Important announcement

I've been dropping vague and ominous-sounding hints about this for the last couple of weeks, but it's more or less official now: Big changes are coming to Respectful Insolence. Don't worry; they're not bad changes. Quite the contrary, in fact, I'm hoping they'll be great changes.

It began back in November, when Christopher Mims of Seed Magazine asked me if I would be interested in joining a new project, a conglomeration of science bloggers (now known as ScienceBlogs). The idea intrigued me, but I was hesitant. No, I wasn't hesitant because I didn't think it was a good idea. I had been planning on moving to different host and using a different blogging platform sometime during the next few months, anyway. Heck, to be able to move to a better blogging platform for free, to be free of having to worry about the costs of hosting, and even to get paid a little bit to blog represented an opportunity that was very tempting right from the beginning, especially since his reassurances that he didn't want me to change a thing seemed sincere and I would not have to sign away all the rights to my work. I think the guys at Seed "get it," as evidenced by how well the first group of blogs have done after moving over.

Unfortunately, I was concerned about my university's reporting requirements for outside income. Given the modest amount of income offered from the advertising, at the time I wasn't sure it was even worth the effort to jump through the necessary hoops to get permission. (This was the reason I never tried signing up for Google Adsense--that and the fact that altie ads frequently pop up on other medical blogs that do use Google Adsense, and I didn't want them showing up on mine.) Then the holidays came, and other things intruded. ScienceBlogs.com launched a couple of weeks ago, and I realized that I had blown it. I had missed out on the opportunity to be in on the ground floor of something that could turn out to be great. Fortunately, Seed Magazine still wanted me; so I took advantage of the opportunity to correct my mistake and seize this opportunity to reach a wider audience. I jumped through the hoops my university set before me and finally got permission late last week.

I will likely be moving over to the new host sometime in the next two or three weeks, depending on when Seed is ready to help me get set up. (Hopefully it won't be much longer than that.) Another announcement will be made when the change is imminent, and the new link will be announced on the day of the transition. As I mentioned before, to ease the transition, I registered the domain respectfulinsolence.net and had it redirected to this blog. I will set it to redirect traffic to the new blog URL after I officially make the jump.

My plan for now will be to continue as I have done for the last 13 months. After the transition, I will leave the Blogspot blog up as an archive and a place to post occasional announcements (not to mention as a safety net in case I fail). It's not going anywhere, although I may rename it to "Archives of Insolence" or something like that. Also, I have no plans to give up organizing the Skeptics' Circle. It will continue more or less as it has for the last year, and the present Skeptics' Circle site will remain as it is now. Indeed, I'm hoping that the higher profile that I hope to attain by joining ScienceBlogs will improve traffic to each host and help me and future hosts push the Circle to even greater heights in its second year.

Finally, one thing that I cannot and do not promise is that there will be no changes resulting from my decision. Even if I didn't want to change, plopping Orac down in the midst of folks like PZ Myers, Chris Mooney, Tim Lambert, Ed Brayton, and the rest of the stable of top-rate bloggers that Seed Magazine has lined up thus far can't help but result in at least a subtle change--hopefully a change for the better. Surgeons are by nature a bit competitive, and being featured next to the high quality bloggers who are already ensconced within the ScienceBlogs servers will, consciously or unconsciously, almost certainly goad me to improve, if only for the reason that I don't want to look like a doofus next to my fellow ScienceBlogs compatriots.

I plan on explaining my vision of where I want to take this blog in a bit more detail as my very first post on ScienceBlogs. However, I will answer one question right now. While there will be a higher percentage of posts on science (particularly medical science), I have no intention of abandoning my other usual topics, namely skepticism, quackery, creationism and Holocaust denial (and, yes, a certain mascot). Indeed, in the case of Holocaust denial, perhaps I'll get into some discussions of the misuses of forensic science that deniers routinely use to justify their lies. They use pseudoscience every bit as ridiculous as creationism or the worst quackery, and they use it for a despicable purpose. (I may, however, wait a while before springing the Hitler zombie on readers again. I'm not sure that ScienceBlogs is quite ready for a brain-eating undead Führer to make an appearance on its servers yet.)

Stay tuned, and thanks to all my readers. Nothing will happen for several days at a minimum, and regular blogging will continue apace here until shortly before the transition, when I may take a couple of days off in order to set up the new blog. I hope you'll stay with me as I try to take this blogging thing to another level. I might fall flat on my face, but the opportunity is worth taking the chance.

Another perspective on Abubakar Tariq Nadama

Recently, I took Dr. Mary Jean Brown, Chief of the Lead Poisoning Prevention Branch of the Centers for Disease Control to task for some ill-considered and ill-advised comments about the death by chelation therapy of a five year old autistic boy named Abubakar Tariq Nadama in August. I wasn't the only health care professional who thought her remarks to be pretty off base. Indeed, Dr. Kimball Atwood also thought her remarks were pretty poorly considered:

Roy Poses was absolutely correct that Dr. Mary Jean Brown, the CDC’s “expert in chelation therapy,” missed the real point of the tragedy: that the child was a victim of quackery, not merely of “medical error.” The truth is even more disturbing than that, however. Dr. Brown may have been technically correct that if calcium-disodium EDTA had been used instead of disodium EDTA, the child would likely not have died of hypocalcemia (though he might have died of another complication; calcium-disodium EDTA is also a dangerous drug). But this was not a simple case of mistaken drug identity, or "look-alike/sound-alike medications," as Dr. Brown supposed. Disodium EDTA is the form of EDTA preferred by the major advocacy group for all implausible uses of "chelation therapy," the American College for Advancement in Medicine (ACAM)*—the same organization that the FTC had cited in 1998 for “false or misleading” claims regarding “chelation therapy” and atherosclerosis.

The reason for that preference seems to be that when EDTA was first being pushed as a miracle cure for atherosclerosis (‘60s-‘70s), its purported mechanism was to leach calcium from plaques. That claim, which can still be found in pro-chelation literature, has largely given way to the theory that chelation works as an anti-oxidant by removing heavy metals such as mercury, lead, copper, and iron. Both of these theories are implausible on stoichiometric and physiological grounds. The disodium form of EDTA persists as the ACAM-recommended preparation, not only for atherosclerosis but for arthritis, Alzheimer’s, Parkinson’s, psoriasis, high blood pressure, scleroderma, cancer, macular degeneration, and more. The rationale for “chelation therapy” in autism, according to advocates, is that the disease is caused by mercury poisoning—mainly from childhood immunizations. This claim is not supported by epidemiologic studies.

More damning, he points out the NIH-funded trial looking at chelation as a "therapy" for atherosclerotic disease and sees Dr. Brown's remarks as an unintentional indictment of the NIH for funding that trial:

The NIH language implies that disodium EDTA for any other purpose is merely “off-label” and is safe, which is what chelationists and their influential champions assert (see p.2 of this slow-loading document). But this is misleading, because the FDA has specifically contraindicated disodium EDTA for atherosclerosis, and a “black box” warning states: “The use of this drug in any particular patient is recommended only when the severity of the clinical condition justifies the aggressive measure associated with this type of therapy.” Thus the numerous unapproved uses of disodium EDTA, prescribed by that strange subculture of practitioners who preach “detoxification” as a near-panacea, do not meet FDA standards for off-label use. On p. 37 of the TACT protocol, version 2, NIH investigators refer to such practitioners as “prominent experts.”

Perhaps unbeknownst to Dr. Brown, her statements would seem to challenge the NIH to explain why it would expose human subjects to a drug that the CDC considers highly dangerous, when a less dangerous substitute is readily available. The larger question is why the NIH would expose 2300 human subjects in a Phase III study of a treatment that has yet to successfully graduate from Phases I or II, and that has not been substantially studied in animals. Federal Code states: “Phase III studies…are performed after preliminary evidence suggesting effectiveness of the drug has been obtained…” The Declaration of Helsinki states: “Medical research involving human subjects must…be based on a thorough knowledge of the scientific literature…and on adequate laboratory and, where appropriate, animal experimentation.”

Indeed. It has never ceased to amaze me that a therapy like chelation therapy for cardiovascular disease, a disease for which there is no evidence that it works and plenty of evidence to suggest that it is no better than placebo, has graduated to a major NIH-funded Phase III study without having passed through the usual hurdles required of new therapies, namely evidence of effectiveness in animal models and then Phase I and/or Phase II studies. Alties frequently complain that "conventional medicine" doesn't give them a chance, doesn't let them prove themselves on a level playing field. It's true that alternative medicine doesn't compete on a level playing field with conventional medicine, but not in the way alties think. In actuality, alternative medicine is held to much lower standards than conventional medicine. In fact, the chelation therapy trial described above is perhaps the best example of giving alties a pass on the usual standards of evidence before funding a major Phase III trial. It is in essence affirmative action for "alternative medicine" and quackery. No drug developed by big pharma, not even Vioxx, got that big a pass. If I were to submit a grant application to fund a trial to test the efficacy of a conventional medication based on evidence as thin as the evidence that got this trial funded and the even thinner evidence that got the trial for the Gonzalez therapy for pancreatic cancer funded, I'd be laughed out of the study section and my application filed in the circular file.

Dr. Poses of the same blog also has a take on this issue that I should have thought of before, namely how a CAM misadventure with a therapy that was being used for a disease for which it should never have been used is attributed to a "drug mixup," just as if it were a medical error:

Chelation therapy for conditions other than lead poisoning has been advocated widely in the complementary and alternative medicine (CAM) community, as per this post in Quackwatch. It is easy to find CAM web-sites that tout chelation therapy for autism, e.g., here and here. There is no good evidence from clinical research to support the use of chelation with calcium disodium EDTA for autism. Substituting a similar, but more dangerous medication for an anecdote-based CAM treatment was not a medical error, because it did not occur in the course of conventional medical treatment. So perhaps it should have been called a "CAM error."

Physicians who attempt to base their practice on science have already been saddled with the responsibility for innumerable medical errors. They do not deserve to also be made responsible for the misadventures of alternative practitioners.

I wish I'd said that.

Even if Dr. Roy Kerry, the quack who killed Abubakar, did mix up the medications, the bottom line is that attributing Abubakar's death to a "medication error" partially lets Dr. Kerry off the hook. It implies that, if he had simply not screwed up the medication (a contention that is not at all clear or proven) that it would then have been acceptable for him to use a potentially lethal medication for a condition for which there is no credible scientific or clinical evidence that this medication does any good. It wouldn't have been acceptable, and it wasn't. Dr. Brown's remarks in essence excuse Dr. Kerry's quackery.

Dubious therapy of the week: "Touchless" chiropractic

I've been looking critically at various claims of alternative medicine practitioners and outright quacks for a while now. I thought I had heard everything. I didn't think there was a claim that I could come across that was so outrageous, so obviously and ridiculously bogus, that it would still have the power to surprise or shock me.

Then I came across "touchless" chiropractic manipulation.

Touchless? Yes touchless:

The popping sound, the grunting and the hands all belong to Dr. Johanna Hoeller. What she does has been described by some as nothing short of a miracle.

Dr. Hoeller is a chiropractor who specializes in a procedure where the atlas or C1 – the small doughnut-shaped ring at the top of the spine – is carefully adjusted back to center, thus balancing the spine.

This practice is part of NUCCA – National Upper Cervical Chiropractic Association.
But it's how the doctor does the adjustment that leaves many of her patients wondering.

Mike West, the morning DJ for KMTT, has been seeing Hoeller for more then 7 years.

“I remember going on the radio and all of sudden, click, and I would have to crawl off the floor to go to the doctor to get her to fix,” he said. “I don't know what she does but it works.”

What has West and other patients – some from as far away as Alaska – scratching their heads is the fact that Joanna Hoeller does not really touch them.

“I'm not a witch doctor,” said Hoeller.

But wait, you say. Isn't chiropractic dependent upon spinal "manipulation" to treat everything from back problems to, say, migraines or asthma? And doesn't that manipulation or "spinal adjustment" depend upon the chiropracter's supposed skill in realigning your spinal column using good old-fashioned muscle? At least that's what I always thought chiropractic involved.

You can learn about it from a video segment done by a particularly credulous host named John Curley for a show in Seattle called Evening Magazine. After the Curley's introduction, in which he describes how his wife had been suffering neck pain after an auto accident and had given up on getting relief, the video segment went to a photo of Joanna Hoeller leaning over a patient moving her hands over his neck and grunting. We hear popping sounds. It certainly seems as though she's doing something. But what? No movement of the patient's neck or head is observed.

"I'm not a miracle-worker," she says. "The miracle is the human body. It's just a gentle procedure, and, when it's gentle, people have a difficult time with it sometimes."

The procedure is apparently so gentle that it doesn't even require Dr. Hoeller to touch the patient.

No, Dr. Hoeller, I don't have a difficult time with your procedure because it's so "gentle," but rather because there's no physical basis for it to work unless you believe in some sort of magic or "energy transfer." Even by the stated basis of chiropractic of realigning the spine as a means of treating disease, it can't work. Indeed, one of her patients interviewed on the segment unintentionally seems to nail it on the head when he said, "I used to try to figure out what she did, and how she did it. I do believe she has some sort of magical powers. I just think she's that kind of a person."

Another patient: "Like I said, if it works I like it. I don't care what it is. Hocus-pocus, whatever. If it takes the pain away, hooray."

Hocus-pocus indeed, Hoeller's claims sure sounds like magic or hocus-pocus, and it would take such a belief in magic to think that such a ridiculous "therapy" could work. (Calling the Amazing Randi!) For one thing, it's not the patient's neck that's popping, but Dr. Hoeller's wrists, something Curley himself narrates later in the segment, when he says that Dr. Hoeller will keep doing the adjustment until the "popping in her wrist stops." Says Hoeller, "My body is my instrument, so to speak. When the atlas and the structure is correct, my hand tends to stop popping. So that's how I generally have a feedback of whether something is now locked, and then no more force can get in there." Worse, she takes before and after X-rays of the patient's skull and cervical spine. The first one shows (of course) that the patient's spine is horribly "out of alignment," with her head sitting at least a 2 cm lateral to where it should be relative to the atlas (never mind that if her head were truly that much out of whack relative to her spine, her spinal cord would probably have been crushed or severed). And--miracle of miracles!--the second one is almost "perfectly" aligned. In fact, if you look closely at the two X-rays, all that changed is where Dr. Hoeller drew her blue and red lines, as Skepdic showed very nicely here.

Hard to believe that anyone falls for this, isn't it? What's even harder to swallow is the part where Curley shows Dr. Hoeller a videotape of herself in action, and she claims she had never realized that she wasn't touching the patient. Come on, give me a break! What we have here is simply confirmation bias and self-deception on Dr. Hoeller's part, probably with a dash of magical thinking thrown in for good measure, and the placebo effect on the part of the patients. There's almost certainly a bit of regression to the mean (also known as the regressive fallacy) in there as well.

Of course, even if Hoeller could do what she claims without touching her patient, there is no basis in science to assume that upper cervical adjustment will do anything. She uses a method called N.U.C.C.A (for National Upper Cervical Chiropractic Association). This flavor of chiropractic teaches that many diseases can be treated by "adjusting" the upper cervical spine, specifically C1 (the atlas) back to "center," thus supposedly "realigning" the spine. To quote Joanna Hoeller, "Just when you thought you have tried everything, have you checked to see if your head is on straight?"

No, Joanna. Have you?

To see a whole bunch of pseudoscientific altie claims, one need only look at NUCCA's website, which greets visitors with:

An era of amazing recoveries from illness began over 100 years ago, with the discovery of Chiropractic by an American, Dr. Daniel David Palmer. Thousands of patients, who had given up hope of finding any help, recovered from their illness by the improvement of their nervous system function.

Sixty years ago, a study of upper-cervical cases revealed that sick folk, possessed by over 5,000 different types of diseases, were in large measure restored to good health and long life by restoring a good communication link between the brain and body!

Over 5,000 types of diseases can be restored to good health with this method? Apparently so, according to NUCCA:

After an upper cervical correction...

"An 80 year old man, suffering from numbness in both legs, receives an upper cervical adjustment and immediately experiences a return of normal feeling and mobility in his legs."

"A new scientific research study just concluding reveals Chronic Fatigue Syndrome and Fibro Myalgia cases have recovered in 3-12 months, but the Mayo Clinic reports 3 years of drug treatment with no improvement or hope."

"ADD (Attention Deficit Disorder) and similar cases have shown remarkable recovery with neck correction, enabling the freedom from the harmful drugs used in such cases... drugs now suspected of addicting some children."

"A thirty year old father was sent by his neurologist for an upper cervical analysis and correction. He had suffered from migraine headaches for ten years with severe side effects which disabled him from his work for 3 to 5 days per week. No treatment which he had received had helped him. Two adjustments left him symptom free for two years. A truck accident caused a temporary relapse but for over 5 years he has been symptom free!"

"A child with bronchial asthma breathes normally again, the acute attack stilled by a chiropractic adjustment!"

Nothing but testimonials.

I can see how one might--I repeat, might--get relief from spinal manipulation for nerve root compression or back pain, but no chiropracter has yet been able to explain to me how it can do anything for asthma, migraines, ADD, or chronic fatigue syndrome, or any other disease not related to the spine. The NUCCA site (like every other chiropractic site I've seen) is long on testimonials and impressive-sounding jargon about nerves and the spine and short on actual data from scientific studies and clinical trials.

What's next? Autism? Yes, chiropractors even claim they can treat autism and hiatal hernias. Is there any disease chiropractors can't treat by manipulating the spine?

Apparently not. And at least one of them doesn't even need to touch the patient to do it.

Traditional Chinese medicine healers who practice qigong (energy healing) had better watch out. It looks as though at least one chiropracter is getting ready to muscle in on their business.

Skepticism busting out everywhere!

After having plugged a good skeptical blog over the weekend (whose proprietor has now, by the way, agreed to host the Skeptics' Circle in May), I've now found yet another one. This one's called Unintelligent Design, and the blogger, Clark, introduces himself thusly:

I am a skeptic. In fact I don't believe in anything without cold hard facts. And to be honest It makes me mad that I am forced to have my astrological sign and Zodiak animal from Chinese mythology on my profile. It's all crap. And don't even get me started on Alternative medicine. I also like sunny days and puppy dogs.

Sounds like a man after my own heart.

Particularly enjoyable is his debunking of the Aqua Detox System.

Let's hope the rate of growth of the number of skeptical blogs continues.

