Carnival barking

I can't believe I did it.

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

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

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

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

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

More rebuttals of HIV/AIDS "skeptics"

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

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

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

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

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

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

Dr. Bennett covers a lot of the same ground as Trent and I did. He nicely takes apart Al-Bayati's attribution of Eliza Jane's collapse to an anaphylactic (allergic) reaction to amoxicillin on clinical grounds. He points out that multinucleated giant cells in inflammatory lesions in the brain without granulomas are very characteristic of HIV encephalitis, even if it hasn't manifested symptoms yet. He says basically the same thing as Trent and me with regards to Al-Bayati's bogus attempt to blame parvovirus for the Eliza Jane's anemia. All of this is different in emphasis and better on some details, but Dr. Bennett's unique contribution to debunking Dr. Al-Bayati's report comes from his perspective as a pediatrician. Using that experience, Dr. Bennett does something that I (and I daresay Trent) probably never would have thought to do (neither of us being pediatricians or primary care doctors). He takes a much closer look at Eliza Jane's growth curves:

I note that Al-Bayati says that EJ’s weight is within the normal range for a child of her age. She is according to him within the 5th centile for her age, but a proper growth chart plot shows that she in fact suffered from a striking failure to thrive from the age of approximately one year. Although she did indeed gain 22 pounds during her life, a child born at 7lbs of weight is expected to weigh 4 pounds more than she did at the age of her death (a difference of around 15% of her actual body mass). In addition, it is clear that this final weight is an aberration from her normal growth curve, as if she had continued along her past track she should have only weighed 26-27lbs at the time of death. The extra 2 lbs (around 900 ml equivalent) is perhaps accounted for by the additional fluid found within and surrounding her organs at the time of death. As such, it appears more likely that the fluid accumulated over time, rather than as a result of simply moving out of the vascular spaces, as if that would have happened her total mass would remain unchanged. Alternatively it may simply be a result of the fluid boluses given to her during resuscitation – without being able to see the actual medical notes I can’t say either way. A significant resuscitation of 40ml/kg would account for around half of that additional volume.

He concludes:

As such, it would appear to me that EJ had some form of significant clinical problem for the 2 and a half years prior to her death, regardless of her status regarding other childhood illnesses (which by all accounts was unremarkable). Her weight is in lower centiles by my reckoning than what Al-Bayati states, but that may simply be a result of using different growth charts or rounding-up to the nearest line. These charts are the current (2002) versions from the CDC website, accessed Nov 2005. The lowest line is the 3rd centile, which EJ generally remains below. In basic terms, if around 100 kids of the same age were lined up, EJ would have been the smallest.

There is a possibility of a metabolic disorder resulting in failure to thrive, but since she did so well for the first 12 months of her live, I don’t consider that a real possibility. Regardless of cause, aged 3.5 years she weighed only as much as a 2.5 year old would normally weigh (and remember, she was born smack in the middle of the spread, at 7 lbs).

He further concludes that there is good evidence that her failure to thrive and fluid accumulation may have been due to nephrotic syndrome due to Minimal Change Disease, a kidney disease that shows little or no change in the kidney structure on biopsy and can be precipitated by HIV infection. Whether he's right or not about this (this is clearly more speculative than his points about parvovirus, amoxicillin allergies, etc.), he makes a compelling case, and that diagnosis as a cause of EJ's generalized edema is one I never would have thought of. Also, if the data regarding Eliza Jane's weights at various ages are correct, Dr. Bennett's analysis also casts doubt on the HIV denialist claims that Eliza Jane was "perfectly healthy" all her life. She may have seemed healthy, but if there was indeed a failure to grow it should have tipped off her pediatricians that something might be wrong. But you really should read all of Dr. Bennett's analysis. It's quite accessible to the lay person.

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

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

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

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

Oddly enough, though, Dean seemed the most annoyed by a throw-away comment I had made about how he liked to argue from authority a lot and tended to wave Dr. Duesberg's credentials around like "a talisman to ward off attacks against his pseudoscientific posturing." (OK, perhaps that was a bit more of a rhetorical flourish than I needed to use; but give me a break; I was on a roll.) Quoth Dean in the comments:

I tried reading Orac’s response, by the way, but it was so full of false accusations that I couldn’t get through it. The man argues first and foremost through attacks on others’ credibility. I do not, for example, “wave credentials” at anybody, not for my friends or detractors. I note only that credentials do matter, and that in any area of science, a qualified scientist should be respected as having the right to a dissent, even if it’s a minority position, AND, that one shouldn’t treat qualified scientists as kooks or people who can be dismissed with an airy wave of the hand. That is all I have ever said on the subject of credentials; Orac’s dishonesty in this leads me to the (admittedly ad hominem) conclusion that he can’t be trusted to be honest on anything else.

Of course, notice (as Joseph did) that Dean neglected to point out a single instance of a "false accusation." Surely if I'm that dishonest, it should have been child's play to point one example of my "dishonesty" out. Second, he characterizes my debunking of Dr. Al-Bayati's nonsense as being primarily an ad hominem attack, when in reality I spent about one paragraph on Dr. Al-Bayati's credentials (or lack thereof, actually) and many long paragraphs addressing the meat of his report. Truth be told, I had learned some unflattering things about Dr. Al-Bayati's previous work that I could have pointed out but intentionally refrained from doing so in order to focus on the report itself. (I will not go into them here, either.) If all you knew about what I wrote is what Dean said, you'd have thought that all I did was to trash Dr. Al-Bayati, when in fact questioning his credentials was a small part of what I wrote.

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

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

My ears are bleeding

Listen to this.

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

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

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

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

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

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

Which fucked-up genius composer are you?
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to you by Quizilla

Excellent!

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

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

Forgive me, Joe, wherever you are.

Fostering scientific innovation, part 1: Impediments to innovation

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

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

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

So here goes:

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

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

But I stayed.

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

She started by describing how large organizations put up roadblocks to new ideas, and immediately I could see she knew what she was talking about. Here are some of the common stumbling blocks to innovation, most of which you'll probably recognize (I'm not listing them all):

1. "Simplify" (also known as the "PowerPoint disease." Managers and others in organizations are always wanting ideas presented to them in the simplest bite-sized form, complete with bullet points. Innovative ideas don't always fit into such constraints. If they do, they may not be all that innovative.
   
2. "We want new ideas, but don't want to be 'first.'" Being first with an innovative idea is risky; what if it doesn't work? Of course, it never seems to enter their minds that an idea is not truly innovative if you're the second person to pursue it.
3. "We want new ideas, just not those new ideas." How many times have you encountered this attitude? I'm not sure what "new" ideas managers have in mind. Probably
   
4. Free thinkers are disruptive to organizations. Indeed they are, because they question the status quo and how things have always been done. They also propose ideas whose potential more conventional thinkers don't see the value of and only see as causing difficulties. Change is difficult.
   

In fact, I think #4 is probably the most significant impediment to true innovation. You might think that universities would be less prone to it than private industry. I would have too, given that medical schools with a heavy research commitment tend to be made up of individual investigators doing their own individual projects, perhaps collaborating with a few of their peers. If the investigators can get outside funding, it's unlikely that anyone in the medical school is going to tell them they can't pursue their ideas.

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

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

But what to do?

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

RINO Sightings, NSFW Edition

The latest RINO Sightings has been posted.

Don Surber sounds like my kind of conservative:

Yes, thank you for the imbalanced budget, Republicans.

Yes, thank you for Intelligent Design, Republicans.

And finally, thank you for Bill Frist. He'll make a fine president: The ethics of Nixon, the brains of Ford.

I couldn't have said it better myself, except that I think Ford looks better by comparison to Frist. The jury's out on how Frist will compare to Nixon.

Busted for cheating...

File under: Strange But True and Amusing Justice.

A woman's parrot tipped her off to her husband's infidelity:

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

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

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

“I heard him doing Frank's voice, but saying ‘Uta, Uta’,” says Petra.

I'm guessing Frank will be a bit more careful in the future about who (or what) is around him when he's having an adulterous tryst.

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

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

Moving on to other topics, lightening my spirit this morning was this story about the notorious Holocaust denier David Irving:

A lawyer for British historian David Irving said on the eve of a court hearing that Irving admitted past statements could be interpreted as denying the existence of Nazi gas chambers - but now acknowledges they existed.

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

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

Irving has changed his views on gas chambers in recent years, his attorney, Elmar Kresbach said.

The History News Network has also referenced a Guardian story on the issue, which gives a little more background:

In the past, Irving has claimed that Adolf Hitler knew nothing about the systematic slaughter of 6 million Jews, and has been quoted as saying there was ``not one shred of evidence'' the Nazis carried out their ``Final Solution'' to exterminate the Jewish population on such a massive scale.

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

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

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

No trial date has yet been announced. In Austria, suspected violations of the law banning attempts to publicly diminish, deny or justify the Holocaust are heard by an eight-person jury and three judges.

Before I comment, let me just reiterate how much I detest laws against Holocaust denial. They are an abomination against free speech. Worse, they give the vilest scum, Holocaust deniers, a plausible-sounding reason (plausible, at least, to people who don't know much about the Holocaust, which is most people) to don the mantle of free speech martyrs. I can see the purpose of these laws decades ago, when there was a real danger that Nazi-ism might rise again and Germany and Austria no doubt wanted to show the world that they would not allow this to happen. These days, however, such laws do more harm than good.

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

In fact, a story this morning shows that Irving is willing to plead guilty in the hopes of leniency:

He [Irving] is to be tried under a 1947 Austrian law banning Nazi revivalism and criminalising belittling or justifying the crimes of the Third Reich. No trial date has been set. The case should be heard in January. Irving faces a jail term of one to 10 years if found guilty.

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

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

"He said, 'I fully accept this, it's a fact. The discussion on Auschwitz, the gas chambers and the Holocaust is finished ... it's useless to dispute it'."

The problem with this defense is, of course, that his "revelation" that the Holocaust did indeed happen must have come quite recently. Just reading his website shows that as recently as early 2005 Irving was still denying the gas chambers at Auschwitz.

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

Posts on this issue:

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

Comment moderation has been temporarily turned on

I didn't want to do it.

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

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

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

Internet squatter: J. B. Handley

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

A reader (whom I wish to thank publicly and profusely) tipping me off to a dirty trick, that's what. This reader, apparently, mistakenly typed "www.oracknows.com" into her browser and found herself redirected to the Generation Rescue website, you remember, the site that states:

Generation Rescue believes that childhood neurological disorders such as autism, Asperger's, ADHD/ADD, speech delay, sensory integration disorder, and many other developmental delays are all misdiagnoses for mercury poisoning.

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

oracknows.com = [ 69.20.5.151 ]

Registrant:
GR
JB Handley
[ADDRESS DELETED by ORAC]
US
Email: jbh@spcap.com

Registrar Name....: REGISTER.COM INC.
Registrar Whois...: whois.register.com
Registrar Homepage: www.register.com
Domain Name: oracknows.com
Created on..............: Thu Nov 03 2005
Expires on..............: Mon Nov 03 2008
Record last updated on..: Thu Nov 03 2005
Administrative Contact:
GR
JB Handley
[ADDRESS DELETED by ORAC]
US
Phone: 1-[PHONE NUMBER DELETED by ORAC]
Email: jbh@spcap.com

Technical Contact:
Registercom
Domain Registrar
575 8th Avenue
New York NY 10018
US
Phone: 1-902-7492701
Email: domainregistrar@register.com

DNS Servers:
ns.rackspace.com
ns2.rackspace.com
Register your domain name at http://www.register.com

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

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

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

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

autismdiva.com = [ 69.20.5.151 ]

Registrant:
GR
JB Handley
[ADDRESS DELETED by ORAC]
US
Email: jbh@spcap.com

Registrar Name....: REGISTER.COM INC.
Registrar Whois...: whois.register.com
Registrar Homepage: www.register.com
Domain Name: autismdiva.com
Created on..............: Tue Nov 01 2005
Expires on..............: Mon Nov 01 2010
Record last updated on..: Thu Nov 03 2005
Administrative Contact:
GR
JB Handley
[ADDRESS DELETED by ORAC]
US
Phone: 1-[PHONE NUMBER DELETED by ORAC]
Email: jbh@spcap.com

Technical Contact:
Registercom
Domain Registrar
575 8th Avenue
New York NY 10018
US
Phone: 1-902-7492701
Email: domainregistrar@register.com

DNS Servers:
ns.rackspace.com
ns2.rackspace.com
Register your domain name at http://www.register.com

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

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

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

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

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

Probably nothing.

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

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

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

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

Happy Thanksgiving

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

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

(More on this Thanksgiving classic here and here.)

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

Here's a quickie.

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

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

It appears that they almost managed to be featured in Teen People without their vile racist beliefs being mentioned:

Teen People nixed a story about Hitler-loving teenybopper twins Prussian Blue - amid outrage that the glossy had promised to avoid the words "hate," "supremacist" and "Nazi" in its piece on the racist singing sisters.

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

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

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

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

Hours later, the company yanked the entire project.

"During an editorial review of this assignment, we learned that a junior employee made unauthorized assurances to the mother of the Gaede twins regarding the prohibition of certain words in the story," said Time spokeswoman Ali Zalenko.

Nice try, racist scumbags. (Gee, I wonder if the photoshoot mentioned here was for the Teen People piece.)

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

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

May it always be so.

The Twenty-second Meeting of the Skeptics' Circle

EXTRA! EXTRA! Read all about it!

The National Weekly World Inquirer News has published an interview account of the Twenty-second Meeting of the Skeptics' Circle at MileZero.org in a tabloid format:

"It's hard, you know? I won't lie to you now. It's hard." The yeti leans back in his chair, a stylish Swedish contraption made of balsa wood and green canvas. I expected to be in a forest for this interview, but instead my directions brought me to a condo in Greenbelt, Maryland. The yeti met me at the door and gave me a Coke, which I sip in his lounge-themed living room.

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

Go and read the rest!

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

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

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

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

How to cut costs in my lab

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

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

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

And that's where the MacGyver Project comes in.

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

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

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

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

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

Carnival barking

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

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

Dr. Buttar has a new protocol

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

A certain commenter infested the comments section of these two posts with impassioned defenses of a certain chelationist by the name of Dr. Rashid Buttar, a man who uses a "transdermal" form of chelation therapy to "treat" autism, posting long (and lame) justifications for why Dr. Buttar can't seem to be bothered to do some very basic tests to demonstrate that his transdermal DMPS (TD-DMPS) actually gets absorbed through the skin into the blood, much less chelates any mercury (as he claims it does), much less "cures" autism. There was a lot of dancing around by this commenter relaying responses from Dr. Buttar when I and others pointed out that, if the DMPS is not absorbed through the skin, then it couldn't possibly chelate anything and further pointed out that, if it doesn't chelate mercury, then, by Dr. Buttar's own belief that chelating mercury can "cure" autism, TD-DMPS couldn't possibly work! At that point, Dr. Buttar changed his tact to claiming he had "empiric" evidence that TD-DMPS helped autistics and emphasizing that DMPS was safer, both in IV form and his "transdermal" form, at one point saying:

It is a "SAFETY" issue I'm talking about....I don't care to prove a damn thing to those people that you have been dueling it out with. The NIH has said our treatment and DMPS specifically is DANGEROUS....so I will take DMPS intravenously to show that it is NOT dangerous. That's why I want the media....to show the world how safe DMPS is. And if it's safe to take intravenously, then it's OBVIOUSLY safer to take it transdermally.

Of course it's "safer" to take it transdermally, given that it's almost certainly not absorbed transdermally. (At least, Dr. Buttar has not produced any evidence that it is.) Earlier, Buttar's defenders had spouted even lamer justifications:

It is well known that whatever is placed on your skin is absorbed. If you swim in a chlorinated pool, the skin will absorb a certain amount chlorine, right? You are concerned that there is no measure for how much DMPS is entering the skin. I say who cares if they have not yet done randomized, double-blind, placebo studies to determine how much DMPS is entering into the bloodstream through the skin? That costs money and why do a big expensive study on a substance that is already approved by the FDA? What they do know is that heavy metals are being removed without any other explanation as to why, other than TD-DMPS.

Buttar did admit to using IV chelation sometimes, but one of his main selling points for his TD-DMPS that makes it attractive to the parents is that it is supposedly "safer." (Again, in my opinion, the very reason it is "safer" is because it is not absorbed and therefore chelates nothing.) Dr. Buttar also seemed to be arguing that IV DMPS was safer compared to IV EDTA. Apparently, however, Dr. Buttar is changing his tune (and his favored treatment) about EDTA. Thanks to a tip from a reader, I've been directed to a link suggesting that Dr. Buttar is now "treating" autism using a new regimen that includes IV EDTA (the chelator that killed Tariq), ozone, and minerals to remove "persistent organics" and asking other parents what they thought of it:

Dr Buttar's office has asked us (after being on TD DMPS for about 11 mos) to come on IV EDTA/ozone protocol over a two month period every two weeks. TD DMPS and TD EDTA will continue on a Mon, Wed, Fri schedule after the IV's

Every 2 weeks our son will get IV EDTA and ozone (which will be infused in his blood and given via IV) and on the second day he will get minerals. The reason given for ozone is to reduce persistent organics in his system. There is no test being recommended to determine if the child will be a good candidate for ozone. Apparently, some children are seeing good results and Dr Buttar is trying this treatment on older children (greater than 7). Dr Buttar's office has provided some research on ozone done by a MD researcher in NY whom we spoke with. The immediate reaction of this researcher was that there has not been any study with children while ozone therapy is safe and has been used on millions of people in Europe. The researcher was not aware of Dr Buttar or his protocol on children and said that one needs to establish first if ozone therapy is needed.

Oooh boy. "Trying his treatment on older children"? Where to start? To the credit of some of the mothers on the list, they weren't totally buying into this, with one even saying that she "would not want to be first in line" and another saying:

I think IVs of EDTA (or any other chelation agent) are a BAD idea. I wonder what possible rationale he has for this, since I think it is such a bad idea. Besides being the most dangerous form of chelation, IVs are also really expensive, in case they need another strike against them.

