in preparing the article for publication. The print copy will contain a sidebar from Ms. Clark, providing perspective from her experience as the mother of a thimerosal-injured child and advocate for removing mercury from vaccines.

So the preparation of the article was heavily influenced by an antivaccination activist. Gee, why am I not surprised to learn this? Why didn't Salon.com just let Lujene Clark write the article? The result would have been the same. In any case, there's so much misinformation, paranoid conspiracy-theory raving, and one-sided stuff in this article that it's hard to know where to start. Fortunately, I've dealt with this topic a few times before recently. Here are just a few of the major problems with the article:

Quote mining. The article begins by making dire insinuations about a conference that was held at the CDC, known as the Simpsonwood Conference, after the conference center where it was held in 2000. It is not an auspicious start, as RFK Jr. does what mercury-autism activists do best: quote-mining. This meeting was a preliminary meeting about the Vaccine Safety Datalink (VSD). The entire transcript (warning: big file) of the meeting is over 260 pages long (although there is a version with selected excerpts), and RFK Jr. has carefully chosen a couple of quotes that, when taken out of context, sound like a coverup. I haven't had time to read the whole transcript (and I can assure you that what I have read of it is incredibly dry and dull), but what I see is a lot of discussion about the consistency and accuracy of the early data collection, sources of potential bias in the studies, and debate about what it means. The quote about how the data have to be "handled" is described by RFK Jr. thusly:

Dr. John Clements, vaccines advisor at the World Health Organization, declared flatly that the study "should not have been done at all" and warned that the results "will be taken by others and will be used in ways beyond the control of this group. The research results have to be handled."

Here is what Dr. Clements actually said in context (warning, link to a big file):

I am really concerned that we have taken off like a boat going down one arm of the mangrove swamp at high speed, when in fact there was not enough discussion really early on about which way the boat should go at all. And I really want to risk offending everyone in the room by saying that perhaps this study should not have been done at all, because the outcome of it could have, to some extent, been predicted, and we have all reached this point now where we are left hanging, even though I hear the majority of consultants say to the Board that they are not convinced there is a causality direct link between Thimerosal and various neurological outcomes.

I know how we handle it from here is extremely problematic. The ACIP is going to depend on comments from this group in order to move forward into policy, and I have been advised that whatever I say should not move into the policy area because that is not the point of this meeting. But nonetheless, we know from many experiences in history that the pure scientist has done research because of pure science. But that pure science has resulted in splitting the atom or some other process which is completely beyond the power of the scientists who did the research to control it. And what we have here is people who have, for every best reason in the world, pursued a direction of research. But there is now the point at which the research reults have to be handled, and even if this committee decides that there is no association and that information gets out, the work that has been done and through the freedom of information that will be taken by others and will be used in ways beyond the control of this group. And I am very concerned about that as I suspect it is already too late to do anything regardless of any professional body and what they say. (p. 247)

It sure sounds a whole lot less conspiratorial in context, doesn't it? Dr. Clements was just expressing a quite reasonable fear that lawyers will use very preliminary and unconfirmed studies for their own ends, which is what they do indeed routinely do. Such a concern was not at all unreasonable and is still not unreasonable. In fact, RFK Jr.'s highly selective quoting of Dr. Clements' words is a perfect example of what Dr. Clements was clearly afraid of!

Confusing correlation and causation. The article repeats the usual canard about how autism was unknown before the 1940's, which, coincidentally was when thimerosal-containing vaccines were first used. The article even goes so far as to claim:

The disease was unknown until 1943, when it was identified and diagnosed among 11 children born in the months after thimerosal was first added to baby vaccines in 1931.

No, the reason the disease was "unknown" until 1943 was because it was not described as a specific condition by Dr. Leo Kanner until 1943, after which Dr. Hans Asperger described a similar condition that now bears his name in 1944. Before that, although Dr. Eugen Bleuler had coined the term "autism" in 1911, no specific diagnostic criteria existed for the disease. Even for decades after 1943 autism was not infrequently confused with mental retardation or schizophrenia, and over the last two decades the diagnostic criteria for autism and autism spectum disorders have been widened. In any case, if thimerosal in vaccines were the cause of autism, we would expect autism rates in Denmark and Canada to have plummeted recently, because Denmark eliminated thimerosal from its vaccines by 1995 and Canada removed them around the same time. No such decrease in autism rates has occurred in either country, even though there has been more than enough time for such a decrease to make itself apparent if there were truly a link between mercury exposure and autism. I would ask the mercury-autism activists: If this particular correlation does mean causation, if mercury in thimerosal is indeed a major cause or contributor to autism, why is it, then, that autism rates have not started to fall dramatically in Denmark and Canada by now? That there has been no such decrease is very strong epidemiological evidence that there is no link.

RFK then goes on to list a bunch of studies supposedly showing how toxic thimerosal is, berry-picked and without descriptions of the actual doses of thimerosal used. However, the most idiotic statement is here:

In 1930, the company [Eli Lilly] tested thimerosal by administering it to 22 patients with terminal meningitis, all of whom died within weeks of being injected -- a fact Lilly didn't bother to report in its study declaring thimerosal safe.

The patients had "terminal meningitis" in 1930 and died after injection with thimerosal? Imagine that. Given that penicillin had not been discovered yet, I would have been surprised if any of them lived.

Double standards in looking at "conflicts of interest." RFK Jr. goes on and on about alleged conflicts of interest by vaccine researchers who accept funding from pharmaceutical companies, going so far as to imply that the Institute of Medicine reports of 2001 and 2004 that stated that there is no link between mercury and autism were basically done at the behest of the pharmaceutical companies, never mind the comprehensive review of the literature in 2004 that also failed to find a link. It's the usual conspiracy-mongering insinuations we hear from antivaccination activists and other types of cranks. However, in marked contrast, RFK Jr. approvingly cites the research of Dr. Mark Geier and his son David, both of whom are activists for the mercury-autism crowd, never once mentioning that Dr. Geier is a professional expert witness for vaccine plantiffs, who has been involved in over 100 legal cases brought against vaccine manufacturers and the government on behalf of parents and whose testimony has been disallowed in some for not being sufficiently qualified. Dr. Geier's son David runs a company called 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.

Hmmm. Sounds to me as though the Geiers have a definite financial conflict of interest when it comes to vaccine studies, and they have published several studies that are widely cited by antivaccination activists as "proof" of a mercury-autism link. None of their studies has ever failed to show such a link. I wonder why RFK didn't see fit to mention that, given his great concern over conflicts of interest in vaccine research. He also didn't mention that the Geiers have used shoddy study methodology and also engaged in data collection irregularities, drawing a rebuke from the CDC and suspension of Dr. Geier's IRB approval from Kaiser-Permanente. Overall, RFK Jr. seems pretty selective in his outrage over conflicts of interest and shoddy research, doesn't he?

The "hidden hordes" fallacy. RFK Jr. cites Professor Boyd Haley, Chairman of the Department of Chemistry at the University of Kentucky, who is an activist and Chair of the Advisory Committee for Toxic Teeth, an anti-amalgam group and whose fallacious reasoning with regards to mercury and autism has been pointed out by Peter Bowditch. This is the same Boyd Haley who got into trouble last year for labeling autism as "Mad Child Disease," leading to a demand for him to apologize, which he has refused to do. Haley is quoted as saying "If the epidemic is truly an artifact of poor diagnosis, then where are all the 20-year-old autistics?" I'll borrow Michelle Dawson's response to that fallacy, which she was kind enough to have posted in the comments of my blog while responding to David Kirby's recent book on vaccines and autism:

Mr Kirby deploys the "hidden hordes" to express his disbelief in the possibility that there is no autism epidemic. Were numbers of autistics steady over the years, he argues, America would be clogged with aging hopeless autistics gruesomely burdening society. Mr Kirby cannot find us (I'm one of his "hidden hordes") how and where he expects (doomed and confined to institutions), so he denies we exist.

Szatmari et al (1989) suggests that Mr Kirby should look for his hordes in university records. In a follow-up of autistics diagnosed as children before 1970, 7 of 16 had university degrees (one was an MBA).

This is in essence a variant of the argument that there is an autism "epidemic" favored by so many advocates favoring a link between autism and mercury. Like many antivaccination activists, RFK also misuses the word "epidemic" by referring to an "autism epidemic," a concept that the Autism Diva debunks rather nicely. Kevin Leitch agrees that there is no autism epidemic and points it out here and here, concluding:

Just to reiterate – there is no autism epidemic. Diagnostic criteria have widened and reporting methods have vastly improved. There may well be an increase in actual case percentage but epidemic? Hardly.

I could go on, but I'm getting tired and I've already failed utterly in my attempt to keep this brief. Besides, I've covered nearly all the fallacies, double standards, and selective data mining like that seen in the Salon.com article before here, here, here, here, and here. I also point out that, due to activist pressure, the U.S. has already removed thimerosal from nearly all childhood vaccines, with the last vaccines expiring two years ago. Consequently, the main purpose of trying to "prove" this probably nonexistent "link" now is to provide trial lawyers with "evidence" to use in lawsuits. The next 5 years will tell the tale as the children who have received no thimerosal-containing vaccines reach the age at which autism is commonly diagnosed. I'll admit it if I'm wrong and autism rates plummet, but don't expect an apology from the activists when (as is much more likely, given the examples of Denmark and Canada) the rates don't.

The bottom line is that this article is indeed a humongous runny, stinking turd. Salon.com and Rolling Stone have let their readers down, contributed to the hysteria over a probably nonexistent link between mercury and autism, and utterly trashed their own credibility in the process. They've handed the antivaccination activists a significant propaganda victory and an article that they will be citing for years to come, frightening parents who wonder if vaccines are safe and wrongly adding to the guilt that parents of autistic children already feel by making them wonder if they were responsible for their child's condition.


ADDENDUM #1: Argh! It's been pointed out to me that Tom Tomorrow, one of my favorite lefty cartoonists, has drunk the thimerosal-autism Kool Aid as well (the June 16 entry on his blog, if the link doesn't work correctly). Well, my opinion of him has just fallen several notches. It just goes to show, with Dan Burton, Salon.com, and Tom Tomorrow all falling on the same side of the fence in this issue, that mercury-autism junk science is the fallacy that all sides of the political spectrum seem to like to fall for, although my perception persists that it is more favored on the left.

ADDENDUM #2: Bummer. It looks like ABC News will show the interviews with RFK Jr. about this story after all.

ADDENDUM #3: Autism Diva has weighed in and posted the entire A-CHAMP Action Alert that I had quoted. (This piece was more than long enough already, which was why I didn't post the whole thing myself.) Soapgun has also pointed out that Don Imus is on board the mercury-autism bandwagon big time. Ali at blendor has also castigated Salon.com, beating me to it.

I join the Commissar

The Commissar over at The Politburo Diktat has come up with a great idea. Quoth he:

For the past few weeks, I've been looking around for more secular conservative, or moderate blogs. RINO's, if you will. Are RINO's an endangered species? How can Conservative bloggers who might not want to drink the Party Kool-Aid on every single issue (ESCR, Schiavo, small government, fiscal responsibility, senatorial compromises, free markets/trade, just to name a few) find each other? Maybe you're just concerned about rhetorical excesses by "our side." Neo-libertarians and 'little l' libertarians welcome too.

NZ Bear's new "Communities" feature prompted me to organize a community for RINO's, secular conservatives, moderates, or whatever people of such thinking might be called.

So here it is: "Raging RINOs" - Republicans / Independents Not Overdosed (on the Party Kool Aid)

I hear, Comrade, and answer the call!

Woo-hoo!

Oh yeah! I just finished watching the NBA Finals, and my hometown team the Detroit Pistons have just utterly annihilated the San Antonio Spurs 102-71, tying the series at 2-2.

Now that's the way you do it!

One of the overarching themes of this blog has been skepticism in the claims of alternative medicine. Consequently, a recurring type of post has been the debunking of some claim or other made by the proponents of alternative medicine. Sometimes debunking these claims is like shooting fish in a barrel, allowing for humorous play with the concept, and sometimes the claims are a bit harder to debunk, requiring a more serious approach. In the end, however, the vast majority of altie claims turn out to be without a solid basis in science and without evidence of efficacy if you look at them with a critical eye. From these posts, some conclude that I'm hoplessly hostile and biased against alternative medicine, but such is not the case at all. I merely insist that the claims of alternative medicine advocates be subjected to the same scientific standards as conventional medicine .

It is not at all uncommon for cancer patients to ask if there are any dietary manipulations that will treat their cancer. My stock response is usually that, although there is evidence for the efficacy of various dietary manipulations in reducing one's risk of cancer, there is little or no good evidence that dietary manipulations will treat a cancer once it's become established. By the time a patient develops a detectable cancer requiring treatment, the horse has left the barn a long time ago, so to speak. Consequently, other than making sure one eats a standard good diet with adequate calories, lots of fruits and vegetables, low fat, high fiber, etc., there are no known specific diets that will improve a cancer patient's chances of beating the disease, at least none with any good evidence to support it. However, a recent study out of the Princess Margaret Hospital Cancer Center and the Massachusetts General Hospital Cancer Center may provide the basis for suggesting one dietary manipulation that might ultimately be useful in treating breast cancer, if subsequent studies pan out.

It has been known for a while that lignans have antiestrogenic properties, and blocking estrogen has been the mainstay of breast cancer treatment for estrogen receptor-positive tumors for decades. There are also preclinical studies indicating that lignans may have antitumor properties. It turns out that flaxseed is one of the richest sources of mammalian lignan precursors such as secoisolariciresinol diglucoside (SDG). These lignan precursors are converted by the bacteria in the colon into enterodiol (ED) and enterolactone (EL), the active lignans as shown below:

There is also preclinical evidence that putting flaxseed in the diet can inhibit the growth of tumors in mice and even potentiate the efficacy of the estrogen blocker Tamoxifen. Based on this, the investigators decided to test whether this might be true in humans; so they designed a clinical trial, and you're going to love how they did it. First off (this isn't the part you're going to love, but it has to be described), they designed the trial the same way many neoadjuvant therapy trials. Thirty-two postmenopausal women with a needle biopsy-proven cancer were randomized to two groups, one of which would receive the treatment and the other the placebo for 30-40 days prior to definitive surgery, with measurements of tumor markers of aggressiveness measured in the first pretreatment biopsy and then again in the definitive resection. Note that this is the sort of study that could only be done in a country with a national health care system. In the U.S., it would be difficult indeed to persuade women recently diagnosed with to wait 30-40 days for their definitive surgery. In Canada, though, that's the usual waiting time; so the investigators could quite reasonably use the argument that their therapy was not unduly delaying definitive surgery.