Whittling away the Americans With Disabilities Act

I don't often do this, but at the request of a reader of mine who happens to have reason to be intimately familiar with this issue I am posting this plea:

It seems that the restaurant industry is leading to fight to keep America inaccessible to people in wheelchairs. There was a problem in Kansas (where else?) last year that was shot down.

These businesses have had nearly 15 years to make the small changes that are needed for accessibility. Some of these businesses were established after the ADA was law, and ignored it. Now, they want to have up to another year to make things accessible, and not be otherwise penalized for their indifference (I am being charitable).

This measure should never reach the ballot:

Building and Restaurant Industries Trying to Stop Disability Rights Enforcement

The California Building Industry Association and California Restaurant Association started out 2006 by submitting a proposed ballot initiative to the California Attorney General for inclusion on the November 2006 ballot.

The proposed initiative, which is awaiting Attorney General approval and will then require signature collection before it can be put on the ballot, would amend the California disability rights laws and construction defect laws to make it much more difficult for Californians to enforce the law.

The proposal would require people injured by discrimination in disability access, or by construction defects in their homes, to notify the building owner or builder by certified mail, and wait 30 business days (amounting to 40 days total) for the owner to respond. The owner/builder can then choose to (1) ignore the notice or reject the claim (in which case the injured party can proceed to court) or (2) respond by promising to make improvements within 120 business days (200 actual days ( 6.6 months)) or by demonstrating that the violations have already been corrected after the incident occurred. If the building owner cannot get the corrections made in 120 days, he can get an extension of another 120 business days - thus delaying compliance by up to 13 months!

If the owner's modifications have fixed or will fix the access violation, the injured person will have NO RIGHT to seek compensation for the initial discrimination or injuries caused by it. He or she will not be compensated for injuries and will not be reimbursed for having to pay an attorney to investigate the case. Over 15 years after the passage of the Americans with Disabilities Act (and more than 20 years after the California disability rights laws), building owners will be exempt from compensating victims for their ongoing discrimination.

If the owner's modifications are inadequate, the owner can force the injured party to go into a "prelitigation procedure" where a neutral access specialist (paid, in part, by the injured party) reviews the property or the owner/builder's proposal to fix the property and approves it as complying with access requirements. This process has no deadlines and will presumably extend the 120 day period for making improvements. At the end, if the neutral reviewer approves the modifications, the injured person will have no rights to compensation for the initial discrimination or injury, will have no right to reimbursement for attorneys fees and costs for participating in the "prelitigation procedure", and will, in fact, have to spend additional money to pay the neutral reviewer.

Notably, this initiative, applies to new construction and alterations, even though owners and builders have no defenses to providing access in new buildings. Moreover, the initiative will let both private businesses and state and local governments off the hook for new and ongoing access violations. This proposal would make people with disabilities the forced, unpaid consultants for business and governments - people with disabilities will, in effect, have to subsidize building owners' compliance (we will have to pay all of their access consultants!) with the law and will have no ability to enforce disability civil rights.

The Disability Rights Legal Center will work actively to oppose this ballot initiative in every possible way. Your support will be essential to this effort, which will require us to educate voters across the state about why disability rights should not be restricted and why, after decades of laws requiring disability access, building owners should not be encouraged to ignore those laws even longer and to place responsibility for compliance on us.

It's already bad enough for someone to be confined to a wheelchair, but part of what makes it so bad is the difficulties put in their way when they try to go to public facilities, businesse,s adn restaurants, difficulties that are not that onerous to correct. More when I find out more.

International Internet-free Day?

I hadn't been planning on posting anything at all today; I usually like to take at least one day off a week from posting (and in the future may stop posting anything on the weekends at all).

Then I was made aware of this:

Have you started tilting your head sideways to smile? When you check your e-mail and it says "No new messages", do you immediately check again? Do you dream in HTML? You could be spending too much time on the Internet. So Sunday January 29th has come along at the right time, as it is International Internet-Free Day.

An idea promoted by the online democratic think-tank the Global Ideas Bank, Internet-Free Day is a day to log off, get out and enjoy the real world.

Why an Internet-Free Day?

• Because it's all too easy to miss out on face-to-face interaction with your family, friends and neighbours.
• Because the net can be addictive, and a day of cold turkey won't hurt.
• Because blogging doesn't provide your daily vitamins and minerals.
• Because you've got RSI coming on in your mouse arm.
• Because we all need time to reflect.
• Because the real world is a wonderful place.
• Because if the mere idea of it enrages you, you definitely need it

Contrarian that I am, I decided right then and there that I had to post something today; so I did.

That is all.

Prometheus wants your skepticism!

Since I'm plugging skepticism today, I should take this time to remind everyone that on Thursday Prometheus is hosting the 26th Meeting of the Skeptics' Circle at A Photon in the Darkness, but he's not happy. At least not yet. Here it is, the weekend before he's scheduled to host, and he still needs more skepticism. After all, a guy who can write something like A Field Guide to Quackery and Pseudoscience won't be satisfied until he's scoured the entire skeptical blogosphere for the very best critical thinking and put together an Amazing Meeting of his own.

So give a skeptic a hand and send him your best skeptical blogging by Wednesday night!

More Saturday morning blog housekeeping

Inspired by the cybersquatting of J. B. Handley a couple of months ago, I finally got off my behind and registered the domain name respectfulinsolence.net. No, I never got back oracknows.com (J. B. hates me too much ever to do the right thing in that respect, and yes, oracknows.com still redirects traffic to a Site I Will Not Name.) It doesn't much matter anyway. I had been planning on phasing out the "Orac Knows" part of my blog title for a while now, although I will continue to use "Orac Knows" on the sidebar to group my list of favorite past posts.

In any case, I've set www.respectfulinsolence.net to redirect traffic right here to the blog. So, if you change your bookmark to the above URL, as long as the domain remains registered to me, it will always direct you right here to your fix of the finest respectful insolence in the universe. (If you're using a newsfeed aggregator, my feed remains the same.) Finally, if you happen to be a blogger and have me in your blogroll, please keep using the old Blogspot URL http://oracknows.blogspot.com. I'd hate to see my TTLB Ecosystem rank plummet because of this, you know.

An announcement describing the big changes in this blog that I've been hinting at the last couple of weeks will finally be posted either Monday or Tuesday, and my reasons for registering that domain may become more clear then.

Skeptico on Deepak Chopra and EoR on credulous circles

I love it when Skeptico fisks New Ager Supreme Deepak Chopra and his pseudoscientific appeal to other ways of knowing. My favorite part is where he rebuts Chopra's claim about "subtle bodies" that "whatever is invisible has little standing in a materialistic culture where reality is defined by science":

Yes, science has no time for invisible things like radio waves, atoms, MRIs etc. – all things discovered by science incidentally, not by drips like Chopra. Of course, what he means is that science is only interested in things that have a measurable effect – things that can be tested. If something has no measurable effect (for example, this "subtle body" he’s talking about), then it might just as well not exist. So does his "subtle body" have a measurable effect or is it just too damn subtle to measure?

Heh.

While Orac is in a mood to plug other people's work (perhaps being too lazy today to write some of his own), there's a new skeptical blog in town that I've been meaning to plug for a month or so now. The blog is The Second Sight, and any blogger who can title a series of posts Going Around in Credulous Circles (Parts 1, 2, 3, and 4) or write a post entitled The More Things Change (the Less Homeopathy Does)... (or, for that matter, list his comments as "psychic responses," in the same sort of way that I list mine as "attempts at insolence") is definitely a someone who belongs on my blogroll.

Birthday shoutout

I'd just like to take this opportunity to send a birthday shoutout to my Mom. Here's hoping you have a great day and many more like it!

I know you're reading...

Oprah slaps down James Frey

I normally don't watch The Oprah Winfrey Show. Oh, I occasionally catch part of it when my wife watches it, as it's on at 7 PM on one station in our market, but I don't generally watch it. But I really wish I had seen this episode here, when Oprah slapped down dissembling "memoirist" James Frey for his making up a large part of his supposed memoir A Million Little Pieces and lambasting his publisher for not doing even the most rudimentary fact checking, all the while apologizing to her viewers for having been taken in.

As enjoyable as the spectacle might have been, I can see one consequence of this dustup that I don't look forward to seeing. Recently, Oprah picked Elie Wiesel's book about Auschwitz Night as her next Book Club selection. I can already see the Holocaust deniers chomping at the bit to take James Frey's exaggerations and made-up incidents being represented as nonfiction and use them to attack Elie Wiesel's book about Auschwitz. It's coming.

Just wait.

Holocaust Memorial Day: The 61st anniversary of the liberation of Auschwitz

Today, the 61st anniversary of the liberation of Auschwitz, the most notorious of Nazi camps, by the Red Army, is also Holocaust Remembrance Day in the U.K. The theme this year is the celebration of the courage of rescuers who helped the persecuted:

The stories of the rescuers show everyone how even small actions can make a difference to the persecuted and hunted. It also highlights the dangers of indifference to the plight of those in danger. As last year we hope that learning about the courage of the rescuers will enable everyone of us, young and old, of whatever faith or no faith, to change our attitudes to our fellow man. We must be aware that each individual is responsible for his/her own actions and we must not be indifferent to our neighbour’s pain. We will then have learnt one of the most valuable lessons of the Holocaust – that ‘One Person Can Make a Difference’.

It occurs to me that I've never written about rescuers, and perhaps I should do so sometime. In the meantime, for those of you who weren't regulars or never saw this article, I thought I'd direct you to what I wrote a year ago on this occasion. Given that back then I only got at most a few dozen visits to this blog per day, it's unlikely that the vast majority of my present readership has seen or read it. On this particular day, I think it's worth checking out and hope that you will do so and perhaps comment here. (Because the article is a year old, I closed comments on it long ago.) Perhaps it will explain some of the reasons for my interest in Holocaust denial.

Finally, I present a list of links to relevant posts that I have written over the past year or so. Hopefully, it will acquaint newcomers with my previous writings on the subject and remind longtime readers of why we should never forget.

Holocaust:

60 years ago today: The evacuation of Auschwitz and start of the death march

60 years ago today: The liberation of Buchenwald

Sunday afternoon history lesson

60 years ago today: The liberation of Bergen-Belsen

60 years ago today: The liberation of Dachau

Eugenics and involuntary euthanasia

67 years ago tonight: Kristallnacht

Oprah goes to Auschwitz

You can't make stuff like this up: Mel Gibson is planning a TV miniseries about the Holocaust

Holocaust denial:

The 60th Anniversary of the Liberation of Auschwitz: How I discovered Holocaust denial

How David Irving became a Holocaust denier

A truly offensive use of Halloween

Taboos of Holocaust deniers

Schadenfreude

More schadenfreude: Irving now admitting there were gas chambers?

David Irving to stand trial in Austria)

The President of Iran: Holocaust denier and anti-Semite

An unexpected analogy

The loon running Iran

More on David Irving

I hadn't gotten around to this, but today seems an appropriate day to point to an article in Der Spiegel in which David Irving, now in prison for Holocaust denial in Austria, was interviewed. Some choice excerpts follow.

On why David Irving went to Austria, even though he knew there was a warrant for his arrest there:

Before leaving London for Austria, he left behind 60 blank checks and packed eight shirts, even though the trip was only scheduled to take two days. He is always prepared for anything, says Irving, meaninfully raising his bushy eyebrows. "Be prepared," the motto of the Boy Scouts, is apparently also his motto.

He knew that there was a warrant for his arrest in Austria. In 1989, then Chancellor Franz Vranitzky personally threatened Irving with immediate arrest if he ever showed his face in Austria again. But the stubborn Hitler apologist saw Vranitzky's threat as an invitation to return to Austria as quickly as possible. "I come from a family of officers," he growls from behind the plate glass, "we march towards cannon fire." But he did make a mistake when it came to picking suitable shoes. Prisoners are allowed to walk in the prison yard every day, but Irving has, "unfortunately, only one pair of very expensive shoes," and they're slowly falling apart.

Speculations on what may be part of his motivation:

British historian Paul Addison described Irving as "normally a giant when it comes to research, but often a schoolboy when it comes to judgment." As horrific as it sounds, there is reason to believe that he is not just driven by the lucrative business of the Holocaust denial industry, but also by a scurrilous and ultimately banal delight in provocation.

This delight is not uncommon among the upper classes in England, as Prince Harry's recent appearance at a party wearing a swastika armband demonstrates. Irving takes advantage of the considerable tolerance of his countrymen, whose regard for freedom of opinion protects even the most tasteless pronouncements of an eccentric.

It is no coincidence that a man like Irving comes from a country where "Führer" jokes are still part of the standard repertoire of the tabloid press, and where delight in provocation is considered acceptable even in polite society. Irving undoubtedly has as many detractors in Britain as anywhere else. But statements such as "more people were killed in the back seat of Edward Kennedy's car in Chappaquiddick than in the gas chambers at Auschwitz," with their blend of sexual innuendo and deliberate affront, are a reflection of the trivial ignorance with which many a product of the British boarding school system tries to show the world belongs to him. "He is a megalomaniacal class tyrant," says Holocaust expert Deborah Lipstadt, against whom Irving filed a spectacular lawsuit six years ago, at the end of which, however, the judge in the case declared him an anti-Semite, a racist and a liar.

"Yes, I did many silly things", says Irving simply, noting that the British way of doing things isn't always polite.

And:

Irving, who grew up without a father, started rebelling against the established order when he was a schoolboy. When he won a book award at school, he asked for Hitler's "Mein Kampf" as his prize. It was the same impetus that prompted him to drape a Soviet flag over the gate of his school. He had merely intended to shock people, Irving told Britain's Observer newspaper in 1992. "It was all in good fun, and when I write, I try to introduce a bit of fun onto each page." In 1993, he told another interviewer that he had no political agenda apart from enjoying seeing "other historians make fools of themselves."

Finally, the writer speculates that Irving's admiration for Hitler comes from his yearning for empire and his view of history as a panorama of "eating or being eaten":

Irving is unaware of moral or even human contradictions. He is too amoral to even understand that jokes such as the one about Kennedy's car are an affront to the survivors of the Holocaust. Irving's understanding of history is not unlike that of the Nazis. History is a panorama of eating or being eaten. Only the strong can win, and Irving reserves his unabashed admiration exclusively for the strong.

One of those people is "Bomber" Harris. In his first book, Irving turned the world's attention to the horrors of the bombing of Dresden. Nevertheless, he insists that Air Marshall Sir Arthur Harris was a great man. "I'm talking about a commander. Like Dönitz," he explains, his eyes flashing. "Someone who can send 20,000 young people to their deaths each day is a great commander." Given these views, Irving's admiration for Hitler comes as no great surprise.

Indeed it doesn't, and Irving has been more explicit about his admiration, saying about Hitler, "He's like the curate's egg - good in parts." Nonetheless, as odious as his views are, Irving should not be in prison for them. As Professor Deborah Lipstadt said, "Let him go home and let him continue talking to six people in a basement."

A most uncomfortable question

[NOTE: This story is loosely based on a real patient encounter, but some details have been changed, and there's no way for the reader to know when the event upon which the story is based actually happened.]


"Doctor?"

I paused. I had been on my way out the door of the examining room, having completed the visit. I turned around again. "Yes." I said. Maybe I had turned around too soon after having asked if she had any more questions.

"Do you believe in God?"

*****

The patient list had simply listed her as having an abnormal mammogram. That's probably the most common complaint of breast patients that come in to see me. They have their regular mammogram and are told by their primary care physician that it is abnormal. The next thing they know, they're sitting in one of my examining rooms. However, the patient list is quite brief. It's just meant to be a quick capsule of what patient has what basic complaint. Nothing on the list prepared me for the woman I greeted when I walked in the examination room.

This patient was enormous, and I do mean enormous. Morbidly obese, she told me she wasn't sure how much she weighed, but that it was at least 450 lbs. Sitting in a wheelchair massive enough to support her, rolls of fat hung over the armrests, and her breath wheezed like a mortally wounded Darth Vader near the end of Return of the Jedi, right before he took his helmet off and revealed Anakin Skywalker beneath the mask. Indeed, on the same theme, I could not help but be reminded of Jabba the Hutt. Yes, I know that physicians aren't supposed to think that way about their patients, and, honestly, I tried not to. However, we're human, just like everyone else, and even our years of professional training can't entirely suppress our baser thoughts. At least I managed to keep enough self-control to restrain myself from voicing such thoughts to my nurse or any of the clinic staff. Not all clinicians exercise such self-restraint, and, I'm embarrassed to say, there have been times in the past when I didn't either.

Normally, dealing with a patient with suspicious microcalcifications on her mammogram is fairly simple. A biopsy is indicated, and there are basically two techniques to choose from. You can do a mammotome or stereotactic biopsy, which is in essence a mammogram-guided core needle biopsy, or you can do an old-fashioned wire localization (or needle localization) breast biopsy. Given that even the surgical option is usually a same day surgery using local anaesthesia and sedation, even that isn't so hard. The surgery can sometimes be a little trickier than one might think, but even then it's not all that hard. Oh, sometimes you get patients with multiple abnormalities, and you have to decide if you want to go after them all or if you want to perform a triage and decide that some of them need to be biopsied and some of them don't, all the while realizing that if you miss a cancer it can be a major disaster for the patient.

Of course, a 450+ lb. patient adds a new level of challenge. For one thing, she was way too heavy for the table; so stereotactic biopsy wasn't even an option. Not surprisingly, her health was horrible. She was a smoker, and had severe chronic obstructive pulmonary disease (COPD) and sleep apnea, plus hypertension, type II diabetes, and a history of congestive heart failure. Her medication list read like the Physicians' Desk Reference. I needed to examine her. However, I had a very real fear that, even if we could manage to get her up on the examination table (which, so sturdy before, now looked pathetically inadequate for the task of supporting this woman), she would have a high chance of damaging it. So I made do and did my best to examine her while she was sitting in her wheelchair. It was a suboptimal examination, but, given the size of the room, it was all I could manage. Morbidly obese patients, because of their size, frequently make it very difficult to provide optimal care to them.

By the time I was done, I felt profoundly sorry for this woman. How on earth does such a person live, given her physical and medical problems? Despite my sympathy, I maintained the professional bedside manner that we're all trained to keep up and explained what was abnormal about her mammogram, that she would need a biopsy, and how the biopsy would be done. I also explained the risks (which, for her, were much higher than the minuscule risks most patients undergoing this procedure face), and arranged for her to be seen by her pulmonologist and cardiologist in case something more than local anaesthesia were needed.

When finished, I asked if there were any more questions, gave her my card, and made my way past the family members to the door. Although it was near the end of the day, there were still a couple of more patients to see.