Indeed. Once again, I emphasize that there is no evidence that chelating mercury or anything else improves the symptoms of autism. Unfortunately, this same mother was rather credulous about the ozone therapy, suggesting that the first mother instead should purchase her own ozone setup. Then, in a followup, I also became aware of another discussion of new "protocol" on a different discussion group. In this discussion, one mother stated that, for children over 7, Dr. Buttar was recommending an IV drip of DMPS and glutathione, followed by ozone, minerals, and some sort of "pesticide remover" or "environmental detoxifier." Moreover, as the discussion unwound, it was stated that Dr. Buttar charges $2,000 a session plus a charge for supplements, with a total of four visits being required, leading to a complaint by another that "only the rich" can afford his therapy. Another person was unhappy that Dr. Buttar was not planning on making his new protocol public and lamented that he was charging $17,000 to other doctors to take a 7 day course in administering this new protocol. I don't know how accurate this characterization of Buttar's new protocol is or his pricing structure is (it may be a second- or third-hand account), but, if true, it sounds like some serious quackery to me. The reports I've been able to glean from the discussion thus far are conflicting about whether Dr. Buttar now uses IV EDTA or DMPS, but they all appear to agree that he is now using IV chelation of some kind with glutathione, minerals, ozone, and some sort of "environmental detoxifier."

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

One thing that struck me about this new protocol is how much it resembled another form of autism quackery that I wrote about a while ago. Indeed, it appears to be an unholy union of a different form of "oxygenation" therapy other than hyperbaric oxygen "therapy" for autism I used EneMan to poke fun at earlier this month and that favorite dubious therapy of the mercury/autism activists, chelation therapy. Unfortunately, the intravenous injection of ozone hasn't been shown to be effective for any condition that I can find. Ozone therapy may be somewhat useful, as hyperbaric oxygen therapy is useful, in treating chronic wounds, but not much else. Even so, it is not generally used as a treatment for chronic wounds. That doesn't stop a lot of quacks from touting it as a treatment for everything from cancer to AIDS. Here is what happens when ozone is administered intravenously:

When ozone is introduced into blood, it reacts with water in red cells producing hydrogen peroxide. This aqueous decomposition of ozone also produces bactericidal and membrane-damaging free radicals [21]. Ozone used for treatment [24] is prepared by creating an electric spark in a chamber of pure oxygen. The final mixture contains between 0.l and 5.0% ozone, concentrations that are equivalent to from l.0 ppm to 50 ppm ozone in pure oxygen.

Ozone generated this way has a half life of 45 minutes at room temperature, and under ideal conditions of sterility, dryness, and cleanliness, it must be prepared on site each time it is used. A two-hour exposure to 1200 ppm ozone is needed to kill microorganisms on open surfaces and in water [25]. Concentrations of ozone recommended are: for topical treatment of superficial wounds, 70 to 100 ppm; for slow-healing ulcers, between 40 and 70 ppm; and when oxygenating effects are needed to treat diseases associated with hypoxia, from l to 40 ppm [26].

One has to wonder how "ideal" or "sterile" Dr. Buttar's conditions are or why one would want to let loose so many free radicals to damage one's blood cells. In any event, ozone is a highly reactive, oxidative gas with many industrial applications, with OSHA recommended guidelines for safe exposure of less than 0.10 ppm. There is no evidence that it is any good for treating cancer, HIV, or autism. (A PubMed search failed to turn up a single reference that suggested ozone might be good to treat autism.) Indeed, at least as of 1999, ozone was not FDA-approved for the treatment of any condition, and the FDA has even arrested and prosecuted people for selling ozone generators and making claims that it can treat medical conditions:

Proponents of medical ozone generators believe ozone can kill viruses and bacteria in the body. While ozone is used as a germicide in the cleaning of manufacturing equipment, FDA is not aware of any scientific data that supports the safety or effectiveness of ozone generators for treating medical conditions. In fact, the agency believes that at the levels needed to work effectively as a germicide, ozone could be detrimental to human health.

"These devices keep popping up," says Bob Gatling, a biomedical engineer and director of the program operations staff in FDA's Center for Devices and Radiological Health. "We always tell their makers": 'Show us some data,' but no one ever pursues it."

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

Given that my source of information thus far consists of online discussions, I would love more substantive confirmation. I would also love to ask Dr. Buttar or his defenders these questions:

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

Inquiring minds want to know!

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

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

Dean Esmay, who likes to present himself to his readers as a hard-nosed "skeptic," but is in actuality a rather credulous fellow, at least when it comes to HIV "dissidents" and seemingly not understanding why it's such a bad idea to teach "intelligent design" creationism in the science classroom in public schools, is not happy with me, not happy with me at all. On Saturday, as I was about to sit down to watch the Michigan-Ohio State game, I noticed an influx of referrals here from his blog. Given that I hadn't recalled seeing referrals here from Dean before, I checked it out his blog and, amidst a self-congratulatory tirade against bloggers who considered the Eliza Jane Scovill case a tragic example of what can happen to a child when her parents believe won't accept the science showing that HIV causes AIDS, found this comment regarding the case of Eliza Jane, the daughter of HIV denialist Christine Maggiore, who died in May and whose autopsy showed that she had AIDS-associated pneumonia:

I wonder if the Suicide Girls or Orac Knows will show any class, decency or honesty on the subject now that we know the truth? Or will they keep to their lynch-mob prejudices?

Geez. I don't know what brought this on. I've never questioned Dean's honesty. I do think he's prone to excessive credulity when it comes to HIV "skepticism" and that HIV denialism has the potential to do great harm in terms of controlling the spread of AIDS, but I've never impugned Dean's honesty or decency.

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

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

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

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

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

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

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

The first thing I noticed reading Dr. Al-Bayati's report is that it appears not to be intended for a scientific audience. (Perhaps this is why Dean found it so compelling, assuming he actually read the whole thing.) Instead, it is constructed more like a legal document designed to cast "reasonable" doubt on the coroner's conclusion that AIDS-related pneumonia was the cause of Eliza Jane's death, rather than actually putting together a coherent case for an alternate explanation. Without ever having seen the body or any of the raw data from the autopsy, Dr. Al-Bayati dives right in. One particularly egregious example of his style is that he lambastes the coroner for not testing for a certain virus (more about this below), and then confidently concludes that Eliza Jane had that virus and not HIV, even though he couldn't possibly make such a conclusion without the results of the very test that he criticizes the coroner for not having done in the first place! Before I myself dive in, however, let's summarize the autopsy conclusions as Dr. Al-Bayati reports them:

1. Pneumocystis carinii was found in Eliza Jane's lungs by Gomori methenamine silver staining in association with pink foamy casts in the alveoli. The lungs were also edematous (water-logged).
   
2. Eliza Jane was mildly neutropenic (low neutrophil--a type of white blood cell--count) and profoundly anemic (low red blood cell count)
   
3. Eliza Jane's brain contained throughout its white matter with relative sparing of cortex a number of variable-sized microglial nodules characterized by multinucleate giant cells associated with moderate pallor and myelination, occasional macrophages, and and angiocentric pattern. These lesions stained positive by immunohistochemistry (IHC) for the HIV core p24 protein, a finding consistent with HIV encephalitis.
   
4. There was atrophy of the spleen and thymus
5. There was enlargement of the liver with fatty infiltrate of the cells (steatosis) and ascites
   

Dr. Al-Bayati then tries to "refute" each of these findings, using a variety of handwaving techniques and "might have beens" that truly astound. One thing that puzzled me, though, was why he thought it so important to refute the finding that HIV was present at all. After all, if, as Dr. Al-Bayati clearly believes very strongly, HIV does not cause AIDS, then why not just come right out and argue that in his report? Why not just argue that AIDS couldn't possibly have killed Eliza Jane and that the HIV protein detected in her brain was a red herring? Heck, why doesn't Dean just argue that?

But I digress.

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

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

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

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

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

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

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

The bottom line is that you can compare these two sets of conclusions about what caused Eliza Jane's death and decide which seems more plausible. The first, the coroner's report, looks at a child of an HIV-positive mother who refused to take AZT during pregnancy, breast-fed her child even though that is known to increase the rate of transmission of HIV, and refused to have her child tested for HIV, a child who collapsed after upper respiratory and ear infections, whose autopsy findings showed HIV encephalitis, P. carinii in the lungs, and severe anemia. Given such findings, it's hard not to conclude that Eliza Jane died of AIDS complications. (Whether or not Dean's contention that the coroner had some sort of horrendous bias or was grandstanding is true, I cannot say, but certainly Dean hasn't provided any compelling evidence that he was.) The second hypothesis, promulgated by an HIV "dissident" with a definite axe to grind, requires us to believe in not just one, but three, highly unlikely occurrences (plus one simply unlikely occurence), namely:

1. A previously completely healthy girl developed PVB19 infection leading to both encephalitis and aplastic anemia (possible, but highly unlikely, and, even if PVB19 were found, it would be far more likely that it was able to cause anemia because of immunosuppression due to AIDS).
2. This same girl also developed an acute allergic reaction to amoxicillin that led to cardiovascular collapse and--oh, by the way--also caused steatosis of the liver within a day after starting the drug, the steatosis being something even Dr. Al-Bayati's own references do not seem to support as being likely.
   
3. This same otherwise healthy girl had sufficient quantity of P. carinii in her lungs to show up on Gomori methenamine silver staining at her autopsy.
4. The medical examiner and neuropathologist either botched the staining for the p24 protein (or that it was a false positive) and an experienced neuropathologist didn't know the pitfalls of the diagnosis of HIV encephalitis using brain tissue sections.
   

A veritable herd of zebras indeed. To believe Dr. Al-Bayati's scenario, you have to believe that at least four very unlikely things happened in the same case, rather than the very likely conclusion (based on the autopsy findings) that AIDS killed Eliza Jane.

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

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

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

Bill Hicks on young earth creationism

Nothing to post today, but this short movie about young earth creationism is pretty funny. Enjoy.

Followup on herbal medicine in the U.K.

Earlier this week, I commented on how traditional Chinese herbal medicines in the U.K. had been found to be adulterated with dangerous and banned drugs, such as fenfluramine.

I've become aware of a link that leads to streaming audio of the original BBC Radio Live Five report on this story, which gives a much more detailed account. My main quibble is that they treat the claims of the herbalists interviewed about the efficacy of their herbs with a bit more credulity than they should have.

Also, for all you alties out there concerned about mercury poisoning causing a wide variety of diseases, consider this warning: There are often high levels of arsenic and mercury Ayurvedic and traditional Chinese medicines:

The Agency first became aware of Fufang Luhui Jiaonang back in July 2004, when it warned consumers that it had been recalled from 35 outlets across the UK after being found to contain around 11% mercury.

Dr. Linda Anderson from the MHRA said: “The toxic effects of mercuric salts such as those found in the products tested are well known. The levels found could initially cause nausea, abdominal pain, vomiting, diarrhoea, headache and lead to serious damage to the kidneys and the nervous system. Any pregnant woman taking the products would be at risk of miscarriage and possible damage to the unborn foetus.”

11% mercury by weight! Holy crap! I wonder what Boyd Haley would have to say about this? Alties get all upset about miniscule amounts of mercury that might--might--leech from dental amalgams and by brief exposures to mercury in the form of vaccinations, but I have yet to see them express much concern about this potential source of mercury, which could be large in someone taking these herbal medications on a daily basis.

But that's not all. Besides fenfluramine, arsenic, and mercury, the British government also warns about other potentially dangerous substances found in traditional Chinese medications:

Other ingredients found to be illegally included in TCMs in recent months have included: the banned ingredient Aristolochia, associated with kidney failure and cancer; prescription only ingredients glibenclamide (used in the treatment of diabetes; improper use can be fatal) and corticosteroids (found in 'herbal' skin creams). The TCMs involved have been in a number of forms, including pills and capsules.

Sir Alasdair Breckenridge, Chair of the MHRA, said:

"We recognise that many consumers value traditional Chinese medicines but they should be aware that we continue to find some products which are manufactured to low quality standards and which contain potentially harmful substances.

I'm going to have to look into what regulations cover these sorts of medications in the U.S. I know that the FDA has in the past banned the import of certain brands of ginseng and ginseng powder because of contamination with pesticides. (A couple of years back I got into a little dustup with one guy selling this stuff from Canada at something like $300 for a 20 g tin.)

So, fans of Chinese medicine. Be very careful where you get your herbs from.

That's all for today. The Michigan-Ohio State game is going to start soon, and I plan on watching it.

Rescued from the streets of Chicago!

My wife and I were a little worried.

A couple of weeks ago, our friend's boyfriend found a little Chihuahua wandering on the streets of Chicago. The poor guy was fairly old and apparently a stray. Canvassing the neighborhood failed to find the owner. Our friend didn't think she could keep him because of her cat, and her boyfriend routinely worked 12-15 hour days. It seemed that this little guy might have to be taken to the shelter, where, given his age, it was highly unlikely that anyone would adopt him.

Well, we're worried no more. I'm pleased to report that this little guy has found a home with his rescuer and has become the de facto mascot at the auction house where he works (where the boss apparently doesn't mind his being around). And here the little guy is, posing in the studio where as part of his job at the auction hous his rescuer takes pictures of various pieces of furniture for sale:

Charles Krauthhammer tells it like it is

Even conservative stalwarts are starting to recognize "intelligent design" creationism for what it is, in this case, Charles Krauthammer:

Let's be clear. Intelligent design may be interesting as theology, but as science it is a fraud. It is a self-enclosed, tautological "theory" whose only holding is that when there are gaps in some area of scientific knowledge -- in this case, evolution -- they are to be filled by God. It is a "theory" that admits that evolution and natural selection explain such things as the development of drug resistance in bacteria and other such evolutionary changes within species but also says that every once in a while God steps into this world of constant and accumulating change and says, "I think I'll make me a lemur today." A "theory" that violates the most basic requirement of anything pretending to be science -- that it be empirically disprovable. How does one empirically disprove the proposition that God was behind the lemur, or evolution -- or behind the motion of the tides or the "strong force" that holds the atom together?

In order to justify the farce that intelligent design is science, Kansas had to corrupt the very definition of science, dropping the phrase " natural explanations for what we observe in the world around us," thus unmistakably implying -- by fiat of definition, no less -- that the supernatural is an integral part of science. This is an insult both to religion and science.

The school board thinks it is indicting evolution by branding it an "unguided process" with no "discernible direction or goal." This is as ridiculous as indicting Newtonian mechanics for positing an "unguided process" by which Earth is pulled around the sun every year without discernible purpose. What is chemistry if not an "unguided process" of molecular interactions without "purpose"? Or are we to teach children that God is behind every hydrogen atom in electrolysis?

He may be, of course. But that discussion is the province of religion, not science. The relentless attempt to confuse the two by teaching warmed-over creationism as science can only bring ridicule to religion, gratuitously discrediting a great human endeavor and our deepest source of wisdom precisely about those questions -- arguably, the most important questions in life -- that lie beyond the material.

He's right. I particularly like the part comparing ID "criticisms" of evolution with indicting Newtonian mechanics or chemistry for being "unguided" processes.

What kind of humanist is Orac?

At the risk of annoying certain people who think these things are frivolous...another test that's been making the rounds of the scientific and skeptical blogosphere. I actually took this about a week ago but, stung by criticism of last week's test, debated whether or not to post it all week.

In any case, it amuses me to take a test called "What kind of humanist are you?" because Orac is not "human," as he has told you so many times. However, this silly little test suggests the kind of humanist Orac's creator Ensor might have been:

Handholder

You go out of your way to build bridges with people of different views and beliefs and have quite a few religious friends. You believe in the essential goodness of people , which means you’re always looking for common ground even if that entails compromises. You would defend Salman Rushdie’s right to criticise Islam but you’re sorry he attacked it so viciously, just as you feel uncomfortable with some of the more outspoken and unkind views of religion in the pages of this magazine.

You prefer the inclusive approach of writers like Zadie Smith or the radical Christian values of Edward Said. Don’t fall into the same trap as super–naïve Lib Dem MP Jenny Tonge who declared it was okay for clerics like Yusuf al–Qaradawi to justify their monstrous prejudices as a legitimate interpretation of the Koran: a perfect example of how the will to understand can mean the sacrifice of fundamental principles. Sometimes, you just have to hold out for what you know is right even if it hurts someone’s feelings.

What kind of humanist are you? Click here to find out.


This cannot be right. Ensor was definitely a prickly character, and so is Orac. On the other hand, I do get the feeling that I seem to be considerably less hostile towards religion than most of my fellow skeptical bloggers.

(Via Anne.)

Schadenfreude

[NOTE: Due to interesting developments on the Holocaust denial front yesterday, your regularly scheduled frivolous Friday post has been preempted. It will appear sometime next week.]

Well, well, well...

Despite my general dislike of hate speech laws and laws in some European countries against denying the Holocaust and incitement to racial hatred, it's still rather hard for me not to feel a wee bit of schadenfreude upon learning of this story yesterday:

VIENNA, Austria (AP) - Right-wing British historian David Irving, who once famously said that Adolf Hitler knew nothing about the systematic slaughter of 6 million Jews, has been arrested in Austria on a warrant accusing him of denying the Holocaust.

Irving, 67, was detained Nov. 11 in the southern province of Styria on a warrant issued in 1989 under Austrian laws making Holocaust denial a crime, police Maj. Rudolf Gollia, a spokesman for the Interior Ministry, said Thursday.

Austrian media said the charges stemmed from speeches Irving delivered that year in Vienna and in the southern town of Leoben.

In a statement posted on his Web site, Irving's supporters said he was arrested while on a one-day visit to Vienna, where they said he had been invited ``by courageous students to address an ancient university association.''