Now here's the part you're going to love. The way they decided to administer flaxseed or placebo was to bake it into muffins that women were to eat every day. From the Methods section of the paper:

Study muffins. Study muffins were prepared in the standard manner by Canada Bread Co. (Toronto, ON, Canada). They contained similar ingredients and were prepared to contain 20.7 g white wheat flour for flaxseed muffins or 20.7 g whole-wheat flour for placebo muffins. Flaxseed muffins contained 25 g ground flaxseed. Placebo muffins were prepared with whole-wheat flour instead of white wheat flour to raise the dietary fiber content closer to that of the flaxseed muffins. All muffins were formulated to be isocaloric and equivalent in fat, protein, and dietary fiber. Hence additional canola oil (10 g) was added to placebo muffins but not to the flaxseed muffins. Muffins were also flavored with nutmeg, cinnamon, and vanilla extract to help maintain subject blindness. All flaxseed came from the same source (Omega Products, Melfort, Saskatchewan, Canada) and batch, and contained 2 mg of secoisolariciresinol diglucoside per gram. The patients kept their weekly supply of muffins at 20° C and defrosted them as needed. They ate one muffin per day at breakfast time. Any uneaten muffins or portions thereof were returned and weighed. The total intake of flaxseed was estimated as 25 g X treatment days - uneaten amounts.

I can assure you that I've never seen a section in a Methods section of a scientific paper entitled "Study Muffins" before. My partners and I were discussing this article at journal club and we couldn't help but have a healthy chuckle and make all sorts of jokes about "studmuffins" and "magic muffins." It didn't help that the first sentence in the Results section read:

Muffin intake compliance was good (95.4% in the placebo and 92.5% in the flaxseed group) and did not differ significantly between the groups.

"Muffin intake compliance"? I love it. I can't help but wonder if the investigators had a sense of humor and did that on purpose, knowing how it would sound.

All kidding aside, though, this was a pretty well-designed prospective randomized, double-blind, placebo-controlled pilot trial to look at what effect consuming flaxseed oil had on tumor markers in breast cancer. They measured urinary lignan excretion to show that it went up in the experimental group, meaning that lignans were being made, and they controlled for caloric and micronutrient intake between groups. What they found is as follows:

1. A marker of tumor cell proliferation (Ki-67) decreased by 34.7% in the tumors in the experimental group compared to the control. Ki-67 reduction has been shown to be a pretty good surrogate endpoint biomarker for the efficacy of hormonal therapy in breast cancer. It is thought, but not yet proven mechanistically, that the mechanism of action of lignans is antiestrogenic. Given that estrogen-receptor tumors also demonstrated a reduction in Ki-67, it is clear that antiestrogenic effects alone cannot explain the action of flaxseed, and there are a number of hypotheses as to the mechanism of action of flaxseed.
   
2. The c-erbB2 score (another marker of tumor cell proliferation and aggressiveness based on scoring the expression of the oncogene Her-2/neu, which is another name for c-erbB2) decreased by 71% in the control group compared to the control.
3. Tumor cell apoptosis (programmed cell death) increased by 30.7% in the experimental group but remained the same in the control.

The amazing thing about these results is that, while the changes in the biomarkers caused by flaxseed are small compared to those induced by Tamoxifen in other trials of neoadjuvant therapy done over a similar timeframe, they are not that much smaller. Also, flaxseed is a dietary manipulation without major side effects, which might make it more attractive than Tamoxifen or other newer antiestrogen drugs in patients who are at high risk for side effects from such drugs. If flaxseed has efficacy in inhibiting breast cancer growth that is only, say 75%, of that of Tamoxifen with minimal side effects, it still might be worthwhile in some patients. Indeed, the investigators noted no side effects other than this:

The only side effects reported by subjects were increased abdominal fullness and bowel movements due to the high fiber content of flaxseed. As an increase in bowel movement may be desirable for patients with low fiber intake and chronic constipation, this effect may not be considered adverse compared to other side effects seen with breast cancer drugs such as tamoxifen or aromatase inhibitors.

So, does this mean postmenopausal women with breast cancer should toss their Tamoxifen or Arimidex into the trash and start making flaxseed muffins? Absolutely not. Not on the basis of this small unconfirmed trial, it doesn't. This study needs to be confirmed in a larger number of women over a longer treatment period of time with definitive demonstration of actual tumor shrinkage. Biomarkers do not always correlate with antitumor response. The more likely implication of this study is that this dietary manipulation might have utility as a strategy for breast cancer prevention, either in lieu of long term Tamoxifen or Arimidex or as an adjunct. There is also the problem of standardization common to herbal remedies or natural substance remedies like flaxseed that can make it difficult to make sure that every lot of flaxseed has the the same amount of active ingredient.

Another important implication of this study is that, contrary to what some alties will tell you, it is possible to evaluate alternative medical claims in well-designed, well-controlled scientific studies. As I have pointed out before, the vast majority of these claims will not stand up to the light of careful scientific scrutiny, but it is possible that, in this one case, one claim for one alternative medicine intervention will.

And this is the way you start to do find out which of these claims might have something behind them.

More on Kylie Minogue and "energy healing"

Anthony Cox, of Black Triangle, has posted more on Kylie Minogue's choice to use an "energy healer" to help her with her breast cancer. I had no idea how loony this "healer" (Alla Svirinskaya) is. Her claims are:

If the patient is well, she says, she can feel their energy loud and clear. If they are ill, their energy feels like a badly-tuned radio. During treatment many patients report a tingling sensation, a hot or cold wave, or a magnetic pull. Everyone, according to Svirinskaya, feels a sense of relaxation. By adjusting a person’s aura, she says that she can harmonise their energy. She claims this improves blood circulation in the affected organ and increases blood-oxygen levels. She even claims that she can detect ulcers, thyroid problems, disc and joint disintegration, the early stages of cancer, and psychosomatic illness.

Ooh boy. It's a good thing Minogue isn't giving up her conventional therapy for this quackery.

Dalek-globin, anyone?

Medical geek that I am, I want one of these, to go along side my Dalek...

Terri Schiavo's autopsy results are in

I wasn't going to comment on this. I really wasn't. Back when it was in full swing a couple of months ago, I commented a couple of times and since then I had gotten sick of the entire case and how the right had made a political football out of what should have been a private matter. But as a doctor it's hard to resist just one brief mention, although I'm sure I'll probably end up regretting it. Today, the results of Terri Schiavo's autopsy were released and are here. There was no evidence of injury or abuse, as claimed by some. Her visual cortex was gone, which casts a bit of doubt on the claims that she could track objects and look at people, although it is possible she could react to light by reflex. Her brain had severe anoxic damage and was only 1/2 the weight of the brain of a normal woman her age.

Unfortunately, as expected, that won't satisfy those who wouldn't let her wishes be fulfilled. Just look at the comments in this post. A couple of examples:

• The results that are reported on the autopsy report are baloney!!! Of course they're going to say that. I wonder if we'll ever know the real truth. I was very passionate about this when this was going on before she died and just cannot get myself emotionally involved like that again. Too upsetting. I have no faith in our government anymore at all.
• I have to say that the autopsy isn't going to show what we think.. it's been too long. As for her brain being 1/2 the size of a "normal" brain, that is due to the horrid dehydration they put her through. It's common knowledge that organs shrivel up without hydration. But of course, those jerks, won't tell us that.... *sigh*

(As an aside, dehydration won't cause the brain to shrink nearly that much, nor would it cause the histological findings noted on autopsy.)

More paranoid conspiracy theory rantings are here. It's depressing reading.

But enough already! Let the poor woman rest in peace and let the family try to find some healing. It's over.

Tangled Bank XXX

Tangled Bank XXX has been posted at The Geomblog. Time to ditch the scientific journals for a little while and dive into the best of the science blogosphere, with a twist:

Since this is after all the GEOMblog, I have created a new twist; posts on mathematically oriented topics tend to be in short supply on the web, and physicists tend to be under-represented in the TB, so I have gone hunting for posts that I think represent a sample of some of the best in mathematical and physics writing. If you like what the authors have to say, add their blogs to your feeds, and visit their sites!

Unfortunately, when I'm done perusing the Tangled Bank, my journals will still be there...

History Carnival X

The History Carnival X has been posted by Marc at Spinning Clio, a blog run by one of the more unusual species of academic, a historian who is conservative politically. Once again, as usual, there's lots of great writing about history from the blogosphere is gathered into one place. This carnival has really blossomed in its previous editions to become one of the ones I most look forward to. Unlike the song, these guys do "know much about history," although, given that, I'm still not sure why they post my contributions...

Intellectual curiosity at its finest

One of the criticisms of "intelligent design" (ID) creationism is that it doesn't really offer any new theory or even hypothesis to replace the theory of evolution, which it seeks to supplant (at least in the public schools). It merely exaggerates perceived weaknesses in evolutionary theory and misrepresents disagreements between scientists on the mechanisms by which evolution occurs as "proof" that the theory of evolution is "hopelessly flawed." So, how does one ID advocate answer the question of what she would replace the theory of evolution with? With intellectual curiosity at its finest, of course! Take a look at Denyse O'Leary's response to a reader e-mail/comment asking "what she would replace Darwinism with":

I don’t have to replace Darwinism with anything. Just as there is no good theory of the origin of life, it may be that there is no good theory of the development of life. That’s not my fault and, much as I might like to fix it, I can’t.

Ooh, boy.

Fortunately for all of us, science doesn't work that way. If it did, we might all still be living in huts in small hunting and gathering societies and making tools of stone. Her statement is also more than a little disingenuous because, although she routinely touts ID and slams the theory of evolution on her blog, when asked what new theory in her opinion should replace "Darwinism," she passes on the opportunity to voice her opinion. She punts. Instead of saying "intelligent design, of course" (which, given all that she's written before and her labeling of herself as a "post-Darwinist," is what she clearly seems to believe) she demurs, saying in effect "nothing." Could it be that she is subconsciously conceding that ID is not a scientific theory in any real sense?

Later, she continues:

Even if I knew how to replace the Darwinbots’ superstition with a different one, why would I?

I'll forgive Denyse (sort of), as a journalist, for thinking that such an attitude might be acceptable. (Maybe I shouldn't forgive her, though. Can you imagine Woodward and Bernstein with such an attitude towards finding out about Watergate?) It's a good thing Denyse isn't a scientist, though. She wouldn't last very long in the field at all. Scientists reject such a defeatist and dogmatic attitude because the very purpose of science is to work towards a better understanding of how nature works, of what the laws of nature are. By labeling a well-supported theory as a "superstition" that can be (or not be) replaced with a "different" superstition, she displays a profound ignorance of what a scientific theory is and what level of evidence is needed for a set of suppositions to rise to the level of a scientific theory. (She's also profoundly annoying in the way that she so shamelessly hawks her book at the end of almost every post, leading to her nickname Denyse "Buy My Book" O'Leary.)

Let's look at some real scientists, shall we, and imagine them if they had Denyse's attitude towards the flaws in the accepted science of their days? What if Albert Einstein had looked at Newton's Laws of Motion and, seeing the flaws in them that become apparent as objects reach velocities that are significant fractions of the speed of light, and had, as Denyse has done, thrown up his hands and said, "I don't have to replace Newton's Laws with anything; there just isn't a good theory of motion"? What if Copernicus or Galileo, seeing the flaws in the geocentric concept of the universe, had thrown up their hands and said, "I don't have to replace geocentrism with anything; there just isn't a good theory of planetary motion"? What if Louis Pasteur, knowing the flaws in the understanding of how people got sick in his day (thought to be due to evil "humors" or "imbalances in bile," concepts that, oddly enough, still persist in many altie circles), had simply thrown up his hands and said, "I don't have to replace current theory of disease with anything; there just isn't a good theory"? Fortunately, they were scientists. They looked at the data. They developed models, equations (when appropriate), and coherent sets of postulates to describe the phenomeon they were looking at and predict natural behavior. Then they finally came up with coherent theories that described the phenomenon in question. That's what real scientists do when they encounter what they consider to be an incorrect or seriously flawed theory. They look for the evidence and models to come up with a better one! They certainly don't just shrug and say, "there is no good theory" or "God did it" as ID advocates do. God may indeed have "done it," but whether or not He did is not something that science can determine.

If you think I'm just picking on Denyse, I'm not. Unfortunately, this attitude runs rampant through the ID community. Some of the best examples came recently from the Kansas hearings on whether ID concepts should be taught in science classes. Red State Rabble, Panda's Thumb, and Pharyngula have all been posting excerpts from the transcripts (excerpt 1, 2, 3, 4, 5, 6, and 7) that make it abundantly clear the utter intellectual and scientific vacuity and disingenuousness of ID advocates. If, after reading these excerpts, you still have a strong enough stomach, the complete transcripts are here. It's truly depressing reading.

In science, anyone who would tear down currently reigning theory is expected to propose something to replace it with and then defend that new theory or hypothesis. If they cannot, then there is no practical or intellectual reason to abandon current theory. Why? Even when it is flawed, a set of postulates only manages to rise to the level of being called a "theory" because scientists come to a consensus that that set of postulates represents the best understanding we currently have and thus has some utility to predict natural phenomenon and direct further research. And some utility is better than no utility, which is what tearing down current theory without proposing a competing theory to replace it is. That's why simply tearing down evolution and saying that there is "no good theory" is not good enough. It is anti-science and anti-intellectualism. (No wonder ID is not taken seriously by serious biologists.) No, the flaws and weaknesses in present day theories are exactly what drive scientists to fill in the gaps to fine-tune accepted theories or even to come up with new theories that better describe and explain nature. In order to become accepted, any new theory seeking to supplant the old has to explain natural phenomenon better, account for the known data more completely, and predict the behavior of natural phenomena more accurately than current theory. It is possible, even likely, that someday another theory will supplant evolution. It will be a theory that takes into account any flaws in existing evolutionary theory in the light of new data, encompasses the new data, and explains both existing and new data and experimentation better than current theory. Given those requirements, that theory will almost certainly not be ID.