*****

"Do you believe in God?"

I was still standing there, hesitating. To be honest, my first thought was: Why on earth should it matter whether I believe in God or not? Belief in God has nothing whatsoever to do with whether I'm a competent surgeon or not. Personally, if I needed surgery I'd prefer a surgeon who is a flame-throwing militant atheist like PZ or Richard Dawkins, as long as he or she is highly competent and has a bedside manner that doesn't bother me (and, of course, doesn't push his or her beliefs on me), over a believer who is not as competent. In the same vein, it wouldn't matter to me if the surgeon is a Bible thumper, again as long as he or she is highly competent, easy for me to get along with, and doesn't push fundamentalist beliefs on me. To me, the question of belief in God is utterly irrelevant to the question of whether a surgeon is skilled or not, but apparently not everyone sees it this way. Thinking back on this incident, I can't help but remember an interview I had heard with Eddie Tabash, an atheist attorney who mentioned during the interview that he sometimes defended prostitutes. During the interview, he went on to mention that it was not infrequent for prostitutes to become very uneasy about having him as their attorney when they found out about his militant atheism. I had never encountered this phenomenon among my patients, however.

My second thought was: Why on earth would this woman still believe that there was a benevolent God looking down on her? She was a mess. She couldn't walk more than a few feet without assistance; she could hardly breathe; and she was on enough medications to stock a Walgreens. Her health was so bad that even a minor surgical procedure such as a breast biopsy could put her life at risk.

Worse, the question brought into sharp focus a question that I myself have been wrestling with myself for the last three years or so, a question whose answer seems to be yes one day and no on others. There's nothing like being trapped in a small examination room with a 450 lb. woman and three members of her family, with nowhere to run and no way to dodge the question. I was trapped. A believer might have said that the woman's question was God's way of making me face my fluctuation between belief and disbelief; an atheist might say that such an assertion is wishful thinking. Whichever was the truth, that didn't prevent the formation of a little bead of sweat that was rapidly enlarging on my brow. I suspect the question would have still been uncomfortable for me to answer even if I were as religious as I was when I was younger, as even then I tend to view religion as a private matter, one I didn't usually talk about much.

What if I were to tell her that was an atheist, that I didn't believe in God? Would she have sought out another surgeon? For a fleeting moment, I was sorely tempted to say just that. It might have been an out, a way of not having to do the case. On the other hand, this woman had no insurance and had to rely on charity care/Medicaid, which meant that she probably didn't have the option of going to a different surgeon. (Working for a state institution, I take care of quite a few Medicaid patients.) If that were the case and I said I was an atheist, she would then be going into surgery with no confidence in her surgeon, clearly an undesirable situation. Besides, saying that I was an atheist wouldn't really be the truth; so I couldn't say that anyway.

So what did I finally say?

I punted. "I'm Catholic," I said. A pause. "But, to be honest, I don't go to Mass much anymore."

This answer was perfectly true. It also seemed to answer her question, but in reality didn't. Not really. The truth is much more complicated, but she didn't need to know that. Fortunately, because the patient was Catholic herself, my answer seemed to satisfy her. "God will guide your hand," she said.

"I hope so," I replied. Bullet dodged successfully.

I walked out of the examination room not looking forward to the day when this patient and I would meet again in the operating room--or to contemplating her question seriously when the day was done.

Orac applies some Respectful Insolence™ to a comment spammer

I hate spammers.

On the scale of Internet scumbags, spammers rank just one notch above pedophiles (barely). When they're not busy flooding your e-mail In Box with ads for "herbal Viagra" or various pyramid schemes, they're cluttering up my blog with comment spam. Unfortunately, some spammers seem to have found a way to get around Blogger's Word Recognition feature. Normally, I just delete such spams without comment as soon as I see the e-mail notification that they have arrived. Also, if the posts to which the spam comments were added are over a month old, I usually shut down comments for them. Rarely have I considered it worth devoting precious blog space to slapping down a spammer.

Until now.

What makes this spammer different? Take a look (I left one spam intact to let you see):

Hi,
While I was searching through Blogger I came past your site, it is not really the information I was after about breast cancer research but I did stay to read your blog and found it interesting and well done. Keep up the good work and hopefully I will visit again sometime and also find the information on breast cancer research that I was looking for in my travels.
Regards,Regards,

Great. An altie spamming my blog! I got this same comment on 10 different comments in about an hour yesterday, and I just got a couple more this morning. Time to put off the straight medblogging I had intended for Monday (and then Tuesday) at least one more day. Damn.

From the page listed, I quickly found this link, with these claims (text maintained):

THIS INFORMATION COULD SAVE YOUR LIFE ... HOW OVER 2,000 PEOPLE CURED THEIR CANCER NATURALLY, USING THE TREATMENTS REVEALED IN THIS E-BOOK. DISCOVER OVER 350 GENTLE & NON-TOXIC CANCER TREATMENTS THAT NO-ONE ELSE WILL TELL YOU ABOUT!

It gets worse, though. Get a load of these claims:

Learn about more than 350 drug-free, natural cancer treatments used by thousands to cure their cancer:

• Documented proof these treatments work - with over 2,000 testimonials you can read for free
• Almost all treatments are non-specific, that is, they work with any cancer anywhere in the body
• Treatments based on little-known scientific studies and inventions
• Amazing insights revealed - people with advanced breast, prostate, colon and lung cancer do not live longer after receiving chemotherapy
• There are alternatives to harmful chemotherapy*
• Discover best-priced and inexpensive sources of the treatments - some are free!
• You can commence many treatments immediately
• All contained in a set of 4 e-Books and Reports quickly and easily downloadable to your computer
• Inexpensively priced to reach the maximum number of people who need the information
• 100% refund if you are not satisfied
• Order and download now and this vital information can be yours in less than 5 minutes!

Great. Same old overblown and unsupported altie claims for miracle cures, same use of testimonials rather than evidence, same ridiculous claims of a treatment that works for "any cancer anywhere in the body." Do these people work with Hulda Clark or something? All of the above claims are so obviously without scientific support or clinical trial evidence to back them up and are all the sort of snake oil that I've debunked time and time again, that I didn't really want to bother with them at first, even if the company selling them is a spammer that irritated me by spamming my blog.

And then I saw this link on the site:

There exists a technology that can detect an issue YEARS before a tumor can be seen on X-ray or palpated during an exam. This technology has been approved by the FDA as an adjunctive screening tool since 1982 and offers NO RADIATION, NO COMPRESSION AND NO PAIN. For women who are refusing to have a mammogram or those who want clinical correlation for an existing problem, digital infrared thermal imaging may be of interest.

There are very strict protocols both for testing and interpreting. Perhaps due to these guidelines, thermography (as with all digital technology) has exploded in its technique and capabilities. Thermal cameras detect heat emitted from the body and display it as a picture on a computer monitor. These images are unique to the person and remain stable over time. It is because of these characteristics that thermal imaging is a valuable and effective screening tool. Tumors or other breast diseases measures warmer than surrounding tissue and can thereby alert a physician to a problem before a tumor is actually palpable.

Medical doctors who interpret the breast scans are board certified thermologists. Thermography is not limited by breast density and is ideal for women who have had cosmetic or reconstructive surgery. Thermography, because it analyzes a developing process, may identify a problem several years before mammography. DITI may allow women time and opportunity to support their immune system, change their lifestyle and give their body the best chance to alter their fate.

DITI has an average sensitivity and specificity of 90%. An abnormal thermogram carries a 10x greater risk for cancer. A persistently abnormal thermogram carries a 22x greater risk for cancer. Thermography, as well as mammography is a personal choice for women. This decision ideally should be made in collaboration between you and your physician. However, thermography does not require a physician’s order.

The company's name is Proactive Health Solutions, and it's selling a technology called Digital Infrared Thermography Imaging (a.k.a. DITI).

Oh, boy. These guys sure spammed the wrong blog this time! I do breast surgery for a living, as well as cancer research, after all, and I don't like claims that are unsupported by evidence. In fact, I detest such claims so much that I started a blog, a large percentage of whose content is devoted to shooting down dubious health claims. Clearly, it's time to apply some of Orac's brand of Respectful Insolence™ to this obnoxious spammer.

First, to be fair, I should mention that thermography has indeed been the subject of legitimate study as a means of diagnosing breast cancer for decades. The reason thermography might work is because tumors have increased blood flow (angiogenesis) compared to normal tissue. Its problem has always been a lack of resolution and specificity. Recent advances in computing power and detection technology may have made thermography more attractive as a test to detect breast cancer. (Indeed, I've even been involved in a research protocol that looked at a device that uses infrared light to do something similar to DITI, but with a clever twist.) However, even with better technology, there are still some major hurdles to overcome, and thermography is nowhere near ready for prime time.

Judging from its spamming (or from its hiring a spammer to advertise its wares) and the statements on its website, though, this company is probably not interested in determining whether or not thermography is a useful tool to detect breast cancer. It's interested in making a buck by selling a screening test that has not yet been validated in large clinical trials and is not covered by insurance companies, much as the breast MRI companies did a couple of years ago selling MRI as a screening test. Proactive Health claims a 90% sensitivity and 90% specificity for thermography but does not cite any articles in the peer-reviewed literature to support these estimates, which, if true, would definitely be better than mammography. Indeed, I searched PubMed and was unable to find a single reference to support such an extravagant claim for the sensitivity and specificity of thermography. I also know from personal experience and my knowledge of the literature that thermography as a technology to detect breast is cancer is still very much an experimental modality. In fact, although thermography was FDA approved in 1982 as a supplement to mammography, it never gained widespread acceptance because of its many limitations. These days, the only modalities that are FDA-approved for screening for breast cancer are screening and diagnostic mammography, and the only FDA-approved adjuncts to mammography are ultrasound, MRI, scintimammography (seldom used these days--in fact, I've never ordered one), and electric impedance imaging (almost never used either).

So, what are the problems with thermography and technologies based on thermography, like DITI or computerized thermal imaging? For one thing, they're very difficult to read, something Proactive's literature seems to acknowledge. Also, the literature shows that, because of the lack of spatial resolution, they produce a lot of false positives, making the claim of 90% specificity seem highly unlikely. Finally, unlike mammography, it can't detect microcalcifications, which are sometimes a harbinger of breast cancer and are detected quite well by mammography. Another thing to consider is that, because thermography doesn't produce the fine spacial resolution that mammography, ultrasound, and particularly MRI can, one has to wonder what its value could possibly be compared to MRI, which can detect increased blood flow in tumors quite well and give a nice detailed picture of it. This article says it best:

While thermography may be appealing to some women because it is a pain-free exam, most physicians do not recommend thermal imaging. Scientific research over the last 20 years has shown that thermography is not reliable for detecting breast cancer. In 1977, the Beahrs Committee of the National Cancer Institute (NCI) recommended that thermography be discontinued as a routine screening modality in the NCI’s Breast Cancer Detection Demonstration Project.

Since then, studies have failed to show a clear benefit of thermal imaging in helping to detect breast cancer. In their 1998 document, "Evaluation of Common Breast Problems: Guidance for Primary Care Providers," Barbara Smith, MD, PhD and her colleagues wrote, "currently, thermography has no role in breast cancer screening or diagnostic evaluation." Several other reports have drawn similar conclusions. That is not to say that improved thermography technology may not one day aid in the breast cancer diagnostic process (see computerized thermal imaging sections below); however, at the moment, thermography is not widely accepted as an effective means of detecting breast cancer.

Indeed, it It might not be so bad if this company were only selling thermography as a possible adjunct to mammography, but that's not the impression I get from its literature. Indeed, Proactive Health Solutions seems to be implicitly selling it as a replacement for mammography. Oh, the e-mail I got when I registered on the site says that, honestly, really, and truly, they aren't saying that thermography should replace mammography at all, but this statement makes me wonder:

Many women are now refusing to have another mammogram for various personal reasons. Although that is a personal decision, we do not encourage this practice. In fact, when both breast thermography and mammography are used together, detection rates improve up to 95-98%.

Nudge, nudge, wink, wink. Orac's translation: "We're not actually saying that it's OK for you to give up mammography, but, if you happen to decide you want to, we think thermography is just super as an alternative and would love to sell it to you. Know what I mean?" Nudge, nudge, wink, wink. Say no more.

I wonder what studies demonstrate such an astounding sensitivity when the two techniques are combined. It doesn't help my skepticism any to see that this technique is being marketed through a site that pushes all sorts of altie nonsense and includes the standard "cover your ass" disclaimer: "Do not delay in seeking advice from a qualified licensed medical professional about treatment for your cancer. The information is provided for educational and informational purposes only, and is not intended to be a substitute for the diagnosis, treatment and advice of a qualified licensed medical professional. We are not doctors, and shall have neither liability nor responsibility to any person or entity with respect to any loss, damage, or injury caused or alleged to be caused directly or indirectly by the information provided." It also doesn't help (me, at least) that there are claims that one can diagnose fibromyalgia and chronic fatigue syndrome using thermography, all presented without any references in the peer-reviewed literature to support them.

With new advances in technology, detectors, and imaging, could thermography turn out to be a useful adjunct to mammography and other imaging studies? There's certainly that possibility, but my opinion is that that particular ship sailed long ago. Other technologies have taken over its potential niche, like MRI, a study that can do more or less what thermography does (measure blood flow) and produce much more detailed images. There's a big difference between a technology having the potential to be useful and its actually having been shown to be useful. Before any test can be widely used to screen an asymptomatic population for a disease like cancer, it has to be validated in large trials to show its level of sensitivity and specificity in the population at large with the existing prevalence of the disease in question. Thermography hasn't, meaning it's very premature to be marketing it to women or to be claiming that it is more sensitive and specific than the existing standard, mammography.

In any case, Proactive Health Solutions is marketing its thermal imaging technology using a site that pushes all sorts of medical misinformation and through comment spamming of blogs, leading me to ask: If its technology is so great, why is it resorting to such lowlife spamming techniques to market it?



ADDENDUM: I've been laying down a lot of Respectful Insolence (and not-so-respectful insolence) lately. Perhaps too much. After all, there is such a thing as too much of a good thing. It might be time for a change of pace tomorrow...

ADDENDUM #2:To anyone from either company who might be annoyed by my little smackdown: Remember that you fired the first shot by spamming my blog. (In actuality, I toned down the final post in comparison to the first version that emerged from my keyboard.) If you hadn't spammed me, chances are that, even if I had somehow come across your websites, I probably wouldn't have bothered with them. In any case, I could have been much nastier. As far as I'm concerned, spammers and comment spammers are among the lowest of Internet scumbags; so perhaps it's a misguided sense of restraint that prevented me from really unloading.

Grand Rounds, Vol. 2, No. 18

A Blogger outage earlier this morning during my usual posting time (between around 6 and 7 AM) prevented me from mentioning this before. (It also made this blog unreachable for an unknown period of time.) But I'm back now and taking a minute to post my weekly plug for Grand Rounds, Vol. 2, No. 18, which has been posted at Kevin, MD. Enjoy!

A particularly egregious misrepresentation of a study

I was made aware of a most interesting study today appearing in the journal Cancer, which is the official journal of the American Cancer Society. However, I wasn't made aware of it through the journal itself, but rather through a very deceptive misrepresentation of the article. The title alone got my attention: 'Miracle' cures shown to work. It begins:

Doctors have found statistical evidence that alternative treatments such as special diets, herbal potions and faith healing can cure apparently terminal illness, but they remain unsure about the reasons.

How do I know that the study is being misrepresented? It's mind-numbingly obvious from reading the the rest of the article that it is, that's why:

A study of patients with incurable lung cancer who were given weeks to live and received only low-dose radiotherapy to make their final weeks more comfortable found a small number recovered completely.

Researchers who followed 2,337 patients whose disease was too advanced for curative treatment found that 25 had survived five years and 18 had achieved "an apparent cure". They appeared to have been cured by treatment that "would not normally be considered to have any curative potential whatsoever".

The researchers, led by Michael MacManus, a consultant radiation oncologist in Melbourne, say: "Our data indicate that a chance for prolonged survival and possibly even cure exists for approximately 1 per cent of patients with non small cell lung cancer who receive palliative radiotherapy.

"It is important that the frequency of this phenomenon should be appreciated so that claims of apparent cure by novel treatment strategies or even by unconventional medicine or 'faith healing' can be seen in an appropriate context."

Unorthodox cancer cures have included vitamin C, laetrile extracted from apricot stones, and the Gershon diet of raw vegetables.

The discovery of a small group of patients who unexpectedly recovered could yield new insights into the disease, the researchers say.

Note that there was no mention in the actual study of the Gershon diet, laetrile, or any other alternative therapy "curing" anything. Instead, the study simply presented findings that a small number of "terminal" lung cancer patients (approximately 1%) were still alive five years after low dose radiation therapy given strictly for palliative purposes, even though the median survival for such patients is usually between 4 and 5 months. In fact, the study's lead author even went out of his way to state that the results of this study should allow investigators to take the claims of alternative medicine practitioners of "miracle cancer cures" in proper context, given that a small number of patients survive considerably longer than expected. If you don't believe me, look at the abstract itself, downloaded through my university (it's an e-publication ahead of print):

Unexpected long-term survival after low-dose palliative radiotherapy for nonsmall cell lung cancer

Michael P. MacManus, M.D., Jane P. Matthews, Ph.D, Morikatsu Wada, Andrew Wirth, Valentina Worotniuk, David L. Ball, M.D.

BACKGROUND
Many experienced oncologists have encountered patients with proven nonsmall cell lung cancer (NSCLC) who received modest doses of palliative radiotherapy (RT) and who unexpectedly survived for > 5 years; some were apparently cured. We used a very large prospective database to estimate the frequency of this phenomenon and to look for correlative prognostic factors.

METHODS
Patients with histologically or cytologically proven NSCLC, treated with palliative RT to a dose of 36 Gy, were identified from a prospective database containing details of 3035 new patients registered from 1984-1990.

RESULTS
An estimated 1.1% (95% confidence interval, 0.7-1.6%) of 2337 palliative RT patients survived for 5 or more years after commencement of RT, including 18 patients who survived progression-free for 5 years. Estimated median survival was 4.6 months. Five-year survivors had significantly better Eastern Cooperative Oncology Group performance status at presentation than non-5-year survivors (P = 0.024) and were less likely to have distant metastases (P = 0.020). RT dose did not appear to be a significant prognostic factor. Patients who survived 5 years without progression had an estimated 78% probability of remaining free from progression in the next 5 years.