Despite precautions taken by Irving, he was arrested by police who allegedly learned of his visit ``by wiretaps or intercepting e-mails,'' the statement alleged. It said that en route to Austria, Irving had privately visited German playwright Rolf Hochhuth, a friend he had not seen in 20 years.

I despise Holocaust deniers and all that they stand for, hence the schadenfreude. However, in general, I oppose hate speech laws and think that laws against Holocaust denial are a very bad idea. I can understand why Germany and Austria might have considered strong laws banning anti-Semitic hate speech necessary in the aftermath of the fall of the Third Reich. For decades afterward, there was a very real fear of Nazi-ism rising again. But it's been 60 years now. Germany and Austria are stable democracies, and I have to question whether such laws are advisable or necessary anymore. (As an aside, my general opposition to hate speech laws is an area where I have sometimes disagreed with fellow travelers countering online Holocaust denial, and we have occasionally had some rather heated--but civil--debates on this issue.) Even though it is rather unlikely that the maximum penalty of 20 years in prison would be applied in this case and it is uncertain whether the prosecutor will even choose to press charges over a 16-year-old warrant, it is hard for me not to find it disturbing that the potential penalties for violating these "hate speech" laws would be so harsh, even when applied to someone like Irving. Moreover, since Irving is considered likely to offend again if released, he may well remain in prison until trial. In fact, although I can understand the sentiment, I find it very troubling to read this quote:

The Britain-based Holocaust Educational Trust congratulated Austrian authorities on the arrest. Trust chairman Lord Greville Janner, noting that Britain has no such laws that make denying the Holocaust a crime, praised the Austrians ``for doing what our law should but does not permit.''

``I hope this will lead to a successful prosecution,'' Janner said.

Am I wrong to find this casual dismissal of free speech troubling?

Even so, in a way, it's hard for me to feel too much sympathy for David Irving, who has spoken in front of far right wing groups like the National Alliance. (Indeed, regarding his associations with extremists, Irving has made the excuse that he is simply speaking the "truth" as he knows it, and cannot help it if those whom he attracts are old Nazis, neo-Nazis, antisemites and white supremacists; yet he does nothing to discourage these associations, suggesting he does not find them that troubling. I suspect that he likes the attention and especially the financial support.) He seemed almost to be asking to get busted. He must have known that there was an open warrant on him in Austria; yet he went there anyway, leading me to wonder how many times he may have sneaked into Austria before. Perhaps it was the hubris that had developed over his years of being able to travel in style to address adoring audiences of far right wingers and Holocaust deniers, even though he had a judgment against him from his loss in his lawsuit in 2000 against Deborah Lipstadt. On the other hand, perhaps he has developed a martyr complex. In the days before he went, he worried on his own website whether the students to whom he was going to speak had been blabbing about his trip:

TYING up loose ends. . . I am becoming apprehensive about the [...] event; so much can go wrong, especially if it is a trap. How much have the students talked about my coming?

On previous trips to the United States at least, Irving seemed to have been a bit more clever just to avoid protests or the appearance of people (some of whom I know) at his talks who might challenge him and ask him very uncomfortable questions about his Holocaust denial. He would generally be very careful about not announcing where he would appear until the last possible moment and circulating the information through difficult-to-penetrate means. It is odd that he would seemingly not be as careful when the stakes were so much higher, and arrest, rather than annoyance by protesters, would be the penalty for mistakes. Was he getting careless? Who knows? The student group that invited him, the Burschenshaft Olympia, is known for inviting far right wing speakers, but they seem to have had more notice than is typical for an Irving appearance. It seems rather likely that communications among the students were what tipped the authorities off.

All in all, it's been a bad few months for Holocaust deniers. Just this week, the U.S. deported Holocaust denier Germar Rudolf to Germany, where he is serving a sentence previously passed and may face new charges. Before that, Ernst Zundel was deported from Canada to Germany, after having previously been deported from the U.S. to Canada and is standing trial. In the case of Zundel and Rudolf, I have little problem with their being deported for breaking our immigration laws, and, while here, they did consort with some far right wing groups whose purpose was not always lawful. Indeed, it terms of being prosecuted under laws against Holocaust denial, it is pretty uncommon for that to be the sole reason an individual Holocaust denier is tried. When Holocaust deniers are tried for violating laws against Holocaust denial, it is usually not so much their espousing of Holocaust denial and anti-Semitism that gets them into hot water but their associations with violent far right and neo-Nazi groups, and that is likely true. Hopefully, these associations will come out at their trials.

Nonetheless, I am uncomfortable about deporting these Holocaust deniers, no matter how much I despise them and their views, to nations that will prosecute them primarily for their speech, no matter how despicable. (Irving is a different case, however; no one forced him to go to Austria.) No, I don't want them here in the U.S. and would prefer them gone back to their native countries, but I don't want them in jail, either, unless they committed other crimes. When Holocaust deniers consort with violent right wing extremist groups and break the law, they of course should be prosecuted and locked up, but prosecuting them for their Holocaust denial alone may in fact be counterproductive. What will likely come out in most news reports about their incarceration is not their associations with violent far right extremists, but rather that they are being prosecuted and jailed for denying the Holocaust, allowing the most odious and despicable anti-Semites to claim the mantle of persecuted free speech martyrs with some credibility, at least to people who know little about the Holocaust or Holocaust denial. Making someone like Irving into a free speech martyr is particularly laughable, given his attempts to stifle Professor Lipstadt's free speech by suing her in England, which has libel laws slanted highly in favor of plaintiffs.

Posts on this issue:

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

ADDENDUM: Andrew Mathis has taken on the issue. Like me, he has a problem with anti-Holocaust denial laws. He also comes up with the best quote about Holocaust deniers I've seen in while:

Now I have a big problem with such laws. All laws against Holocaust denial do is make the deniers, who would have to hang around with pedophiles to do social climbing, seem like martyrs. Let them spew their rot and them let them be refuted by truth.

Damn. I wish I'd said that! Let me just add that the antidote to hate speech such as Holocaust denial is not incarceration, but refutation with the truth.

Skeptics Circle reminder

Don't forget, everyone. Due to the Thanksgiving Holiday next Thursday, the next edition of the Skeptics' Circle will be appearing at Mile Zero a day early, next Wednesday, November 23, rather than the usual Thursday. Get your best skeptical blogging sent to Tom by Tuesday night, and, prior to feasting next week, get your fill ahead of time of some great blogging from a skeptical viewpoint.

(Geez, I can't believe Thanksgiving is only one week away. Where did 2005 go?)

Historians taking on "intelligent design"

It's good to see history blogs like the History News Network jumping into the fray against "intelligent design", especially given the way that one historian swallowed whole the distortions of ID a few months ago and disgraced himself and his profession by writing a vacuous and ill-informed article. This week, Richard Cravatts contributes an article pointing out how the advocates of the pseudoscience of creationism use the same sorts of logical fallacies and distorted arguments that advocates of the pseudohistory of Holocaust denial:

Ironically, deniers conduct their research and have come to their findings about the Holocaust in a manner similar to the way intelligent design theorists come to theirs. In his essay “Why Revisionism Isn't,” Gordon McFee seems to echo, in the context of revisionist history, the court’s appraisal of how intelligent design was researched and promoted. Just as creationists start with the premise that the theory of evolution is flawed and subject to doubt, wrote McFee, “‘Revisionists’ depart from the conclusion that the Holocaust did not occur and work backwards through the facts to adapt them to that preordained conclusion.” “Put another way, they reverse the proper methodology . . , thus turning the proper historical method of investigation and analysis on its head . . . To put it tritely, ‘revisionists’ revise the facts based on their conclusion.”

Deniers may have concluded and may passionately want to believe that there was no “Final Solution,” that gas chambers were used merely to delouse prisoners, that only hundreds of thousands of Jews, not millions, were exterminated, and that the Holocaust is overall a hoax perpetrated by Jewish victims to extract sympathy and reparations from the world; but all of their invidious scholarship cannot prove the unprovable, and nor obviously would their theories deserve to be taught as an alternative ‘history’ in public schools merely because they question history and employ perverse scholarship to deny and distort the magnitude of one of the most documented and pernicious events of contemporary times.

Precisely.

Now, once again, as I always do when this comparison comes up, I have to caution Dr. Cravatts, not because it isn't a valid comparison in terms of methodology, but rather because the comparison with Holocaust deniers is so toxic. Because Holocaust denial stems from anti-Semitism and/or neo-Nazi beliefs, one has to be careful not to leave the impression of accusing creationists of being anti-Semites or Nazis when invoking this comparison. (I know, I know, I'm repeating myself, but it's hard not to repeat oneself at least occasionally when you've been blogging almost a year.) The way around this is simply to be very careful about how you make the comparison and emphasize that you are comparing methods of argument and rhetoric, not political beliefs.

In any case, the most pertinent principle that applies to both Holocaust deniers and "intelligent design" creationists is Falsus in Uno, Falsus in Omnibus (one thing mistaken, all things mistaken). As Gord McFee puts it:

Since, as this list shows, the amount of empirical evidence for the Holocaust is so overwhelming, the "revisionists" must throw in another dismissal trick. This has been called the "falsus in uno, falsus in omnibus" condition (one thing mistaken equals all things mistaken). It means, for example, that if any single piece of survivor evidence can be shown to be wrong, all survivor evidence is wrong and is to be dismissed. If any Nazi official lied about an aspect of the Holocaust (on-topic or not), all Nazi officials lied, and anything Nazis said after the war is dismissed. If any Nazi can be shown to have been tortured or mistreated, they all were and anything they said is invalid.

Sound familiar? This is exactly what Holocaust deniers do all the time. I've seen it again and again on alt.revisionism and surfing Holocaust denial websites. Clearly it's ridiculous in historical analysis (evidence is never absolutely 100% consistent), and it's almost as ridiculous to apply to science.

But it's also what "intelligent design" creationists do, in part. How often do we hear creationists attacking one shortcoming of evolutionary theory (whether real, or, more commonly, exaggerated, or even made up out of whole cloth) and then implying that this must mean the whole theory must be called into question, conveniently ignoring all the other overwhelming evidence supporting evolution and that their alleged flaw is not of the variety of evidence that could falsify evolutionary theory. (Of course, this technique is somewhat easier for Holocaust denial, because deniers can always find a few eyewitness accounts that are flawed, incorrect, or made by people with dubious motives to tart up as "proof" that the Holocaust never happened.) Also, it's worth pointing out that there are single pieces of evidence that, if found and verified, could put evolutionary theory in serious doubt or even falsify it. However, such evidence has to this date never been found, which is why ID creationists never cite any evidence that truly calls evolution into question. Instead, they are reduced to distorting the evidence for evolution (or even outright lying about it), distorting what the theory of evolution actually says, and misrepresenting real scientific controversies in evolution (for example, punctuated equilibrium) as casting grave doubt upon the validity of the underpinnings of current day evolutionary theory. The also like to call evolutionary biologists "Darwinists," even though biology has moved on in the 150 years since Darwin's work, correcting areas where Darwin got it wrong and building upon areas where Darwin got it right.

Read the rest of Gord's essay and this additional essay and decide for yourself how similar creationists' methods of "argumentation" and "debate" are to those used by Holocaust deniers. And, of course, if you want to know more about Holocaust denial, The Holocaust History Project is a great place to start.

Comment policy revisited

The other day, I briefly mentioned my comment policy, which is, boiled to its essence, that I reserve the right to delete any comment for any reason, but that I only very rarely exercise that right. Browsing around Blogger's controls, I see that Blogger has added a new feature that allows me to moderate comments. Basically, if I were to turn comment moderation on, I would have to approve each comment before it would appear.

I'm not going to turn comment moderation on, though. For one thing, it's fairly uncommon for me to get truly obnoxious comments, and Blogger's Word Recognition has eliminated almost all comment spam, which, prior to my turning it on, had started to reach annoying levels. For another thing, although I realize that I occasionally post the quick plug for a carnival or answer a comment from work (although I try not to), it would definitely not be acceptable for me to be moderating comments from work, and that would mean an average of 10-13 hours a day during the week when comments wouldn't appear. It would totally destroy the exchange of ideas here by readers here for no good reason. In short, it would be too much work, too disruptive, and therefore not worth doing without a compelling reason.

Even though I have made up my mind not to use comment moderation (unless things change radically), I was wondering if any other bloggers who still use Blogspot had tried (or thought of trying it out) the comment moderation feature or what people think of moderated comments on blogs. Let me know.

The Art of Medicine in Ancient Egypt, Part 2

Last week, I wrote about my visit to the Metropolitan Museum of Art's exhibit The Art of Medicine in Ancient Egypt, where I enjoyed examining the Edwin Smith Papyrus. This papyrus, as you may recall, is one of the earliest surviving medical texts, and what is remarkable about it is that the knowledge is presented as a series of case reports not all that much unlike the way we sometimes present cases today. What I discussed last time was mostly the management of head wounds, and I picked a couple of cases from the papyrus to illustrate that the practical management of these head wounds is not all that different today in some ways. I also rather like the way that the Egyptian physicians divided diseases and wounds into "an ailment I will handle" (a problem for which there was a treatment), "an ailment I will fight with" (a problem for which the treatment was less certain), or "an ailment for which nothing is done."

I had been planning on moving on to a different type of injury for the second part of my series, but then I looked at the very first case again and noticed something that perhaps I should have talked about last week. So, hopefully it won't perturb anyone if I revisit the ancient Egyptian method of treating head injuries. I'll get to different injuries and illnesses in the next installment. For the moment, I'd like to revisit the head injuries. Bear with me, and I think you'll see why. So, here is the first case on the Edwin Smith papyrus, a rather straightforward scalp laceration (note that this part of the papyrus is fragmentary, leaving gaps):

Case 1. A Flesh Wound in the Head

TITLE: Practices for a man who suffers from a wound in his head, which has reached to the bone of his skull without gaping.

EXAMINATION AND PROGNOSIS: If you treat a man with a wound in his head whose wound's lips are closed and not gaping, and [...], and then you say about him: "One who has a wound in his head: an ailment I will handle."

TREATMENT: You have to bandage him with fresh meat the first day and treat him afterward with oil and honey dressing every day until he gets well.

EXPLANATIONS: As for "you treat a man," it is taking acount of someone like taking account of things with a grain measure, treating one takes account of whatever things with a grain measure or takes account of something with the fingers in order to [...] them. As for measuring things with a grain measure [...], suffering is taking account of in the same way.

Measuring a man's suffering in order to [...]. As for the heart, there are vessels from it to [every] limb. As for that on which any lay-priest of Seihment and physician puts his hands or fingers--[on the head, on the back of the] head, on the hands, on the pulse, on the legs--he measures the heart. For it is the case that its vessles are in the back of the head and in the pulse, and it is the case that it speaks to every vessel and every limb, revealing the measurement of his [...]--on the vessels of the head, of the back of his head, of his legs. [...] his heart in order to learn the knowledge that comes from it, for [it] reveals its measurement to one who ould learn what has happened there.

As for "who suffers from [...] his wound," it is to say his would is small [not wide] without gaping from one side to the other.

As for "which has reached [to the bone of his skull without] gaping," it is to say there has been gaping by the flishe , while that which [...] on the bone of his skull has no aping and is small, not wide.

What's interesting about this passage is that it is one of the very earliest writings describing the cardiovascular system and apparently describing how to monitor the pulse as a means of monitoring the patient. It's not clear to me why the scribe chose to include this information for what in essence sounds like a relatively minor scalp laceration, but I can speculate. This is the very first case presented on the papyrus. Perhaps the scribe wanted to emphasize this information early, to be used for the 47 additional cases that were to follow as a general principle. It's hard to say, and the papyrus is rather fragmented around this case, hence the missing text.

What is most interesting about this case is that it suggests that the Egyptians understood the rudiments of how the cardiovascular system works. They appear to have understood that the heart was at the center of the cardiovascular system and that it pumped blood to the rest of the body ("to every vessel and every limb"). Of course, these ancient physicians had no idea what the purpose of pumping the blood to the rest of the body was or what the blood was carrying. Even so, they also appeared to have understood that monitoring the pulse would help them in the assessment of how badly injured the patient was. It is also important to remember that the process of mummification involved removing the internal organs, giving Egyptian physicians of this time period (1,600 B. C.) the opportunity to examine gross pathology of organs in a way that few civilizations would for more than 3,000 years. Although the heart was usually left in place during mummification, it would be difficult not to note the large tubular structures (arteries and veins) entering and proceeding from the heart.

And, indeed, there may have been signficant contact between embalmers and physicians, as indicated in Case 9, which describes a "forehead wound with skull fracture." The examination and treatment state:

If you treat a man for a wound in the front of his face, which has fractured the shell of his skull, you have to make him the egg of an ostrich, ground with oil, and put it in the mouth of the wound. Afterward, you have to make him the egg of an ostrich, grownd and made into a powder: that is what dries the wound. You have to put for him a cloth of a physician's outfit on it.

Besides the rather strange use of ostrich eggs, an important comment is made in the explanation:

As for "a cloth of a physician's outfit," it is the strip of cloth that is used by the bandager.

And who is this bandager?

It's the embalmer, the professional whose charge it was to make mummies. This passage therefore suggests that there may have been contact and exchanging of knowledge between these two professional groups, suggesting the possibility of physicians learning from the removal of organs during the preparation of corpses for burial.

Despite all this knowledge, however, we should not forget that much of the treatments in ancient Egypt were based on magic. For example, before using the ostrich egg concoction, the papyrus instructs:

What is said as magic over this prescription: "The enemy in the wound has been driven off; the conspiracy in the blood has been made to tremble; the fulbure of every side has been given to the mouth of the effective goddess. This temple will not deterioriate; there is no crocodile or poison therein. For I am in the effective goddess's protection: Osiris's son is rescued."

For all the surprising level of knowledge about disease for such an ancient time, Egyptian physicians were primarily priests. Many of the treatments they used were based on magic and superstition. Even so, through observation, they managed to understand more than you might think.