Grand Rounds XXXVIII

Grand Rounds XXXVIII has been posted at Red State Moron. More of the best stuff from the medical blogosphere. I have to guess that the name "Red State Moron" is intended ironically, because no moron could tie together so many posts so well...

Another Suzanne Somers in the making

Via Anne, I've learned that Kylie Minogue has turned to "alternative" therapies after surgery to treat her breast cancer:

The pop babe, who was diagnosed with the life-threatening illness last month, has began seeing a bio-energy healer to help her cope with the course of radiotherapy she is about to begin.

During the sessions, the healer will try to beam positive energy in to Kylie's body with one hand and remove negative energy with the other.

In a bid to beat the illness, the 'Slow' singer has also turned to colour therapy, insisting a room at the private hospital where she received her lumpectomy be painted pink in a bid to assist her recovery.

It is believed Kylie, 37, turned to alternative therapies after speaking with fellow breast cancer sufferer Olivia Newton-John who used Buddhist chanting to overcome the disease.

Ms. Minogue certainly has the right to choose any "therapy" she wishes, and it is to her credit that she has not abandoned conventional treatment in favor of this "bioenergy healing." Fortunately, I can't think of any way that this sort of thing is likely to harm her chances of a cure. Unfortunately, I can't think of any way it will help her chances either, other than serving as a very fancy (and probably very expensive) placebo. Indeed, even a 9-year-old-girl was able to show that these "energy healers" can't even detect the human "energy fields" they claim to be able to manipulate. She even managed to get her study published in the Journal of the American Medical Association! (Thanks to Skeptico and Nurse Kelly for the reference; a more detailed description is here and the article is here.) Of course, energy healing and therapeutic touch advocates jumped all over this study, claiming it was invalid because there was no eye contact or, even more amusing, because the experiment involved a "nonhealing" task and lacked the "intention of doing the greatest good for the person being treated." (Are they really trying to argue that a "healer's" ability to "detect" these human "energy fields" depends upon the intent of the healer to "do good"?) Worse, they even teach this stuff in nursing schools as a serious therapy, and, as Kelly points out, no mention of the JAMA study is made, even in newer textbooks. Fortunately, not all nurses buy into this. It may well be true that a good "therapeutic touch" or a good massage can relieve tension and make a patient feel better, but the salutory effect of such human contact almost certainly has nothing to do with "energy fields" or "redirecting these energies to bring the person back into energy balance," nor do you have to worry about using it on people "sensitive to energy repatterning" (mainly because there is no "energy repatterning"). I also can't help but wonder how these "healers" determined what points on the body are the proper targets of "therapeutic touch." Somehow I doubt there was any science involved.

But I digress, as I am wont to do sometimes and promised to try to stop doing.

Regardless of the specific "alternative medicine" therapeutic modality chosen, I dealt with the issue of people choosing alternative medicine for breast cancer treatment in detail veryearly on in this weblog's history; specifically, how patients who choose alternative therapy after having had conventional therapy will often become "testimonials" for that therapy and will attribute their good outcome more to the "alternative" therapy than the conventional therapy they had already undergone. (The converse is also true; they tend not to blame these alternative therapies when they relapse.) Unfortunately, celebrities seem particularly prone to this phenomenon. For example, Suzanne Somers decided to opt for injections of the mistletoe extract Iscador rather than chemotherapy after her surgery and later had glowing things to say about it. Olivia Newton-John turned Kylie on to therapeutic touch. Both have become a "testimonial" for alternative medicine, and it looks as though Kylie Minogue may be heading down that path.

What one needs to understand in evaluating these "alternative therapies" is that surgery alone or surgery plus radiation therapy cures most early stage breast cancers. The chemotherapy and/or hormonal therapy can reduce the rate of recurrence signficantly, but the bulk of the "cure" comes from the local therapy. In effect, chemotherapy is just "icing on the cake." What's going to "cure" Ms. Minogue will not be "energy healing," "color therapy," or Buddhist chanting, but rather the scientifically-proven (and much less glamorous) treatments of surgery, radiation therapy, chemotherapy, and possibly hormonal therapy, just as surgery cured Suzanne Somers. However, like many cancer patients who supplement their therapy with such means, it is possible (even likely) that, once her therapy is complete, assuming she does well she will attribute her cure to the "alternative" therapy more than than the conventional therapy that preceded and accompanied it. She will become a "testimonial" for these therapies.

Ah, you say, Kylie Minogue is continuing to pursue standard therapy; so maybe she is just using these therapies to help her deal with the potential side effects of radiation therapy, such as fatigue and skin rashes or perhaps she'll use it later to help with chemotherapy side effects. Possibly. The article does make it sound as though that is what she is using these unconventional methods for. Unfortunately, there is no evidence that "energy healing" does anything whatsoever to help these symptoms. Personally, I'd like to know how any "healer" can "beam positive energy" into Kylie (or anyone) with one hand and "remove negative energy" with the other. What is the frequency of this "energy"? How can we detect or measure it? How does the healer identify what "energy" is "positive" and what energy is "negative," much less control such energy flows? It's all religious or New Age hokum, nothing more than a very expensive and showy placebo.

What bothers me is not so much that a celebrity has chosen this sort of therapy. It's more the way the press tends to give credulous and positive coverage to such unproven and questionable therapies or, at the very least, to "balance" the skeptics with the testimonials of the advocates. Even in the CNN article describing the study debunking therapeutic touch, a note of credulity slipped in; the article recounted glowing testimonials of patients who had undergone therapeutic touch and even wrote:

Advocates are blasting the young science student's research, and even skeptics concede many patients benefit from the therapy.

Which skeptics concede this? They don't name or quote these skeptics who "concede" this. Inquiring minds want to know who these "skeptics" are!

In any case, Anne got it right when she pointed out:

In a few year uncritical reporters will be talking of Kylie (or Olivia Newton John) and how she used "bio-energy healing" to overcome her disease

Indeed they will, the same way they talk of Suzanne Somers as having used mistletoe extract to overcome her disease, even though it was her surgery that cured her. Actually, if you look at the original storyAnne cites, it looks as though credulous reporters have already begun to do just that. Notice the utter lack of questioning whether such methods have any efficacy. The writer seems to assume that these methods have value because the celebrity has chosen them. I usually have no objection to patients using such therapies in addition to the proven, as long as I know what they are so that I can know if they might interfere with her standard treatment. (For example, some vitamins will interfere with clotting at high doses, and we surgeons don't like anything to interfere with clotting.) Unfortunately, the "testimonials" that come out of such use often make it sound as though the alternative, rather than the standard, therapy is responsible for the patient's survival. Even if Kylie herself does not give undue credit to this therapy for her cure, you can bet the press will do glowing puff pieces on her and how she used "unconventional" means to "beat" breast cancer.

Welcome a new warrior against pseudoscience

Phil Plait (a.k.a. The Bad Astronomer) has thrown down the gauntlet. Watching intelligent design creationists try to subvert biology education with religious pseudoscience, he's seen the writing on the wall for his field, astronomy, and predicts it won't be long before creationists start seriously moving into the field of astronomy. He wants to add his voice:

Many people like to say that science and religion are compatible. I find that to be a monumentally naive statement. Perhaps science and some religions can be reconciled, but if your religion says that Jupiter is really made of pixie dust, or that the Earth is flat, or that 1+1 =3, then your religion is wrong. It’s really just that simple. The Universe knows what it’s doing, and the reality of it is what science seeks. If your religion cannot be reconciled with that reality, then your religion is wrong (and I would certainly say the same thing about any science which incorrectly describes reality). Perhaps not all religions contradict reality, but certainly creationism does, as does Intelligent Design.

Welcome to the battle, Phil.

You're right; it won't be long before creationists seriously go after the cosmological sciences. Almost every major religion has reconciled itself with an old universe, an old Earth, and evolution. It's unbelievable that in the 21st century there is a significant proportion of the population that cannot reconcile scientific knowledge with their faith.

Another perspective on my Harry Potter predictions

John McKay of archy, although he mostly agreed with predictions by Coturnix and me that the Harry Potter character who's going to die in the Book #6 will be Albus Dumbledore, couldn't resist playing the contrarian and presenting a counter case that it may not be Dumbledore. He may have a point. It's possible, as he says, that the information that led to a cluster of Internet betting on Dumbledore's death originating from a town were previous Harry Potter books had been published may have been misinformation and misdirection.

He has a point, but I'm still sticking to my original prediction, though. Dumbledore's going to buy it in the next book, and Snape's going to become Headmaster of Hogwarts to replace him. However, I will give OutEast credit for one-upping me by suggesting that Snape is still a Death Eater and that the reason he is so loyal to Dumbledore is because Dumbledore will supplant Valdemort as the Dark Lord, making him real the foe that Harry will end up having to face.

Cool idea, but I don't think so.

Six months

I can't believe I forgot to mention this over the weekend, but Saturday marked six months since I started blogging. I realize that some consider posting about your own blog or blogging in general to be a bit lame or self-indulgent, but I don't think it's necessarily inappropriate at major "blog-iversaries," like my very first half-year mark and then maybe yearly anniversaries after that (assuming I make it that far). So allow me to reminisce a moment...

It was a deep, dark Saturday afternoon in December. The buzz about blogging was in full force in all the year-end media retrospectives and Presidential election postmortems. I was bored. I was also depressed (don't ask why). I don't remember why, but on a whim I started this blog. Indeed, you can look at my very first post here. (OK, it wasn't really my first post, which is here, but it was my first substantive post.) Since then, blogging has almost completely replaced my previous favorite online pastime, sparring with Holocaust deniers and alties on Usenet. Like others who have migrated from Usenet to blogging, I've now found that I enjoy blogging more. For me, the reason is because my blog can be what I want to write when I want to write it, rather than my reaction to what others write (which is what most Usenet posts amount to). It also serves as an outlet for my creativity and, yes, outright weirdness, which 15 years of nothing but technical and scientific writing and always having to be the fine upstanding citizen was slowly crushing. Even better, it simply replaced one online hobby with another, so that my total time online hasn't changed appreciably as far as I can tell. What that means is that I've almost completely disappeared from Usenet. It's probably not a big loss; Usenet is so big and diffuse, tens of thousands of different newsgroups, and relatively few readers relative to the potential of the web.

Although much has changed in six months and Respectful Insolence has evolved in ways I never could have foreseen (for example, as you might imagine I had never planned on EneMan becoming the de facto mascot of this weblog), what strikes me as I look at those old posts again is how consistent with my original vision I've managed to remain. Oh, sure, there have been times when I haven't been happy with what I've written or have wandered off on a tangent of mediocre posts, but for the most part I like my work. I think I've managed to fill a unique niche in the blogosphere. As far as I know, there are no other academic surgeons with labs out there blogging. (If anyone is aware of another one, please let me know. It's lonely being the only one.) In fact, I'm unaware of any academic physicians out there with blogs, but I can't believe that there aren't some out there somewhere. Further, I'm unaware of anyone whose main theme is critical thinking that encompasses science, alternative medicine, and history in quite the same ratios as that I like to discuss, who also throws in his eclectic musical tastes and strange humor.

As I enter the second half of my first year, now is as good a time as any to take stock and figure out more ways to try to improve. I think that this blog is better than it was when it started, and I will have failed if it fails to continue to improve and is not significantly better six months from now. In the interests of continuing to get better, here are some changes I'm seriously considering:

1. Shorter posts. I want to try to shorten the average length of my posts and make them punchier. As you may have noticed, I have a tendency towards excessive verbosity, and the lack of an editor or any space constraints (as journal articles and grant applications have) lets me indulge it more than I should. (In fact, it's harder for me to be concise than it is just to ramble on.) If I decide to go this route, I'll still write the occasional magnum opus, just not as often. Consider this as simply an ongoing effort on my part to correct what has always been a weakness in my writing style, no matter what kind of writing I'm doing. I hope the constant practice will pay off not just here with more concise and entertaining posts but also in my professional life when I have to write grants and manuscripts that must come in under certain lengths or abstracts, for which space is very limited.
   
2. Tighten the focus. The original focus of this blog was to be medicine, science, and critical thinking. I rather suspect things have become too diffuse (note the Harry Potter and Doctor Who posts over the weekend). This doesn't mean that I won't still occasionally do the odd music or movie review or that I won't post something totally unrelated to the theme of this blog if the mood strikes me. I'll just try to do it less.
   
3. More variety within the main focus. Lately I've been spending too much time on a few areas of alternative medicine and pseudoscience. There's so much more credulity and quackery out there to debunk. Why limit myself to so few topics and risk getting repetitive and stale? Ditto with medical and scientific topics. Besides, doing research for some of these pieces broadens my horizons and often teaches me something I didn't know before.
   
4. More pictures and illustrations. This blog is very text intensive; I'd like to illustrate my posts a bit more. This would most useful when I try to explain scientific concepts in the future. For example PZ does this well.
5. Aggregate comments.Back when I only got a few dozen hits per day and only the occasional comment, it was easy to keep up and respond to most comments. Now that I average several hundred hits per day and occasionally 20-40 comments after certain posts, I just can't respond to everything anymore, no matter how much I want to and enjoy doing it. I don't want to go the Rude Pundit route and not allow comments at all, but something needs to be done. There have been times recently when I've responded to comments during the day while I was at work, a habit I need to nip in the bud right now. (Most of the time, I write my posts in the evening and on weekends and then post them either early in the morning before I go to work or right after I arrive at the office.) Consequently, I'm thinking of occasionally posting an "ask Orac" feature or "reader mail" feature (kind of like the "Ask Yoda" feature of Master Yoda's Blog--just kidding), in which I respond to a few choice comments that I didn't respond to in the original post or that interest me. Regardless of whether I do this or not, from now on you will also, if ever, get an answer from me to comments before 6 or 7 PM (or 8 or 9 PM) on weekdays. Don't worry, though. I don't get so many comments that I don't still read every one, and I'll still wade into the comments fairly frequently; so, please, keep 'em coming. One reason I liked Usenet so much is because of the free-ranging discussion, and I'd like to keep a taste of that here. I will just have to be a bit more selective in what I respond to directly.
   