CONCLUSIONS
Approximately 1% of patients with proven NSCLC survived for > 5 years after palliative RT, and many of these patients appeared to have been cured by a treatment usually considered to be without curative potential. Because of the potential for long-term survival, doses to late-reacting normal tissues should be kept within tolerance when prescribing palliative RT in NSCLC.

If you read the paper itself, you see that all the investigators did was to study patients with advanced "incurable" lung cancer treated for palliative purposes only, following them to see how long they survived. They followed 2,337 such patients, of which 2,297 completed enough of the course of radiation therapy to be counted in the final analysis, for five or more years and observed that there were 24 five year survivors, approximately 1.1%. Of these, 18 had no evidence of disease progression at five years. Of the known five year survivors, 32% survived another five years, or approximately 0.35% of the total (which means that the 24 five year survivors weren't all apparent "cures"--as the news article called them--because more than half of them still went on to die of their disease). Survival was not correlated with radiation dose. The only characteristic that survival seemed to correlate with was performance status (a measure of general health and ability to handle activities of daily living) and having no distant metastases at the time of the commencement of treatment. The authors speculate that these patients may represent a very small subset of non-small cell lung cancer patients whose tumors are either highly responsive to radiation or not biologically aggressive. The money paragraph is this:

Our data indicate that a chance for prolonged survival and possibly even cure exists for approximately 1% of patients with NSCLC who receive palliative RT. This is a very small proportion, but lung cancer is a very common malignancy. It is important that the frequency of this phenomenon should be appreciated, so that claims of apparent cure by novel treatment strategies or even by unconventional medicine or faith healing can be seen in an appropriate context. All patients in this study had histologic or cytologic diagnoses of NSCLC in an appropriate clinical context. It is possible that errors could have been made in diagnosis in a proportion of cases, but it is very unlikely that all of the cases were misdiagnoses. In many of these patients, biopsy specimens were generous, including some surgical cases. It is well known that conventional cytologic or histopathologic tumor morphology is, by itself, a poor predictor of treatment response in NSCLC. The phenomenon reported here is potentially an important one, in that a subset of patients with NSCLC appears to have disease that is curable with minimal therapy and that prospective identification of such patients could potentially profoundly influence treatment.

There are two possibilities. One possibility is that the reporter just straight out lied about the findings of the study. However, an equally plausible explanation is that the reporter accurately reported the results of this very interesting study, and then his editor inserted text to represent the study as supporting "miracle cures," either because of bias or just to "spice up" the story. Consider: The first sentence is jarringly inconsistent with the rest of the story. After all, the article even included the money quote about how this study demonstrates that there is a small, but real, subset of lung cancer patients who are "cured" by palliative low dose radiation therapy and how this observation should be taken into account when evaluating claims for lung cancer "cures," either due to new conventional treatment or due to alternative therapy or faith healers. Given how common lung cancer is, there are probably a fair number of these patients out there, some of whom undoubtedly attribute their good fortune to some alternative medicine or other. (Also, given how rare these long term lung survivors are, there almost certainly aren't as many such patients as there are breast cancer patients, whose testimonials I discussed long ago, but certainly enough for alties to point to.) Another obviously out of place sentence is this one: "Unorthodox cancer cures have included vitamin C, laetrile extracted from apricot stones, and the Gershon diet of raw vegetables." Nowhere in the study or even the description of the study is any mention of alternative medicine other than the one I cited, and certainly nowhere in the article is an indication that any "miracle cures" from alternative medicine were observed or even possible. In fact, it should be emphasized that every single patient analyzed received conventional therapy; i.e., radiation therapy. Consequently, even if the use of alternative medicine had been identified as a factor associated with long term survival of these patients, that observation would not have shown that alternative medicine had any value on its own for "curing" lung cancer.

My guess is that the reporter probably interviewed Dr. MacManus and did a straightforward story about this study, and then the editor inserted the two sentences in question and gave the article its dubious title. The title is a lie, pure and simple, and the "spin" put on the article is such an obvious hack job that I stand in awe that the editor and/or the reporter could think its readers are so incredibly stupid that they won't see the disconnect between what the study actually says and how it has been represented. Nonetheless, right here I make this not-so-bold prediction: It won't be long before this news story describing this study makes appearances on altie websites, Usenet newsgroups (like misc.health.alternative), and perhaps even in other media sources, offered by alties as "proof" that alternative medicine can "cure" lung cancer.

Just watch.

And if you ever happen to see this study being misused that way, feel free to respond with a link to this blog posting.

I could have said it better

If you're a blogger, don't you hate it when a commenter either says something better than you did or makes a point that you should have made in a post?

So do I.

However, I believe in giving props to commenters who manage to one-up Orac, so much so that I even preempted my intended post for today (a rare straight medblog-style post about a rather disquieting patient encounter I had a while back--so stay tuned for it) with this post instead. So, regarding my post about "ethnoscience" and how I viewed it as nothing more than a a bunch of alties trying to change the definition of science to include their particular brand of woo-woo, much as "intelligent design" creationists did in Kansas recently, John Stone added this comment:

Ethnoscience is just good old whacked-out postmodernism with a few twists. (When is the last time you made an appointment with your witch-doctor?) Dr. Robert Imrie did a incredibly good job of disecting one "EthnoVeterinarian" case at this location. This is one of my favorite pieces of writing on the net. http://www.vet-task-force.com/SW41Imr.htm

He's absolutely right. That's exactly what it is, nothing other than a form of postmodernism, and the link he mentioned is well worth checking out. The best one-liner:

As we’ll see, in the context of ERD&E, the term “research” refers not to the critical scientific investigation of traditional or folk medical practices, but to their “judgment-free” investigation and “validation” in accordance with the tenets of cultural anthropology.

And that's exactly what advocates of "ethnoscience" want for their various unscientific and/or religious "healing arts." Indeed the Dr. Imrie nails it exactly right here:

In any case, I’m certain that advocates of scientific biomedicine share my conviction that various “traditional medical systems” merit rigorous but open-minded scientific evaluation. Who can say what treasures these resources might yield? I suspect that conventional “Western” and even “Third World” veterinarians share Dr. McCorkle’s and my eagerness to “integrate what works in folk medicine” with “what works in scientific biomedicine.” Where we differ seems to be in how we propose to determine “what works and what doesn’t.”

Precisely. Advocates of "ethnoscience" seem to think that we in Western medicine should just accept on faith that the various therapies they're enamored of do what the healers claim they do or that we should subject the claims of "ethnoscience" to a lesser standard of proof (special pleading again). Their underlying assumption seems to be that, because millions of people have believed for hundreds, if not thousands, of years that these therapies "work," they must have efficacy or, at the very least, there must be something to them. Well, maybe or maybe not. In many cases, that millions of people believe in something is irrelevant to whether that something is correct. For example, millions of people have believed for thousands of years that ghosts exist, among other examples of superstitious, religious, or pseudoscientific beliefs that large percentages of the population hold. Does that mean I should just accept that there might be something to the contention that ghosts exist and communicate with the living without demanding scientific evidence? No! What about astrology? Millions have believed in it for thousands of years as well? Should I just accept it as having the same validity as astronomy for that reason. Of course not! Yet the underlying assumption, usually unspoken but not always, of "ethnoscience" seems to be that we should, often with the not-so-subtle implication that, if we don't, it is due to racism or elitism. Indeed, the very coining of the term "ethnoscience" seems a conscious effort by its advocates to imply that we should accept its claims as co-equal with those of science.

So what's wrong with anecdotes, personal experience, and folk wisdom in determining what treatments "work." It's not that anything is "wrong" with it per se; it's more that we now know that it is not the best way to determine whether a treatment works or is widely applicable. We medical researchers know from the history of science and through long and bitter experience just how easy it is for limited sample size, confirmation bias, regression to the mean, selection bias, and other confounding factors can lead us into thinking a treatment works when it does no. We also know how easy it is for doctors to allow inherent biases and their desire to help people lead them to become too attached to a therapy's supposed efficacy. What seems to be poorly understood among the lay public is that randomized clinical trials exist not because we as physicians and investigators trust ourselves or other scientists but rather because we know that human nature is such that we can't trust ourselves or other scientists to be totally objective. In addition, as hard as it might be for us to accept, we can't trust our own personal experiences to be generalizable to all patients. That's why we need objective measurements, double-blinding where possible, and randomization.

What also infuriates me about much of alternative medicine is that the attitude seems to be that we should have to test everything, even if there is no plausible scientific basis for the proposed therapy. So, while I'm giving other bloggers props for explaining and reinforcing what I'm trying to say, I might as well point out that Dr. RW put it nicely when he decried this attitude:

Other notions proffered for “research” are, in my considered opinion, exercises in pseudoscience---attempts to validate claims that have been debunked and have no biologic plausibility. What’s the point of looking for clinical effects of energy fields undetectable by instruments of physicists and Star Wars forces left behind in water after active ingredients are diluted out?

A strict empiricist might object to my requirement of biologic plausibility, but I maintain a line must be drawn. Otherwise we might as well burn the chemistry and physics books and study every claim that comes along. Why stop with Therapeutic Touch, Homeopathy and Reiki? Let’s go on down the slippery slope and fund studies of astrology, telekinesis and shamanism. And while we’re on the subject of energy medicine why not resurrect Franz Mesmer’s theory of animal magnetism? If only we do enough research his claims will surely be validated. (Discredited in the 18th century, Mesmer would likely be on faculty at a medical school today).

This is a stronger statement what I've been saying all along, but have been perhaps a bit wimpy in emphasizing. Consider, for example, the very concept of homeopathy, the "healing art" that claims that you can dilute a substance to the point where there isn't even one molecule of the original substance in the water, and that the water somehow retains a "memory" of the compound such that it is effective in treating disease. For homeopathy to work, the very foundations of our understandings of chemistry, physics, and biochemistry would have to be seriously flawed or just plain wrong. It may be possible that homeopathy works by some previously understood chemical or biological mechanism, but it's so unlikely that it does that it is incumbent upon advocates of homeopathy to produce clearcut and convincing evidence that it works, not for conventional medicine to "prove" that it does not. The same should apply to any therapy that claims to manipulate "qi," an "life energy" that no physicist or instrument can seem to manage to measure (yet which practitioners of traditional Chinese medicine assure us that they can manipulate to heal patients), or to the African shamanism that whose inclusion in an exhibit on "ethnoscience" I decried. Why should I take this seriously if practitioners cannot show me how to measure qi empirically or by what mechanism chi can lead to healing?

Contrast this desire for acceptance without meeting the standard of science by "ethnoscience" advocates with a recent example from the world of conventional medicine, namely the discovery of H. pylori as the cause for most duodenal ulcers by Robin Warren and Barry Marshall. Yes, Marshall and Warren's ideas were met with extreme skepticism and even ridicule when they first presented their hypothesis that the cause of most duodenal ulcers was bacterial. One of the criticisms was that the proposed mechanism wasn't biologically plausible, that it didn't fit in with existing science. If Warren and Marshall had been alties, they likely would have whined that they weren't being taken seriously by the "conventional medical establishment" or perhaps tried to pull the Galileo gambit prematurely. Fortunately for ulcer patients everywhere, they were and are scientists. So they did what scientists do. They did experiments. They gathered more data. The data was convincing, so much so that other investigators started to wonder if maybe Marshall and Warren might be on to something about H. pylori after all. More investigators started looking into the possible connection and found the same thing. Over a decade, momentum gathered, until there was a paradigm shift in the late 1980's and early 1990's, and a new scientific consensus developed. Warren and Marshall earned the right to be taken seriously, and, in fact, their efforts led them to be taken so seriously that they were awarded the most prestigious prize in medicine last year.

As I've said time and time again, I'm all for scientifically testing various alternative medicines for efficacy and examining mechanisms by which those with efficacy exert their effect. However, we don't have the unlimited resources that it would take to do clinical trials on every claim made by alternative medicine advocates, which is why we need a "triage" system to decide which are worth looking at in more detail. We need reasonable criteria for determining which ones are worth evaluating scientifically. To me, one very basic first screen should be that the therapy being proposed should have a biologically plausible mechanism by which it might work, even if somewhat tenuous. By that standard, many herbal remedies would likely be worth checking out, given that many substances herbs and plants have pharmacological activity. Energy healing would not, because this energy or "qi" cannot be measured, detected, or even objectively described in a way that science can study it. Acupuncture would fall somewhere between as possibly worth checking out. Even though we have to do a bit of handwaving to come up with a semiplausible physiologic and biologic mechanism by which it might work, such mechanisms can be proposed. Not so for homeopathy, pyramid healing, various forms of shamanistic "spirit" healing, or distance healing. The likelihood that any new or efficacious therapy would come from studying these latter alternative medicine therapies is so low that they should be at the bottom of the list in terms of dedication of resources to study them.

It is indeed important to test alternative medical therapies, as there may indeed be hidden gems that we in medicine could appropriate and integrate into our therapies, to the benefit of our patients. However, it is equally important that we do not dilute this effort by evaluating therapies whose basis is without biological, chemical, or even scientific plausibility, unless very clear evidence of efficacy is demonstrated by their advocates.

Time for another episode of 24

In anticipation, I've found 24 Rules of the 24 Universe. Several examples lifted from the list:

1. Given the chance to kill Jack Bauer, an evil-doer will not do so.
2. Given the chance to kill another major ‘good’ character, there’s a 50/50 chance an evil-doer will do so.
3. Given the chance to kill any other ‘good’ character, an evil-doer will do so.
4. When guarding an exit door, police officers will always stand looking out said door, instead of back at the hallway, making it easy for any evil-doer to slide up behind them and take them out.
5. When guarding an area, CTU and the police will leave one blatantly obvious exit path unguarded.
6. The CTU motor pool issues only large American-made SUVs, typically silver.
7. All evil-doers also drive large American-made SUVs, typically black.
8. Most any problem can be solved by opening a port.
9. If opening a port doesn’t solve the problem, then you must create a protocol.
10. Protocols must be followed, unless you’re Jack Bauer.
11. If you work for “Division,” you only care about protocols and covering your butt in case things go wrong.
12. CTU’s systems can increase image resolution while zooming in to see fine details.
13. CTU’s annual budget request for cubicle walls is always rejected, leading to the inability of anyone on the floor to do anything in secret.

My favorite one, however, is:

Those on the ‘good’ side get Macs. Evil-doers get PCs.

Which is as it should be.

One rule he forgot is this one:

Jack Bauer can go 24 hours without a trip to the bathroom.

Illogical

I'm probably going to end up regretting posting this, but the above picture irritated me.

No, it didn't irritate me because the woman is demonstrating in support of abortion rights. Rather, the photo offended my sense of skepticism and critical thinking. It shouldn't matter what one's position is in the abortion debate to see that, on a logical basis alone, the above body painting, seen at one of the many marches on the anniversary of Roe v. Wade yesterday, is pretty illogical and indeed borders on downright idiotic.

Think about it a second.

If a fetus could think and have an opinion on abortion, is it logical or even reasonable to think that it would support a position that might potentially result in its own destruction? That seems to be the implication of the body painted message above.

Just a thought.

Orac has now had himself placed in a special asbestos case. At least he wasn't as snarky about this photo as Dave was, although he was definitely tempted.

The irony about David Irving's imprisonment

Ben Macintyre wrote an excellent opinion piece for the Times that says more or less exactly what I've been saying all along about Austria's imprisonment of David Irving for Holocaust denial:

Irving’s opinions are indefensible; his right to hold them, however, must be defended. For reasons of both principle and expediency, he should go free. Freedom of speech includes the right to be hopelessly, demonstrably and repeatedly wrong. It is not to be applied selectively, depending on the nature of the speech in question, but universally and consistently. The UN Declaration of Human Rights is unequivocal: “Everyone has the right to freedom of opinion and expression.”

To defend free speech when we happen to share the speaker’s opinion is an easy task. Take Orhan Pamuk, the Turkish writer who is facing trial for saying, in defiance of the official Turkish view of history, that his compatriots carried out the genocide of Armenians during the First World War. Many writers (including this one) have defended his right to do so. Far harder, but just as essential, is the defence of speech that we find morally disgusting and intellectually bankrupt. When a conference in Turkey on the Armenian question was cancelled under state pressure, the liberal West was outraged; when Iran recently announced a conference to question the authenticity of the Holocaust, the West was, once again, outraged. But in the case of both Irving and Pamuk, the issue should be settled in the court of public discussion, not the law courts; so long as speech does not directly incite racial hatred, it must remain free.

In doing so, however, he brings up an irony that I hadn't considered:

For Austria, beset by the rise of the far Right in the unpleasant shape of Jörg Haider, Irving has appeared at a politically opportune moment. Sticking the “revisionist” in prison for something that he said 16 years ago, based on a law nearly 60 years old, is a neat way for Austria to demonstrate its liberal bona fides. Of the nine countries with laws banning Holocaust denial, Austria is the strictest. Yet the country has too often shied away from admitting its Nazi past.

The Simon Wiesenthal Centre estimates that some 40 Nazi suspects are still living in Austria, and accuses Austria of a lamentable record in apprehending war criminals.

Irving is in prison for writing about the Holocaust, in a country where people who took part in the Holocaust are still at liberty. Irving would be able to argue that the people who operated the gas chambers should be prosecuted before people who make speeches about them, except that he is on record as saying that the gas chambers never existed. Ironies don’t come much more savoury than that.

Indeed, they don't.

ADDENDUM: I've been remiss in not posting a link to Andrew Mathis' essay The Semantics of Holocaust Denial. I may have to put my two cents in about some of what he wrote sometime next week, mainly because what he says about how semantics are used in Holocaust denial also has relevance to pseudoscience and quackery, as well as the pseudohistory of Holocaust denial.

Saturday morning blog housekeeping again

A reader who has the misfortune of using Internet Explorer got fed up with the way my new template looks on IE, with the right sidebar and/or the main panel being pushed down under the left panel. I hadn't been able to discover a fix, and the template looked fine in every other browser I had tried it on, including even the old Macintosh version of Internet Explorer (v. 5.2). I couldn't even replicate the bug at home, because even when I used Virtual PC with Windows 2000, the template looked OK. However, when I checked the template out on a PC at work, I would frequently see some or all of the problems being complained about.

I just threw up my hands and gave up for the moment.

Fortunately, not everyone else did. This reader found a potential fix, and I'm going to apply it today:

It's an unfortunate fact that Internet Explorer will always incorrectly expand any dimensionally restricted block element so that oversize content is unable to overflow, as the specs require that content to do. I will be comparing IE/win's way with the correct behavior as seen in Firefox. The W3C says a rigidly sized block box should allow oversize content to protrude or overflow beyond the edges of the sized box.