Next week: Chest wounds. Or maybe neck injuries. (I'll decide when I get around to writing.) Also, note that I've acquired another book on medicine in ancient Egypt that relies on much more than the Edwin Smith papyrus and has some rather interesting passages on how Egyptians dealt with heart disease and problems with the GI tract.

Wingnut or not?

Remember Vox Day?

It looks as though he still doesn't like me after all these months. That's good. I'm surprised he even remembers. Given that Vox doesn't think women should have the right to vote because, according to him, they are "fascists at heart," I'd start worrying about myself if he ever started speaking highly of me.

I will concede one point, however. It may have been exaggerating a bit to refer to Scott Adams as a "wingut" just for his ill-considered comments about the evolution/ID conflict. Adams definitely appears ignorant and unable to evaluate evidence and judge which positions are more valid than others. But a "wingnut"? Perhaps I should have reserved judgment. On the other hand, Adams' nihilistic concept that no one who has a preexisting opinion or "a financial/career incentive" can be considered "credible" about an issue does flirt with wingnuttery. Such a position implies that Adams considers people who don't know enough about a topic to have formed an opinion and who have no professional connection to the issue at hand to be "more credible" than experts who have studied a problem all their lives. It's one thing to have a healthy skepticism about the claims of experts, but it's another thing entirely to dismiss all experts as "not credible" just because they have a preexisting opinion or because they make their living studying an issue. That's a simplistic and childish approach. Nonetheless, in the future, I should probably reserve the term "wingnut" for people to whom it truly applies.

People like Vox.

More carnival barking: Tangled Bank

The latest edition of Tangled Bank, the biweekly carnival for science blogging, has been posted at Flags and Lollipops. Check it out!

The History Carnival XX

The History Carnival XX has been posted at Tigerlily Lounge. Once again, time for the bimonthly parade of the best history blogging there is.

Grand Rounds, Vol. 2, No. 8

Grand Rounds, Vol. 2, No. 8 has been posted at Mr. Hassle's Long Underpants. Enjoy.

Prometheus vs. ID

Prometheus has recently posted a hum-dinger of a fisking of "intelligent design." Basically, he points out legal, ethical, and practical consequences that ID advocates may not have considered. It's an essay well worth reading. I do, however, have a relatively minor quibble.

At one point, Prometheus makes the Pandora's box argument:

Once the "Intelligent Design" promoters get their "camel's nose" into the tent of the public schools, they may find that they have opened a door that they would rather have kept shut. After all, if "ID" believers are allowed to preach their religious tenents in public schools, why not everybody else? Of course, the other religions would also have to "dress up" their beliefs as the "Intelligent Design" promoters have, but that shouldn't be too difficult, given the template that "ID" has provided.

Personally, I think that the obvious next candidate for inclusion would be the Atheists, who should be allowed to present their "theory" that there is no "Intelligent Designer". Their data is just as compelling as that of the "ID" people, so I see no reason why they shouldn't be allowed to have their day in school. Of course, the Atheists wouldn't say that there is no God, just that there is no "Intelligent Designer". That's different - isn't it?

Prometheus is correct that, if we allow one form of disguised religion into the science classroom, there would then be nothing (in principle, at least) to stop other forms of disguised religion. However his comment about atheists is somewhat off base. In actuality, ID proponents would say that atheism is already being taught in the form of evolution, that atheists are already getting the opportunity to present their "theory" that there is no "intelligent designer." Even though there is no inherent conflict between belief in God and accepting the science of evolution, ID proponents still like to try to link evolution with atheism, and make the "argument" that ID is only countering the "inherent" atheism of evolutionary theory (while at the same time trying very hard not to admit that, by the "designer," they mean God). Far more effective is the second part of his argument, namely that, under the terms of ID, there is no reason that pantheists shouldn't be able to present a "theory" that there are many "intelligent designers."

Minor quibble aside, it's an excellent article, well worth reading.

A policy I may have to steal

I may have to steal ahistoricality's comment policy.

Truth be told, I almost never delete comments, and then usually only when they're comment spam or someone reposting an entire copyrighted article, rather than a link to the article with excerpts. But it is perhaps worth reminding my readers (in somewhat less blunt language than ahistoricality chose to use) that, given recent blog pissing matches degenerating into blustering threats of legal action, I do reserve the right to delete any comment for any reason. (This blog is what I like to think of as a benevolent dictatorship, not a democracy.) It's just that I very rarely choose to exercise that right. I could if I so chose, but almost never do. I like to think that's part of my charm.

I hope you agree.

RINO Sightings

This week's edition of RINO Sightings has been posted at The Strata-Sphere. More good stuff.

I have to wonder if my membership in the Raging RINO's is in jeopardy, though. I've just learned that Respectful Insolence has been listed on "A List of Essential Blogs - the ones you visit at least once a day" at--of all places--The Democratic Underground. Yep, there I am, listed right alongside such left wing blogs as Daily Kos, Eschaton, and Liberal Oasis. Worse, I'm on the same list as that repository of altie wingnuttery, The Huffington Post. (On the other hand, it is an honor to be listed alongside Pharyngula, although politically we often disagree.) No doubt my family, particularly my sister who happens to be active posting on the DU discussion boards, will be pleased.

Commissar, it's not my fault! Don't revoke my RINO membership...

Will I ever live this down? Who cares? Anything that brings more traffic....

Beware "herbal" remedies

Well, isn't this interesting?

Scores of traditional Chinese medicine stores in Britain's high streets are being investigated for selling illegal medicines, the BBC has learned.

Radio Five Live has discovered that 67 outlets selling Chinese medicines are under suspicion.

It is estimated that 6,000 stores across the country offer treatment for conditions ranging from eczema to the menopause.

But the industry, although growing in popularity, is largely unregulated.

At the Herb Garden store in Leigh on Sea, Essex, an undercover reporter from the Five Live Report was two weeks ago sold a herbal slimming pill and told it contained rhubarb and honeysuckle.

Tests showed it contained fenfluarmine - an illegal pharmaceutical considered to be so dangerous that it is banned in most countries worldwide, including the UK.

The owner of the store, Anna Yang, was prosecuted earlier this year for illegally selling the same drug.

Alties like to tell us that their products are more "natural," that they're effective but much safer than conventional drugs. One wonders why, if that were the case, these particular sellers of "traditional Chinese medicines" in Britain would be so tempted to spike their "herbal slimming pills" with fenfluaramine, an effective albeit dangerous weight loss drug. (Fenfluramine has been banned by the FDA and is also illegal in most other countries because it has been linked to heart valve problems, particularly when taken with dexfenfluramine, the compound being known as Fen-phen for short.) Surely if their herbal remedies were so effective and safe, there would be no incentive to risk prison to pull a fast one like this, would there?

But that's not all. The same BBC reporter was sold two other prescription-only drugs:

The BBC reporter was also sold two other prescription-only drugs - Danthron - a specialist laxative which has cancer causing properties and is only recommended for use with terminally ill patients, and Sibutramine - prescribed in cases of extreme obesity.

I am not familiar with either of these drugs, but a brief search showed that Danthron is carcinogenic, causing a large increase in adenomatous polyps of the colon in rats, and that it causes genetic damage in in vitro cell culture systems, with the money quote being: "Products containing Danthron as a laxative are no longer generally recognized as safe and effective and may not be marketed in the United States." Apparently, however, it is still used in Britain in the limited situation of severe constipation in terminally ill patients.

If you think this doesn't have a human toll, think again:

Dr Karl Metcalfe, a consultant physician at Southend hospital said he has treated nine of Anna Yang's former patients but fears there may be more as some people may not have reported symptoms to their GPs.

"For a medically qualified person to be issuing these drugs would be reprehensible.

"For a non medically qualified person to be doing it is well very alarming and quite clearly criminal."

Another doctor, Dr. Mark Thurz, agrees:

Dr Mark Thursz, a consultant physician at St Mary's Hospital in Paddington said he had seen a huge rise in the number of patients being referred to him with liver failure or hepatitis after taking Chinese herbal medicine.

He said: "Many people believe herbal remedies are safe, but they should be seen in the light as conventional remedies in that they can adverse reactions.

Precisely. In the U.K., it's gotten so that even the Association of Traditional Chinese Medicine is calling for tighter regulation of herbal remedies.

The lessons from this case, even though it happened in the U.K., are applicable to the U.S., because herbal medicines and supplements are just as poorly regulated here as they are in the U.K. You have very little assurance that the herbal remedies you purchase contain what they say they contain and in essence zero assurance that they do what the sellers claim they will do. Remember this as well: If a supplement, herbal remedy, or other treatment has any real effect on your body, it is acting as a drug, and all drugs have side effects. For all drugs, it is a question of risk versus benefit, whether the benefits of the drug outweigh its side effect profile and risks. In the case of fenfluramine, the benefits were outweighed by the risk of heart damage, which was why it was banned.

The distinction by alties between "natural" medicines and "artificial drugs" (those manufactured by drug companies) is artificial and designed to fool the unwary. Any "natural" or "herbal" remedy that has an objectively measurable therapeutic effect in your body is acting as a drug. Indeed, many of the drugs we use today for many purposes were initially discovered in nature, in plants or molds, or whatever. Penicillin, as most people know, came from a common mold. Digoxin is isolated from the foxglove plant (Digitalis purpurea). Taxol, now used to treat breast cancer and other malignancies, was isolated from the bark of the Pacific Yew tree. The difference is, when you use herbal remedies, unlike the case for drugs manufactured by pharmaceutical companies, you have very little assurance that you will actually be getting the correct amount of therapeutic components, that the amounts of those components won't vary considerably from lot to lot, or that the herbs haven't been treated with pesticides or spiked with something else. The whole reason "conventional" medicine moved away from using drugs directly in the form of plants or natural products and towards isolating the active components of those plants in purified form was to avoid these problems of variability and uncertainty in dosing. That is why, when you purchase, for example, digoxin, you can have assurance that, each time you buy it, a 0.125 mg pill will contain 0.125 mg of Digoxin within a very narrow range of variation and that it will not be adulterated with other components. You could munch on foxglove leaves, as was done before the active component was identified, but you'd be taking a chance. Given the narrow therapeutic window of digoxin, you'd have a high probability of either taking a dose too low to be therapeutic or of overdosing yourself.

The bottom line is that alties will raise a huge ruckus about problems with drugs like Vioxx being found after they have been approved by the FDA and on the market. Fair enough. Safety testing of drugs before approval has occasionally failed, but for the most part drugs that make it to market are safe and effective. Those that aren't are usually discovered fairly soon after release and use by a large population. Also, pharmaceutical companies pay a heavy price in terms of lawsuits if their drugs are found to be unsafe, an additional incentive to make sure that they are, in fact, safe. No such regulatory mechanism exists for herbal remedies and "supplements." This lack may not have been such a big deal a couple of decades ago, but, with more and more people using supplements and herbal remedies, this situation is no longer acceptable.

Is Scott Adams an IDiot?

Say it ain't so, Scott!

Say it ain't so that you're an intelligent design apologist. How can someone so capable of mocking the follies of the tech industry be so credulous about pseudoscience?

Fortunately, PZ Myers does the takedown.

Man "cured" of HIV?

I was browsing the medical blogosphere yesterday when I came across this story:

A hospital in London is to carry out tests on a British man reported to become the first person to be cured of HIV.

In August 2002, 25-year-old Andrew Stimpson was diagnosed as HIV positive.

However, 14 months later Mr Stimpson, who had not taken any medication for HIV, was found to be clear of the virus.

Mr Stimpson sought compensation for what he thought was an initial error but was told that there was no case to answer because there was no fault with the testing procedure.

Personally, I think they're getting a little carried away. Even if there was "no fault in the testing procedure," the most likely explanation is still that the first test was a false positive. No medical test, even perfectly carried out, is without false positives and false negatives. It is true that false positives are pretty rare with the combination of an initial ELISA for screening purposes followed by a Western blot or indirect immunofluorescence assay, but with millions being screened it is still inevitable that false positives will pop up now and then. Nonetheless, the man's original blood sample is still around, it should be retested.

Alternatively, possibly Mr. Stimpson is a carrier of the CCR5Δ32 mutation, which demolishes an HIV coreceptor on lymphoid cells and leading to a potent resistant to HIV infection in carriers (although it's unlikely that such a mutation would cause anti-HIV antibody to fall to undetectable levels so fast after being positive). It is also possible, albeit much less likely, that Mr. Stimpson's initial test was not a false positive and that he has some new form of resistance to HIV that can't be explained by the known mutation that confers HIV resistance (CCR5Δ32). In that case, he would definitely be worth studying.

Here's a prediction, though: Look for the HIV denialists to try to make some hay over this story if it gets out widely into the blogosphere. Just watch. Never mind that, even in the unlikely event that the first test was not a false positive and that Mr. Stimpson does indeed have some sort of previously undescribed resistance to HIV infection, it would not invalidate the data showing that HIV infection causes AIDS.

Consider my comments pre-emption.

(This is one prediction that will make me happy if I turn out to be wrong.)

(Via Kevin, MD and Medpundit)

ADDENDUM: Here's a more detailed account.

ADDENDUM #2: The whole story's starting to sound fishier and fishier. Mr. Stimpson is claiming he rid his body of HIV taking nothing more than vitamins and is now "declining" to undergo further testing, despite mounting pressure from the medical community and HIV advocates. Money quote:

Though Mr Stimpson insists he will "do anything I can", associates said yesterday that he had gone away to rest and escape the media spotlight.

Campaigners are annoyed that having not yet undergone the vital tests, Mr Stimpson nevertheless signed contracts with the News of The World and the Mail on Sunday, both of which published his claims yesterday.

They also sounded a note of caution, noting that disclosures in his case arose not from medical research or peer review but from legal correspondence relating to an action Mr Stimpson was pursuing against the health trust. He had feared the positive results might have been wrong and had sought compensation. The trust's contention that both sets of blood tests were accurate emerged as it tried to defend itself from litigation.

Mr Stimpson, who lives in London with his partner, who is HIV positive, said: "There are 34.9 million people with HIV globally and I am just one person who managed to control it, to survive from it and to get rid of it from my body. For me that is unbelievable - it is a miracle. I think I'm one of the luckiest people alive.

"I was just taking daily supplements to keep myself as healthy as possible so as not to get full-blown Aids."

But Annabel Kanabus, director of the Aids charity, Avert, said he must match words with deeds. "He must come forward. Organisations such as ours will be inundated this week. There is enough confusion surrounding the issue of HIV. We don't need any more."

She said the sequence of events is troubling. "He was told in October that he would not be paid by the trust so he goes to the newspapers. I think he should have gone straight to his doctors."

Sounds to me as though Mr. Stimpson may be looking to score some cash from this. Of course, his apparent greed doesn't rule out the possibility that his story is true and he did somehow "cure" himself with vitamins, but his behavior is making that explanation appear more and more dubious. There's only one way to find out. Here's hoping he permits the testing that needs to be done to sort out what happened.

(Hat tip to Kevin, M.D. again. And yet one more story here.)

ADDENDUM #3: It turns out that my initial prediction in the original post was correct. No big surprise there, as it was quite a safe bet. I would have been more surprised if I had been wrong.

The Cybermen return

I hadn't been planning on posting anything today (I've been working--or procrastinating about working--on a grant all weekend), but then I changed my mind when I found out about this. Given yesterday's post, this also seemed rather appropriate, not to mention that it was a great excuse to pull myself away from the tedium of grantwriting for a little while.

I know; I'm bad that way.

Regulars around here know I'm a big fan of Doctor Who, so much so that I've managed to see most of the episodes of the new Doctor, courtesy of my mother, who happens to live close enough to the Canadian border to get the episodes by the CBC and was willing to record them and periodically send them to me. I have no idea why BBC American never broadcast the show, but it wouldn't have mattered anyway, because Cablevision doesn't carry BBC America around here. In any case, I really liked Christopher Eccleston's take on the Doctor and was sorry to see him go after only one season. I'm hoping the new Doctor is as good.

I've just learned, via Alun, that one of the classic villains, the Cybermen, are slated to return. The Cybermen were a race of cyborgs from the planet Mondas, who had developed the technology to replace their diseased and dying body parts and later bodies, leaving robotic bodies driven by humanoid brains, leaving creatures without emotion but with a desire to claim the Earth for their own. The costumes for the Cybermen were always among the cheesiest of any of the old Doctor Who characters, but, so compelling were they as villains, that somehow the cheapness of their costumes didn't usually bother me. Indeed, they were the featured villains in one of the best Doctor Who stories of all time, Earthshock, and also a rarity in that one of the Doctor's companions was actually killed off, which gave the episode an emotional resonance and depth usually not found in the series.

To give you an idea of the improvement, here are the old Cybermen as they appeared in Earthshock:

Believe it or not, they looked even more cheesy in earlier iterations.

And, now, here are the new, improved Cybermen:

Big improvement. Way cool. The costume no longer looks like the actor's wearing a tinfoil jumpsuit and a helmet. Given what the producers have done with the revival of the Doctor, I'll be very interested in seeing these new episodes.

Science at its finest

You know all those paranoid conspiracy theorists? You know how they're sometimes mocked for wearing tinfoil hats to prevent alien or government mind control rays from getting to them. Did you ever wonder if there was anything to that? Did you ever wonder whether those tinfoil hats work?

Ali Rahami at MIT did, and he did some experiments to see what the effect of aluminum foil hats on the absorption of radio waves is. He even tested three different designs of hats. Here are his conclusions:

The helmets amplify frequency bands that coincide with those allocated to the US government between 1.2 Ghz and 1.4 Ghz. According to the FCC, These bands are supposedly reserved for ''radio location'' (ie, GPS), and other communications with satellites (see, for example, [3]). The 2.6 Ghz band coincides with mobile phone technology. Though not affiliated by government, these bands are at the hands of multinational corporations.

It requires no stretch of the imagination to conclude that the current helmet craze is likely to have been propagated by the Government, possibly with the involvement of the FCC. We hope this report will encourage the paranoid community to develop improved helmet designs to avoid falling prey to these shortcomings.