6. Occasional blog holidays. I can't remember the last time I missed a day. I've decided that there's no need to post seven days a week every week, even though most weeks I want to.
7. Challenge myself. Every so often, I want to post something totally off the wall, totally outside my usual style, maybe even bizarre or maybe even fiction. I realize this conflicts with #2.
8. More posts on Holocaust denial. I really haven't done much explaining what it is and some of the specific lies and exaggerations that Holocaust deniers use. Combatting Holocaust denial is a large part of what kept me on Usenet since 1998, and I haven't done much here about it.
   

Those are just some of my thoughts about ways to make this blog better, but in the interests of #1 I'm going to stop now. I may implement them all or none of them. Most likely I'll implement a subset of them (#1 and #5, for instance, are more or less already decided on).

I'm also going to solicit some of your feedback. What do you think? What topics would you like to see that I haven't covered? What other things could I do to improve?

Finally, just as a plug for my future posts, starting Wednesday or Thursday, I plan on starting a brief series on scientific innovation. That was a major topic at the Era of Hope Meeting last week, and it's a topic worth covering in more detail.

The nuttiest creationist arguments I've ever heard of

Earlier this month, I mentioned the most amusing creationist book I've ever heard of, in which evil "fallen" angels lead dinosaurs against Noah's ark, but are stopped by good angels. Well, PZ ordered himself a copy of the book and now reveals that it's so full of bizarre and half-baked "refutations" of evolution that I'm amazed that PZ could read it without his brain exploding. (The illustration of a "steg-0-moeba" trying to will itself to evolve into a stegosaurus is priceless!) Fortunately, PZ's brain survived intact and allowed him to write this amusing deconstruction of the book and some of its more bizarre claims, complete with examples from the book.

Eeewwww!

Checking the referral logs on Sitemeter can sometimes yield the strangest things. For example, it never ceases to amaze me what kinds of searches lead to referrals to this blog. Yesterday, someone searched Altavista for "man to man enemas." In the results of this search was my post about the Orange Man, the story of a patient I encountered during my residency who chose the Gerson therapy (which involves coffee enemas and megadoses of carrots) over surgery for his rectal cancer, with tragic results.

The same search also turned up this link.

Somehow, I suspect that neither of these results were what the person doing the search for "man to man enemas" had in mind. However, I do hope that my post did manage to educate him on the ineffectiveness of coffee enemas and megadoses of carrots as a treatment for colorectal cancer and that the other link amused him with its description of the travails of giving a cat an enema.

Calling the Doctor!

As a longtime fan of the Doctor, I couldn't help but mention this when I found out about it.

The BBC has reported that kidnappers have stolen a Dalek, believed to be one of the original Daleks from the first run of the classic BBC science fiction/fantasy show Doctor Who (which, by the way, was resurrected this year after about a 15 year hiatus). Daleks were among the Doctor's most deadly (and most popular) foe, known for looking like giant salt shakers and for issuing their famous robotic cry of "Exterminate!" just before they zapped their enemies with rays coming out of an arm that looked like a toilet plunger. The Dalek was stolen from the Wookey Hole Caves (no, I'm not making this up!) on Monday, leading its owners to offer a £500 reward for its return. On Thursday, a ransom note was found with the arm of the Dalek neatly amputated. The note was signed by a group calling itself "Guardians of the Planet Earth" and said:

We are holding the Dalek in captivity and isolation.

For the safety of the human race, we have disarmed and removed its destructive mechanism.

We demand further instructions from the Doctor.

Will the Doctor respond?

Fortunately, there appears to be no damage. Wookey Hole manager (how does one get such a title?) Daniel Medley said: "The arm has been removed quite carefully, it hasn't been ripped off, there's no

torture involved."

Well, that's a relief.

Speculation as to who took the Dalek ranges from students taking it as a prank to protesters stealing it to use in their protests for the upcoming G8 summit in Edinborough. Personally, I tend to think it's a bunch of Doctor Who fans pulling a prank, although, geek that I am, I do think that a full-size Dalek would make a fine addition to the decor of my office--although I'm sure my wife would most definitely not agree. I also would never have damaged the model by removing its arm.

In any case, this incident reminds me that, as a long-time fan, I've been meaning to do a piece on Doctor Who for some time now. The new series is being shown in the U.K., but it's also being shown in Canada on the BBC. Unfortunately, it's not being shown in most of the U.S., including where I live. Fortunately, my family lives in Detroit, which means they can pick up the CBC broadcasts. Even more fortunately, my mother also happens to be a fan and is systematically taping the new episodes for me. I've already seen the first two, and they were surprisingly good, better than I expected. I still have a tape of four more of the new episodes, but I just haven't had time to look at them yet. Perhaps after I do I'll have seen enough to comment more definitively on the new series and the new Doctor in the context of the old series and previous actors who have taken on the mantle of the Doctor.

Either way, I need to find around four hours to go through the tape I have now before a new one arrives in the mail...

(Via SciFiDaily.)

ADDENDUM: I just learned that former Doctor Who actor Colin Baker has been in touch with staff at the attraction, and may be asked to send a message to the kidnappers.

It figures. It would have to be Colin Baker. His was the most obnoxious and annoying incarnation of the Doctor. Of course, Baker's having been a guest star on Blakes 7 in the episode City at the Edge of the World can't help but warm the cockles of Orac's circuits, Baker's poor fit for the role of the Doctor notwithstanding. And even despite Baker's generally disagreeable take on the Doctor, among the mediocre stories, there were still a couple of really good Doctor Who stories during his tenure, Revelation of the Daleks and The Ultimate Foe.

Couldn't they have gotten the other Baker who played the Doctor, Tom Baker (the fourth--and best--incarnation of Doctor), or at least Peter Davison (the fifth--and my second favorite--Doctor)? Heck, the guy who's presently playing the Doctor, Christopher Eccleston, would be good. I like his take on the Doctor. Too bad he's planning on leaving the series after only one season in the TARDIS.

"Boosting the immune system": a meaningless claim

I've mentioned before that one of the most meaningless claims that alties make for their therapies is that they "boost the immune system." Apparently Dr. Eric Hoy agrees with me, and Paul at Confessions of a Quackbuster has with permission reprinted a letter by Dr. Hoy that provides five questions you should ask any altie practitioner who claims that his or her treatment "boosts" or "strengthens" the immune system. Dr. Hoy has challenged at least 50 websites or individuals to answer these questions. Unsurprisingly, not one has managed to do it yet. As Dr. Hoy points out, the immune system is a finely tuned network of immune cells and signals. Indiscriminately boosting the immune system can be potentially disastrous to the host, resulting in various autoimmune diseases.

Fortunately, I've yet to see an altie remedy that actually does boost the immune system in any detectable way. Whenever you hear a vague claim such as "boosts the immune system" without a detailed description of how this is accomplished, you should run, not walk, away from the practitioner. He's very likely a quack.

Which Harry Potter character is going to bite it in Book #6?

Warning: Minor spoilers for previous Harry Potter books and major speculations about the next book ahead.

I'm a latecomer to the whole Harry Potter phenomenon. In fact, I didn't even read the first book in the series, Harry Potter and the Sorcerer's Stone until sometime around Christmas last year. I found it quite entertaining, although a bit too much a children's book for my taste. (Yes, I know that The Hobbit was a children's book; but somehow it didn't seem as much like one.) Before that, I had no idea what the books were about and any mention of Harry Potter characters or any Harry Potter analogies would go right over my head. Then, I continued the series, and I was impressed with how each book built on the last and was better and more complex than the last. (Well, maybe with the exception of the fourth book, Harry Potter and the Goblet of Fire, which dragged a bit in places but was still on par with its predecessor, Harry Potter and the Prisoner of Azkaban.) The most recent book in the series, Harry Potter and the Order of the Phoenix , was without a doubt the best in the series so far, much richer and more emotionally resonant than the previous books. (The chapter near the end in which Aldus Dumbledore confesses what he knows about Harry's destiny was worth the price of the book alone.) I blew through it on my recent trip to the West Coast, finishing it between the two plane rides, one of which was horribly prolonged by various SNAFUs, and finally watched the movies too.

So, in a manner of around four months, I became a Harry Potter addict, just like almost everyone else in the English-speaking world. Better late than never, I guess. My wife has even become a fan and is working on the most recent book, hopefully to finish it before the new one comes out. I don't plan on camping out at a bookstore the night it's released to get my copy at the stroke of midnight the night of July 16 (my secretary does, though). However, I'll certainly get a copy within a few days after the book's release and start reading. You might even notice a slowdown or even cessation of blogging here for a few days until I can finish it.

There has been much speculation about which character is going to take the dirt nap in Harry Potter and the Half-Blood Prince, given that J.K. Rowling has stated that a major character would die in this offering. Indeed, there has been a lot of betting on which character will die, with the odds-on favorite at present being Albus Dumbledore, the Headmaster of Hogwarts. I had been planning on writing about this for a while, but somehow other topics got in the way and I never did. Then, I came across Coturnix's speculations about who would be the most likely to die, and it reminded me to get off my butt and start prognosticating! And just because his analysis is spot-on and I agree with him isn't going to stop me from speculating myself, either.

It's going to be Dumbledore.

With everyone else these days predicting it'll be Dumbledore, you'll just have to take my word for it that I made that prediction a couple of months ago, but I did. He's the most likely character to bite it for one simple reason: The Harry Potter novels are, in essence, a coming-of-age story. In all coming of age stories, the hero must reach a point where he has to stand on his own against his foe, without mentors, without help, without anyone to fall back on, especially his wise mentor/father figure. This will be the sixth of seven planned novels, which means that Harry's final battle, in which he must face and defeat the evil Lord Valdemort, will occur in the next book. To clear the decks for this final confrontation, Dumbledore has to go. As Obi-Wan Kenobi and Yoda both had to die before Luke could face Darth Vader and finally defeat him, so will it be with Dumbledore before Harry can face Valdemort for the final time and defeat him once and for all. I really like Dumbledore and will really hate to see him die (in fact, he's probably my favorite character in the novels), but for Harry to finally stand on his own as a young man, Dumbledore can't be around in Book #7 to save him. Coturnix agrees:

He [Dumbledore] has to die in #6 so nobody expects him to help Harry in #7. Even if JKR lets him travel far away, readers will expect him to come back in the nick of time. Even if JKR makes Dumbledore old, sick and out of his mind, the readers would expect him to get sane, strong and healthy enough to help Harry. Old Albus has to go. I'll be mad and sad when it happens, but I cannot see how else can JKR go on to finish the series otherwise (except perhaps kill Dumbledore at the BEGINNING of #7 which is the same thing in a sense).

Indeed. The only way Dumbledore isn't going to die at the end of #6 is if Rowling kills him off in the beginning of #7. There's even some evidence from the betting that is suggestive that somebody has some inside information that it's going to be Dumbledore who dies, although there has also been speculation that Severus Snape is the one who will die. (Like Coturnix, I tend to discount that, because Snape is such a disliked character that many fans would probably be happy if it were him. I suppose there's an outside chance that Rowling could have him go down nobly, demonstrating to Harry why Dumbledore continued to trust him despite his past, but I doubt that will happen.)

To finish up, though, here's a special bonus prediction from me (you heard it here first): I predict that Severus Snape will be appointed Headmaster of Hogwarts after the death of Dumbledore--at Dumbledore's personal recommendation in his will. Remember that, despite Snape's shady history as a Death Eater (a servant of Valdemort), Dumbledore has reemphasized several times that he trusts Snape (even though he won't explain why, leaving his reasons mysterious), and this would be the ultimate way to show his trust. It would also make sense in that Valdemort is rising and one could speculate that Dumbledore would consider Snape, who has always had an interest in the Dark Arts, the perfect one to defend Hogwarts. Face it, if the other senior-most professor at Hogwarts, Minerva McGonagall, who is the head of Harry's House (Gryffindor) and is probably as friendly to Harry as Dumbledore, were made Headmaster, Hogwarts would remain a cozy, supportive place for Harry. If Harry is truly to stand on his own, his remaining major support other than Dumbledore (Hogwarts) has to be made much less hospitable. I know, I know, something like that happened already when Dumbledore was temporarily displaced by the Ministry of Magic as Headmaster, but he came back and Hogwarts was restored to its status quo. This time Dumbledore won't be able to return. Putting Harry Potter's least favorite professor in charge would add another element forcing Harry to stand on his own--particularly if Snape turns out at the end to be still a Death Eater. (I suppose whether you think Snape is still a Death Eater or not depends on how good a judge of character you think Dumbledore is.)

Hmmm. Maybe I should try my hand at writing fiction.

And if my predictions are incorrect? Hey, it's only a novel. You think you have better predictions? Lay 'em on me now (with explanation/justification) in the comments section!

Who knew?

What do Mick Jones, Mark Knopfler, Paula Abdul, Billy Joel, Gene Simmons, Beck, and Pink have in common?

They're Jews, and they rock. (OK, not Paula Abdul. She is Jewish, but she most definitely does not rock. Hmmm. Billy Joel and Pink are questionable, too. I also left out the obvious ones, like Bob Dylan, because then the question would be too easy.)

And where did I learn all this? On Jews Rock, of course!

Take the quiz and find out which rock stars are and aren't Jewish. Then check out a comprehensive list of Jewish stage names.

I love this site's emblem, by the way, a stylized guitarist hitting a power chord while standing on a Star of David.

And I'm not even Jewish.

The World Naked Bike Ride 2005

File this under the amusing but pointless. I've become aware that tomorrow there will be a World Naked Bike Ride in over 50 cities around the world. From the organizers' site:

On June 11th, 2005 over 50 cities across the world will experience the naked joy of the worlds largest naked protest against oil dependency and car culture in the history of humanity. It is time to stop indecent exposure to automobile emissions and to celebrate the power and individuality of our bodies! Naked Bicycle People Power!