There is no real "fix" for IE/win's incorrect behavior, except to work around or avoid it.

More:

It's a "float drop", and it's caused by having oversized content in a fixed-width floated div that must fit into a particular spot in the layout. In this case, the oversized content is the URL string in the green float.

And:

One common cause of box expansion in IE/win is when you have oversized content such as a long "unbreakable" URL, with no spaces where word wrapping may take place.

The proposed workaround is this:

Try adding the word-wrap property with the value break-word.

Although this has no effect on Firefox, it does force IE/win to break up "unbreakable" text so that it no longer expands the width of the box containing the text.

Be aware that word-wrap is a proprietary Microsoft CSS rule. It is not part of the W3C specification at this time, and will invalidate the page unless that code is hidden inside a Conditional Comment, like this:

<***!--[if IE]>
<***style type="text/css">
***body {word-wrap: break-word;
}
<***!--[endif]-->

(Note: Remove the "***" before each line. I had to insert them to make the code visible, because otherwise it was treated as a comment and not shown.)

That style block is contained in the CC, which can go in the head section of the web page. Only IE/win will look inside the CC, while all other browsers and the W3C validator see only an ordinary HTML comment, and ignore everything inside. It's not a pure solution, but it does work safely on potientially damaging long text strings, and does validate too. Notice that this rule inherits to all page elements from the body element, providing page-wide protection.

I just applied this fix to the page. IE users out there, please let me know if it worked. It looks fine on Firefox and Safari; so at least I didn't screw anything up.

What is "ethnoscience"?

I know I'm a bit of a stickler, a curmudgeon, if you will, when it comes to medicine. Call me crazy, but I have this rather annoying tendency to want to see evidence-based research based on sound physiologic principles backed up by basic science and well-designed and well-executed clinical studies that show a treatment, drug, or remedy to be effective. When someone makes a claim for a drug, herb, therapy, etc., my first reaction is to ask for the evidence behind those claims. Also, contrary to some straw men arguments that are sometimes made in response to my writings, this evidence does not necessarily have to be in the form of a randomized, double-blinded, placebo-controlled trial. True, they represent the gold standard, but all doctors, including me, know that some therapies are just not easily amenable to such trials. For example, it can be impossible to double-blind participants and doctors during clinical trials of surgical therapies, particularly trials involving surgery versus no surgery or trials involving two different operations (in which the surgeon, at least, knows what operation was done). There are also diseases which are not sufficiently common to produce enough patients to do a randomized trial with adequate statistical power to detect differences in outcome. In these cases, the goal is evidence as close as possible to randomized, double-blinded trials, and, the closer to that goal the evidence is, the more credible it usually is. I'm also aware that for many treatments the literature is sometimes contradictory, meaning that a synthesis of the best scientific and clinical evidence is what is needed to come up with treatment recommendations. Even so, to me scientific evidence-based medicine represents the best method by which to determine if treatments do what is claimed.

Not surprisingly, this has gotten me some rather negative reactions from alties. And, contrary to some accusations, I do try to apply these criteria to both "alternative" and "conventional" medical treatments that I come across. I also get a bit annoyed when I see, as is all too frequently the case, fawning credulous articles written about unproven, ineffective, or pseudoscientific treatments:

When Ismael Calderon was growing up in Puerto Rico, his mother was the nurse of the neighborhood. There were no doctors.

"People would come to her and she would cure them by using plants," said Calderon, now science director of The Newark Museum. "She did not have a license to practice, but she learned ethnobotany from her predecessors. Different plants have chemicals that assist us in having better health."

Was his mother a scientist? No. But what she practiced was ethnoscience, which refers to time-tested traditions passed down by various ethnic groups through the ages.

Ethnoscience is not pseudoscience, Calderon emphasized. Neither is it fad science. It is good ancestral science.

My first thought was: "What the hell is 'ethnoscience'?"

"Ethnoscience is not pseudoscience?"?

You just know that a statement like that is going to get my attention, because I really hate it when alties misappropriate the term "science" in order to claim the mantle of authority that science brings. Science involves the empiric observation of measurable quantities and the testing of hypotheses to falsify or support them. Mr. Calderon's mother may have had a lot of practical experience, but she was not doing science. Consider: What diseases did she "cure" using plants? How do we know she "cured" them, rather than the disease being self-limited? How do we know her apparent "cures" weren't due to the placebo effect? Did she make hypotheses, test new treatments based on those hypotheses, and cease using treatments that didn't work and, most importantly, record her observations carefully and as empirically as possible, so that others could build on them?

The answer is almost certainly no. For one thing, traditional "healers" almost never stop using any treatment that has been passed down to them, even ones that clearly don't do what is claimed, such as homeopathy or using echicinea. The same "healing" just gets passed on from generation to generation with little or no change. For another thing, such healers almost never do anything resembling a clinical trial to see if their treatments truly work. They instead rely on memory and experience with their treatments. Sometimes their experience may be correct in concluding that a certain treatment or herb is effective against a certain disease, but confirmation bias and regression to the mean (a problem that is difficult to control for even in well-designed clinical trials), among other problems and biases, will guarantee that at least as frequently their "experience" will lead to a conclusion that appears correct to them but in reality is not. In either case, they're not really doing science.

Finally, look at some of these statements and see if you think that any of these should be able to claim the mantle of "science." I pick the one that's closest to something that is empirically testable and might have elements that stand up to scientific scrutiny first:

Colbin's specialty -- how food changes the way the body works -- was sparked long ago when she discovered that modifying her diet cleared her complexion and gave her a deep supply of energy. The truth was never more apparent to her, she said, than the day she cured a migraine with applesauce.

Using food therapeutically is inexpensive, easy and available to anyone with enough will to learn, she said.

There's no doubt that food may influence health. The problem is determining what foods and how. In any case Colbin's statements are so vague as to be meaningless. "Deep supply of energy"? What the heck does that mean? How do you measure this "energy"? "Cure a migraine with applesauce"? If that's truly effective in treating migraines, it shouldn't be too hard to demonstrate empirically, should it? If it's that effective, it would take just a small clinical trial that wouldn't take very long to perform. Believe me, having known some people with horrible migraine problems that were poorly responsive to standard treatments, I know that their doctors would have been more than happy to recommend applesauce to them if it actually helped them get rid of migraines. In any case, there's little doubt that improving one's diet can result in better health, but what, specifically, constitutes "improvement" in the diet? What specific food items can prevent disease? Science represents the best way to find out.

Now, let's go to one therapy that's even less scientific:

Kejian Xiao, originally from Changsha, China, and currently practicing traditional Chinese medicine in New Jersey, will diagnose the public's chi and then prescribe individual teas to balance their ying and yang energies.

One recent day in her K.J. Clinic in Skillman, Xiao made teas and spoke about the Taoist ying/yang philosophy that underlies traditional Chinese medicine. Ying, she said, comprises the substances of the body -- blood, fluids, structures. Yang is the movement of the ying. The two are always in flux, establishing and re-establishing balance in the body.

Health problems happen when there is sluggish or no movement, resulting in stagnation, stiffness and pain.

"Most of the diseases start with the yang and the body not moving correctly," Xiao said. "Over a long time, eventually you develop a disease."

Various teas, blended for individuals' unique ying/yang mix, are created using some 400 herbs, including leaves, twigs, roots, flowers, mineral products, animal products and oyster shells, depending on the practitioner's style. Xiao uses six to 12 herbs in her formulas.

What is "chi"? How is it measured empirically and objectively? The definition of Ying is so vague as to be meaningless, as is the definition of Yang. Be that as it may, let's ask this: How does she know that the "Yang" and the body "not moving correctly" cause disease? What diseases? All diseases? It's certainly possible that some of the herbs or teas that Xiao likes to use may have therapeutic benefit, but on what scientific basis does she know that they "work" or which one "works" for which disease? How does she determine each individual's "unique ying/yang mix" using teas?

Not surprisingly, regardless of the disease, in most cases the treatment is more or less the same:

The concept of ying and yang extends even to a person's mental life, according to Xiao. An overactive mind, considered too yang, is manifested by excessive talking, frustration and the overstimulation of stress. A mind that is too still, however, can manifest in depression.

Both are considered out of balance. Both are treated with teas.

Or how about this, the least scientific therapy of all in the exhibit:

Dr. Kamau Kokayi, who earned his medical degree at Yale University School of Medicine and is medical director of the Olive Leaf Wholeness Center in Manhattan, will cap off the day's events with a 4 p.m. talk and demonstration of African medicine.

"I'll introduce the attendees to traditional African medicine as another cultural expression of the healing power that's inherent in human beings," Kokayi said. "Most people in the Western world now have heard about Chinese medicine and Ayurvedic medicine, but when they think about Africa they don't associate it with healing potential.

"Africa usually is seen as an area in constant need of aid from the West. I want to dispel that notion."

Central to African medicine is the belief that people are spirits encased in physical bodies. Given that assumption, divination is key, according to Kokayi, who was born in the United States but has traveled extensively in seven African countries to create a documentary on traditional healers there. He will bring traditional African diviners to the museum to demonstrate what they do.

"Spirits encased in physical bodies"? This may or may not be true, but it is definitely not science, "ethnoscience" or otherwise. "Divination is the key"? What the heck is "divination"? On what basis do they divinate? What empiric observations lead to their divinations for specific patients and diseases? Has the accuracy of their divination ever been empirically tested? How? What were the results? Finally, if it isn't empiric observations that lead to divination and treatment, then why on earth should I take the claims of these African healers any more seriously than I take those of John Edwards or other psychics or spiritualists? Without empiric evidence and a basis in observable, reproducible natural phenomena, all that's left is superstition and pseudoscience.

The bottom line is, whatever the basis of these "healing systems" are, whatever value some components of them may have in complementing "conventional" medical treatments, the vast majority of these systems aren't scientific in any way, shape, or form. Much of what is contained in them isn't even empirical. Indeed, in large part, these "ethnoscience" healing arts are based on untested and untestable religious beliefs (Chi, Ying/Yang, "spirits encased in physical bodies," etc.) that remain outside the purview of science because they cannot be empirically measured or tested. It is quite possible that some of the herbal remedies used by these healers have value, given that many drugs are derived from plants and natural products, or that some treatments like acupuncture may help pain, and it is worth testing empirically the ones that give an indication that they might have some efficacy. Nonetheless, for these "healers" to try to claim the mantle of science by labeling their belief systems "ethnoscience" sounds to me like a case of special pleading, where they try to argue that they are entitled to claim the mantle of science even though their evidence and methods do not meet or conform to the standards demanded by science because of their special situation or history;. Also, at least in part, this appropriation and modification of the word "science" can be seen as a case of pseudoscience and religious beliefs trying to redefine what science is to include the supernatural, as "intelligent design" creationism advocates on the State Board of Education have voted to do in Kansas. Fortunately, science doesn't (or at least shouldn't) work that way. If advocates of these "healing systems" want to claim the mantle of science for their specialties (be it "ethnoscience" or any other hyphenated science), they should be held to the same standards of hypothesis generation, experimentation, and evidence as scientists are.

Until advocates of these different "healing arts" can conform to and meet the standards of science to demonstrate that their herbs, treatments, and "rebalancing of energy" can do what they claim they can do for patients and provide a scientifically plausible mechanism by which they accomplish this, it's way too premature to grant the label of science to these "healing arts."

Speaking of amusing alt-med stuff: Lookin' for love in all the wrong places...

While I'm on the topic of amusing alt-med odds and ends, I've discovered that supporter of quackery and scammer extraordinaire Kevin Trudeau is going to be on ABC's 20/20 tonight at 10 PM. At least John Stossel is doing the interview, which might make it interesting. (Yes, I know that John Stossel likes to represent himself as a "skeptic" but tends to be rather credulous when it comes to the claims of industry and conservative groups. Nonetheless, for this particular purpose he'll do just fine.) Even so, given that Battlestar Galactica is on at the same time, I have no intention of watching. I'm not sure if it's even worth taping it to debunk him. After all, debunking Kevin Trudeau's pseudoscientific and antiscientific quackery is like fishing with dynamite in a small pond. It produces a satisfying boom and splash, but even that gets boring after a while because it's just too easy. There's no challenge.

On the other hand, there is a really amusing tidbit that I just discovered about Kevin Trudeau. I'm not entirely sure if it's legit or not, but if it isn't Trudeau it's a hell of a practical joke.

Go to this site and enter "memoryguy" in the "Username" field.

Bwahahahahahaha!

Feel free to post right here your favorite excerpt from what you find!

Oh, and don't worry. I saved the page as a web archive. If it disappears, I have a record.

One of the funniest warnings I have ever seen

This has to be the funniest "disclaimer" I have ever seen on an alternative medicine website:

United States Government

WARNING

The following health suggestions and opinions by Dr. Richard Schulze are based on his 20 years of clinical practice assisting thousands of patients to heal themselves.

Warning: His knowledge and experience are not necessarily shared, nor have they been evaluated or approved by the FDA, the AMA, or any other 3-lettered federal, state, or local agency.

Therefore, if you are ill, have any disease, are pregnant, or just improving your health, we are forced to warn you to go to a medical doctor. Because of the current lack of health freedom in America it is legal for them to kill you but not legal for Dr. Schulze to help you heal yourself.

Upon entering this site, you hereby agree to take full responsibility for yourself, your health and release, indemnify and hold harmless, Dr. Richard Schulze, American Botanical Pharmacy, Natural Healing Publications, their employees and heirs.

What a putz!

Two things:

First, apparently Dr. Schulze doesn't know what any physician knows, namely that promises not to sue for malpractice, even if signed and notarized, are not enforceable. They aren't worth the paper they're printed on, and clicking on an "I Agree" button for such a disclaimer on a website means even less.

Second, Dr. Schulze appears to be tacitly admitting that he is somehow doing something illegal or immoral when he says it is "not legal for Dr. Schulze to help you heal yourself." After all, as his autobiography (and, of course, testimonial), he is not a medical doctor, but rather a "medical herbalist" and "natural doctor" (whatever that is).

Third, like most such alties, he appeals to his authority and personal experience, rather than scientific evidence:

During the next 20 years of clinical practice my patients’ real life illnesses taught me what I needed to know about making herbal medicine that works, heals, and keeps you healthy. In the clinic it’s very black and white; it either works, or it doesn’t. I also developed numerous natural healing and herbal programs and routines like my 3 Food Programs, Intestinal Detoxification Program, 5 Day Cleansing and Detoxification Program, Liver/Gallbladder Cleansing Program, Kidney/Bladder Cleansing Program and my now famous Incurables Program.

Note the concrete thinking. To him, in the clinic it's all "black and white"; to him it either works or doesn't. Few situations in medicine are that black and white, but that doesn't stop him from implying that they are. And, of course, he doesn't produce even a halfway decently designed case series to support his claims. All he gives is just his "word" that all his various herbal concoctions "work." Finally, as expected, he's also peddling a veritable panoply of unproven and/or ineffective altie treatments, particularly gallbladder flushes, along with the usual tired old meaningless claptrap about "boosting the immune system" or "detoxifying" the blood.

No wonder he has to add to the end of his pages this additional disclaimer:

WARNING: None of the above statements have been evaluated or approved by the Food and Drug Administration or the American Medical Association. The information provided on this site is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. Always seek the advice of your physician or other qualified health care provider before using any herbal products.

This is about the only thing that I don't entirely disagree with on the whole website. In fact, I've started to notice this very disclaimer or ones very similar to it on quite a few altie websites. Somehow, I doubt that the disclaimer would protect them if anyone gets upset when their remedies don't do what's promised.

On the 64th anniversary of the Wannsee Conference

Today is the 64th anniversary of the Wannsee Conference; that is, the conference held at a mansion in the plush Wannsee district of Berlin, during which the first major discussion of the Final Solution occurred. The Wannsee Conference was a major turning point in the history of the Holocaust, when Nazi policy went from one of expulsion of Jews from the territories controlled by the Third Reich to one of industrialized extermination. In general, newer evidence suggests that the decision to exterminate the Jews had been made months before, but that the Wannsee Conference was convened to formalize it and establish SS control of the process.

Three news stories indicate that the museum that the mansion in which the conference was held has become has revamped its displays to include new information:

BERLIN, Jan 20 (Reuters) - On Jan. 20, 1942, a group of 15 senior Nazis met in the dining room of an idyllic lakeside villa where they ate breakfast, drank cognac and discussed the bureaucratic details of killing Europe's Jews.

The villa in Berlin's posh Wannsee district where the meeting took place is now a museum. On Friday, it reopens with a new permanent exhibition that offers a broad view of the "Wannsee Conference" and how the Holocaust was carried out.

"The main reason for revamping the exhibition was the opening of archives across eastern Europe," said Norbert Kampe, director of the Wannsee villa memorial. "That led to a rather unexpected breakthrough in research."

"The role of police and Gestapo in exterminating the Jews of eastern Europe has become much clearer," he told reporters.

The centre of the exhibition is the villa itself.

The dining room, with large windows overlooking the lake, is where the participants discussed what SS-Obergruppenfuehrer Reinhard Heydrich described in an invitation to one senior official as "the final solution of the Jewish question."

The invitation letter is on display in the dining room. Dated Jan. 8, 1942, it was sent from Prague and addressed to Undersecretary of State Martin Luther at the Foreign Office.

"Discussion to be followed by breakfast, on 20 January 1942 at noon, Am grossen Wannsee 56-58," the invitation says.

The minutes from the meeting, known as the "Wannsee Protocol", are one of the most important documents from the war and played a key role in the Nuremberg war crimes trials.

"The Wannsee Protocol is emblematic of the Holocaust not just in its methodical blueprint for murder," historian Mark Roseman wrote in a book on the Wannsee Conference.

"It reminds us that the Holocaust is the best-documented mass murder in history. Bureaucracy was its hallmark."

Indeed. Claims of Holocaust deniers (such as David Irving or the nutjob who is presently President of Iran) aside, the Holocaust was almost certainly the best-documented genocide in history. The minutes of the Wannsee Conference, known as the Wannsee Protocol, although couching the conference's intent in euphemisms, leave little doubt that the formal policy of the Nazi government towards the Jews was now extermination or use as slave labor, and then extermination. So, what's in the new displays? This, for one:

The documents, posters, newspaper articles and photographs added to the exhibit are less dramatic than the minutes but create a clear picture of the day-to-day business of genocide.