Now that's some science answering a practical question! (I particularly love the last line, which is so typical of scientific papers.) I'm guessing a corrollary of this work is that aluminum foil hats probably don't protect you against the dreaded cell phone radio waves that are purported to cause all sorts of horrible brain tumors.

So, there you go. Those folks railing against government mind control may be using defective equipment to protect themselves from the Illuminati, ZOG, and the U.N. with its black helicopters, ironically tricked by the very forces they are trying to protect themselves against. New designs are clearly needed immediately! Kudos to Dr. Rahimi for providing some desperately needed data to the conspiracy theory crowd! If he doesn't win an IgNobel Prize next year for his important work, you'll know the government (or the Masons or the Illuminati or. . .someone) got to him and hushed it up.

However, in the interests of scientific rigor and presenting criticisms of Dr. Rahimi's experimental design, it should be pointed out that his findings have been questioned by at least one person:

First and foremost, Rahimi et al. only considered simple radio frequencies. As I explained in detail in chapter 4 ("Psychotronic and AFDB Theory") of my book [2], only psychotronic energy can affect the brain in any coherent manner. Simple EM fields have only trivial effects -- such as causing indistinct sensations of a supernatural presence [3] -- over short distances. Only by converting electromagnetic energy into psychotronic energy using a psychotron-based device can the forces of mind control access from afar the neural network of a brain to both implant and extract thought complexes.

Perhaps Mr. Zapato would be willing to provide a device that would produce this "psychotronic energy" for more rigorous testing. Another criticism:

There's another odd discrepancy in their procedure description: While they say that the test helmets were made of Reynolds aluminum foil, in the lower left of Fig. 2 ("B" in enhanced version above) one can clearly see a box of Chef's Pride brand foil on their work bench next to the completed helmets. Well, Rahimi et al., which is it?

Personally, I'm not sure that the above would be a valid criticism, even if true, although using different brands could introduce unwanted variability in the results. And finally:

The "current helmet craze" may indeed have been propagated by government forces, but that has nothing to do with the effectiveness of AFDBs or their non-crazed use by sensible paranoids. It is a common MO of the NWO and allied conspirators to disingenuously promote that which they aspire to destroy. The current rise in joking references to AFDBs -- which is what Rahimi et al. are referring to by "the current helmet craze" -- is most likely a calculated ploy to scare off would be paranoids from the mental protection of foil. That the forces of mind control are bothering to do this is itself evidence of the effectiveness of AFDBs.

The most important question raised by the Rahimi et al. study is: Should paranoids trust people working for an organization deeply involved in the Military-Industrial Complex? While Rahimi, the lead investigator whose site the paper is hosted on, is from MIT's EE and CS departments, the et al. (Ben Recht, Jason Taylor, and Noah Vawter) are from MIT's notorious Media Lab, which receives funding from DARPA [4] -- one of those government agencies they pretend to be concerned about. When it comes to mind control, they are hardly an unbiased party. That, combined with the aforementioned discrepancies and questionable procedures, makes their conclusions highly suspect.

Clearly more research is needed, although it would appear to me that MIT would be exactly the folks who could answer this important question. Maybe these designs could be adapted to protect the brain against both government mind control waves and cell phone emissions...

(Via Slashdot)

Of course, it makes perfect sense...

Lazy Saturday in the lab waiting for my real-time PCR run to finish. I might as well take another silly Internet quiz, especially because I'm such a Tolkien fanatic:


Numenorean

To which race of Middle Earth do you belong?
brought to you by Quizilla


Of course, it makes perfect sense, although I'm not so sure about "tragic"--at least not yet. On the other hand, I do like the idea of having a lifespan many times that of other human races...

(Hat tip to ahistoricality!)

I knew it; nobody expects me...

I know this one's been making the rounds for a while now, but anyone who knows me would just know that I would have to take this quiz sooner or later:


You are a cardinal! You love to try & get others
into trouble, even if you have to make up
lies...NO ONE expects the Spanish Inquisition!

What Monty Python Sketch Character are you?
brought to you by Quizilla

Hmmm. I was thinking I might end up being the Minister of Silly Walks or Mr. Nudge (if you know what I mean, wink, wink, nudge, nudge). Oh, well. The cardinals do have very nice red robes, plus the ability to cause fear and intimidation:

Our chief weapon is suprise...surprise and fear...fear and surprise.... Our two weapons are fear and surprise...and ruthless efficiency.... Our *three* weapons are fear, surprise, and ruthless efficiency...and an almost fanatical devotion to the Pope.... Our *four*...no...*Amongst* our weapons.... Amongst our weaponry...are such elements as fear, surprise.... I'll come in again.

Oh, never mind. Let's get straight to the torture.

Cardinal Fang! Fetch...THE COMFY CHAIR!

Taboos of Holocaust deniers

Holocaust deniers often make the claim that it is "taboo" to discuss the "real" story of the Holocaust (by which they mean their version, in which Hitler didn't really intend to kill millions of Jews, where the "real" number of Jews killed was supposedly much lower than the 5-6 million whom evidence shows to have been killed in the Holocaust, where there were no homicidal gas chambers and the gas chambers there were used only for "delousing"). They love to claim the mantle "free inquiry" and "intellectual freedom." It's rare that they admit to "taboos" of their own, but Bradley Smith did just that on his blog the other day:

Revisionists have our own taboos. It is taboo to criticize the published writings or statements of revisionists who admire Hitler and the Hitlerian regime. It is taboo to publicly question the racialist arguments of specific revisionists. Taboo to argue publicly against the anti-semitism that exists among revisionists. It is not that we cannot do it, or occasionally do not do it, but we understand that when we do we will break the taboo against doing it, and we’ll suffer the consequences.

The consequences being, I guess, that their fellow Holocaust "revisionists" will get upset at being labeled what they truly are. Of course, given the association between the Holocaust denial movement and far right wing hate groups, the "consequences" of "breaking the taboo" could conceivably include physical violence. Perhaps that's why Smith didn't name any Holocaust denier names in his conveniently general statements about this taboo.

Of course, the reason it is taboo for Holocaust deniers to criticize their fellow Holocaust deniers for such beliefs is because virtually all Holocaust deniers are at least anti-Semites at heart, with some of them falling into the "Holocaust didn't happen but the Jews deserved it" brand of Holocaust denial. A not insignificant proportion of deniers do admire Hitler and the Nazi regime. And certainly some of them harbor white nationalist beliefs that drive their Holocaust denial. Granted, just harboring anti-Semitic beliefs that lead you to deny or downplay the Holocaust because you think "the Jews" are taking advantage of it to gain sympathy, suppress Palestinian aspirations, make money, etc., is a far cry from Nazi-ism or white nationalism, being of the same cloth of conspiratorial thinking everywhere, just with Jews as the source of the "conspiracy." But since Holocaust deniers are virtually all at least anti-Semites and consider themselves besieged on all sides, it is not surprising that they would be reluctant to criticize their fellow travelers for what are simply more extreme versions of what they themselves believe, much less to criticize them for anti-Semitic beliefs they share. In addition, the more clever Holocaust deniers try very hard to hide their anti-Semitism and insist they are "scholars" only interested in "correcting myths" about the Holocaust; they don't like their less discrete fellows openly voicing what underlies their own "revisionism" and undermining their attempts to hide the anti-Semitic core of Holocaust denial.

I will give Mr. Smith some small credit, though. At least he admits that there are anti-Semites, white nationalists, and Nazi sympathizers in the Holocaust denial movement. (He just doesn't consider himself one of them.) Most Holocaust deniers will try to claim that they are only interested in the "truth," that (according to them, at least) those nasty Jews (or, as Holocaust deniers prefer to call them, "Zionists") don't want you to know. To them, it's, "Nope, no anti-Semites or racists here." Smith has just openly admitted that there are indeed anti-Semites and racists there. He just can't admit that the whole enterprise of Holocaust denial is based on anti-Semitism.

Veterans' Day

Today is Veterans' Day. Please take a moment to remember the soldiers who fought our wars and the soldiers who continue to fight our wars.

Pat Robertson: Open mouth, insert foot--again

Citizens of Dover, PA, be afraid. Be very afraid. Pat Robertson says, that, by voting out the school board that tried to introduce the teaching of intelligent design in science classrooms, you have offended God and had better watch out:

On today's broadcast of "The 700 Club," Robertson told Dover residents, "If there is a disaster in your area, don't turn to God." The founder of the Christian Broadcasting Network explained, "You just voted God out of your city."

So let me get this straight. By legally voicing through the ballot box their disapproval of religiously-motivated school board members who tried to get religiously-inspired pseudoscience into the science classroom to be taught to all the children of Dover, whether they share the fundamentalist Christian faith that inspired "intelligent design" creationism or not, and wasted large quantities of the school district's money fighting a lawsuit over their actions that they are highly unlikely to win, given the patent unconstitutionality of the school board's actions, the citizens of Dover have somehow called God's wrath down upon them? Certainly, that's what Pat seems to be saying:

“I’d like to say to the good citizens of Dover. If there is a disaster in your area, don’t turn to God, you just rejected Him from your city. And don’t wonder why He hasn’t helped you when problems begin, if they begin. I’m not saying they will, but if they do, just remember, you just voted God out of your city. And if that’s the case, don’t ask for His help because he might not be there.”

What's next, Pat? Fire and brimstone? Floods and tornadoes leveling Dover? How pissed off is God at the citizens of Dover because they were unhappy with their elected officials' attempts to teach religious ideas as science? Do tell us. Or are you going to use your supposed "personal relationship with God" to ask Him to cause some "problems" for Dover or to provide a disaster? If anything bad does happen in Dover, look for idiots like Pat Robertson to proclaim it "God's punishment" for rejecting intelligent design.

This sort of absolutist thinking is a hallmark of fundamentalists. There's no room for rational disagreement. If you don't agree with the religious position, you have "rejected God," and are therefore shunned by believers. And just what was it that Michael Behe and all the Discovery Institute drones are always saying that the "intelligent designer"is not necessarily God, that "intelligent design" is not creationism, not a religious concept? Perhaps they had better have a little talk with Pat Roberts. It would appear that he hasn't gotten the memo. He's wandering off the talking points.

(Hat tip to The Probe.)

UPDATE: Pat Robertson has issued a "clarification":

Later Thursday, Robertson issued a statement saying he was simply trying to point out that "our spiritual actions have consequences."

"God is tolerant and loving, but we can't keep sticking our finger in his eye forever," Robertson said. "If they have future problems in Dover, I recommend they call on Charles Darwin. Maybe he can help them."

Talk about digging yourself in a deeper hole! I think Pat went totally off the deep end after 9/11, and this is just one more example supporting that conclusion. It's also typical for fundies to try to make the specious claim that evolution is a "religion" (Pat's sarcastic comment about "calling on Charles Darwin).

You know, it occurs to me. The slate of candidates elected in Dover is not actually hostile to ID. They have stated that ID would be appropriate as subject matter in comparative religion or sociology classes, which, of course, it would. (I would certainly have no objection to teaching about ID in such classes.) They simply agree with nearly every biologist that evolution is established science, the underpinning of modern biology, and that ID is not appropriate subject matter for the science classroom (mainly because it isn't science and they don't think we should be teaching religious ideas in the science classroom).

But that's offensive to Pat Robertson and his minions, apparently. It's not enough to Pat Robertson's version of God to allow ID to be taught in public schools. No, it must be taught in science classes as science! And, if you don't agree, well, Pat's version of God will "take care" of you. He'll make you pay.

(Hat tip to Ed.)

The Twenty-first Meeting of the Skeptics' Circle

The Twenty-first Meeting of the Skeptics' Circle has been posted at Pooflingers Anonymous, and Matt may have come up with the most unusual and creative format yet. Shakespeare, anyone? It begins:

A school of thought, lacking credulity,
In Skeptics' Circle, where we lay our scene,
From doubting mind springs forth some sanity,
Where decent thought doth wash the B.S. clean.
'Tis here we place the quacks in fatal throes,
For lies do seem to take on their own life;
And greatly do increase the public's woes,
Thus do the skeptics ever dwell in strife.
'Tis this, the thing which doubters most do love:
To purge the crap and bring the truth to light.
They do not ask for answers from above,
But use critical thinking as they might.
If your most patient eyes do wish to read,
The Circle hath such answers as you need.

Go thou forth and be inoculated against the credulous claims that flood the blogosphere!

Next up is Mile Zero on November 23. Please note that this upcoming edition of the Skeptics' Circle will be posted one day early (on Wednesday instead of Thursday), because of the Thanksgiving Day holiday in the U.S. I figured that most American fans of the Circle would have better things to do that day, such as watching football and feasting. (Although, really, what could be better than enjoying some skeptical takedowns of pseudoscience, paranormal, and other topics worthy of a good debunking?) I hope this won't bother our non-American readers, but, like most bloggers, I'm a traffic whore, and traffic is likely to be way down on a major holiday. I'm sure participants will understand.

Speaking of participants, you can be one. Send examples of your best skeptical blogging to Tom at Mile Zero by November 22. Guidelines are here and here. And, as always, if you think you have what it takes to host, if you think you can stand up to the Hovind Creationism Stupo-Rays the way Matt did (on second thought, maybe that's asking too much of anybody) and put together a great blog carnival, drop me a line at oracknows@gmail.com.

Competitor for the most ignorant attack on evolution ever (other than Kent Hovind's)

Speaking of evolution...

I just came across what has to be one of the top three most ignorant attacks on evolution ever at BlogCritics.org. (OK, it doesn't sink to the level of Hovind's "did you come from a monkey" or "did you come from a rock" harangues, but it's close.) It starts out with the usual blather about how "those who push evolution only and don't want anything taught that might expose flaws in that theory" and "those opposing the inclusion of intelligent design in US science texts must feel insecure about their beliefs."

Nothing new there; if that's all that the article contained, I would have just ignored it.

But then I came across a "criticism" of evolution by someone named Kevin Surbaugh, of Topeka, KS, so mind-numbingly ignorant, that I couldn't resist pointing it out:

A major flaw I see: Evolution teaches that life started with simple forms that developed into complex ones. Obviously, that is impossible. If life began that way, then the chicken egg would not need to go through a chicken in order to hatch. Human babies would not need two complex humans to come together and plant, fertilize and carry the egg. Nor would we need science to do these things artificially in a laboratory.

A longer version of this post can be found at Surbaugh's own blog here.

I wonder if that inimitable evolution advocate PZ Myers, who loves slapping down creationist nonsense hard has ever encountered a comment that shows so much ignorance of what evolution actually says in such a short paragraph. The first statement, that it is "impossible" for complex forms to have developed from simpler forms is simply ridiculous, as the evidence that simplicity has given rise to complexity is all around us. Also, "simple" is relative, given that even "simple" organisms are amazingly complex. The second part of his argument is a huge non sequitur. How Kevin Surbaugh takes the evolutionary principle of common descent and from it concludes that evolution implies that a chicken egg "would not need to go through a chicken in order to hatch" or that it would not require two gametes to combine to make an embryo is beyond me. It's so unrelated to any real scientific deficiencies in evolutionary theory as to be laughable.

Perhaps Surbaugh is simply applying "intelligent design" to the problem of chicken and human reproduction. Just because he can't imagine how systems of reproductions such as chicken eggs or the fertilization of human eggs could have come about by evolution, he concludes evolution couldn't have been responsible. And, of course, as with all ID, if evolution couldn't have been responsible, then that means a certain "designer" (who, of course, they swear, is not necessarily God) must have done it. In the comments, he also betrays a profound ignorance of what constitutes a scientific hypothesis or theory:

Evolution is also a hypothesis, which as I pointed out has many holes. A hypothesis is what most of science is. In the case of evolution there is no hard fact, just hypothesis that is taught as fact.

Fact is even in the ID realm, there are those that believe evolution was used by an inteligent designer. To say ID is only a hypothesis and not science, but evolution is, hogwash.

They are both theories and both are hypothesis. Both have scientists that back them up, but the main stream media does not present the full accurate story, so the public does not a balanced view of this.

Apparently the only "holes" in evolution that he can find are his misconceptions of what evoluton says! Also evolution is much more than a hypothesis, while ID doesn't even rise to the level of a scientific hypothesis.

I have to stop now. Exposure to such concentrated logical fallacies and ignorance of science gives me a headache. This is the sort of stuff that Pat Hayes and Josh Rosenau have to deal with. I don't know how they put up with it.

Win a few, lose a few

Because my post yesterday was linked to the anniversary of a specific historical event and I didn't want to dilute the message by writing about anything else, I intentionally did not comment on rather important events that occurred in the unending struggle of religious fundamentalists to foist "intelligent design" off as science on students in public schools.

First up, the good news. In Dover, PA, where the school board who supported the introduction of "intelligent design" creationism as an "alternative" to evolution lost their bid for re-election. It was a clean sweep, or, as the NYT put it, a "repudiation of the first school district in the nation to order the introduction of intelligent design in a science class curriculum." Another likely cause was voter dissatisfaction with the perceived waste of school money paying for the lawsuit that resulted. They were replaced by a slate of candidates who support the teaching of intelligent design in the classroom--the comparative religion classroom, where it belongs. Now, with the finish of the Dover intelligent design trial, we can only hope that the court puts the final nail in the coffin by ruling against the school board. The beautiful thing about this case was that the utter vacuity of the arguments for ID and the connection between creationism and intelligent design was publicized and put in the public record for all to see.

Unfortunately, all is not well. In Kansas, the state Board of Education has approved new science education standards that downplay evolution:

OPEKA, Kan. - Risking the kind of nationwide ridicule it faced six years ago, the Kansas Board of Education approved new public-school science standards Tuesday that cast doubt on the theory of evolution.

The 6-4 vote was a victory for “intelligent design” advocates who helped draft the standards. Intelligent design holds that the universe is so complex that it must have been created by a higher power.