No. I don't plan on participating. I doubt anyone would be interested in seeing my pasty white behind, anyway. Other than street theater and possibly the opportunity to ogle naked people slathered in body paint, I really don't see the point of this, nor do I understand how it would advance the cause of weaning humanity from its addiction to fossil fuels. (But then I'm not a naturist.) I do recall that in 1978 Queen staged a nude female bicycle race as a publicity for its album Jazz (about which the song Bicycle Race is thought to be) but that was for purely mercenary purposes, to promote their album. There was nothing idealistic whatsoever about it. (As a humorous aside, when the company that rented Queen the bikes found out what they were used for, it refused to take them back.)

As a guy, though, I find the that the thought of riding a bike naked with my--well, you know what--being subjected to the pounding of a hard bicycle seat while riding over bumpy city streets, never knowing which side it will come to rest on (if you know what I mean) rather painful-sounding. I don't even think it would be that great for a woman, probably for the same reason I've heard some women complain that thongs are very uncomfortable--except with the bicycle you get to deal with road bumps. But, hey, if these intrepid protesters want to subject their bodies to massive quantities of paint and abuse of their nether regions, all in the name of some vague feel-good "positive body image" and alleged "freedom from oil dependency," more power to 'em. Personally, I think that some people need to have more of a negative body image, at least enough to keep them from flaunting their flabby bods where no one wants to see them.

Oddly enough, none of the cities listed are within two hundred miles of where I live. (I say "oddly enough" because, as you may know, I live within striking distance of New York City.) I do notice, however, that Chicago is one city where this will be taking place tomorrow. In fact, it's starting at 6 PM at 1666 N. California.

Whoa. (Keanu Reeves moment.) I know right where that is. And the pre-party "body painting" will occur at Buddy Gallery at 1542 N. Milwaukee Avenue. Geez. I used to live mere blocks from there. (OK, it was back in 1997, but still...)

I wonder if I can get any of my spies in Chicago to document the festivities, as one of them once documented a large number of Polish bikers appearing at a Polish church to pay tribute to Pope John Paul II after he died...

The zombie of Hitler's corpse is eating people's brains

Last week, inspired by this post, I discussed how quick politicians and pundits are these days to make fallacious comparisons to Hitler or the Nazis, pointing out that such comparisons are generally poorly thought out and serve more as a means of demonizing one's political opponents rather than making a serious comparison. I also noted that "argumentum ad Nazium" (a.k.a. the Hitler card") was once a favored tactic mainly of the left, but that right wing hacks like Rick Santorum had unfortunately now adopted, making weak Hitler/Nazi/Holocaust comparisons the bad historical analogy that hacks of all political stripes love to indulge in these days. (Remember the lead-up to the Iraq War and all the "Saddam Husein=Hitler" comparisons?)

Now, I find out that Democrat Charlie Rangel has joined in the fun, comparing the war in Iraq to the Holocaust:

It's the biggest fraud ever committed on the people of this country," Rangel told WWRL Radio's Steve Malzberg and Karen Hunter. "This is just as bad as six million Jews being killed. The whole world knew it and they were quiet about it, because it wasn't their ox that was being gored."

Oooh boy. OK, the Iraq war was, in my opinion, a horrible mistake that has gotten the U.S. involved in an open-ended counter-insurgency action that will last many years, has cost nearly 1,700 U.S. soldiers and probably ten times that number of Iraqis their lives, and is likely to cause all sorts of harm to our military capability over the long haul. However, it is most definitely not the equivalent of the Holocaust, not by any stretch of the imagination. When asked to clarify, Rangel added:

"I am saying that people's silence when they know terrible things are happening is the same thing as the Holocaust, where everyone would have me believe that no one knew those Jews were killed over there."

Hmmm. So Charlie didn't exactly compare the Iraq War to the Holocaust, at least not directly; he just compared the public reaction to the Iraq War to the the public's indifference to the Holocaust, thereby indirectly implying that the Iraq War was as bad as the Holocaust. Way to go, Charlie! Don't let that Republican hack Rick Santorum upstage you or Robert Byrd when it comes to idiotic Nazi analogies!

As you can imagine, the conservative blogosphere has jumped all over this, with Chrenkoff, Michelle Malkin, McQ, and Polipundit weighing in. (I don't recall if they were as indignant when Rick Santorum made his boneheaded Nazi analogy, but somehow I very much doubt it.) I also note that, while castigating Charlie Rangel for his fallacious Holocaust analogy (abuse that Charlie richly deserves), they generally let Abe Foxman of the Anti-Defamation League off the hook for his own questionable Holocaust analogy made in response to Rangel:

"It is so outrageous that I think he owes an apology not only to the families of the victims of the Shoah, but he also owes an apology to the soldiers who are fighting for freedom. If the world had recognized the evil of Hitler early enough - just like we're confronting the evil of terrorism and fundamentalism now - then maybe the 6 million wouldn't have died."

Oooh boy. Again, Saddam Hussein was not a good guy. He was a very bad guy who killed lots of his own people. But the equivalent of Hitler? No. Ditto "terrorism," al Qaeda, and "fundamentalism" when compared to the Nazi regime.

One of the rightwingers proposed a rather questionable solution, however: The Bipartisan Anti-Inflammation Pledge of 2005. The pledge states:

I pledge for the length of my public career:

1. To never compare a politician to Stalin, or a prison to the Gulag, unless millions of said politician's countrymen have been starved, murdered, worked to death, or otherwise killed, for the sole purpose of establishing a worldwide revolution or in the service of Communism.
2. To never compare a politician to Hitler, unless said politician has dissolved Congress, usurped power totally, murdered political opponents, attempted to rule an entire continent through invasion, and instigated a war that has engulfed the entire world.
3. To never compare any event whatsoever, anytime, anyplace, to the Holocaust, perhaps the most evil event in humanity's lifespan.

This is simplistic and a bit disingenuous in that it appears intended to preclude all such comparisons, except under very limited situations. (Note the mention of gulags, which is a clear allusion to Amnesty International's comparing the Guantanamo Bay detention facility to a gulag. Ask yourself: Why limit such comparisons only to detention camps run by Communist regimes? Why would comparing a mass detention center in the service of a non-Communist regime not be appropriate?)

Since my original post on this topic, I think I've come up with (I hope) a better idea. Whenever someone makes a Hitler or Nazi comparison, be it "Bush=Hitler" or "Hillary=Hitler" or "Whomever=Hitler" or a questionable Holocaust comparison, don't just accept it or shrug and walk away. Pin down the person making the analogy. Ask him what, specifically, he means! Make him justify the analogy with history, facts, and logic. Ask him specifically what similarities and what historical events lead him to make that analogy. At least 95% of the time, you'll get either no answer (and you'll hopefully make the idiot making the analogy very uncomfortable); a meaningless "because X is as bad as Hitler," "because X got us in a war," or "X is like the Holocaust because lots of people are being killed" kind of an answer or an obviously fallacious answer like Charlie Rangel's or Abe Foxman's. The other 5% of the time (or usually way less), you may get something as thoughtful as David Neiwart's essays (not as long, of course). If interviewers who encounter such analogies from politicians they're interviewing would consistently, calmly, and insistently ask followup questions demanding justification and pointedly asking why the politician being interviewed chose the Hitler/Nazi analogy rather than another, a lot of this silliness would disappear. It wouldn't stop the bad analogies in political speeches, but it might make TV and radio political punditry just a little less annoying by making politicians acutely aware that they will be called on it when they use Nazi comparisons. At the very least, it would make politicians making such overheated analogies squirm on the air a bit, and that's always a good thing. In fact, maybe we could even have pundits invoke Godwin's Law. Now that I would like to see.

Bummer

My hometown team the Pistons just lost the first game of the NBA finals, and lost it badly, 84-69. (I was born in Detroit, grew up in the Detroit area, and spent the first 26 years of my life in southeast Michigan.)

I was sitting at the bar at the Independence Brew Pub, sipping a brew and watching the game. When the Pistons fell behind by 12 points with around 7 minutes to go, I knew it was over. They weren't playing well enough to close that big a deficit in in so little time. For some reason, in the second half, they just couldn't sink a basket to save their lives. I finished my IPA and headed back to my hotel room in disgust. There seemed to be a lot of San Antonio fans there.

Oh, well, there are still six games to go.

The Tenth Skeptics' Circle

The Tenth Edition of the Skeptics' Circle has been posted at Skeptico. If I were PZ, this is the place I'd make some joke or other about how "I doubt it" or "don't believe it unless you see it yourself."

You can believe it. Trust me.

The Era of Hope

Blogging will be light the next few days, and I certainly won't have time to respond to comments before late tonight. I'm in Philadelphia (along with a couple thousand other investigators) attending the Era of Hope Department of Defense Breast Cancer Research Meeting. Unfortunately, I'm not giving a talk, just presenting a poster. Many of you probably don't realize that the Army actually funds a fair amount of cancer research and research into other diseases. The amount of funding isn't what it used to be during the flush years when Congress mandated that the Army fund this research, given the war and all. However, it used to be a nice, relatively easily obtainable source of funding for young investigators just getting started. I wouldn't be where I am now, nor would I have succeeded in competing for and winning my NIH grant were it not for the start I got in funding through an Army breast cancer grant. In a way, it's rather sad to see how difficult it's become to get these grants the last couple of years, but, given that the primary purpose of the Army is to fight wars and we are presently at war, it's perfectly understandable that this funding source isn't what it used to be. It wouldn't be so bad, except that, thanks to our massive budget deficit, all discretionary programs are getting squeezed, including the NIH. Funding for biomedical research through the NIH and for scientific research through the National Science Foundation are going to be really tight the next couple of years, at least. I have to hope fervently that the situation improves within four years, because that's when I will have to try to renew my NIH grant.

In any case, as you may recall from my previous trips to meetings, it could go one of two ways with the blog. If I end up sitting in my hotel room a lot at night bored, there's little better to pass the time than blogging. If, on the other hand, I find some colleagues and/or friends to hang out with, then blogging may be very light or nonexistent. (There's only one way to find out which wins out, of course. Check back here. Often. And don't forget that I always have odds and ends lying around already written that can be posted in a pinch.) There's also the time factor to consider. This is the Army, after all. First sessions start at 7 AM and the final sessions don't finish until 8:30-9:00 PM every night. It would take an act of superhuman will to go to every session for 13-14 hours a day, but I probably will make it to 10 hours worth. But there are some really interesting-looking sessions that I will definitely check out. Maybe they'll even give me some ideas for topics to write about next week. I've been meaning to write about breast cancer therapies for a long time now. Time to get cracking...

Dr. Gordon's at it again

I know. You're tired of Dr. Gordon's antics. I am too, which is why this will be uncharacteristically brief. Everything I said here applies to his most recent post.

Dr. Gordon, the Huffington Post's resident anti-vaccination blogger, is once again dissing a vaccine study solely on the basis of its funding source. As usual, he hasn't looked at the study itself critically to tell us why it should be ignored on the basis of the study design and science. Instead, he just makes his usual dark insinuations that because the study was funded by a pharmaceutical company and because the author of a commentary on the study has served as a consultant to that company that the study is automatically bad. (He also attributes shingles to "when the chicken pox vaccine is reactivated in normal adults." Odd. His own link states that shingles is due to the reactivation of the chickenpox virus in adults who had chickenpox as children.) Fortunately, a doctor by the name of Dr. Slavin is there to "comment."

Quoth Dr. Slavin:

Before flaming the entire industry and well respected clinicians and researchers, I would suggest seriously reading both the study and editorial and determining for yourself if financial bias played any role in the results or editorial comments.

Amen.

Reply to a 14 year old creationist

Blogging tends to be a rather immediate, short-term activity. Posts that are more than a few days old might as well be ancient history as far as blogging is concerned. Yet, every so often, a post will provoke a reaction long after I've forgotten I had even written it. So it was last week, when in my e-mail I found a comment about a post I had made over a month earlier. The post in question was a bit of ridicule directed at Frank Peretti, a writer of Christian-themed novels, who had recently written a horror novel whose theme was that "evolution makes us monsters." My beef with Mr. Peretti was the utterly incorrect statements he made while promoting his book, among which was his claim that there are no "beneficial" mutations. Here is what the comment said:

A 14 year old Creationist (and proud of it!) said...

I agree with Frank Peretti and his statements. I also agree with his beliefs on evolution and its "evidence" of mutations. Evolutionists practically contradict themselves by saying that mutations support their theory of evolution. (That's right, evolution is a theory, not a fact!) By definition the word mutation means an error in the genetic code. The word error as defined by the Webster Dictionary means a mistake or inaccuracy with a negative effect (notice the key word 'negative'). It is a scientific fact that negative effects have negative results. Therefore the human race, by the Theory of Evolution, is a negative effect to the universe. I find that a little depressing and inaccurate. Don't agree? Visit www.arky.org and complain some more.

Hmmmm. How should I handle this? I asked myself. Should I even handle it at all? If this really is a 14-year-old, I don't want to treat him or her as roughly as I did Mr. Peretti. To see where he was coming from, I clicked on the link he mentioned, heading to the "Who We Are" section. It's pretty hard-core young earth creationist stuff, stating: "We believe Biblical Truth first, scientific theory second, especially since it defines itself as always changing." Would I be wasting my time replying? Probably, but I still felt that I had to try to get through, even if there is little hope of changing this young mind. So, here goes:


Dear 14-Year-Old Creationist (And Proud of It!):

I received your comment. I'm guessing you're probably a fan of Mr. Peretti. I'm further guessing that you probably found my blog through a Google search on his name. In way of a reply, let me first start by emphasizing that my post was not meant to disparage Mr. Peretti's religion or yours. Rather, it was intended to criticize him for making statements about evolution that are incorrect while promoting his book. Although your writing suggests that you're probably a pretty smart kid, I hate to tell you this, but in your comment you too made some comments about evolution that are incorrect. I realize that you've probably learned these ideas from your parents, your school, and your church, all of whom you trust. Consequently, I also realize that it is unlikely that you'll change your mind based on a reply from a semi-anonymous blogger like myself, but, believe it or not, I feel a responsibility at least to try to persuade you. I care about the education of our youth, and I don't want to see someone as apparently smart as you say such things without being exposed to a careful explanation of the "other side."