One such document is a memorandum from a Nazi field commander in the east who says he has halted the "irresponsible" execution of Jews by the soldiers under his command.

The commander acknowledges "the urgent need to cleanse occupied territories of Jews" but questions whether this should be done without regard for the "economic needs of the Reich" -- indicating he thought some could be kept alive for slave labour.

Another paper jubilantly announces the end of the Warsaw ghetto which was destroyed in 1943.

"There is not a single Jewish residential district left in Warsaw anymore!" the document says.

Rainer Lendler, who designed the exhibition, described it as a "historical panorama."

There are photographs of survivors accompanied by personal statements. Relatives of top Nazis are also represented.

It sounds well worth checking out if you live in Germany or plan on traveling to Berlin.

The Twenty-sixth Meeting of the Skeptics' Circle

It's that time again. The Twenty-sixth Meeting of the Skeptics' Circle has been posted at Skeptic Rant, and Sean has done a great job gathering the best blogging devoted to skepticism and critical thinking. He's even gone so far as to create an über-cool Flash animation to lead the reader to the posts in the Circle, thus going above and beyond the call of duty as a host. (I wish I knew how to make Flash animations like that.)

It occurs to me, though. This latest Circle represents the last Skeptics' Circle of its first year. It's been an eventful first year, ever since the very First Skeptics' Circle was hosted by its creator, Saint Nate, to my reluctant assumption of the duties of organizing the Circle when Nate retired from blogging. The next edition, to be hosted on February 2 by Prometheus at Photon in the Darkness, will represent the first Skeptics' Circle of its second year of existence, and I'm urging everyone to help Prometheus get the second year of the Skeptics' Circle off to a great start by sending him your best stuff by a deadline on February 1 to be announced by Prometheus.

Yes, last year was a great year for the Circle, despite its upheaval last summer. I want make its second year even better than the first, but I need your help. Consequently, I'm putting out an appeal for bloggers who might be interested in hosting their very own Meeting of the Skeptics' Circle. If you think you have what it takes to host a Skeptics' Circle that would make The Amazing Randi or Michael Shermer proud, drop me a line at oracknows@gmail.com. We're booked through April, but I'd like to get the rest of the spring taken care of and start working on lining up hosts for the early summer.

The CDC flubs it

I had planned on taking it easy, blog-wise, today, just posting my usual biweekly plug for the Skeptics' Circle and maybe a couple of very brief Instapundit-style link and comment posts that would take only a few minutes to bang out. However, unfortunately, sometimes stories pop up that demand comment, and, ever since I first found myself rebutting conspiracy theories about mercury and autism in June, I now feel almost obligated to comment whenever something important related to this topic happens.

As you know, I've written quite a bit about the use of chelation therapy for "treating" autism and how there is no scientific, physiologic, or clinical basis to suspect it does what its advocates claim it does or any clinical evidence from well-designed trials to suggest that it does anything to relieve the symptoms of autism. All of this made me particularly distressed back in August when I learned of the death of an autistic boy named Abubakar Tariq Nadama while undergoing chelation therapy. To my mind this death was an obvious "clean kill" by the doctor who treated him, Dr. Roy Kerry, and the autopsy results confirmed that it was indeed chelation therapy that caused the tragic and senseless--and completely preventable--death of this boy.

Today, my attention was drawn to this article:

One of the nation's foremost experts in chelation therapy said she has determined "without a doubt" that it was medical error, and not the therapy itself, that led to the death of a 5-year-old boy who was receiving it as a treatment for autism.

Dr. Mary Jean Brown, chief of the Lead Poisoning Prevention Branch of the Atlanta-based Centers for Disease Control and Prevention, said yesterday that Abubakar Tariq Nadama died Aug. 23 in his Butler County doctor's office because he was given the wrong chelation agent.

"It's a case of look-alike/sound-alike medications," she said yesterday. "The child was given Disodium EDTA instead of Calcium Disodium EDTA. The generic names are Versinate and Endrate. They sound alike. They're clear and colorless and odorless. They were mixed up."

Both types of EDTA are synthetic amino acids that latch onto heavy metals in the bloodstream.

Dr. Brown said she obtained the child's autopsy report on behalf of the CDC after reading an article about the death in the Pittsburgh Post-Gazette. She said it didn't take long to figure out what had happened.

Essentially, Tariq died from low blood calcium. Without enough calcium -- a metal -- in the blood, the heart stops beating. Dr. Brown said the Disodium EDTA the child was given as a chelation agent "acted as a claw that pulled too much calcium" from his blood.

"The blood calcium level was below 5 [milligrams]. That's an emergency event," she said.

Officials from the state police, the district attorney's office and the coroner's office will meet soon to decide whether to hold an inquest into the child's death and whether it should remain listed as accidental.

Dr. Brown said the same mix-up happened in two other recent cases: a 2-year-old girl in Texas who died in May during chelation for lead poisoning and a woman from Oregon who died three years ago while receiving chelation for clogged arteries.

Dr. Brown said that in each case, the blood calcium level was below 5 milligrams. Normal is between 7 and 9.

The correct chelation agent -- Calcium Disodium EDTA -- would not have pulled the calcium from the bloodstream, she said.

My first thought was that these comments seem to imply that you "pays your money and takes your choice." Either Dr. Kerry is a quack using potentially dangerous and unproven treatments for autism, or he's an incompetent doctor who, in trying to use a relatively safe but unproven and most likely ineffective treatment for autism, screwed it up, picked the wrong chelator, and thereby killed an innocent child. Personally, I wouldn't want to defend a doctor like that, regardless of which characterization is closer to the truth. Also, contrary to the claims of chelationists that no one has died undergoing chelation since the 1960's, Dr. Brown did point out two other examples of recent fatalities due to complications of chelation therapy. Ironically, one of the deaths was due to the use of chelation therapy for another disease for which it is not indicated and for which there is no evidence that it is effective (in fact, for which there is good evidence from randomized clinical trials that it is not any better than placebo), specifically coronary artery disease.

Dr. Brown herself continued:

She [Dr. Brown] said there have been no reputable medical trials demonstrating the effectiveness of chelation as a therapy for anything but lead poisoning. But if it were administered accurately, the procedure would be harmless.

She said it is well known within the medical community that Disodium EDTA should never be used as a chelation agent. She quoted from a 1985 CDC statement: "Only Calcium Disodium EDTA should be used. Disodium EDTA should never be used ... because it may induce fatal hypocalcemia, low calcium and tetany."

"There is no doubt that this was an unintended use of Disodium EDTA. No medical professional would ever have intended to give the child Disodium EDTA," Dr. Brown said.

Dr. Brown appears not to be living in the real world if she really thinks that no medical professional would ever have intended to give disodium EDTA.

Unfortunately, Dr. Brown did not emphasize nearly enough that there is no evidence from clinical trials or even a halfway decent case series that chelation therapy results in the improvement of autistic symptoms. None. Even if mercury poisoning does cause autism, there is no good physiologic or scientific reason to think that chelation would be likely to reverse the neurologic damage, which, having occurred many months to a few years before autism is usually diagnosed (because children get most of their vaccines before age 1 and most cases of autism are diagnosed between ages 2 to 5), would be unlikely to be reversed by "removal" of mercury at a time so distant from the original "insult." Finally, she didn't emphasize nearly enough that there is at present no good physiological reason or scientific reason to suspect that autism is caused by mercury from the preservatives in childhood vaccines in the first place, mainly because the present epidemiological evidence does not support a link and autism does not resemble the symptoms of mercury poisoning.

At least Dr. Brown confirmed how Tariq died. He definitely died of hypocalcemia, which is what I've been saying all along. Indeed, a Ca++ level of less than 5 mg/dL is critically low (normal is between 8.5 and 10.2 mg/dL) and will very frequently lead to severe cardiac arrhythmias, with a dangerously high likelihood of progressing to cardiac arrest. Such profound hypocalcemia is a medical emergency. Even when the arrest occurred, the situation could still have been salvaged and the boy saved if proper safety measures had been in place. It's unknown if they were, but at a minimum there should have been a crash cart present fully stocked with all advanced cardiac life support drugs, a defibrillator, and, given the known risks of chelation therapy, calcium gluconate readily available to reverse hypocalcemia. You also need to have personnel trained in pediatric advanced life support on premise to undertake resuscitative action. You don't do a medical procedure that can cause severe hypocalcemia without such basic safety precautions in place.

I rather suspect that Dr. Brown is probably coming at this case as someone used to seeing chelation used for its intended medical purpose, to treat lead poisoning, an indication for which EDTA is effective and recommended. She also works for the CDC, one of the functions of which is to monitor rates of drug and treatment errors; so it is not surprising that she would emphasize this aspect, although she seems to be speculating about whether or not the wrong form of EDTA was used. (It seems that it never occurred to her that any doctor would misuse chelation or intentionally choose a less safe drug to do it with.) I could be wrong, but I also rather suspect that she is probably not well versed in the way that activists have claimed that mercury from vaccines cause autism and that chelation is the way to reverse the damage. Consequently, assuming she is correct, she is looking at this from purely a technical standpoint. In other words, she isn't really questioning that strongly why EDTA was being given to Tariq, just the form of EDTA that was administered (which, while safer than dicalcium disodium EDTA, is not without potential complications, such as renal failure and excessive anticoagulation). She doesn't seem to be grasping the big picture. Also, you don't get to be the head of a branch of the CDC or the NIH without being a bit of a politician; so likely by nature she is going to choose her words carefully.

Besides, as an expert in chelation therapy, Dr. Brown must know that EDTA has not been the treatment of choice for true cases of mercury poisoning for many years now. (She implicitly seemed to indicate as much when she said that the only indication for EDTA is to treat lead poisoning.) A drug called DMSA is and also has the added advantage over EDTA of being effective when given orally. As has been pointed out, in physiologic conditions in the body EDTA is a relatively weak chelator of mercury ions compared to the -SH group-containing proteins in the body's tissues. This means that, at equilibrium, mercury ions will remain preferentially bound to -SH group-containing tissue proteins in the body and EDTA will not be effective at competing for binding mercury. Effective mercury chelators contain -SH groups and have higher affinity for mercury than body tissues. Examples include compounds such as the previously mentioned 2,3-dimercaptosuccinic acid (DMSA) and 2,3-dimercaptopropane-1-sulfonate (DMPS, which is rarely used anymore because it is more toxic than DMSA). In comparison, EDTA is a relatively poor choice as a therapeutic agent to remove mercury from the body, even though in the test tube it binds mercury more avidly than calcium.

I wonder how chelation advocates will react to Dr. Brown's statements. No doubt they will desperately want to use them as tactical air support in absolving Dr. Kerry of medical misconduct, but it will gall them to do so. After all, to them the CDC is evil incarnate, the very source of the alleged "coverup" to suppress their pet idea that mercury from the preservative in childhood vaccines somehow causes autism. It can't be fun for them to have to point to a statement by the Chief of the Lead Poisoning Prevention Branch of the CDC to use as a shield for Dr. Kerry against discipline by the State Medical Board. Nonetheless, regardless of what Dr. Brown has said, the fact remains that Tariq was given a treatment for which at present there was no justifiable medical indication. Whether it was due to medical error in giving the treatment or not is irrelevant, because he shouldn't have been getting chelation therapy for autism to begin with.

He paid the price with his life.

More on this case:

1. Drug Error, Not Chelation Therapy, Killed Boy, Expert Says, in which Kevin Leitch asks the question: How can a trained doctor who ostensibly was a chelationist mix up medications?
2. What killed Abubakar? In the post and comments, Autism Diva explains that calcium disodium EDTA is not without potential complications, including cerebral edema.

Tangled Bank #45

The latest Tangled Bank is out! Enjoy the best science blogging out there.

I'd be under the table in the first ten minutes

How come I've never heard of this before? It's the 24 Drinking Game. A few examples of what you have to take a drink for:

• Jack says “You have got to trust me”, take 1 shot– if the emphasis is on “got”, i.e. “You have GOT to trust me”, take an extra shot
• Jack doesn’t have time to explain, take 1 shot
• Jack doesn’t have time for this, take 1 shot
• Jack says “You’ve got to do it”, take 1 shot– if this is followed by “and you’ve got to do it now,” take 2 more
• Anyone points out something that is “against regulations”, take 1 shot
• Anyone has got to understand what is at stake here, take 1 shot
• Satellite coordinates are requested, take 1 shot– if they can’t get the coordinates, take another

I take that back. Like The Commissar, I probably wouldn't last five minutes...


[NOTE: Back to medical/science topics tomorrow, and the Skeptics' Circle will be appearing. Yes, procrastinators still have several hours before the deadline tonight to get their submissions to Sean.]

The loon running Iran

I hadn't really wanted to mention this nutcase again for a while, but unfortunately he's like the Energizer Bunny of Holocaust denial. He just keeps going and going and going and goin. If theres's any doubt about it now that the President of Iran is a complete and total wingnut, this ought to put it to rest:

Iran announced yesterday it would stage a conference to question the authenticity of the Holocaust, a move certain to stir international anger.

The statement follows a series of inflammatory remarks by Iran's hawkish president, Mahmoud Ahmadinejad, who has described the murder of six million Jews by the Nazis in the second world war as a myth and called for Israel to be "wiped off the map". He has also suggested an alternative Jewish state should be set up in Europe or Alaska.

An Iranian foreign ministry spokesman said the proposed conference would examine the Holocaust's "scientific aspects and its repercussions". The description echoes Mr Ahmadinejad's characterisation of Holocaust denial earlier this month as a "scientific debate".

It is not clear who will attend. But following a chorus of anti-Zionist rhetoric since the president was elected last June, the announcement will trigger suspicions that the aim is to deny that the Holocaust happened. Last month, Mr Ahmadinejad dismissed it as a concoction invented to justify Israel's existence in the heart of the Muslim world. His comments drew widespread condemnation. At a meeting with President George Bush last week, the German chancellor, Angela Merkel, described Mr Ahmadinejad's position on the Holocaust as unacceptable.

At a rare news conference on Saturday, however, the Iranian president was unrepentant. He described Mrs Merkel and Mr Bush as terrorists and war criminals, who would soon be put on trial for their support of Israel.

Describing the Holocaust as a question that had to be cleared up by scholars, he added: "My question was very clear. On the pretext of the killing of Jews in Europe, are they supporting the aggression and massacres [of Israel]? They will not intimidate me. Instead they have to answer me. If you started this killing of the Jews, you have to make amends yourself. This is very clear. It's based on laws and legal considerations. If you committed a mistake or a crime, why should others pay for it? Those who murdered [the Jews] should permit them to go back to their own fatherlands. That should be the end of it. You shouldn't say that nobody is permitted to say anything about this."

In any case, here we go with typical Holocaust denial paranoia. Naturally, it's all the "Jews'" fault; it's all a Jewish conspiracy, and Ahmadinejad is representing himself as the "brave" seeker of truth pitted against nefarious forces that don't want him to find the "truth." Anyone want to make a bet that about what this "conference" will end up concluding? Gee, you don't think they'll conclude that the Holocaust was exaggerated and the extermination of European Jewry was not the intent of Hitler and the Nazis, do you? If you have any doubts, this interview on state-controlled Iranian television should lay them to doubt, an interview in which the Institute for Historical Review, the granddaddy of Holocaust denial organizations, is cited as a credible source, The Protocols of the Elders of Zion is treated as truth, and lots of denier canards are trotted out as fact, should lay them to rest. A couple of excerpts:

Dr. Majid Goudarzi: "The [Zionists] claimed that they had to be the rulers of the world. That's why they prepared the Protocols [of the Elders of Zion] in Russia, and implemented each and every clause. They wrote instructions how to gain control of the global media, and how to control the world's natural resources. Part of this control..."

Interviewer: "They became the board of directors of the world."

Dr. Majid Goudarzi: "Yes."

[...]

"They want to write history as they wish, and in light of their unparalleled power in the media - if you like, we could talk about that on another show - they have managed to impose the [Holocaust] issue, and to depict themselves as oppressed."

And here's another tidbit:

Dr. Majid Goudarzi: "Mr. Ahmadinejad's message is very clear: If the Europeans did it, they should be the ones to compensate [the Jews]. But who exactly should pay the compensation? It should have been that generation, not the current one. For example, if you want to buy a television in Germany, they take 20 percent tax from you in advance. Some of that tax is on account of the crematoria, the existence of which is in doubt... The money goes into the pockets of victims who do not exist - because, after all, if they perished, there would be no survivors. So it goes into the pockets of the Zionist regime..."

Interviewer: "Do you believe this never really happened?"

Dr. Majid Goudarzi: "Look, what they are saying is more false than true. As my colleague has said, if they had even the smallest piece of evidence, they would not sit still, given their great power in the media. Even those who believe that this actually happened doubt the figures. One of the mistakes they made - despite their cleverness - was to claim that [the Nazis] used Zyklon-B gas. This gas, according to chemists - and I asked before this program, just to make sure - is a very dangerous gas. It remains in the air and on the skin for a long time. In the photographs they published, German soldiers are seen dragging the bodies of those who suffocated, and they are doing so without gloves or masks. If this was true, the German soldiers should also have died.

"Besides, if six million people had died, wouldn't there be a record somewhere of at least a hundred names?

It's interesting to note that apparently the curse of ignorant pundits spouting off confidently on television about topics they clearly know little or nothing about isn't a phenomenon limited to the U.S.. ("After all, if they perished, there would be no survivors"? What a moron.) Apparently, Dr. Goudarzi has never heard of Yad Vashem's Central Database of Shoah Victims' Names. It already contains close to three million names, with its organizers working to find and verify more before the generation that endured the Holocaust passes from this earth. These supposed "experts" are also spouting the most basic, easily debunked denier canards out there, ones I've debunked again and again on alt.revisionism and whose detailed rebuttals can be found through a perfunctory perusal of The Holocaust History Project and Nizkor.

I'm guessing that any "conference" called by Ahmadinejad will be highly unlikely to be attended by real historians like Deborah Lipstadt. More likely it will include such noted Holocaust "scholars" as Mark Weber, Bradley Smith, pseudoscientist and pseudo-"engineer" Fred Leuchter, Robert Faurisson, Arthur Butz, or Friedrich Paul Berg (whose description of his website as "ravings" of a "revisionist heretic" is pretty accurate--he's definitely raving, especially the part about diesel exhaust not being lethal), Michael Hoffmann II, or Carlos Porter. I'm sure they'd invite Ernst Zündel, David Irving, or Germar Rudolf as well, were it not for the inconvenient fact that they are in jail right now. (Irving might be free if the conference is held after his trial on February 20.) It'll be just like one of David Irving's "Real History" Conferences (a misnomer if ever there was one), only with sand, Muslim fundamentalist extremists, and a cast of Arab Holocaust deniers whom, unlike the case for those listed above, I've never heard of.