Critics of the new language charged that it was an attempt to inject God and creationism into public schools, in violation of the constitutional ban on state establishment of religion.

All six of those who voted for the new standards were Republicans. Two Republicans and two Democrats voted no.

“This is a sad day. We’re becoming a laughingstock of not only the nation, but of the world, and I hate that,” said board member Janet Waugh, a Kansas City Democrat.

Sadly, it's true. Although it's unfair to consider Kansas a laughingstock, it's hard not to consider the Kansas state government and Board of Education to be utter laughingstocks, given that the Board even went so far as to change the definition of science such that it will no longer be limited to a search for natural explanations of observed phenomena. Gee, does that mean I can postulate ghosts, angels, or evil spirits as the cause of various natural phenomena? After all, if you don't limit science to naturalistic explanations, why stop at evolution?

We can only hope that the good voters of Kansas, spurred on by people like Pat Hayes and Josh Rosenau and others who know what science is and support the teaching of good science in public schools, throw the bums out next year. Here's also hoping that the present Board of Education doesn't do too much damage in the year remaining.

In the meantime, perhaps we should all all heed these warning stickers that I found at the Annals of Improbable Research (which also noted that Kansas, in its previous attempts to undermine the teaching of evolution, is the co-winner of the IgNobel Prize for Science Education:

NOT VALID IN KANSAS
as per order of the Board of Education,
November 8, 2005

Use of this device or substance may
require, imply, and/or endorse the existence
of one or more of the following:
chemistry; evolution; electromagnetism;
gravity; mathematics; thermodynamics;
education.

A printable PDF file can be found here.

The Wreck of the Edmund Fitzgerald

Today is the 30th anniversary of the sinking of the Edmund Fitzgerald. She encountered heavy weather in Lake Superior and was only 17 miles from the safety of Whitefish Bay when she foundered and sank, with the loss of all 29 officers and crew. The sinking was immortalized by one of my favorite folk singers, Gordon Lightfoot, in the song, The Wreck of the Edmond Fitzgerald.

67 years ago tonight: Kristallnacht

One of the "myths" of the Holocaust common among those who have not studied its history other than superficially or who have obtained their concept of what the Holocaust was through popular culture is that the Holocaust equals gas chambers (and, no, I do not use the term as Holocaust deniers do, who mean to imply falsely that the Holocaust was a "myth"). Gas chambers were indeed a major part of the machinery of the Holocaust, but in reality they were a fairly late development. Hitler took power in January 1933. Yet, the first large scale gassings did not occur until late 1941, when at the Chelmno extermination camp that mobile gas vans using diesel exhaust were first used to kill the Jews of the Lodz Ghetto and other towns of the Warthenegau, as well as the Roma rounded up in the area. It is true that smaller scale gassings using carbon monoxide occurred as part of the T4 euthanasia program in late 1939 through 1941, and it was during this operation to rid the Reich of the "feeble-minded" or "life unworthy of life" that the techniques of using gas to kill large numbers of people were first developed, a "proving ground," if you will, for what was to follow. It was not until January 1942 at the Wannsee Conference that the decision was made to exterminate the Jews of Europe. Large scale gassings at stationary camps using carbon monoxide from diesel exhaust began at Belzec, Sobibor, and Treblinka soon thereafter. At Auschwitz, experiments with Zyklon-B, which generated cyanide gas, led to an even more efficient means of killing., which was adopted by other camps. Other extermination camps also sprang up. However, the majority of Jews killed in the Holocaust died of other causes, including starvation, over 1 million shot by the Einsatzgruppen, hanging, and disease.

But in early 1942 the Third Reich had been in existence nine years. It had already passed through three quarters of its life and only had slightly more than three years before its demise. The exterminationist phase of the Holocaust was the last phase. Before that, much had happened to lay the groundwork for the paroxysm of slaughter carried out during the last three years of the war.

After obtaining power in January 1933, Hitler wasted little time in carrying out his designs on the Jews and others he viewed as threats to his new order. Within a few months after taking power, the Nazis constructed the first concentration camp Dachau. On April 1, Hitler called for a boycott of Jewish businesses, and storm troopers were placed in front of Jewish shops, to discourage any who might decide to defy the boycott. Six days later, "The Law of the Restoration of the Civil Service" was introduced, which barred "non-Aryans" from civil service positions. All Jews in the civil service immediately lost their jobs. Later that month, Jews were prohibited from serving as doctors in state-run insurance institutions or as patent lawyers, and a law placed tight limits on the number of Jews who would be permitted to enroll to public schools. On May 10, the first massive burning of books by "Jewish intellectuals" was held. By October, the Civil Service law had been made stricter, so that spouses of non-Aryans could no longer work for the government; Jews had been banned from all cultural and entertainment activities; and all Jewish newspapers had been placed under Nazi control.

In September 1935, the Nuremberg Race Laws were passed. The first of these, the Reich Citizenship Law, stripped Jews of their German citizenship and made "subjects" of the Reich. The second Nuremberg Law, the Law for the Protection of German Blood and German Honor, forbade intermarriage between Jews and Germans, outlawed sexual relations between Germans and Jews, prohibited Jews from employing Germans under the age of 45 in their household, and denied Jews the right to fly the German flag.

By November 1938, Jews had no rights in the Reich and had been under steadily increasing restrictions and degradation. They were no longer allowed to work for the government or practice in government institutions and could no longer marry non-Jews. They could not participate in the arts or even go to shows. They were banned from many professional occupations, including being accountants, teachers, or dentists and had to carry special identity cards, as well as register all their business, wealth, and property with the government. Jewish doctors could no longer practice.

It was against this backdrop that Kristallnacht (the Night of Broken Glass) occurred.

In the months leading up to Kristallnacht, the Polish government, in a desperate attempt to stem the tide of Jewish refugees fleeing Austria in the wake of the Anschluss in March 1938, rendered stateless thousands of Poles living abroad, including 50,000 Polish Jews living in Germany. If the plight of German Jews was bleak, the plight of foreign Jews in the Third Reich was even bleaker, if that could be imagined. In October, Nazi authorities rounded up 17,000 Polish Jews violently and forced them to the border, where the Poles refused to admit them, leaving them stranded in a no-man's-land between the two nations. The deportees included the family of Herschel Grynszpan, a 17-year-old Polish Jew who was living alone in Paris. He sought an audience with the German ambassador on November 7, but was referred to a lesser official, Ernst vom Rath, whom he shot five times.

The Nazi propagandists seized on this shooting, labeling it the product of an "international Jewish conspiracy," even though vom Rath was a lukewarm Nazi at best. Schemes to "punish" the Jews with a retaliatory tax were revived. vom Rath managed to hang on for two days. He finally died of his wounds on November 9, which, by perhaps the worst stroke of luck imaginable, happened to coincide with one of the "holiest of holy" days on the Nazi calendar, the 15th anniversary of the failed Beer Hall Putsch in Munich in 1923. By 1938, November 8 and 9 had developed into a two-day event of myth-making and commemoration of those who had died in the botched attempt to take over the government. It was Hitler's custom to give a speech each year at Bürgerbräukeller and then march with blood-stained flags to the graves of the dead. Against this backdrop, vom Rath's death was bound to stir up passions. Already, there had been reported attacks on synagogues and businesses, as well as assaults on Jews. It would not take much to provoke a pogrom.

And provoke one Goebbels did, with Hitler's tacit approval: "The SA should be allowed to have a fling." Later that evening, Goebbels delivered a fiery anti-Semitic tirade with a call for vengeance against the Jews, after which the assembled Party and SA made a flurry of phone calls to local Nazi leaders with instructions. Stormtroopers were to incite the outrage of crowds, and local law enforcement officials were instructed not to intervene, except to save German life or property. Orders were given that, while Jewish shops and homes could be destroyed, that looting would not be permitted (mainly because the Nazis intended to seize the property after the pogrom was over).

As these calls were being made, all over Germany, mass violence against Jews, synagogues, and Jewish businesses erupted, spurred on by the SA and local Gauleiters. An estimated 7,500 business were damaged or destroyed. In some cases, Jewish men were murdered in their own homes in front of their wives and children. Looting was widespread, despite the orders. In some places, Jews were publicly humiliated by being forced to walk over their prayer shawls; to sing the Nazi Horst Wessel song; or to read passages from Mein Kampf aloud. In Beuthen in Upper Silesia, Jews were made to stand for hours in front of their burning synagogues The pogrom and a wave of arrests of Jews continued throughout Germany and Austria and in some places didn't peter out in some parts of Austria until as late as November 13. There were at least 91 deaths, and it was estimated that 680 Jews committed suicide in Austria in the wake of this pogrom. In its aftermath, the Nazis intensified their efforts to pressure Jews to emigrate, and Hermann Goering imposed a fine of one billion Reichsmark on the Jews of Germany--a final insult.

The pogrom provoked disgust among other nations, with intense and vocal criticism from abroad directed at the Nazi regime. Indeed, significant numbers of Germans also viewed the pogrom with disgust, particularly (but not limited to) Catholics, who viewed Nazi racial anti-Semitism as being of a piece with Nazi anticlericalism and neopaganism. Indeed, in December, a Protestnant pastor named Eric Klapproth even went so far as to write a letter to Hitler, Goering, and Goebbels, in which he said, in part:

The events that occurred amongst our people on and after November 9 of this year force me to take a clear stand. Far be it from me to disregard the sins that many member of the Jewish people have committed against our Fatherland...and far be it from me to deny the right of orderly and moderate proceedings against the Jewish race. But not only will I on no account justify the numerous excesses against Jewry that took place on or after Nov. 9 of this year (it is unnecessary to go into details) but I reject them deeply ashamed, as they are a blot on the good name of Germans...I, as a Christian Protestant, have no doubt that carrying out and tolerance of such reprisals will evoke the wrath of God against our people and the Fatherland, as sure as there is a God in heaven. (From: Michael Burleigh, The Third Reich: A New History)

Klapproth was not alone, although he was clearly far braver than most. The liberal middle classes also voiced distaste for the pogrom, mostly quietly, but unmistakably. Reactions were formed by many factors, including common decency, humanitarianism, Christian values, and fear of the vile example being given to the young, who made up the bulk of the gangs partaking of the violence. One consequence of this popular disapproval of the pogrom is that the Nazis discovered that, although they had satisfied the bloodlust of their hardcore followers, the majority of Germans were profoundly uncomfortable with such open displays of violence, despite the intensity of anti-Semitism prevalent in the nation. It also disturbed Germans that such barbarism and murder could occur in their civilized country and the government appeared to have so little regard for private property. The Nazis' reaction to criticism from abroad, in contrast, was full of bravado: "We have become immune to any increase in the great screaming of world Jewry."

However full of bravado they were, however, the Nazis were not stupid. They realized that excessive open violence and perception of lawlessness could hurt their standing with Germans. Consequently, they reverted back to legalized forms of persecution, rather than mass violence, at least in the short term. However, through this orgiastic and spasmodic outpouring of mass violence against its perceived deadliest enemy, the regime had become further radicalized. Economic separation of Jews and Germans was no longer enough. From this point on, in Germany proper at least, the Nazis conducted mass violence against Jews more quietly or even in secret.

The seeds for what would come later had been sown.

Skeptics' Circle reminder: Save Matt from himself!

I fear for Matt, proprietor of Pooflingers Anonymous and the host of this week's Skeptics' Circle.

First, Matt subjected himself to a Kent Hovind video a week for twelve weeks and then debunked the creationist looniness of each one in a painstaking deconstruction of Hovind's antiscience that he aptly named The Hovind Files: Lying for Jesus. Such was the amazing stupidity of those videos that Matt had PZ Myers and me offering sympathy for (and wonder at) his willingness to subject himself to such severe mental abuse for the cause of skepticism. As I said before, I could feel my neurons dying after just a short exposure to Hovind's blather. I still have no idea how Matt pulled it off.

Now, not content to rest on his laurels, yesterday Matt announced that he has acquired a copy of The Evolution Cruncher, a 900-page young earth creationist book that purports to "crunch" all the arguments for evolution:

The point is: the book made it into my collection and the time has come for another creationist material review session. I will not be writing a blow-by-blow account of the entire work as I did during the Hovind video reviews; there are over nine-hundred pages to the book and most of the arguments would simply be a rewrite of things covered both here and elsewhere. I have, however, noticed upon a cursory inspection of the book a number of arguments against evolution not commonly found. It is these that I intend to tackle...

At least he's learned some moderation. If he were to do a blow-by-blow deconstruction of the entire work, I would fear that it might destroy what's left of his skeptical skills after the Hovind experience. If you want to get an idea of what Matt's put himself up against, I've found the Cruncher's Table of Contents, along with what seems to be links to large excerpts from the book. This rapidly me to a bunch of painful-to-read creationist quote-mining and canards, such as this one, which caught my interest after a brief perusal of a page or two:

Hiroshima (1945), is an evolutionist’s paradise; for it is filled with people heavily irradiated, which—according to evolutionary mutation theory—should be able to produce children which are new, different, and a more exalted species. But this has not happened. Only injury and death resulted from the August 6, 1945, nuclear explosion. Mutations are always harmful and frequently lethal within a generation or two (*Animal Species and Evolution, p. 170, *H.J. Muller, Time, November 11, 1946, p. 38).

This is, of course, a misunderstanding of evolution. First off, most mutations are neutral; because so much of our DNA does not code for any genes (the misnamed "junk DNA"), most mutations occur in DNA where they will not cause a change in any encoded protein. Many mutations that do occur in a coding region similarly result in no change in a functional protein because of the redundancy of the genetic code. Second, it's either a mistake or a lie to claim that mutations are "always harmful." There are beneficial mutations that have been reported. Finally, evolution works over generations. Increased mutation rates due to radiation are indeed harmful in the short term, because most mutations are not beneficial, much less producing "new" or "exalted" traits.. The above is also an example of creationist quote-mining and taking quotes out of context. H. J. Muller believed that evolution is a valid theory, although he turned out to be incorrect about the vast majority of mutations being harmful.

As you can see, 900 pages of such concentrated distortions could be harmful to Matt. It might even impair his ability to be a properly skeptical host. Yes, I know that he proved his mettle wrestling with Hovind's nonsense, but one shouldn't tempt fate too much. That's why I'm worried and plead with Matt:

Stop right now! Don't read another word of this book. You're the host of the Skeptics' Circle this week. I need your mind intact--at least until this Thursday. I can't take the risk that even a small exposure to such concentrated IDiocy might render your skeptical faculties incapable of doing the job you have before you this week!

As a means of distracting Matt from his chosen task (at least until after Thursday), I'm imploring everyone to bury him with submissions to the Skeptics' Circle before the Wednesday night deadline! Keep him so busy reading submissions and putting the Circle together that he doesn't have time to turn his attention to The Evolution Cruncher until next week. Good skeptical blogging may even have the salutary effect of inoculating Matt against the credulity he is about to willingly expose himself to.

At least I hope it will. I'm actually rather interested in finding out about less commonly used creationist arguments against evolution, and, unlike Matt, I don't have the fortitude to read 900+ pages of creationist drivel to find them.

Grand Rounds Vol. 2, No. 7

Grand Rounds Vol. 2, No. 7 has been posted at MSSP Nexus Blog. Time for the Tuesday ritual of immersing oneself in the best the medical blogosphere has to offer.

Could EneMan have some competition?

Regulars around here are familiar with EneMan, who first appeared because he was a most bizarre example of strange stuff that doctors get from pharmaceutical representatives.

Well, via a comment (hat tip to Pharmagossip) posted after one of the Colon Crusader's appearances, I've learned that EneMan has some competition--and that competition also ran the New York City Marathon last weekend!

Are you ready for Mr. Testicles?

Neither am I, but apparently the U.K. is.

I suspect that EneMan's position is secure, at least as far as pharmaceutical company mascots go. As far as strange medical mascots, though, it looks like a real race.

RINO Sightings

The latest edition of RINO Sightings has been posted at Tinkerty Tonk. They're raging, as always...

The Art of Medicine in Ancient Egypt

Over the weekend, I visited the Metropolitan Museum of Art. My wife and I were interested primarily in two exhibits: Vincent Van Gogh: The Drawings and The Art of Medicine in Ancient Egypt. As you might expect, my wife was more interested in the Van Gogh exhibit, and I was more interested in the Egyptian exhibit.

I will admit that the Van Gogh exhibit impressed me quite a bit. Art near-illiterate that I am, I had had no idea that Van Gogh, whom I had usually associated with imaginative and bright paintings, such as the famous Sunflowers or The Starry Night was also highly accomplished at drawing. Yet, gallery after gallery of Van Gogh's drawings showed me how little I knew about this master. The drawings included in the exhibit, some of which were paired with paintings derived from the drawings, were a revelation, and even the self-important woman who tried to lecture my wife on the exhibit could not mar the experience. If you live near New York or will be in New York before December 31, I highly recommend that you check this exhibit out.

The Egyptian exhibit was far more modest in scale, being contained in one relatively small gallery. However, to me, it was probably more interesting because of the centerpiece of the exhibit, the Edwin Smith Papyrus. This papyrus was named after the American Egyptologist who purchased it in Luxor in 1862 and brought it back to the U.S. The papyrus dates to approximately 1600 B.C. and appears to be a copy of a document that dates back 200-300 years earlier still. What fascinated me is that this papyrus was a practical guide to the treatment of various ailments and embodied the medical thinking of Egyptian physicians of the time. Even more fascinating is that the knowledge contained in the scroll was presented as several cases. Most of the cases were, as might be expected, how to deal with traumatic wounds. There are also included eight magic spells purported to protect against airborne disease, but there is also one for preventing harm from an accidentally swallowed fly. Showing that some things never change, there were also two prescription for cosmetic purposes, one of which was for an ointment to combat a head cold, as well as for "rejuvenation of the skin and repelling of wrinkles, any age spots, any sign of old age, and any fever that may be in the body."

And you wonder where alties got their ideas from.