You state that "evolution is a theory, not a fact!" You are half correct in this statement. In actuality, evolution is both a theory and a fact. It is a fact in that evolution has definitely occurred. Indeed, one reason that creationism "evolved" from its original Biblically literal young earth variety to its current "intelligent design" concept is because the evidence that living things evolve is so overwhelming that even most creationists were ultimately forced to acknowledge that evolution has occurred. Evolution is also a theory in that it is a set of ideas that attempts to explain how and why evolution occurs. However, I'm wondering if you are aware of what the word "theory" means to scientists; in science the meaning of the word is different than it is in colloquial use. To most laypeople, the word "theory" in essence suggests an "educated" guess. Indeed, the famous science fiction writer Isaac Asimov once said this about the "just a theory" claim about evolution: "Creationists make it sound like a 'theory' is something you dreamt up after being out drunk all night." That they do so (often, but not always, unknowingly) is mainly because of the more rigorous meaning that scientists give to the word "theory" compared to its more common meaning.

You must understand that, to scientists, the word "theory" has a much more specific meaning. To scientists, the word "theory" means a supposition or statement of ideas intended to explain a natural phenomenon (such as the "theory of evolution"). But it is more than that. To scientists, the word "theory" implies that the supposition or statement of ideas at present best explains the available data, has utility as a conceptual principle, and makes predictions regarding the behavior of natural phenomenon. To be recognized as a "theory," such a statement of ideas must be supported by an enormous quantity of data, so much so that scientists at present cannot think of a better set of suppositions that explains the data and makes predictions of natural behavior. So it is with the Theory of Relativity, and so it is with the Theory of Evolution. No other set of ideas comes close to explaining the wealth of fossil, observational, experimental, and molecular biological evidence regarding how species adapt and evolve and how species come to be. Creationism, regardless of whether it's the "intelligent design" or Biblical "young earth" variety does not come close and even contradicts much of the known evidence. That is why scientists do not consider creationism to be a theory. Also, to be useful to scientists, theories must be falsifiable. That means there must be evidence that, if found, would prove the theory incorrect. Creationism fails as a theory in that respect as well, because there is no way any scientist could ever prove that there is no God. That is one reason why scientists consider creationism to be religion or philosophy and not science, and thus not properly part of the teaching of biology. The problem with creationism, as far as scientists go, is that the explanation for unanswered questions becomes, in essence, "God did it." That answer may be fine as a matter of faith, but it does not help science progress.

Because it is a theory, does that mean that the theory of evolution is set in stone? Of course not! Scientific theories are always subject to revision as new evidence is discovered and new experiments yield results that the old theory does not explain. However, such changes must always continue to explain the wealth of old data and old experiments that have been done, which means new theories almost always encompass the old theory somehow. One example is the Theory of Relativity. Einstein didn't prove Newton wrong. He simply showed that Newton's Laws of Motion described the special case of bodies traveling at velocities that are very small fractions of the speed of light. He also showed that his theory described the motion of such bodies more accurately when velocities approached the speed of light. Given that Newton had no way to measure the motion of bodies traveling that fast, his Laws were the best that could be derived at his time. If any new theory of evolution rises to replace the present one, something similar will almost certainly happen, and the new theory will not invalidate the old theory. Rather, it will likely show that the present theory is incomplete.

Next, it is true that mutations are changes in the genetic code that come about during DNA replication. You can view them as "mistakes" in DNA replication if you like. However, it is not true that all mutations have a negative consequence. Most are neutral in that they either change one amino acid to another in the protein the gene encodes without significant functional consequence or they occur in areas of DNA that do not encode any proteins. Some mutations are, of course, harmful, although rarely in the "monstrous" way Mr. Peretti fictionalizes. Contrary to what Mr. Peretti says, some mutations are beneficial. For example, did you know that some Scandanavian people carry a mutation in a gene called CCR5 that makes them highly resistant to infection by the AIDS virus? It's true. If that's not a beneficial mutation, I don't know what is. This same mutation probably became prevalent several hundred years ago because it also confers resistance to the bubonic plague. There are also other beneficial mutations. One more example is a mutation in a gene called apolipoprotein AI, carriers of which have a much decreased risk of heart disease due to clogged arteries. The list goes on.

I do have to admit one thing. I'm rather intrigued by your inference that "the human race, by the Theory of Evolution, is a negative effect to the universe." Although the theory of evolution implies no such thing, it is a rather interesting philosophical question whether humanity is, on balance, a positive or negative effect on the universe. I like that you're thinking about such things, but I have to tell you that such questions can't be answered by the theory of evolution or even science itself, because deciding whether something is "negative" or "positive" is largely a value judgment. But keep thinking about such issues. It's good for your intellectual development.

Finally, given that you seem to be trying to think for yourself, even if the conclusions you're coming up with aren't scientifically correct, perhaps you'd like to contemplate the relationship between religion and science, specifically the science of evolution. One self-described "Bible-thumpin'" minister recently commented on my blog:

Those who use the Bible to disprove evolution obviously do not understand how to read and interpret scripture. The Bible is not a book about the "how" of creation, but of the "who" of creation. Leave the "how" to the scientists and the "who" to the Bible.

To me, this sounds like very reasonable advice. In addition, many other highly religious people have decided that there is no inherent conflict between their belief in God and accepting the theory of evolution. These clergy, for example. Even the highly conservative late Pope John Paul II stated that evolution is not incompatible with Catholicism. Similarly, although it is a common misconception even among Mormons that Mormonism mandates belief in creationism, there is no such requirement in the Mormon religion. As has been pointed out here:

Science can never prove nor disprove the existence of a God. The argument is circular. If a higher power created the universe and established its rules, it could choose to remain forever anonymous.

Do you see the truth of that statement?

I'd like to leave you with a few questions to ponder: If, as you almost certainly believe, God is indeed the source of all truth, why would He leave so much evidence scattered about His creation showing that the earth is billions of years old and that animals and plants evolved into different species over hundreds of millions of years if it were not the truth that this is so? Why would He endow humans with the intellect and desire to delve deeply into the mysteries of His creation to try to learn what His natural laws are, if the truth of creation and His natural laws are not the same as what His creation tells them? As a Christian, does it not make more sense to conclude, as the minister above (and others) do, that God set things in motion and evolution was His preferred mechanism to produce all the diversity of life on this planet?

Ponder these questions, and I hope that you will start to see why faith does not necessarily have to be incompatible with science. I hope I've also shown you that creationism is based on incorrect understandings of what the theory of evolution actually says. After all, if your faith depends upon believing something that can someday be shown to be untrue, than it is on shaky ground indeed, and each new scientific discovery could put it at risk.

Sincerely

Orac

P.S. Also, check out this comment from Dan S., who made some good points in answering you.

Water quackery

Water is water, right? You'd think that it would be hard to make the claim that water can cure disease and have people believe you. You'd be wrong. St. Nate has a good post on the many ways quacks jazz up water and claim that it can cure disease.

Soylent green is PETA people

Via Unscrewing the Inscrutable, see one of the stranger PETA protests, in which wacky naked PETA people in Rhode Island placed themselves in giant supermarket meat trays with labels like "Flesh" on them, in order to compare eating meat to cannibalism. Fun for the whole family!

Actually, it looks rather dangerous to me. What if they didn't make enough air holes and one of the protestors suffocated?

Unfortunately, PETA is not just about silly street theater. They are about intimidation of their opponents and enemies and their families. For example, yesterday on PETA2's Daily Blog Noah Cooper posted a call to harass Sharon Waller, the wife of the CEO of WetSeal, Joel Waller, by phoning her at home on her birthday. He even posted her home phone number and address. (Scroll to the bottom.)

To extremists like PETA, anything is OK in the name of a righteous cause, I suppose.

The five stages of Intel Macs

Like many, I was very surprised to hear that Apple is going to phase out IBM PowerPC processors and transition over to Intel processors by the end of 2007. Apparently, I'm not the only one...

Grand Rounds XXXVII

It's that time of the week again. Grand Rounds XXXVII has been posted at Medgadget. It's graduation time, and the medical blogosphere offers its wisdom to the Class of 2005.

The L.A. Times on medblogging

This week's host of Grand Rounds (not yet posted as of this writing), Medgadget, has been recently featured in a Los Angeles Times article on medical blogging, The doctor is logged in. Also featured in the same article are fellow medbloggers Nick (the founder of Grand Rounds), Dr. Hildreth (a.k.a. The Cheerful Oncologist), Medpundit, Symtym, and Gruntdoc, among others. All in all, it's an interesting article on the relatively niche area of blogging known as medblogging. There's only one problem.

Why no Respectful Insolence?

Oh, well. Maybe next time...

One statement from the article did immediately catch my attention, though:

And yet, curiously, most of the doctors don't tell their patients about their blogs. As Dr. Charles, a 30-year-old family medicine physician in Philadelphia who asks that his name not be used, says: "We have to maintain an air of professionalism in the office. But on the Internet we are much more candid about what we are thinking about healthcare and patient care."

Why "curiously"? It's not "curious" at all why doctors who blog usually don't tell their patients about it.

When I first started blogging, as someone who straddles the line between medblogging, science blogging, and occasionally just plain political blogging, I noticed immediately that, in notable contrast to most scientists who blog, most doctors with blogs use a pseudonym. It makes perfect sense. Whenever anyone asks me why I use a pseudonym rather than my real name, my answer is really simple. These days, patients often Google physicians and surgeons they are scheduled to see. I don't want my blog to be the first thing that comes up on such searches; I want my university and medical group web pages to be the first things that come up. After all, I doubt most patients would understand why a doctor might want to adopt a pseudonym based on a cranky computer from an old BBC science fiction series, mix it up with alties and pseudsocience advocates, and pseudohistorians, while adopting a very strange mascot for his blog. Some might understand. But most won't. Also, unlike many medbloggers, I'm not in private practice. I work at a relatively large medical school. Consequently, I need to make it clear that my online meanderings have nothing whatsoever to do with the official policies and positions of my employer, and a pseudonym is one additional way to do that, other than my disclaimer. If Dr. Charles, whose excellent blog doesn't delve into the strangeness that Orac regularly likes to mine, admits to being hesitant to tell his patients about his blog, well, then, tell me, what should Orac do?

Come on, admit it, regular readers. There are times when you wonder if this Orac character isn't just a little bit off his rocker, aren't there? Sure there are.

Hmmm. Maybe the writer for the L.A. Times actually did see Respectful Insolence after all, and it was all of the above that scared her away. (EneMan sometimes has that effect on people.)

Yeah, yeah, that's the ticket...

Wouldn't it be cool?

Wouldn't it be cool if blogging were really like this?

Of course, if it really were like that, Orac has to wonder: If and when Respectful Insolence ever reaches 1,000,000 hits, who would his blogging death match opponent be? An altie? (This is what an altie is.) An "intelligent design" creationist? For those of you out there with blogs, if and when you ever reach 1,000,000 hits, who would your death match opponent be?

I guess I'll have to wait. It looks like it'll be quite a long time before this blog reaches that milestone, a little less than five years at the present rate...

Anniversary

61 years ago today, the Allies landed at Normandy, heralding the beginning of the end of the Third Reich.

13 years ago today, my wife and I were married.

There have been speculations that the two are not entirely unrelated.

OK, it's an old joke for us to link our wedding date to D-Day. It came up soon after my wife and I set June 6 as our wedding date, and my best man even used a variation of it in his wedding toast. Given my interest in World War II history, such allusions are inevitable. However, on this anniversary, please indulge me for a moment as I take a brief stroll down memory lane. In honor of my wife (who doesn't quite understand my fascination with World War II history), there won't be any more references to World War II.

I promise.

The year was 1990. I was a freshly minted graduate student, having just finished the first two years of my surgical residency and had plunged into a Ph.D. program, a guinea pig for my Chairman to test whether it was possible for his residents to get through a Ph.D. program in the context of the residency program. The night of June 30, I was on call mopping up trauma patients at the county hospital. The morning of July 1, I was. . .confused. The culture shock was enormous, going from having to be at the hospital at 6 AM or earlier to being viewed as odd for coming in before 9 AM; from action and task orientation to having to study, take classes, and having a lot of unscheduled time to do experiments; from having to take call every third night to getting to go home every night. Overall, I adjusted fairly quickly, but I was now in essence cut off from all my friends in residency, who had either moved on to the third year or gone elsewhere to do research. It took me a while to figure out what to do with myself.

Sometime during that first summer in the lab I met her. I don't remember the first time we actually spoke, but she was working as a technician in a lab down the hall from the lab I was doing my first research rotation in. When September rolled around, I found that we were in a first year graduate level class together. Somehow, we started to "happen" to run into each other at the coffee machine rather frequently. There was clearly an attraction. Eventually, I got up the nerve to ask her out, something that wasn't so easy, given how shy I was back then.

I don't remember how this was decided, but we went out for dinner and then a show at the Improv in Cleveland. The headliner of the night was, oddly enough, Spanky. I remember being a bit embarrassed because his act, though quite funny, was also quite raunchy (raunchier than I had expected). I did not know her tolerance for this kind of entertainment or whether she would be offended. With each dirty joke, I couldn't help but wonder if my chances of my ever having a second date with her were slipping away. (Take note, young men, make sure you really know what the evening's entertainment will be like before deciding on it for your first date with a woman.) Fortunately, she wasn't.

We survived that initial awkwardness, kept dating, and rapidly became inseparable. Over the following months we fell in love. Less than two years after our first date, we were married.

The rest is history.

And I'd do it all again in a minute if I could.

Creationism: The pre-conceptual "science"

Danae has been hanging out with too many "intelligent design" creationists, it would seem:

The Huffington Post is still at it

I hadn't planned on writing anything more about vaccines for a while. I figured you might be tired of my harping on one topic too frequently for too long. But, then, in my wanderings across the blogosphere over the weekend, I saw it.

The Huffington Post is at it again. As Michael Corleone said in The Godfather, Part III, "Just when I think I'm out, they drag me back in again!"