The bottom line is that the President of Iran is an anti-Semite and racist of the worst variety, and that's what's behind his Holocaust denial. Even worse, his mind appears to have been consumed by the Hitler zombie, a rare combination. Trying to have it both ways, he denies that Hitler attempted to exterminate European Jewry, yet he still finds the Nazis a convenient evil to use to demonize Israel with by comparing its treatment of the Palestinians with the "aggressions and massacres" of Israel. Never mind that, whatever excesses the Israelis may have committed in dealing with the Palestinians, they aren't even on the same planet when compared to what the Nazis did to their enemies.

Of course, as is the case with many Holocaust deniers, in Ahmadinejad's mind, "refuting" the Holocaust is a way of attacking the basis of Israel's existence and thus justifying its destruction. Indeed, one salutory effect that might occur if Ahmadinejad actually has this conference is that it will do a lot to link the Holocaust denial with blatantly obvious anti-Semitism, which is why, I suspect, most of the "luminaries" of the Holocaust denial movement listed above will politely decline his invitation. On the other hand, I can't discount the possibility, discussed by Professor Lipstadt, that this conference will be "the biggest thing in the world of Holocaust deniers and other liars" and "will give them a stage unlike anything they have had since the trial." (The trial to which she refers is her trial in 2000, when David Irving sued her for libel in the U.K. for calling him a Holocaust denier and lost spectacularly.) I hope my view turns out to be correct, but I fear that Lipstadt may end up having predicted it better.

Grand Rounds, vol. 2, no. 17

Grand Rounds , vol. 2, no. 17 has been posted at GruntDoc. More great medblogging, as usual. Be sure to check it out.

Oprah goes to Auschwitz

I tell ya, this is what I get for taking it easy yesterday. Our cancer center was closed for MLK Day; so I only went to work for a few hours to take care of some odds and ends without the distractions of incoming phone calls and miscellaneous other distractions that occur when everyone's there and working and instead came home early. Because my wife likes The Oprah Winfrey Show, it happened to be on in the late afternoon, and I caught the tail end of it. Yesterday's show happened to be the one in which Oprah announced her latest choice for Oprah's Book Club. Mildly interested to see what new book she would instantly launch onto the bestseller list, I kept watching. If you don't already know, you'll never guess which book she chose:

Night, an account of Elie Wiesel's experiences in Auschwitz during the Holocaust.

Given the usual sorts of books I generally see advertised on Oprah's Book Club, I was amazed and pleasantly surprised. In a single stroke, Oprah had guaranteed that hundreds of thousands of people, if not even more, will read Wiesel's account of his time at Auschwitz and the horrors of what occurred there. She even started Oprah's National High School Essay Contest, in which the topic is: "Why is Elie Wiesel's book Night relevant today?" The combination of these two actions will undoubtedly educate more people about Auschwitz than almost anything else I could think of.

Unfortunately, the next thing Oprah said made me a little bit skeptical of the whole enterprise. She announced that next month she is going to Auschwitz to do her show. Such a trip certainly has the potential to raise awareness of the Holocaust among an American public that is really not that knowledgeable about it, and Oprah does have a history of having interviewed Elie Wiesel before. On the other hand, on the rare times when I have seen her show, I've gotten the impression that the way Oprah does many of her segments strikes me as rather cheesy and hyperdramatic. The thought of Oprah at Auschwitz doing her Oprah thing by the infamous Auschwitz gate (the one inscribed with “Arbeit macht frei,” meaning “Work makes freedom”) and the remains of the Kremas makes me a little nervous.

Should it?

Maybe I'm just being overly sensitive. Certainly it's a step up from having Tom Cruise jump all over her studio couch like a maniac proclaiming his love for Katie Holmes.

A real evil candidate...

On the one hand, Candidate for Governor of Minnesota Jonathan Sharkey certainly isn't Christian, which, on the surface, might appeal to folks like PZ. That is, until you actually look at this guy. My first thought is that this had to be a joke, but it seems to be real.

In fact, Sharkey is very religious. It's just that his religion is Satanism. Sharkey also openly proclaims himself as "evil" and in favor of impaling terrorists and criminals. In that way, he's not really all that different from a lot of the fundamentalist loons who claim that God has struck down certain leaders for displeasing them.

What is it about Minnesota politics? Personally, if I lived in Minnesota, I'd be wanting to bring back Jesse "The Body" Ventura before this clown. True, Jonathan "The Impaler" Sharkey will probably make this year's election entertaining, but I suspect the novelty of seeing a gubernatorial candidate in robes carrying a sword would wear off rather quickly.

Prometheus strikes again

Prometheus strikes again, this time with Part 2 of his series A Field Guide to Quackery and Pseudoscience. It's well worth checking out.

Frontier science versus textbook science

During my usual weekly perusal of the New York Times, I was surprised to come across this rather perceptive article by Nicholas Wade in which he discusses the difference between "frontier" science and "textbook" science. No, I wasn't surprised because Nicholas Wade wrote a perceptive article, but rather because it was published in the New York Times. In it, he asks:

How then can the fraudulent claims by Dr. Hwang Woo Suk have been accepted by Science, a leading journal that rejects most papers submitted to it? How can the community of stem-cell scientists have allowed a very visible claim to have stood unchallenged in their field for 20 months? Little wonder that Richard Doerflinger, an official of the United States Conference of Catholic Bishops, ridiculed the dreams of therapeutic cloning in a statement last week, scoffing that scientists were chasing miracle cures "in pursuit of this mirage."

The contrast between the fallibility of Dr. Hwang's claims and the general solidity of scientific knowledge arises from the existence of two kinds of science - a distinction that is often blurred when new advances are reported first by scientific journals and then by the news media. There is textbook science and frontier science, and the two types carry quite different expiration dates.

Textbook science is material that has stood the test of time and can be largely relied upon. It may include findings made just a few years ago, but which have been reasonably well confirmed by other laboratories.

Dr. Hwang Woo Suk, as you may recall, is the Korean scientist who has now been disgraced for having published what are now widely believed to have been fabricated results indicating that he had created a line of patient-specific stem cells, as well as having committed many ethical lapses such as using eggs from women who worked for him and thus were potentially susceptible to pressure from him. He has blamed the fabricated results on subordinates, but clearly at the very least he is guilty of extreme sloppiness and at the worst outright fraud. The whole scandal has been a major black eye to Korea's previously lauded efforts in stem cell research and has provoked many attacks on the peer review process that allowed Dr. Hwang's papers to have been published in the journal Science, one of the most prestigious and difficult to crack scientific journals in the world.

Mr. Wade makes the point that research such as the kind that Dr. Hwang does is what he characterizes as "frontier" science; that is, science at the very edge of what is known or possible and warns against overreacting:

Science from the frontiers of knowledge, on the other hand, is wild, untamed and often either wrong or irrelevant to future research. A few years after they are published, most scientific papers are never cited again.

Scientific journals try to impose order on the turbulent flow of new claims by having expert reviewers assess their merit. But even at the best journals, reviewers provide only a rough screen. Many papers slip through that later turn out to be innocently wrong. A few, like Dr. Hwang's, are found to be fraudulent.

This rough screening serves a purpose. Tightening it up, in a vain attempt to produce instant textbook science, could retard the pace of scientific advance.

I'm not sure I'd be quite so blithe about the failure of peer review in this particular case, but Mr. Wade does make a good point. Much of science at the very frontiers turns out not to be correct. However, the way it is all too often reported in the press is that it is correct. We in science understand the difference between settled textbook science and the sort of frontier science that makes it into journals like Science. Indeed, we often lament that the very highest tier journals, such as Nature, Science, and Cell, tend to be too enamored of publishing what seems to be "sexy science," exciting or counterintuitive results that really grab the attention of scientists--in other words "cutting edge" or frontier science. Such journals seem to pride themselves on publishing primarily such work (which is one reason why they are so widely read and cited), while more solid, less "sexy" results seem to end up in second-tier journals.

This leads to a paradox. The science that is getting published in the highest profile, most prestigious journals is almost by definition the most tentative science. Given that, it is surprising how much of what is published in such journals actually does stand the test of time, but it should not be surprising that much of it does not. However, the very prestige of such journals gives such research seemingly more authority than research published in less prestigious journals. It is often said that one Nature, Science, or Cell paper is worth five or even ten papers in more pedestrian, middle-of-the-road journals as far as improving a scientist's CV (and chance of a good job or promotion) goes. Perhaps that is because publications in such journals are viewed as an indication that the work a scientist is doing is on the cutting edge. That perception, built up over time, is likely the major reason that it is very, very difficult to get a paper accepted and published in Science, Nature, or Cell. The vast majority of submissions are rejected, many without even being sent out for peer review because an editorial decision is made that they are not "interesting" enough (something that happened to me once). However, scientists understand that papers published in the most cutting edge journals are tentative. They're interested in the papers because such work is the most likely to advance the frontiers of science, but they also know that the papers have a higher than average probability of being wrong, either in part or in whole, or a dead end. Wade nails it when he writes:

But the roughness of the proceedings is not prominently advertised by journal editors, except when cases of blatant fraud are detected, whereupon they proclaim that peer review cannot reasonably be expected to detect fraud. They do not protest so much when newspapers report their journals' claims as if they were certifiably true. Because of Science's authority, Dr. Hwang's claims to have cloned human embryonic cells were prominently reported and presented to the public as if they were important breakthroughs.

I would also point out that, because of the imprimatur of Science, many scientists and physicians, myself included, considered Dr. Hwang's results to be major breakthroughs. Of course, part of this could be due to wish fulfillment, given the promise of fantastic new treatments for a variety of diseases that Dr. Hwang's results and new technique seemed to offer, but that's exactly the sort of situation when we as scientists should really be the most skeptical.

Many ideas for reforming peer review have been floated, but in reality I doubt that any of them would catch a determined fraud. Science and peer review inherently depend upon trust that the investigator presenting his data for publication has not fabricated it. The only real way to detect fraud would be to put such an onerous burden on peer reviewers that it would make finding qualified scientists willing to do be peer reviewers difficult unless they were paid. It would require seeing the raw data, and anyone who has done research knows just how hard it is to go through another's scientist's laboratory notebook to evaluate the raw data. One proposal, however, for reforming publication procedures and peer review that might actually help somewhat is this:

But last week Dr. Kennedy announced he was considering revising the journal's publication procedures, though not with any great hope of preventing future cases of fraud. He suggested that authors would be required to state in writing their specific contributions to a report, a reform perhaps aimed at Dr. Gerald Schatten of the University of Pittsburgh. Dr. Schatten accepted senior authorship of - and thus responsibility for - one of Dr. Hwang's papers, even though Dr. Schatten had performed none of the experiments and was not in a position to vouch for them. All the work was done in Seoul.

A second proposed change is to have all authors state that they agree with an article's conclusions.

Both procedures may seem to include a certain potential for generating strife. Each author could overstate his or her contribution, arousing the wrath of all the others. Some authors may think a conclusion too timid, while others consider it an overstatement.

Medical journals, including JAMA and several surgical journals, have been doing just this for a while now, with no undue burden or generation of strife. It may not prevent fraud, but it definitely makes one feel accountable as an author. I can say from personal experience that, when I sign off on one of those statements for a paper that I am a co-author on, I want to make damned sure that I have read the manuscript in its entirety carefully and that I do indeed agree with it, at least in general.

As Wade points out:

Tightening up the reviewing system may remove some faults but will not erase the inescapable gap between textbook science and frontier science. A more effective protection against being surprised by the likes of Dr. Hwang might be for journalists to recognize that journals like Science and Nature do not, and cannot, publish scientific truths. They publish roughly screened scientific claims, which may or may not turn out to be true.

Indeed. That is the very nature of science. What is published the first time is considered tentative. It may or may not be correct. If other scientists can replicate the results or, even better, replicate the results and use them as a foundation to build upon and make new discoveries, only then does it become less frontier science. And if the results are replicated enough times and by enough people and used as a basis for further discoveries, to the point that they are considered settled results, only then can they become "textbook" science. What, alas, the public often doesn't understand is that science is a process, not a bunch of facts, and that at its cutting edge it is often quite uncertain and controversial among scientists. To a lot of scientists, Dr. Hwang's work seemed fishy, but seeing it in Science allayed many suspicions, at least until other groups could replicate the research. In this case, it turned out that the skeptics were right.

Important safety tips when dealing with Jack Bauer

As planned, I checked out the season premiere of 24 last night. So far, so good. In previous seasons, it sometimes took too much time to get the action going, but this year started out full throttle almost right away.

As expected President Palmer was assassinated, but what wasn't expected was seeing Michelle Dessler get blown up by a car bomb (and Tony Almeida be critically wounded by the same bomb) minutes later. Given that three of the four people who knew that Jack Palmer was still alive were attacked in the first 10 minutes or so of the show, apparently in order to frame Jack, this started things out well, although I really hated to see Michelle buy it. It has also led to these Important Safety tips:

1. Do Not Assassinate Friends of Jack Bauer
2. Do Not Threaten to Kill Friends of Jack Bauer

.....Tips continued here.

History Carnival XIII

The History Carnival XXIII is up at robmacdougall.org. Lots of good stuff there. More stuff than I have time to read, even with not having to go to work tomorrow...

24 is back!

Anyone who was here last year at this time knows that I'm a 24 junkie. For those who aren't familiar with it, 24 is a show that follows a single 24-hour period in the life of an anti-terrorist agent, Jack Bauer (played by Kiefer Sutherland). Each episode represents an hour of that day presented in "real time" (complete with the occasional ticking clock in the corner to remind the viewer what time it is and with split screen montages leading into each commercial break to remind the viewer what's happening simultaneously). It's basically a thrill-ride, with nearly every episode ending on with a cliffhanger.

Yes, I realize that it requires a willing suspension of disbelief to accept that Jack Bauer could do so many things, survive so much physical abuse, and go so many places in a single 24 hour period. Yes, there are a number of inconsistencies and goofs on the show that challenge belief. (For example, Jack never seems to get caught in a typical L.A.-style traffic jam; an entire hour long episode--or two--consisting of Jack going nowhere on the Santa Monica or Harbor Freeway wouldn't make for very interesting television.) Yes, I realize that the show tends to take a rather too accepting view of the legitimacy of torture as a means of extracting information from miscreants and all-too-often seems to view the Bill of Rights merely as a pesky impediment to Jack's ability to do what he does best, namely kicking terrorist butt. As a libertarian-leaning moderate conservative, that "ends justify the means" philosophy that rears its ugly head periodically should be enough to make me hate this show.

And yet....

And yet the show is highly addictive once you watch the first three or four episodes and get hooked. It's a fantasy world where an unbelievably competent, cunning, and ruthless agent is protecting us all from horrible people bent on our destruction, no matter what or who gets in his way, even his own government. This year, the producers have added an interesting twist. Because of his role in a botched assault on the Chinese Embassy to rescue a key informant, Jack has been forced to stage his own death. Everyone, including the weasely and indecisive President (who was the Vice President but was forced to assume the Presidency when Air Force One was shot down and the President critically injured), thinks he is dead, and at the end of last season he was seen walking off alone like The Man With No Name or a samurai warrior. It's an interesting shake-up to the formula that has developed over the last four seasons, and it will be interesting to see how the characters react to the inevitable discovery that Jack is not room temperature. You have to wonder whether the writers can pull it off, but, given their past track record, I wouldn't bet against them.

Also, this year supposedly one of the major characters is going to die early in the first episode. (My guess is that it's got to be former President David Palmer, given that Dennis Haysbert has a new TV series, but who knows?) This has led some blogs to start Season 5 Death Pools.

In any case, you know where I'll be tonight and tomorrow night between 8 and 10 PM....

(After my wandering far afield from medicine, science, etc., it will be back to more normal topics next week, as promised yesterday...)

An official Hooters calendar

This one's for you, Hedwig: The (Un)-Official 2006 Hooters Calendar.

(Via Boing Boing)

Saturday morning blog housekeeping

We're nearly two weeks into the new year, and things are settling down to normal. Those who remember what I said a month ago on my first blogiversary about my plans for the second year may have recognized that those plans have gotten a bit sidetracked. (For one thing, my posting activity this week has been more frequent and manic than it usually is. I don't really know why. It just was.)

Next week, it's time to start implementing what I had planned. Over the weekend, I'll scour my archives for the first of a series of scientific papers to discuss. Also, I'll try to settle on a bogus treatment of the week to take a critical look at. And, of course, I'll continue to fine-tune the new template. Yes, new template has been up a few days now, and I think it's probably what I'll stick with for a while. There will, of course continue to be tweaks that will be evolutionary rather than revolutionary, but nothing like what's been happening over the last couple of weeks.

Finally, I have to note the launch a couple of days ago of ScienceBlogs. A couple of heavy hitters in the science blogging world, such as Deltoid, Pharyngula, and The Intersection have moved over there (note the new URLs), along with some of my usual daily or weekly reads, such as Living the Scientific Live, Evolgen, and Dispatches from the Culture Wars, among several others. More will likely join soon. I'll be updating the science links in the right sidebar as I learn of the changes.

Speaking of major change, I think I'll take this opportunity to mention that there is a fairly strong possibility that big changes in terms of hosting and my blogging platform could be on the way in the near future if I can work some things out that have been making me hesitate to make the move over the last couple of months.

Or there may not. There are a couple of things that might keep these changes from happening, which is why I'm being intentionally vague right now. Even so, I wanted to mention it, so that if it happens it doesn't come as a surprise.

We'll see how things go.

But, whatever happens, I'll keep you informed. Whatever I end up doing, I don't just want to rest on my laurels (minor as they are) but to keep finding new and innovative ways to present the best insolence on the planet to you...

Take down your damned Christmas decorations (Day 3)

A couple of days ago, I pointed out that a neigbor of ours is still firing up his Christmas lights every night as though it were December.

They're still up. The countdown continues.

There were some negative reactions to my original post (which, by the way, was meant to be facetious). However, lest you think that I'm an incorrigible curmudgeon, my wife pointed out that I should inform you about some other things this neighbor did that makes his keeping tacky Christmas decorations up so long of a piece with his other "contributions" to the neighborhood. I'll dribble these out as the series progresses. If his record last year is any indication, this could be an intermittent series until March. So, without further ado...