Actually, reading the translations for some of the remedies filled me with wonder. Remember: The ancient Egyptians had no idea what caused most diseases (which is probably why a lot of this papyrus dealt with trauma, which had a mechanical cause and mostly mechanical treatments). They had no concept of bacteria, only a very rudimentary idea of the circulatory system, knowing only that it originated in the heart, but having no real idea what its purpose was. Diseases were ascribed to the malign influence of various gods and magic, and physicians were often also priests, usually Sekhmet or Imhotep (Greeks equated Imhotep with their own god of medicine, Asklepios). Because Egyptian physicians were both medical doctors and priests, their treatments often combined the practical and the magical.

However, reading some of these cases was quite instructive. The papyrus presents the cases in terms of diagnosis and practical treatment, dividing the conditions into three categories: "An ailment I will handle" (meaning there was a practical treatment available); "an ailment I will fight with" (for ailments for which the treatment and outcome was less certain); and "an ailment for which nothing is done" (for ailments for which no treatment is known). For ailments falling in the first two categories, the papyrus provides a description of the recommended treatment. Take these two cases, one of a head wound with skull damage (case 3) or a head wound with damage to the plates of the skull (case 4):

Case 3. A head wound with skull damage.

Title: Practices for a gaping wound in his head which has penetrated to the bone and violated his skull.

Examination and prognosis: If you treat a man for a gaping wound in his head, which has penetrated to the bone and violated his skull, you have to probe his wound. Should you find him uunable to look at his arms and his chest and suffering from stiffness in his neck, then you say about him: "One who has a gaping wound in the head, which has penetrated to the bone and violated his skull, who suffers from stiffness in his neck: an ailment I will handle."

Treatment: After you stitch him, you have to put fresh meat the first day on his wound. You should not bandage him. He is to be put down on his bead until th etime of his injury passes, and you should treat him afterward with an oil and honey dressing eery day until he gets well.

This sounds like a description of a serious gaping scalp laceration without an underlying skull fracture, and the treatment here is not all that different than what we'd do today (the raw meat and oil and honey dressings excepted, of course). Contrast this to s more serious head wound:

Case 4. A head wound with damage to the plates of the skull.

Title: Practices for a gaping would in his head, which has penetrated to the bone and split his skull.

Examination and prognosis: If you treat a man for a gaping wound in his head, which has penetrated to the bone and split his skull, you have to probe the wound. Should you find something hter uneven under your fingers, should he be very much in pain at it, and should the swelling that is on it be high, while he bleeds from his nostrils and his ears, suffers stiffness in his neck, and is unable to look at his arms and chest, then you say about him: "One who has a gaping wound in his head, which has penetrated to the bone and split his skull, while he bleeds from his notsrilsa nd his ehars and suffers stiffness in the neck: an ailment I will fight with."

Treatment: Since you find that man with his skull split, you should not bandage him. He is to be put down on his bead until the time of his injury passes. Sitting is his treatment, with two supports of brick made for him, until you learn that he arrives at a turning point. ou have to put oil on his head and soften his neck and shoulders with it. You should do likewise for any man you find with his skull split.

Explanations: As for "which has split his skull," it is the pushing away of one plate of his skull from the other, while the pieces stayin in the flesh of his head and do not fall down. As for "the swelling on it is high," it means that the bloating that is on the split is great and lifted upward." As for "you learn that he arrives at a turning point, " it is to say that you learn that he will die or until he has revived, since it is an "ailment I will fight with."

This is a startlingly good description of a head injury with a skull fracture (probably a basilar skull fracture, given the bleeding from the ears), and the examination is not too different from what is done in the trauma bay today: Probe the wound and see if you can feel any fractures. Also surprisingly accurate is the observation that "sitting is his treatment." Elevated intracranial pressure can occur with fractures of this sort, and keeping the head elevated is one way to minimize the rise in intracranial pressure. Indeed, even today, we often keep head-injured patients in a partial sitting position to try to minimize the tendency to intracranial pressure to rise. Of course, we now have CT scans and MRIs to delineate the full extent of the injury and intracranial pressure monitors to determine the extent of the brain selling. We also have hyperventilation and mannitol as adjuncts to try to lower intracranial pressure, and, if they fail, there is always the last resort of the phenobarbital-induced coma. However, given the primitive resources available to ancient Egyptian doctors, it is impressive indeed that they were able to figure out that sitting the patient upright would be helpful for this sort of injury.

I just love this sort of exhibit, as it lets me indulge my interest in both medicine and history. You know, since I happened to have purchased the exhibit book, which contains the complete translations of all the cases in the papyrus, I might have to make this a recurring series, in which I discuss some of the more interesting cases. Maybe later this week...

Can you tell me how to get...

...how to get to Schwarzenegger Street?

The Governator as Ernie? I'm not so sure about that one, but it is pretty funny.

iPorn and iHate?

In the same vein as yesterday's post, I came across this story this morning:

SAN FRANCISCO - Purveyors of porn and entrepreneurs who spied a niche when Apple Computer Inc. unveiled its video-playing iPod are proving that sex even sells in tiny packages — especially when it is portable.

One online social network of amateur pinup girls said it logged 500,000 downloads of the sexy "featurettes" — three- to five-minute video clips — in the first 24 hours targeting the new iPod-toting crowd.

It's a no-brainer: pornography to go.

The naughtiness is already finding its way into video handhelds through business models tried-and-true — along with some new ones — as the adult entertainment industry works to untether video content.

Soon enough, skin flicks whose viewing has been largely restricted to the privacy of homes and theaters could be on view in the open public of parks and mass transit, for all ages to see.

Ah, yes, as Adam Curry predicted days before the video iPod was even released, it didn't take long for the porn industry to see the opportunity for porn-to-go that the new video iPod represents:

Adam Curry, president of PodShow Inc., said this week's announcement of the new video iPod from Apple Computer (AAPL: 61.15, -0.70, -1.1%) sets the stage for more big changes in media.

"Porn is just going to be huge," he told listeners to his Daily Source Code podcast this week. "The porn guys are just going, 'holy moly,' " -- in gratitude for the new market that's opened up to them.

But adult material is only one facet of new commercial opportunities, that Curry foresees. As an example, he said that "video dating should happen. A video dating feed. That's also a form of podcasting."

Unfortunately, it does make sense, because it was pornography that drove the growth of video sales after the advent of VCRs (most non-porn video was rented, not purchased), and clearly porn was a major factor in the development of online transactions and secure mechanisms for making credit card purchases over the web as more and more people started using the Internet. I'm not looking forward to being on the train or on a plane and having someone next to me watching porn on his iPod. Yes, I know I can ignore it, but you know that there will be some idiots who insist on watching it where kids can see it. The only redeeming grace is that the screen is so small.

While it's not so surprising (at least not to anyone aware of the history of video and the web) that the porn industry would embrace the new video iPod so fast what did surprise me is that porn providers are not the only dubious content providers getting in on the act. Hate groups and white supremacist music providers are now providing content for the video iPod. Remember a while back, when I mentioned Prussian Blue, the cute perky 13-year-old blonde twins who are happy to model Hitler T-shirts and whose racist and white nationalist songs have made them the darlings of the white power movement? Well, it turns out that they're selling iTunes/iPod-compatible videos for their racist songs for $1.99 each on their website.

As much as I love my iPod (4th generation, 60 GB), without a significant increase in storage space beyond 60 GB, there's no compelling reason for me to consider a video iPod. Yes, they're smaller and have a much nicer screen, but I remain skeptical of how much I would want to listen watch pre-recorded video on the go. Even so, it's still rather disheartening to think that, if the new video iPod does catch on and become a hit, prominent early "trailblazers" who jumped on the bandwagon early will have been pornographers and white supremacists.

Which dictator would Orac have been?

Boring.

However, compared to the way many dictators meet their well-deserved ends, I suppose not as horrible as the result could have been (Orac as Hitler or Stalin, for instance), and, although he was a serious authoritarian who let ex-Nazis hide in his country, including Josef Mengele. Given how much I loath Nazi-ism, getting this result is still disturbing...

Alfredo Stroessner You scored 0 Ego and 2 Ideology!

As you might've guessed, General Alfredo Stroessner's (1912- ) father was a German emigrant to Paraguay. The workaholic Stroessner overthrew Paraguay's civilian government in 1954 and began work on a sort of low-calorie fascism, throwing money into massive construction projects, battling with the Church, handing out parcels of land to military veterans, and providing refuge to escaped Nazis. He was less brutal than most of his contemporaries, and Paraguay's economy benefitted from his efforts, but the people grew tired of him and he was overthrown in 1989. As of this writing, the old bat is still alive and retired in Brazil. Don't take this the wrong way, but you and Stroessner just aren't very, well, interesting. No torchlit rallies, no enormous statues, no threats of war, no daring political power plays. Just solid, predictable policy. But remember, the nail that sticks its head out is the first to get hammered. Stroessner knew this, and hung around for 35 years. That's plenty of time for you to redecorate the Presidential Palace to your liking.

My test tracked 2 variables How you compared to other people your age and gender: You scored higher than 81% on Ego You scored higher than 90% on Ideology

Link: The Which Evil Dictator Are You? Test written by echopapa on Ok Cupid, home of the 32-Type Dating Test

Brief Friday Mac rant

Things like this irritate the hell out of me. I realize it's rather old news, having been announced last spring, but it's become relevant again because the December 1 implementation date is rapidly approaching. No, what irritates me not that the government is now requiring electronic submission for all NIH grant applications. The Army, for instance, has required electronic submission for years, and I've submitted several grant applications. No, it's this part:

For PureEdge Viewer to function properly, your computer must meet the following system requirements:

Windows 98, ME, NT 4.0, 2000, XP
500 Mhz processor
128 MB of RAM
40 MB disk space
Web browser: Internet Explorer 5.01 or higher, Netscape Communicator 4.5 - 4.8, Netscape 6.1, 6.2, or 7

Notice anything missing?

That's right. No Macintosh client. Once again, Mac users get the shaft. So do Linux and Unix users. This might not be such a big deal if we were talking about a business environment, where Windows rules the roost and at least 95% of desktops are Wintel boxes. But it's a different story in science and academia, where the vast majority of federal grant applications originate. Where I work now, I'd guess that at least one-third to one-half of the researchers use Macs. In the basic science departments where I've worked, the number is probably even a little higher, with some Unix and Linux users thrown into the mix.

Even more annoying is this suggestion for Mac users that they use PC emulation software (Virtual PC being in essence the only game in town these days) to submit their grants. I've used Virtual PC. It's not a bad emulation. However, unless you happen to have the latest, greatest, biggest, baddest Mac, it's painfully slow. Also, there are problems with networking. For instance, with our new HIPAA-compliant network that's being implemented at our institution right now, I'm not so sure how well Virtual PC would work. I already know that it won't work to connect to the secure web server that some doctors use to access radiology images and reports remotely.

Gregory Cook, an Associate Professor of Chemistry at North Dakota State University hit the nail on the head in an open letter to his legislator and to the Department of Health and Human Services:

This system prohibits anyone who does not use the Microsoft Windows operating system from applying for federal research dollars. I am referring to the requirement of the grants.gov website to use proprietary forms software that will only run under Windows to submit a grant application. First, I think it is completely ridiculous to move to a system that does not have cross-platform access. The National Science Foundation has had electronic grant submissions in place using web-based forms and PDF-formated files for the last five years, and it has been performing at an excellent level. Second, this requires everyone who applies for a federal grant to purchase Microsoft Windows, and that is simply a ringing endorsement for the Microsoft corporation.

Amen, brother. I'd also point out that the NIH Loan Repayment Program and the U. S. Army have also used web-based systems for years now (although the Army requires submission through an institutional representative). However, based on And here's Dr. Cook's money quote:

The federal government should not endorse one computer operating environment to be used for anyone funded by federal agencies. All this does is provide a significant guaranteed market for the Microsoft corporation to install their operating system on all computers, not just PC’s. Ideally, I would like to see HHS/grants.gov develop an electronic grant submission system that does not rely on a single operating system. This should not be difficult, and many companies and agencies routinely use web-based forms and PDF documents.

Precisely. Worse, the government is going to force all its funding agencies to move over to this software:

The President's Management Agenda http://www.whitehouse.gov/omb/budget/fy2002/mgmt.pdf and Public Law 106-107 require all Federal Agencies to use a single electronic system to post funding opportunities and accept electronic applications for Federal grant opportunities. The Office of Management and Budget (OMB) has chosen Grants.gov to implement the President's Management Agenda and the Department of Health and Human Services to serve as the managing partner for Grants.gov. For additional information about Grants.gov and P.L. 106-107 go to http://grants.gov/AboutUs?campaignid=topnavtracking081105.

Given that the technology for electronic grant submissions has been in existence for several years now, unifying all the government granting agencies under one system certainly makes a lot of sense. It might even save some of the trees presently being slaughtered to print up multiple copies of voluminous grant applications--if the government doesn't just print up the same number of copies itself that it used to request from researchers (although I imagine that UPS, FedEx, and various other delivery services are probably not too happy about losing the business of all those researchers sending their applications in the day before the deadline). The conspiratorial side of me would like to blame this on the malign influence of Microsoft. Sadly (for my ability to launch into another rant, anyway), that's probably not the case. More likely, it's simply a product of the inherent Windows-centricity of the IT people charged with choosing a single system for grant application submission. They probably don't know a lot about how real scientists in the real world work and figure that, as with the government and most industry and corporate settings, the overwhelming majority use Windows-based machines. Combine this tunnel vision with the natural tendency of government bureaucracies to adopt one-size-fits-all solutions for all its agencies, and this sort of fiasco is the result.

The government claims that it will have a platform-independent solution by November 2006, although other sources indicate that it may not be until spring 2007 or even later. Why so long? (I was planning on submitting at least a couple of grant applications between now and next November; so unfortunately I guess I'm going to have to deal with this mess.) Why should investigators who don't use Windows, a significant percentage of scientists, be forced to use a cobbled-together solution such as using Virtual PC, which isn't cheap? And what about Linux and Unix users? To me it seems like a monumental screw-up not to have simply developed a web-based submission system from the very start.

A little blog housekeeping

Lately, I've been getting hostile comments posted to old posts, dating from June or earlier. Some appear to be outright trolls, and others are just hostile. I rather suspect that such commenters are trying to have the "last word" on various topics about which they disagree with me strenuously, particularly mercury and autism. Given that few people will be likely to be reading these posts or these comments in the future (blogs being a very "in the now" sort of medium, with few people reading posts more than a few weeks old), it hardly seems worth my time to answer them. On the other hand, I don't necessarily want to let obvious trolls have the last word. Consequently, I'm going to begin closing posts older than two months to any new comments. It will take a while to work my way through old posts.

Mourn for Katie Wernecke...

...because it looks like she's doomed.

After I wrote about this unfortunate child yesterday, I was informed that parents have won full custody, and plan on taking her to Kansas as soon as possible for Vitamin C "therapy":

CORPUS CHRISTI — Parents who have been fighting state officials over their 13-year-old daughter's cancer care can make all her medical decisions, a judge ruled today, officially ending a long and widely watched battle.

State District Judge Jack Hunter dismissed the Texas Department of Family and Protective Services from Katie Wernecke's case Monday. But until today he had yet to sign an official order and clarify what treatment at M.D. Anderson Cancer Center in Houston would be completed before the family could pursue an alternative treatment they prefer.

Hunter's ruling said Katie must complete her current round of chemotherapy and be stable to travel, which could happen by the end of the week.

Children's Protective Services spokesman Aaron Reed said the state would respect the judge's ruling.

"I think we all understand that this has been a very emotionally charged case," he said. "We just have different opinions as to what is best for her."

CPS took custody of Katie in June after a doctor told social workers her parents were risking her life by refusing treatment. She has been living with a foster family and attending school at the hospital.

Katie's father, Edward Wernecke, said he wants to take his daughter to the Bright Spot for Health clinic in Wichita, Kan., which offers intravenous vitamin C. Wernecke hopes the vitamin will kill the cancer and strengthen her immune system.

"We'll get her as soon as the doctors say it's OK, hopefully Friday or Saturday," he said. "We're going right to Kansas."

I suppose it could be argued that, because, thanks to her parents' intransigence, Katie's odds of survival are so poor anyway, she might as well spend her remaining time with the family who loves her, rather than being forced to spend her limited time remaining in a foster home that she hates. I can't think of any other reasonable rationale for the judge's decision in this case. Particularly jaw-dropping is this quote:

Peter Johnston of the Texas Center for Family Rights said he was elated by the decision.

"The most intimate decisions are best made by the parents except in cases of serious neglect, where they're not doing anything," Johnston said.

The parents were preventing Katie from receiving life-saving therapy for her cancer! If that's not "serious neglect," I don't know what is. It doesn't matter that they think they're doing the best thing for their daughter. The end result is the same.

Katie's only hope is that the chemotherapy she has received thus far is adequate to save her. However, without high dose chemotherapy and stem cell transplantation, her odds have dropped even more, because intravenous vitamin C is useless for treating cancer. Multiple studies from the 1970's and 1980's show that it does no better than placebo, and there is certainly no evidence that it will kill the cancer or "strengthen her immune system" (an all-purpose altie claim that means nothing). And check out the website for this Bright Spot for Health clinic. It's a veritable cornucopia of altie nonsense:

At The Center, we are specialists in certain alternative approaches. These include, but are not limited to, nutritional medicine, ear and body acupuncture, detecting and removing excessive amounts of heavy metals from the body, detecting adverse food reactions and hidden parasites, therapeutic massage, and techniques of mental medicine which positively impact psychoneuroimmunology.

They also seem to be big on "orthomolecular medicine," the concept that Nobel Prize winner Linus Pauling sullied his legacy by associating himself with it in his later years. The vast majority of the "scientific" articles cited on the website come from the Journal of Orthomolecular Medicine, and the rest do not address the question of whether vitamin C actually does anything to treat cancer in actual living human beings. They do, however, sure look impressive to a non-scientist or non-physician.