Specifically, on Friday, Dr. Jay Gordon, the Post's resident anti-vaccination blogger who has posted articles claiming a link between autism and the thimerosal in vaccines , the one who has so far apparently ignored some of the comments made about a recent anti-vaccination post (see comments), was at it again on Friday. I rather suspect that this latest post may actually be a vague answer to some of the criticisms of his previous post, mine included (here, also, both of which include the links to the relevant posts by Dr. Gordon). In Friday's piece, Dr. Gordon in essence impugns the research of all investigators who accept funding from pharmaceutical companies solely on the basis that it may interfere with their objectivity. While conflicts of interest are certainly a legitimate concern when it comes to evaluating the validity of research sponsored by entities that can profit from the results of that research, Dr. Gordon is quite inconsistent in applying his standard. He in essence tells us we should "ignore the study" he discusses simply on the basis of its funding by Aventis-Pasteur. In direct contradiction to this standard, however, earlier he was quite happy to single out for praise studies by Dr Mark Geier and his son David Geier. He even lamented that the Institute of Medicine "ignored" these studies (not true, as the Geiers studies have been cited for "serious methodological flaws," and the IOM mentioned similar methodologic flaws in its executive summary). Yet, Dr. Gordon considers the Geiers' work "excellent," even though the Geiers have a far more glaring conflict of interest than any scientist I've yet seen Dr. Gordon mention.

Given this, I once again feel forced to respond to Dr. Gordon. I'm not going to respond to him each time he posts more of his dark insinuations, as I don't want his ramblings to control the agenda of my blogging, but today I happen feel like doing so one more time:

Dear Dr. Gordon:

I was very disappointed in your most recent post on vaccines, Dollars Influence Research because it reveals a glaring inconsistency in your position. You state that Dr. Pichicho's study showing the efficacy of a new pertussis vaccine should be ignored based solely on the "appearance of impropriety" due to its having been funded by a drug company. Your logic seems to imply that you should also ignore Mark and David Geier's studies claiming a link between thimerosal and autism (studies that you cited as "excellent" in another post). After all, Dr. Geier is what some have described as a "professional expert witness" in vaccine legal actions (he has participated in at least 100 such cases as a consultant or expert witness, although not always successfully), and finding such a link would likely improve his income potential immensely. His son David runs a consulting company that exists to provide medical and legal counseling to parents seeking to obtain compensation through the National Vaccine Injury Compensation Program and through civil litigation. If that isn't an "appearance of impropriety" when it comes to their research, I don't know what is.

So why do say that you are going to "ignore" Dr. Pichichero's study on the pertussis vaccine and urge your readers to do the same, solely on the basis of the "appearance of impropriety" due to its funding source, when you cited the Geiers' research so approvingly? Why are the Geiers studies not "bordering on being worthless" to you because of the Geiers' clear conflict of interest while Dr. Pichichero's study is? Certainly you present no hard reasons to make such a distinction, nor do you explain why you consider drug company funding to be such a huge conflict of interest while apparently you don't consider making one's living off of lawsuits based on one side of this conflict to be a similar problem.

In actuality, you should look at the evidence in the study itself, how well the study was designed, how well it was executed, and whether the data analysis was appropriate. That's how you should judge this study or any study, not solely on the basis of an "appearance of impropriety." The funding issue can and should color your opinion of the study, as it does for most doctors (including myself) and probably lead you to a more critical evaluation of pharmaceutical company-funded studies, but to dismiss such studies out of hand as you have done is intellectually lazy. And, no, the funding issue alone in and of itself is not a good enough reason; there are many drug company-funded studies that are well-designed and well executed. You have to examine every study primarily on its merits, or lack thereof. Few studies are totally stellar or total crap; all have strengths and weaknesses.

I would take your critique of Dr. Pichichero's study far more seriously if you had actually bothered to tell your readers what, specifically, is wrong with the study to make its results "bordering on being worthless"? So tell us: What specific flaws in the study design do you see? What specific flaws in the execution of the study do you see? What specific flaws in the statistics and data analysis do you see? You conveniently neglect to describe any of these things. Instead, you blithely dismissed Dr. Pichichero's study as "bordering on being worthless" because of its funding source. It makes me wonder if you've bothered to read the study itself, or (as I suspect) you've just read news accounts of it.

I do note that you did make the following two disclaimers:

"Now, I actually believe that the vaccine studied probably works well and that the side effects may not be bad enough to cause a lot of harm.

"I believe that University of Rochester's Michael Pichichero, MD., the lead author of the study is an honest man."

To me, your disclaimers make your criticism of this study appear even more egregiously biased. After all, if you truly believe that the vaccine "probably works" well and that Dr. Pichichero is an "honest man," then don't you owe him (and your readers) a fair evaluation of his study, rather than an out-of-hand dismissal plus an insinuation that Dr. Pichichero and JAMA are biased because of financial support from pharmaceutical companies? (It's possible they are biased; but you haven't provided any evidence to demonstrate it.) If you think we should "ignore this study," don't you owe your readers specific explanations based on science as to why, rather than generalizations based on its funding source? If, as you say in a followup "clarification," you "did not mean to imply that there is something extraordinarily wrong with the manufacturer of the vaccine being studied paying for the study," then how do you justify rejecting this particular study out of hand based solely on such funding?

Inquiring minds want to know!

Sincerely

Orac

Skeptico has also commented on this.

The Skeptics' Circle is fast approaching

The Tenth Edition of the Skeptics' Circle is due to appear this Thursday, June 9 at Skeptico. Richard has put out a call for submissions, with posting guidelines. So fire up your skeptical blogging and get him some articles. I have one that I'm writing now that should be done (I hope) well before the deadline, which is 11:59 PM PDST Wednesday night.

Oh great, more "Darwinbots"

In the brief period of time since I discovered her pro-"intelligent design" (ID) creationism blog, Denyse O'Leary has never failed to disappoint me when it comes to her sarcasm about "Darwinists." I don't know if she or someone else coined the term "Darwinbots" to describe those who got involved in letter-writing campaigns and helped put political pressure on the Smithsonian for its agreeing to host a pro-ID film, but she certainly seems to like the term. Now, she lays it on even thicker:

Some persons have said that it is unkind of me to refer to those who assailed the Smithsonian about the showing of Privileged Planet there — without ever having seen it or intending to see it themselves— as “Darwinbots.”

On the contrary, I am making the kindest assumption I can, namely that they cannot help their behaviour. I have certainly heard ruder names applied to that sort of behaviour ...

"They cannot help their behavior"? And ID advocates claim that scientists are condescending towards them!

Also amusing is her blatant shilling at the end of several of her posts to "buy my book" (a book on "intelligent design," of course).

(Via Red State Rabble.)

The color of my light sabre?

Sounds about right. After all, blue is one of my favorite colors...


Your Lightsaber is Blue

Blue is often associated with depth and stability.
It symbolizes trust, loyalty, wisdom,
confidence, and truth.


What Colored Lightsaber Would You Have?
brought to you by Quizilla

Advice for new interns

With medical school graduations occurring and July 1 rapidly approaching (the date new interns start in the vast majority of residency programs, although some programs start a week earlier), the Mad House Madman has some advice for newly minted doctors. My favorite:

10. Some operational alerts:
a. When a patient says he only drinks alcohol socially, your follow up question should be “How social are you?” You’ll be surprised.
b. When you ask if a patient smokes and he says yes your follow up question is not “How much?” but rather “What?”

Of course, others can't resist getting in on the action, including, Nurse Kelly, who kindly offers a course in Now not to piss of the nurses, with the following purpose:

To keep burned out nurses who don't get breaks despite paying union dues from getting more pissed off and/or annoyed than they already are by keeping useless, dangerous, and/or pointless doctor's orders to a minimum. Oh, and to facilitate good doctor-nurse relations or something like that.

Sounds like a worthy endeavor.

Mysteries of the TTLB Ecosystem

Something's been bothering me for the last three days or so. Sometime between Wednesday and Thursday, an odd thing has happened.

My ranking in the TTLB Ecosystem fell from "Large Mammal" to "Marauding Marsupial," (my numeric ranking fell from somewhere in the low 600's to the 1,600's) overnight, and I can't figure out why. I waited a couple of days to see if it was some sort of fluke, but there my ranking remains. The odd thing is, by Technorati the number of incoming links seems not to have changed radically, and certainly my hitcount is continuing to increase, albeit at a noticeably slower rate than it has been.

It wasn't long after I started blogging that I discovered the TTLB Ecosystem. Naturally, as a new blogger, I was eager to see where I fit in and ranked; so I signed up and put the little snippet of code that's needed to refer to my status into my blog template. It's a fun little thing, and perhaps a bit of an ego boost (or deflation). My ranking rose fairly quickly from "Slimy Mollusc" to "Large Mammal." There I stayed for the last three or four months, with no change. I admit that I have no idea how this happened or any of the details about the TTLB Ecosystem works (the FAQ doesn't explain much), but it was a nice little bit of ego massage that implied that this blog was "evolving" somehow relative to the rest of the blogosphere (although there were times when the slow loading of the code snippet has tempted me to remove it from my blog altogether, lest potential readers become impatient).

Now, just as fast as the TTLB giveth, the TTLB taketh away. It now appears that I've "devolved."

Oh, well. It's no big deal, given that my traffic is, for now anyway, continuing to increase, and I remain quite happy about that. In fact, I can console myself with my thought that "Marauding Marsupial" sounds much cooler than "Large Mammal." However, I am still curious as to how such a drastic decrease in my TTLB ranking (low 600's to high 1,600's) could have occurred so quickly, in essence overnight. I can't seem to find the answer anywhere on the Truth Laid Bear site.

I suppose it will remain a mystery.

The most entertaining creationist book I've ever seen...

...is here.

It tells of evil "fallen" angels leading dinosaurs in an attempt destroy Noah's Ark! I kid you not! How could you fail to be entertained?

(Via Pharyngula and Pandagon.)

Followup on yesterday's rant

One of my favorite fellow surgeon-bloggers, Dr. Bard-Parker, has posted his own comment on the "surgeon as technician" issue. He boiled it down better than I could (I've never been known for my lack of verbosity in writing, unfortunately):

So I am technical, but not a technician.

Damn. I wish I had thought of that one.

If you haven't checked A Chance to Cut is a Chance to Cure lately, you should. His Tales from the Trauma Service series is always a good read. (It also reminds me why I got out of doing trauma surgery six years ago, but I'm glad someone loves that sort of surgery.)

I also note that not everyone was with me on this. If everyone always agreed with me, blogging would get mighty boring mighty fast.

Friday random ten (on Saturday)

I know. Most bloggers do this on Friday. But not Orac. So join Orac as he fires up iTunes on Shuffle Play and lists the first ten songs that appear:

1. David Bowie, Running Gun Blues (from The Man Who Sold the World)
2. The Allman Brothers, Statesboro Blues (from At Fillmore East)
3. Wet Paint, Glass Road (from A Deadly Dose of Wylde Psych: Authentic Way Cool Sixties Artifacts)
4. Frank Sinatra, Witchcraft (from Classic Sinatra: His Great Performances 1953-1960)
5. Violent Femmes, Country Death Song (from Hallowed Ground)
6. Mott the Hoople, Ballad of Mott the Hoople (March 26, 1972 - Zurich) (from The Ballad of Mott: A Retrospective)
7. Elton John, Dan Dare (Pilot of the Future) (from Rock of the Westies)
8. Suede (known in the U.S. as The London Suede), Sleeping Pills (from Suede)
9. Strawberry Alarm Clock, Incense & Peppermints (from Summer Of Love Volume 2: Turn On (Mind Expansion & Signs of the Times))
10. ...And You Will Know Us by the Trail of Dead, Will You Smile Again for Me (from Worlds Apart)

Wow. iTunes is in an eclectic mood, sandwiching Frank Sinatra between some hardcore psychedelia and one of Violent Femmes' more bizarre songs. However, I highly recommend ...And You Will Know Us by the Trail of Dead's Worlds Apart. It's on my short list for the best of 2005.

A fun game

This reminds me of my recent post on cell phone conversations, as well as that of Dr. Charles'.

Sounds like a fun game to play to me...

You want to know how to make a surgeon angry?

Grrr.

I was browsing one of my favorite science blogs, Pharyngula, enjoying PZ's evisceration of a clueless creationist foolish enough to resurrect once again that long-debunked hoary old creationist canard that evolution is somehow not consistent with the Second Law of Thermodynamics, when I saw this in the comments section:

Surgeons and other medical staff are the equivalent of technicians, engineers, plumbers or carpenters. They are not scientists. They are not studying the details of the relevant science. They don't have to understand it - just carry out procedures by rote. Though the ones who do have a clue will be a lot better at adapting to new circumstances because they'll make more correct guesses based on their understanding than the clueless ones will.

I'm sure that my fellow surgeon-bloggers Dr. Bard Parker and Aggravated DocSurg will back me up on this if they see this post, but there are few things you can say that will royally piss off a surgeon faster than a statement like this, which, whether the commenter realizes it or not, relegates surgeons to the realm of not being doctors, but rather to the realm of skilled tradesmen. Don't get me wrong. I have nothing against plumbers or carpenters, both of which represent skilled trades that I can't do. I certainly don't have anything against engineers (a slightly more apt analogy, given that engineering is applied science) either--and indeed one commenter was not happy with engineers being lumped into the group. However, there is so much more to being a surgeon other than doing procedures "by rote" that I had to point out to this person that he clearly had no clue what it took to become a surgeon or what surgeons do. It is true that some of what we do is purely technical. When an oncologist asks me to put a Port-a-Cath (and here) in a patient, I don't need to engage in any heavy thinking or differential diagnoses. I just have to make sure there are no contraindications and schedule the surgery. In addition, although it is true that most surgeons are not scientists, it is also most definitely true that they do need a strong understanding of the relevant science and an understanding of the scientific method in order to evaluate the medical literature and distinguish good studies from the not-so-good. Yes, a lot of what we do is procedure-oriented, but to understand how to do those procedures and, more importantly, whom to do them on and whom not to do them on requires a pretty strong understanding of physiology. We have scrub techs and surgical assistants who can "carry out procedures by rote." Sometimes, they're even technically better than the surgeons with whom they operate, but they cannot take care of the whole patient. That is the role of a surgeon.