As was pointed out in the comments yesterday and as I pointed out very early in this blog's history and then multiple times after, if alties survive cancer (or any other horrible disease) after taking conventional treatments and then alternative medicine, they will almost always credit the alternative medicine and not the previous conventional treatment. If by some miracle Katie beats the odds (which have just gotten a whole lot longer) and survives her cancer recurrence, you can bet that she and her parents won't attribute her survival to the conventional therapy that she has received thus far. They will attribute it to the vitamin C and prayer, not to mention her parent's "courageous battle" against the state to allow them to give her intravenous vitamin C. She will become a testimonial.

For her sake, I hope she does become a testimonial.

Unfortunately for this unlucky child, it is far more likely that she will soon become a cancer mortality statistic.

Birthday wishes

I'd like to take this opportunity to wish my wife a happy birthday today! Somehow, year after year, she still manages to put up with me. How I don't know. She even appears here on occasion to comment...

Tangled Bank #40

The latest Tangled Bank has been posted. This time, the host is a fellow medblogger, Dr. Charles of the excellent blog The Examining Room of Dr. Charles. Show a fellow medblogger some love and check out the best science blogging of the last fortnight!

Misguided faith in alternative medicine endangers a child yet again

I hadn't planned on starting a theme, but I recently learned of yet another story of what happens when parents insist on giving their children worthless and unproven treatments, such that it inspired the blogger from whom I discovered the story to ask, "Is it my imagination, or are these stories of parents fighting to pursue potentially worthless therapies for kids with life-threatening illnesses increasing in frequency?" I certainly hope his perception is not correct, but I can't be sure, as I haven't been closely paying attention to such stories for that long.

This particular story concerns a 13-year-old cancer patient named Katie Wernecke, who was diagnosed with Hodgkin's lymphoma in January and whose parents have been fighting with the state to let them take her to Kansas to receive intravenous vitamin C therapy. Ultimately, Katie was taken away from the parents by Child Protective Services when it was charged that the parents were interfering with her chemotherapy:

Katie was diagnosed in January with Hodgkin's disease, a cancer of the lymphatic system. By May, her parents believed chemotherapy had killed the tumor in her chest and feared the recommended radiation treatment would do her more harm than good.

After a doctor informed Child Protective Services that her parents were interfering with treatment, Michele Wernecke fled with Katie, prompting the state to take custody of the girl.

Katie has since been with a foster family in Houston and undergoing treatment.

In court Friday, Dr. Robert Wells, Katie's pediatric oncologist, said the chances the teen can beat the illness are now less than 25 percent because of the repeated delays. He said the alternative her parents want to try isn't a viable option.

Last week, after a four month legal battle, a compromise of sorts had apparently been reached:

The parents of a 13-year-old cancer patient who have been fighting the state over her medical treatment will be allowed to take her to Kansas to pursue intravenous Vitamin C treatment.

First, however, the girl must undergo five days of chemotherapy, state District Judge Jack Hunter, newly appointed to the case, ruled Friday.

The case was back in court after Katie Wernecke's parents tried to stop their daughter's chemotherapy that was to begin this weekend. They argued the treatment was experimental and that they had not been properly informed about it.

Two days ago, a judge ordered that Katie be placed in the custody of her parents, and presumably she will now receive the intravenous vitamin C, but at least she should receive her chemotherapy first. Unfortunately for Katie, intravenous high dose vitamin C does no good for advanced cancer (or cancer of any kind, for that matter), the claims of its advocates notwithstanding. Randomized double-blind trials testing whether high dose vitamin C can impact cancer progression and survival have been uniformly negative. This is an issue that was settled scientifically through clinical trials back in the 1980's, but for some reason it keeps rearing its ugly head periodically.

Katie's case is little different than the case I discussed the other day, where parents subject their child to a health regimen or treatment that is not in that child's best interest. Hodgkin's lymphoma in children, virtually a death sentence only a few decades ago, is now highly curable with chemotherapy and radiation, even though they are commonly diagnosed at an advanced stage. The standard treatment involves chemotherapy and low dose involved field radiation therapy (LD-IFRT), which involves 15-25 Gy administered to the involved region. Indeed, initially, oncologists estimated Katie's chances of long term survival to be around 80-85%, which is about typical for children with this particular cancer.

This is the spin on the story as told by the family on a blog they've set up, ostensibly written by Katie herself when she was diagnosed:

My doctor is named Dr. Alter and he asked my dad to come look at the results of the Cat Scan with him. It was then Dr. Alter told and showed my dad that I had a large mass under my breast bone chocking off the windpipe and the bronchial tubes to each lung were reduced to pencil size. The cancerous mass was also wrapped aroung the aorta and veins and my heart was being pushed way off to the left side. The doctor told him the Cat Scan looked like it my have spread to the lungs, liver, kidneys, and spleen too. It was Hodgkin's Disease - stage IV - which is the worse as it gets. It was very serious and I would have died had dad not brought me in to the hospital when he did. I wasn't told that at the time. I was told that I had Hodgkin's Disease a type of lymphatic cancer and that the doctor could make me better.

This is advanced stage. But, even so, it was still potentially quite curable, even more so given that, according to the family subsequent workup revealed that the tumor was actually all above the diaphragm:

I have another Cat Scan and a scan called a Gallium Scan. In this scan they inject radioactive gallium into your viens and it shows where the cancer is located. The cancer is still a very large mass under my breast bone. The good news is that it seems to all be located above the diaphram and the doctor changes the call from stage 4, the worse, to a stage 2b. That is the Power of Prayer!!!!. Thanks to all the hundreds of people praying for me. Dr. Alter explained to me and my Dad his treatment protocol. Dr Alter said I would get 2 chemo treatments plus radiation or I could get 4 chemo treatments only. If response to chemo was good after 2 treatments it would be followed by radiation if not we would get 2 more chemo treatments.

So that was the plan. Unfortunately, the family did not follow the full plan. As sometimes happens, Katie's parents appear to have been lulled into a false sense of security because the tumor showed such a good initial response to chemotherapy. In my practice, patients receiving neoadjuvant chemotherapy for breast cancer sometimes wonder if they need to have that mastectomy after all when the chemotherapy response is impressive, and it can sometimes be difficult to explain why they do still, in fact, need surgery. ("The tumor is gone! Why do you need to cut me?") There also seemed to be a large religious component in the parent's decision not to continue radiation therapy. Here is the family's description describing the excellent response of the tumor to chemotherapy:

To me that says there is no active cancer and the tumor is liquidifing. They said this is not normal or "atypical" for lymphoma unless the mass is entirely decomposing or dead. They don't understand it! For us we know that it was the "prayers and the power of God!"

Katie's doctors continued to recommend radiation because her cancer had been advanced at the time of diagnosis. It may also have had poor prognostic factors, but I am unable to determine this for sure. In any case, as can be seen in the quote above, the parents seemed to believe that prayer had saved Katie and from the tumor. Although elated that chemotherapy had appeared to destroy the tumor, the parents balked at the planned followup radiation therapy, fearing its long-term toxicity.

"Radiation's effects on a child are a lot different than they'd be on me," said Edward Wernecke, 53, Katie's father. "It could shape her whole future — make her sterile, stunt her growth, cause her to get breast cancer in her 20s. The effects would be with her the rest of her life."

Katie's parents' attitude also influenced Katie such that at one point she strenuously resisted doctors and her foster family, leading to a judge signing an order to cut off all contact. Katie has been quite adamant at times that she does not want treatment. Unfortunately, what many people (including Katie and her parents) fail to understand is that, even after an apparent complete response to chemotherapy, there are often still microscopic deposits of tumor left, even in the face of a negative PET scan and CT scans showing that the original tumor has seemed to have disappeared. Unfortunately, we do not yet have a test sensitive enough to detect these microscopic tumor deposits that would allow us to determine who does and doesn't need additional therapy, either in the form of surgery or, in cases like Katie's, radiation). Indeed, this is exactly what I tell patients who question why they still need surgery after an apparent complete response to chemotherapy.

Although we as physicians are obligated to be honest and straightforward about the potential benefits of a treatment weighed against its potential risks, such honesty sometimes produces unfortunate consequences, particularly if communication between doctor and patient is not optimal; if the patient has a pre-existing distrust of the medical profession; or has altie tendencies. Some patients (or parents) fixate on the potential complications of therapy and ignore its likely benefits, and I suspect that's what happened here. I also suspect that there may have been a failure of communication, as well. For example, in a blog entry, the family speaks as though the complications are inevitable:

The radiation would damage her lungs (cystic fribrosis), her heart muscle would be damaged, her breasts would be damaged and would likely develop breast cancer later, and her spinal column in her back would be damaged and she would not grow any taller and may have learning problems. Her thyroid and thymos glands would be damaged and she would have hormone problems.

Personally, if I were the parents, I'd gladly trade a risk of "stunted growth" and an increased (but still relatively small) chance of secondary malignancies 20-30 years down the road, especially when compared to the risk of the child dying from cancer now. No, I'm not minimizing the chances and seriousness of potential complications. Indeed, thirty years after treatment, 1/3 of survivors will have health problems that might be related to the treatment and all are at higher risk for miscarriages, sterility, and secondary malignancies. And, yes, there is a significant chance of pulmonary or cardiac damage from chest irradiation. Overall, such children have roughly a four-fold increased risk of having severe health problems attributable to their therapy. Nonetheless, these risks must be weighed against the chances of the tumor coming back and should be considered in the context of the history of the threatment of childhood tumors, where, a few decades ago, nearly all children suffering from such malignancies died from them. Also, studies show that the addition of radiation therapy to chemotherapy improves event-free survival (EFS, defined as survival without tumor recurrence). The question remaining is which subgroups can do without radiation, and in that area research is still ongoing. As the discussion on the NCI website states:

Overall survival of patients who receive chemotherapy alone may be similar to that for patients who receive both chemotherapy and LD-IFRT, despite a difference in EFS. This results from the ability to effectively salvage patients who relapse after initial therapy.[9,18,21] If this potential can be accomplished with relatively nontoxic salvage therapy, then initial treatment with less intense therapy may be appropriate. If, however, salvage therapy results in a substantial risk for late events such as cardiac failure or secondary malignancies, less intense initial therapy would be unwise [Emphasis mine.] Thus, it will be important to evaluate prognostic factors that may influence the magnitude of the EFS benefit that derives from the use of LD-IFRT in patients achieving a complete response to initial chemotherapy. In the German study, the benefit of radiation therapy was greater in patients with advanced-stage disease at presentation. Other potential prognostic factors may include histology, erythrocyte sedimentation rate, bulk disease, and presence of symptoms.

It is not entirely clear whether Katie achieved a complete response after chemotherapy. In their blog entries, the parents seem to claim that she did; I have been unable to verify this independently. Now, if Katie survives her relapse, it will definitely require extremely toxic therapy chemotherapy followed by stem cell transplantation, as well as radiation. If she beats the odds and survives, Katie will be at a much higher risk of suffering from the complications her father feared than if she had received her LD-IFRT in a timely fashion as recommended.

Finally, this case brings up a difficult issue leading to high emotions. People are, quite understandably, quite attached to their children, and even parents who make bad decisions almost always do so believing they are doing the best thing for their child. (To see an example, visit the comment thread in this post about the story, where the conversation starts out intense but generally civil and reasonable and then degenerates into ad hominems and smear tactics directed at Katie's doctors.) It is quite clear that competent adults should be allowed to do whatever they wish with their own bodies and that they should have the right to refuse treatment, even if it means their death. However, that right does not extend to endangering their children by refusing therapies proven to be effective, as children have no choice in their own therapies and are not considered competent to make their own decisions in these matters. Texas CPS had the obligation and duty to intervene. Although the therapeutic decisions in this case are admittedly more complex, when you boil it down, there is little difference between this case and a case of Jehovah's Witnesses refusing to allow their child to receive a life-saving blood transfusion or the parents I discussed who imposed a diet detrimental to their children's health. Worse, taking Katie to receive a useless therapy like intravenous vitamin C will only waste still more time.

ADDENDUM: A followup on this story is here.

EneMan branches out

Once again, it's the first of the month. Regulars around here knows that the first of the month traditionally means the return of everyone's favorite colon health crusader, that six-foot guy whose job you really woundn't want to have, even if you view his job as just dressing up in a truly embarrassing costume to sell enemas for colon preparation before various endoscopic procedures--never mind if he really does what he looks like he could do. (And, yes, Orac has met him at the Fleets Pharmaceuticals booth at an annual meeting of the American college of Surgeons.)

Yes, once again, it's time to Ask EneMan:

Dear EneMan:

I've heard about hyperbaric oxygen therapy. I'm told it's great for all sorts of things, including general health. Heck, the local station here even claims it's good for autism! I happen to have a cousin who's autistic. should I be talking to my aunt and uncle about this? What's the real scoop?--Signed, Heavily Oxygenated in Madison.

Dear Oxygenated:

Oh, my. This is outside of my area. As you know, I mainly deal with colon-related health. However, for you, my crack team of researchers did a little digging. It's obvious to me that hyperbaric oxygen (HO) is one of those altie therapies that has actual medical uses (usually for a limited number of conditions) but gets coopted as supposedly being great for everything, even for warding off the aging process. Never mind that prolonged exposure to HO would be more likely to cause premature aging, not ward it off, given the increased free radicals it would cause. Maybe that's part of the reason why Michael Jackson looks the way he does.

But I digress.

First off, let's get one thing straight. There's absolutely no good scientific evidence that HO does any good for autism. None. Nada. Zip. The whole idea behind HO is to treat diseases for which decreased blood flow or a low oxygenation is major part of the pathophysiology and for which higher oxygen tension might reasonably be thought to help. This also includes conditions for which high oxygen tension can displace a specific toxin from a binding site, like CO bound to hemoglobin. That means that HO is useful for nonhealing wounds, decompression sickness, severe anaerobic bacterial infections, necrotizing fasciitis (the "flesh-eating" bacterial infection), or carbon monoxide poisoning. [Orac note: That's where I had experience with this therapy during my residency: in the treatment of burn patients suffering from CO poisoning.] There's also evidence that it can be helpful in increasing the efficacy of radiation therapy in certain cancers, but only for head and neck tumors.

It's only marginally scientifically plausible that HO would be good for autism. In fact, some evidence in the literature suggests that increased oxidative stress may have relevance to the pathophysiology autism. If that is actually true, then HO might potentially even be harmful to autistics. (Certainly the known possibility of neurotoxicity from HO should give any parent contemplating this therapy for autism pause.) However, there are also studies that suggest decreases in regional cerebral bloodflow in autistics, but the significance of these findings are unclear. Even if these results are consistent and confirmed, it does not necessarily follow that hyperbaric oxygen will do anything to reverse the pathophysiology. In any case, my team looked and looked and couldn't find one trial, one scientific paper, or one bit of convincing evidence that it does anything. Only testimonials. A PubMed search on "hyperbaric oxygen" and "autism" fails to turn up a single hit. They also couldn't find any evidence that HO can reduce the effects of aging, either. Sorry Michael.

Of course, that doesn't stop alties from expanding the number of conditions way beyond the acepted indications for HO to include conditions which there is at present no good evidence for its efficacy, such as cerebral palsy, stroke, multiple sclerosis, post-head injury syndromes, coronary artery disease, migraines, stroke, cancer, HIV, fibromyalgia, autism, and Crohn's disease (finally, a disease up my alley!), among others. For diseases for which preclinical data suggests that HO might help, HO can at best be considered experimental and should not be used outside of clinical trials. For diseases for which there is no such data, then it shouldn't even be considered. Of course, you will hear testimonials otherwise, but remember that testimonials generally exist to sell a product.

Does the above list sound familiar to you? It should. It's the same sort of list of diseases with unrelated pathophysiology that alties claim that chelation therapy, for instance, can treat. Indeed, as a general rule of thumb, it's a sign of dubious medicine at best and quackery at worst when you hear a practitioner claim that a single therapy has efficacy in treating a wide variety of diseases whose pathophysiologies are unrelated. You find exactly the same sort of list (albeit including a different, but overlapping, variety of diseases) touted by advocates of chelation therapy, which, if we are to believe its advocates, can treat heart disease, autism, cancer, hypertension, osteoporosis, skin ulcers, Alzheimer's disease, and many others.

Worse, hyperbaric oxygen is not without complications. The main complications are related to oxygen toxicity, and the two organs most affected are the lungs and the central nervous system. Any doctor who's taken care of ICU patients knows that 100% oxygen is toxic to the lungs, and that when positive end-expiratory pressure (PEEP) is added it's even more toxic. That's why we try very hard to get the inspired oxygen concentration below 50% as quickly as possible in our ventilated patients. Pulmonary oxygen toxicity can occur with as little as 16 hours of exposure. CNS toxicity in the form of convulsions is also possible. True, these complications are considerably less likely if exposure to high partial pressures of oxygen is relatively brief and transient, but they are still possible, given that most HO regimens require many repeat treatments. Why expose yourself to even relatively small risks for a therapy that isn't effective for the condition being treated?

And let's not forget that HO is rather expensive. It's generally $100-500 per treatment, and, as is the case for chelation therapy, many treatments are usually recommended. To me, this sounds like a lot of money for little or no benefit, except for a relatively limited number of diseases and conditions.

Gee. This is fun. I get bored only discussing colon health and debunking all the alties out there who like to purge their colons for no good reason. Maybe I should make a habit of this. In the meantime, it's November, which means that Thanksgiving will soon be here!

November 2002

November 2004

November 2005

And, as always, here is a list of all the past appearances of EneMan, for those of you new to the phenomenon:

October 2005
September 2005
August 2005
July 2005
June 2005
May 2005
April 2005
March 2005
February 2005
January 2005
EneMan's first appearance (December 2004)

Carnival barking

Grand Rounds, Vol. 2, No. 6 has been posted at Kidney Notes for all you medblogging afficianados out there.

For those who like their blogging a little more slimy, Snail's Tales has your menu.