We have a saying in surgery: "You can teach a monkey to operate; you just can't teach a monkey when to operate or who needs what operation--or what to do if things are not what expected." To understand that requires a thorough understanding of human physiology, anatomy, and, yes, sometimes even molecular biology. I would also add that you can't teach a monkey how to take care of the patient before and after the operation. People don't seem to realize that surprisingly little of most surgeons' time is spent actually in the operating room doing procedures, usually no more than two days a week. (One of the biggest surprises awaiting residents when they become attendings is how much less they get to operate; when they are residents they operate almost every day.) Only exceedingly busy surgeons spend more time than that in the operating room. Indeed, we have another saying, at least about general surgeons, that "a surgeon is an internist who can operate." I'm not sure I'd go that far, but it's definitely true that surgeons have to understand far more medicine than internists have to understand surgery. Those of us who deal with critically ill patients (as I routinely did until around 6 years ago) need a very strong understanding of physiology and critical care medicine far beyond what most internists ever achieve without undertaking a critical care fellowship.

Perhaps you might think I over-reacted. I rather suspect that the person making the comment had no idea how annoying it would be (although perhaps he should have guessed, as he managed to irritate an engineer as well). However, his further comments tended to make me think that perhaps I didn't over-react as much as I thought I did. His dismissive "not a scientist" attitude towards surgeons in particular (he pointedly didn't mention internists or other doctors in his "not a scientist" category, just "technicians" and "medical professionals") revealed an attitude that is all too prevalent, however, and that was what rankled. On the other hand, he seemed to use the term "technician" as a catch-all insult for any profesionally, scientist or medical who possessed pseudoscientific beliefs. In the way of context, I will point out that the comment happened to have come up in the context of a discussion about evolution, and it's probably true that most physicians don't have as strong an understanding of evolution as they should. Indeed, many of them embrace intelligent design (and here), and fewer than I would like to admit recognize ID as the pseudoscience that it is. The implications of this and why evolution is important for a good understanding of medicine these days will probably be fodder for another post sometime next week, but those are the numbers. I couldn't resist pointing out, though, that there were quite a few Ph.D.'s who have been seduced by pseudoscience, whether it's Michael Behe and intelligent design, Boyd Haley and anti-vaccination pseudoscience, or even the Nobel Laureate Linus Pauling, who, later in life, became enamored of vitamin C quackery. Even a Ph.D. in a scientific discipline is no guarantee that one will never stray from the path of science. Of course, the problem is, those with a Ph.D. who do stray are often the most intransigent pseudoscientists of all.

But I make no apologies for being annoyed. Perhaps I have a thin skin, given the dismissive "just an M.D." attitude I encounter sometimes among basic scientists. Being a surgeon, I get to experience the dismissive "just a technician" (translation: "not a Real Doctor") attitude that some internists have towards surgeons too. Maybe keeping the underdog attitude is good for me. If I'm lucky, it might keep me from developing a swelled head.

Who's Hitler today?

An amusing post over at Beautiful Atrocities points out briefly that "in the future, everyone will be Hitler for 15 minutes." And then it illustrates the utter truth of that statement. In fact, if you're lucky, even you may find yourself "worthy" of being called "worse than Hitler." (Indeed, one pundit--whom I'm not a fan of--was, I must admit, not too far off when when she quipped, "You know you haven't made it in public life if you haven't been compared to Hitler." I guess that means I haven't made it yet.) I used to think that overblown comparisons to Hitler and/or the Nazis were mainly a province of the left, but this is clearly no longer the case, as Rick Santorum (one of the biggest embarrassments to the Republican Party) so clearly shows. It would appear that Hitler has become an equal opportunity bad historical allusion. Heck, when people start comparing smokers or Hilary Duff to Hitler or Nazis, you know things are getting out of hand!

This all reminds me of Godwin's Law, which, contrary to the popular misconception of it, merely states quite simply:

As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches one.

In fact, it is a custom in many Usenet newsgroups that, when analogies or comparisons involving Hitler or the Nazis come up, the discussion thread is over and the person who first made the comparison should be declared the loser of any debate going on. States the Godwin's Law FAQ:

So, what this means in practical terms:

• If someone brings up Nazis in general conversation when it wasn't necessary or germane without it necessarily being an insult, it's probably about time for the thread to end.
• If someone brings up Nazis in general conversation when it was vaguely related but is basically being used as an insult, the speaker can be considered to be flaming and not debating.
• If someone brings up Nazis in any conversation that has been going on too long for one of the parties, it can be used as a fair excuse to end the thread and declare victory for the other side.

Of course, one must realize that Godwin's Law applies to questionable or inappropriate analogies to Hitler or the Nazis (Rick Santorum's overblown rhetoric or this comparison of Martha Stewart to Hitler in the service of reviewing television biopics on her and Hitler, for example), not to appropriate comparisons. It is certainly appropriate to bring up these topics in the context of discussing Holocaust denial, neo-Nazis, fascism, eugenics, and World War II history, for example. There are of course other situations where such analogies are entirely appropriate. Indeed, virtually all Holocaust deniers are Holocaust deniers because of anti-Semitism or a sympathy for the Nazi philosophy; and they often falsely invoke Godwin's Law when someone points out their obvious anti-Semitism or their defense of Hitler. However, far too many people use these flimsy analogies as a kind of "nuclear option" to throw at their opponents, to demonize them as "fascists," as so richly demonstrated in the post I referenced.

Personally, I wince whenever I hear such comparisons, and view the arguments or assertions of people in a much harsher light than I might have, had they not brought up such inflammatory excess--even when I might be otherwise inclined to agree with them. The reason is that most people who throw such comparisons about in verbal combat have clearly not thought about them carefully and either make no effort to explain or justify the analogy or make only perfunctory (and often historically inaccurate) justifications. (There are occasional exceptions--and here--such that, even when I don't necessarily agree with significant parts of what is written, I have to take the comparison seriously because the author has at least done his research and thought about it. These exceptions are fairly rare, however.) Given all this tossing about of the "H (for "Hitler")-bomb, I once again echo this plea, which I encountered three months ago in the comments of a post in Matt Yglesias's old weblog (he's moved):

Can we please, perhaps, just agree that invoking Hiroshima, The Holocaust, Dresden, The Rape of Nanjing, The Cultural Revolution, The Trail of Tears, The St. Bartholemew's day Massacre, Rwanda, The Black Plague, or The Extinction of the Dinosaurs are all rhetorically excessive when compared to just about any domestic social issue?

To which, I now propose adding "or international" to the word "issue," and then this second plea:

Can we please, perhaps, just agree that comparing anyone to Hitler, the Nazis, Stalin, Pol Pot, Genghis Khan, or similar historical figures are all, except in rare cases, rhetorically excessive when used for almost any person now living?

Such rhetorical excesses shed much heat but very rarely any light. Their usual purpose is to demonize the subject of the attack without actually having to bother to do the heavy lifting of justifying one's criticism of a policy or dislike of a person with actual evidence. When you look at such analogies with a critical eye, it almost always becomes apparent that they are vague and flimsy. When you see this kind of rhetorical excess, it is almost always a sign that the person using it either has a weak argument, is intellectually lazy, or is more interested in polemics (a.k.a. "flaming" when referring to online discussions) than in reasoned debate. That's why my estimation of a person's arguments usually goes down several notches when I hear such flawed analogies. Unfortunately, all too often these days, polemics work, which is why so many like to throw the "H-bomb" in political debate.

You know, sometimes I wish I could invoke Godwin's Law in every day life. Then I remember that, even in online discussions, invoking Godwin's law is often not so easy, even when doing so is entirely appropriate. That's when I give up on that idea. Unfortunately, people like Rick Santorum, many on the left plus many others who misuse the analogy just won't go away that easily.

ADDENDUM 6/10/2005: Don't miss the sequel to Who's Hitler today?: The zombie of Hitler's corpse is eating people's brains. Yum. "More brains!"

Beautiful response

Much has been made across the science blogosphere over the last couple of days of the Smithsonian Institute's foolish decision to "co-sponsor" the showing of a movie touting "intelligent design" (ID) creationism at the Smithsonian for $16,000 with the Discovery Institute. Because all such fees go towards supporting research done by the Smithsonian, this led some to quip that this was the first time the Discovery Institute ever supported and real research. James Randi even offered to donate $20,000 to the Smithsonian if it would cancel the event, an idea that, as much as I respect Randi, I considered to be ill-advised because of how it would be used as propaganda by ID adherents (here, too).

Now, via Panda's Thumb, comes a report of the Smithsonian's response:

Statement by the Director, National Museum of Natural History

The Smithsonian’s National Museum of Natural History recently approved a request by the Discovery Institute to hold a private, invitation-only screening and reception at the Museum on June 23 for the film “The Privileged Planet.” Upon further review we have determined that the content of the film is not consistent with the mission of the Smithsonian Institution’s scientific research. Neither the Smithsonian Institution nor the National Museum of Natural History supports or endorses the Discovery Institute or the film “The Privileged Planet.” However, since Smithsonian policy states that all events held at any museum be “co-sponsored” by the director and the outside organization, and we have signed an agreement with this organization, we will honor the commitment made to provide space for the event.

Beautiful, if this is true. The Smithsonian will take the Discovery Institute's money and at the same time undercut their claims of being "discriminated against" by demolishing the way the Discovery Institute has been implying its "co-sponsoring" this event with the Smithsonian somehow legitimizes its viewpoint. Of course, the creationists are already whining that the evil evolutionists (a.k.a. "Darwinbots") cowed the directors of the Smithsonian into issuing this statement. (What the hell is a "Darwinbot"?) I find such complaints particularly (and most satisfyingly) ironic coming from ID adherents. After all, ID has utterly failed to be accepted as science because ID adherents don't do what past scientists whose hypotheses have met with intial resistance have done to win scientific credibility: Bury their naysayers with compelling evidence, data, and experimentation that force the scientific community to accept their hypothesis. Instead, ID adherents prefer to use exactly the same tactics they are complaining about now (letter-writing campaigns, political pressure, etc.) in the service of persuading gullible politicians and school boards to become their champions. They don't even make much of a pretense of doing science. Now that they've had a taste of their own medicine, they don't like it one bit.

"ID-bots," anyone? It doesn't sound as catchy as "Darwin-bots," but it's more accurate.

Tangled Bank XXIX: The Natural History Museum

Come take a trip to the Blogosphere Natural History Museum at Organic Matter and tour Tangled Bank XXIX. Visit the Astronomy Hall, the Earth Science Wing, the Evolution Wing, the Natural History Wing (with its specimen galleries), and finally the Anthropology Wing. At each of them, you'll find some great science blogging.

Damn. I wish I'd thought of that format when I hosted Tangled Bank those several months ago...

The History Carnival IX

The History Carnival IX is now posted at Cliopatra. It's chock full of great blogging on a variety of subjects, all the way from the changing meaning of Memorial Day to a post about 700 year old jokes (yes, you've probably heard some of them). Check it out.

Half a year of EneMan!

I'm feeling a just little trepidation right now.

It's the first of the month, and regulars around here know what that means. Yes, it's time for Orac to indulge his computational circuitry's strange fascination with that green, white, and orange Fleet Pharmaceuticals mascot and defender of colon health with the hat whose shape and function you really don't want to contemplate too carefully, a character who has become the de facto mascot of this blog.

It's June 1, which means it's EneMan calendar time.

So why the trepidation? Well, I've submitted posts to a number of blog carnivals, all of which are appearing around now. For example, yesterday there were Grand Rounds XXXVI (to which I contributed this) and the Carnival of Bad History (to which I contributed this and this). Today, Tangled Bank will be appearing at Organic Matter, and the History Carnival will be appearing at Cliopatra, and I've contributed to both. That means that (hopefully) there will be a number of new readers who will be experiencing the Respectful Insolence of Orac for the very first time. Will they want to stick around after seeing Orac's mascot? I've asked these questions before, and it seems that you all (well, many of you, anyway) keep clamoring for more of that charismatic colon cleaner, EneMan, but never before has EneMan's scheduled monthly appearance coincided with such a confluence of blog carnival mania to which I've contributed.

Also, I've recently posted a couple of rather vociferous pieces lambasting those who push a questionable (at best) connection between mercury in vaccines and autism, one of which was referenced in the comments of The Huffington Post. Oddly enough, there hasn't yet been the expected influx of anti-vaccination zealots descending upon this blog to trash Orac, as they have done to another blogger via David Kirby's Evidence of Harm message boards and as they've done to me on Usenet before in the past. Heck, there hasn't even been a flood of readers referred from The Huffington Post, as I had half-expected there might be after I learned of my appearance in the comments there. In fact, I'm rather disappointed to report that I have yet to notice even a single reader in my Sitemeter logs who came here via The Huffington Post (which makes me wonder just how many people are actually reading it--perhaps way fewer than I had thought, which further makes me wonder what Skeptico's experience has been, given that he cited himself there as well). But you never know. They might still show up.

And EneMan is just the sort of ammunition they'd love to use against me, I'm sure.

All of the above would suggest that discretion is the better part of valor, that Orac should wait a couple of days; that perhaps he should hold off posting the latest entry from the EneMan calendar until, say, over the weekend; that maybe he should play it safe and curry favor with the new readers, hoping to lure a fraction of them to stick around and become regular readers (shameless blogger self-promoter that he is).

Yes, all of the above would suggest that Orac should probably do the prudent thing.

But since when has Respectful Insolence been about doing the "prudent thing"? No! Orac won't abandon his mascot, consequences be damned! Let the anti-vaxers and/or alties make fun of him for his strange obsession with EneMan and his occasional tendency towards bathroom humor (although, given their own frequent obsession with "colon cleanses," alties are in no position to comment on Orac's proclivities for this sort of humor--indeed perhaps they should meet EneMan). Let the otherss of the new readers scratch their heads and ask themselves, "What the hell is that?" before moving on to check out the latest Instapundit posts.

EneMan will not be denied...

June 2002

June 2004

June 2005

Even better, if you click on the above pictures, you (yes, you!) can get versions that are bigger and brighter than any I've ever posted before. Just click "different sizes" after the picture comes up, and you can see EneMan in a scan twice the size.

Finally, for those of you who have unfortunately come late to the EneMan phenomenon, I'm even providing you with quick links to every appearance he's made on this blog since the very beginning:

May 2005
April 2005
March 2005
February 2005
January 2005
EneMan's first appearance (December 2004)

Enjoy! EneMan will return on July 1.