Sin #1: He moved into a very well-maintained house and immediately ripped up some rather attractive shrubbery to plant some unknown (and ugly) manner of flowers and plants. He then strung up CDs (supposedly to keep the birds away) and left them up far longer than one would deem necessary to protect any seeds (assuming that hanging CDs up even works for such a purpose).

Calling all skeptics! It's Friday the 13th!

Time's flying much faster than you might think. It's Friday the 13th, making it a perfectly appropriate date to point out that the next meeting of the Skeptics' Circle is fast approaching. It's the perfect forum to debunk superstitions (such as Friday the 13th), apply critical thinking to urban legends, and point out pseudoscience and quackery. So fire up your critical thinking and get your best skeptical blogging to Sean at Skeptic Rant. The deadline is next Wednesday, January 18, and the Circle will appear the next day on Thursday, January 19.

As always, I'm also going to take this opportunity to make an appeal for volunteers to host future editions of the Circle. If you think you might be interested, drop me an e-mail. For more information, the schedule is posted here, and additional guidelines can be found here. Come on, skeptics, here's your chance to strut your critical thinking skills, either by submtting your work to the Circle or by hosting a Circle yourself!

Pat Robertson apologizes (sort of)

Pat Robertson, he of the "God struck Sharon down for 'dividing' His land" comments earlier this month, has apologized, sort of:

The US TV evangelist Pat Robertson has apologised to the family of Israel's prime minister, Ariel Sharon, for suggesting that his stroke was God's punishment for withdrawing from Gaza.

In a letter to Mr Sharon's son, Omri, Mr Robertson said his remarks derived from his "concern for the future safety of your nation". But he admitted they were insensitive "in light of a national grief experienced because of your father's illness".

Note that Robertson didn't say he was wrong, just that he was sorry for saying what he said.

I wonder if Robertson's apology has anything to do with this:

The Israeli government is pulling out of a business deal with the American evangelical leader Pat Robertson, after he said Ariel Sharon's stroke was punishment by God for withdrawing from the Gaza strip.

Mr Robertson and the Israeli tourism ministry were shortly to have signed an agreement to fund a $50m (£28m) Christian heritage centre on the shore of the Sea of Galilee.

But the ministry said the deal would not go ahead after Mr Robertson's comments on his popular television show in which he suggested that Mr Sharon had been made to suffer for "dividing God's land".

Or this:

Avi Hartuv, a spokesman for Israel's tourism minister, said officials were furious about the remarks.

"We will not do business with him - only with other evangelicals who don't back these comments," he said. "We will do business with other evangelical leaders, friends of Israel, but not with him."

Could Pat's apology represent an attempt to salvage the deal?

Nahh. Couldn't be. Pat Robertson is a man of God. (At least, that's what he claims.) Business concerns couldn't make him backtrack on core beliefs, could they?

Of course not.

EneMan belatedly rings in the New Year

I know, I know, I've been remiss. However, it just didn't seem right to post the now-traditional first-of-the-month post given what was going on around the 1st. So I held off.

It's time to get back to normal. As a hint of what the theme of this year will be, I present:

Yes, this year, EneMan will be traveling through time to participate in various historical events. Some of them will undoubtedly surprise you. (This also gives me an idea for hosting the History Carnival, but I bet even Sharon won't go for it.)

First on the list, I bet you never knew that EneMan was at Mt. Everest when Sir Edmund Hillary climbed it in 1953:

I'm guessing that costume must be pretty warm, otherwise EneMan's contents would freeze, and he would no longer be useful for his intended purpose. Of course, I'd hate to consider using him for his intended purpose with ice cold contents.

In any case, as we proceed through the year, you'll see just how deeply involved EneMan has been in our history. I bet you never suspected!

You know, now that I think about it, in 2006 EneMan's a lot like The Doctor:

On second thought, no he's not. For one things, the Doctor has a much cooler means of transportation, and I have a hard time believing EneMan as a Time Lord. More importantly, no matter how outrageous the Doctor's various incarnations have dressed, none of them has ever dressed up like a giant enema--although, if given the choice, I think I'd rather that the sixth Doctor (the guy with the umbrella) had dressed up like a giant enema. It would have been less of an eyesore than his actual outfit was.

(As an aside, it turns out that the SciFi Channel has purchased the rights to air the first season of the new incarnation of Doctor Who and will be showing the episodes this spring.)

Finally, as always, a record of every appearance of EneMan since the very beginning:

December 2005
November 2005
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)

Next month, EneMan gives a nod to our Canadian readers...

One last word on "towns vs. gowns"

A couple of days ago, I took a bit of issue with Kevin, MD for an off-handed remark he had made welcoming us academic physicians "to the real world" in response to an article about how demoralized and depressed young academicians have become due to the increasing encroachment of financial pressures and demands to generate more clinical income. I gently pointed out to him that we have been living in the "real world" for many years now. Noting my response, he said he sympathized but thought that proposed solutions coming from academia for the woes of the primary care physician pointed to a lack of connection with the "real world." Maybe so in this instance, although the two suggestions by academicians that the two articles he referenced as evidence of how "out of touch" academic medicine is didn't seem to support his contention all that strongly, at least not when I consider that I haven't seen any suggestions coming from docs in the trenches that seem to me any more "practical."

Be that as it may, however, one comment in Kevin's response by a primary care physician named Dr. Hebert reinforced my point that some PCPs in the community having misconceptions about academic medicine:

I agree with you, Kevin. I just finished residency in 2001 and, though academics certainly work hard, I also have the strong impression that they are out of touch with the "real world." Even when an academic has an active clinical practice, the organization he is with is so large and bureaucratic that he does not face the same situations and decisions a doc in private practice does.

Academics don't have to discipline employees, worry about salary structure, choose hospitals to apply for prividges for, decide on managed care contracts, deal with partnership issues, or deal with patient access issues (like having to treat RA yourself because there isn't a rheumatologist within 100 miles).

These differences in experience do make pronouncements of academics seem out of touch.

No one actually said that we faced the "same" decisions, but certainly we face many pretty analogous decisions and situations, and perhaps some of the misunderstandings come from how one define's the "real" world. Also, Dr. Hebert is completely wrong about academics not having to worry about disciplining employees or about salary structure. I have two people working in my lab and at times have had three or four, not counting students. These are employees, not postdocs. More successful academicians with multiple grants (among whom I hope to be one day) can have double or triple that number or even more. In fact, I'd propose that it is probably more difficult for academicians to discipline employees for the simple reason that most smaller private practices don't have to deal with a union and university policies that make it very hard to get rid of incompetent employees. As for the salary structure, it's can be as complicated as anything I've ever heard described to me in private practice. Faculty pay can derive from university base salary, clinical income, various bonuses, profit-sharing, and, for us researchers, from salary support deriving from grants. And the salary structure where I am for technicians and others that I hire is way more complex; indeed, there are at least nine grades of technician here, complete with different pay ranges, job descriptions, and qualifications. Getting a job posted is a nightmare that can take several weeks, even if you have the grant money to pay for it.

That sounds pretty "real world" to me.

His complaint about dealing with lack of access to care seems more due to a rural location than any difference between working in academia versus private practice. Private practitioners I know who work in nice suburbs and see mostly insured patients have little problem getting access to care for their patients. And, as another commenter pointed out, there can be access problems in academia that are just as bad as some private docs experience, if not more so. In our case, we see a lot of uninsured patients, and, to take one example, getting ininsured women with breast cancer access to a plastic surgeon to do a reconstruction after a mastectomy is a frequent and vexing problem, mainly because very few plastic surgeons around here accept Medicaid or our state's Charity Care.

Perhaps the best comment came from Aggravated DocSurg:

As a surgeon in private practice, I have seen the "town and gown" game played, unfortunately, both sides. Neither private practitioners nor academicians has a lock on appropriate behavior and understanding of the other side.

We are really at a critical time in medical education and research. The financial pressures faced by everyone in medicine is squeezing the life blood out of academic institutions. In the long run, I think there will need to be greater involvement of private practitioners in the education of residents -- but that will take a hefty dose of humility from both sides of the aisle. We in the private world need to understand that academicians have to have time for research and teaching; those in the academic world need to understand that private practitioners do see a large chunk of "interesting" cases and provide good care, and that their residents would benefit from private practice experience.

I agree that medical students and residents would benefit from more exposure to private practice environments. The main reason is that such environments are going to be where the majority of them end up practicing, and Aggravated DocSurg's other reasons are right on. However, I wonder how feasible this would be under the current system of reimbursement. Teaching medical students and residents is a real efficiency-killer, which is one reason (of many) that academic institutions have higher costs and run less efficiently. To take one example, it usually takes mem 30-50% longer to take a resident through a case as it does for me just to do the case myself, but I understood that going in. Private practitioners would have to devote time to doing this, and, in a private practice setting, that time would likely not not be reimbursed. It would either take exceptional dedication to devote more unreimbursed hours or it would take seeing fewer patients or doing fewer cases, and thus generating less revenue.

One thing that's become apparent to me is that the relentless downward pressure on physician reimbursement, coupled with the present malpractice environment, is putting private practitioners and academic physicians in the same boat. Academic medical centers and physicians have had to change their practices to a financial model that more and more resembles that of very large private practices, leaving less time for the research and teaching missions that have traditionally been within their purview. It's becoming increasingly apparent that the present system is, if not broken, rapidly breaking down. It will be up to us, both private practitioners and academicians, to come up with a new model to replace it.

Take down your damned Christmas decorations! (Day 1)

Every neighborhood has one, occasionally more than one. We have one too.

Yes, it's the neighbor who won't take down his Christmas lights. Here it is, mid-January, and he hasn't taken down his lights and lawn decorations yet (and they aren't nearly as attractive as the ones pictured above--rather, they are quite tacky). It wouldn't be so bad if it was just laziness and if he left them turned off, but every night this guy turns the lights on full blast, as if it were December 23. Last year, it was well into February before this guy finally took his decorations down. This year, I have a blog, and I plan on keeping a record. I want to see if he matches or exceeds last year's record.

This guy should have taken his lights down last weekend, but I'll cut him some slack. Instead of making today Day #5, I'll make today Day #1 of the countdown: Take your damned lights down!

Now!

The sociology of the antivaccination movement

I was perusing some journals yesterday, including the most recent issue of Nature, when I came across a rather interesting news/discussion item that began thusly:

Nostradamus we are not, but a safe prediction for 2006 is that initiatives promoting public engagement in science and technology policy-making will proliferate. There will, of course, be devils in the details, and critical assessments will be required. But Nature, having consistently championed public engagement, can nevertheless only welcome its development.

But there are times when no amount of explanation and consultation can counter the resistance of some sectors of the public, often representing a strong current in society, to the most carefully crafted science-based advice. Because the stakes for people's quality of life, economic development and the rights of individuals can be high, governments and the rest of us need to understand how and why such resistance to science develops.

It occurred to me that that same comment could be made about teaching evolution, given the rise of the pseudocientific religious concept disguised as science known as "intelligent design" creationism that various states have been trying to foist on students in the science classroom, a movement that led to a fantastically lucid and pointed rebuttal in the form of a judgment against the Dover Board of Education in Kitzmiller v. Dover. However, in this case, the authors are referring to a recent study of resistance to vaccination in the U.K.:

Studies by social scientists have a major role to play in providing an understanding of how such resistance develops. A notable example is British research led by Melissa Leach at the University of Sussex into strong resistance by parents to their children receiving a freely available vaccination against measles, mumps and rubella (MMR). The relevance of this research extends well beyond the particular circumstances and region studied.

Referenced was a report (a published, peer-reviewed version of which can be found here) examining how resistance to vaccination begins in parents. Not surprisingly, a wide variety of backgrounds and experiences contribute to the development of antivaccination beliefs or overestimation of the dangers of vaccines, particularly how "MMR talk," as the author calls it, either between parents or via antivaccination propaganda being spread via the Internet, as described:

The study of parents’ responses provides a vivid demonstration of how people outside the relevant research communities develop their own knowledge and interpretation of the literature, and how the Internet allows this ‘lay expertise’ to be shared within a climate of shared perceptions of risk (see the unrefereed report MMR Mobilisation: Citizens and Science in a British Vaccine Controversy; www.ids.ac.uk/ids/bookshop/wp/wp247.pdf). For example, one parent, David Thrower, compiled his own review of the literature (www.whale.to/a/thrower04.html), and several websites promptly supplied hostile responses to every government reassurance.

Leach’s research highlights the influences on such resistance. Confounding stereotypes, the parents ranged across the social classes and in many cases displayed a sophisticated understanding of the issues. Surveys of parents on both sides of the debate revealed a significant association of those opposed to MMR with family histories of illness and with an interest in alternative medicines and homeopathy. There was a strong sense of responsibility among mothers ofboth persuasions about decisions over whether to have their children vaccinated, with concerns about the social value of vaccination in terms of herd immunity being given much lower priority.

It's not surprising at all that parents prone to antivaccination beliefs have family histories of illness or an interest in alternative medicine such as homeopathy, as much of "alternative medicine" is hostile to vaccination. It's also quite common for religious beliefs to play a role. However, I would quibble somewhat with whether that apparent "sophisticated" understanding of the issues involved is actually as sophisticated as it appears on the surface. In some cases it may be, but far more often it's a superficial understanding that has little depth, mainly because few lay people have the detailed scientific and medical background to apply the information. It's often a matter of knowing facts, but not having the scientific experience, understanding of mechanisms, or sophistication to put them in context or to apply them to the situation properly, giving the veneer of scientific sophistication. I can't remember how many times that, while "debating" in misc.health.alternative, I would have a study quoted to me as supporting an antivaccination or other alternative medicine viewpoint and find that, when I actually took the trouble to look up the study and download the PDF of the actual article rather than just reading the abstract (which is all most lay people have access to and therefore all they read), I would find a far more nuanced and reasonable point or even that the article didn't support what the altie was saying. One other aspect that often comes into play is an extreme distrust of conventional medicine and/or the government such that few individual studies that question the safety of vaccines are given far more weight in their minds than the many more studies that show vaccines to be extraordinarily safe or large metanalyses (such as those done by the Cochrane Collaboration). Certainly this is one reason why the infamous Wakefield study, despite being shoddily designed and now thoroughly discredited, keeps rearing its ugly head again and again and continues to be cited by antivaccination activists as strong evidence that the MMR vaccine causes autism.

It's not surprising, too, that parents would place more value on whether vaccination benefits their children over the benefits to society through herd immunity. After all, a mother's and father's primary duty is to their own child, not other children. Part of the problem here is likely a matter of vaccination being a victim of its own success. Before, a one or two in a million risk of serious adverse reactions wasn't even blinked at because the diseases vaccines were designed to prevent were common and feared, so much so that it was an no-brainer to consider the risk of vaccination to be acceptable compared to the risk of disease. Now that major vaccine-preventable diseases have been largely controlled or eradicated, the benefit of vaccines in keeping disease at bay is no longer readily apparent in the daily experience of parents, leading to a situation where even the very small risk of serious adverse events from vaccination seems too high for a benefit that that parents cannot see for themselves. Also, parents tend not to understand that their participating in producing a larger pool of unvaccinated children endangers not only other children (both vaccinated and unvaccinated because no vaccine is 100% effective), but their own children, because, as vaccination rates fall, the diseases vaccinated against almost inevitably return.

What all this "MMR talk" and antivaccination agitation leads to is, depending upon the parent, a perceived or real adversarial relationship between antivaccination parents and "conventional" medicine and the government, with in essence an arms war between the medical authorities and the government reassuring people that vaccination is safe and antivaccination zealots trying to refute every reassurance, no matter how sound the science is behind it:

Leach’s work points to a conflict between concerns about MMR based on individual clinical studies versus government reassurances based on epidemiology. Soon after the publication of Leach’s report, a meta-analysis of the literature on MMR by the prestigious Cochrane Collaboration, while highlighting shortcomings in many studies, concluded that there was a lack of evidence to support a link with autism (www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004407/pdf_fs.html).
A visit to one of the websitesopposed to the MMR vaccine(www.jabs.org.uk) reveals a critique of the meta-analysisthat attempts to undermine its reassurance. And so the debate continues. Meanwhile, the uptake of MMR vaccine, which fell significantly, is recovering.

Leach describes it thusly:

The question of debate and dialogue, whether it should take place and what it should be about has been a further recurring theme in the MMR controversy. Mobilising parents frequently claim that they are seeking “open discussion”, and “to be listened to”. And their discussions, whether in local groups, on national organisations’ websites, or in the media, turn frequently on what they see as defensive denial of this by those opposed to thei bodies have invited their representatives to meetings, they have been ignored or delegitimised – for example in the 1997 MRC review (Melanie Philips, Daily Mail, March 2003). They claim that their requests for meetings with senior public health officials and politicians have been shunned, and that the Department of Health has refused to entertain proposals for an independent, off-the-record dialogue and sharing of scientific evidence. They also draw attention to the refusal of pro-MMR government spokespeople and scientists to participate in events that MMR-concerned networks coordinate – such as the televised debate following the Channel 5 docudrama. At the same time, they claim that government spokespeople seek their views covertly, for instance by telephoning JABS pretending to be parents, in order to have inside information with which to undermine them. Those in pro-MMR science-policy networks tend to justify their positions on the grounds that there is nothing to debate; that activists’ claims are spurious and that they have already reached scientific closure on the safety of MMR – the task is just to communicate this to the public. In this context, there have, as a senior Department of Health official put it, been “encounters” between each side in the controversy, but little real dialogue. Frequently taking place through the media and at public events, such encounters have tended to contribute to further polarisation of positions, sharpening further the stand-off and non-closure that has come to characterise the controversy.

The MMR controversy thus rolls on. What began as a parental movement pushing for citizen perspectives and supportive science to be heard and acted upon, has evolved over the last decade into a struggle between two, equally orchestrated campaigns. To understand its dynamics, social movement theories have been helpful. Theories of framing have been important to see how each side constructed and presented its concerns and created discourse coalitions by drawing together elements of previously more separate movements (around autism and around anti-vaccinationism, for instance), and to identify some of the fundamental incompatibilities that have hindered closure to the controversy – such as between parents’ individual-focused, and government’s population-focused, orientations. Theories of social movement identity have been important to see how parents came and remained together, united by common sets of experiences reinforced through everyday movement practices. And political process approaches to social movements, which highlight how framing interacts with movement strategies and the mobilisation of resources (McAdam et al. 2001), have been important to see how, in practice, the campaigns have taken shape and pursued their goals.

Much the same thing can be said about the controversy over thimerosal. Unfortunately, I'm not sure that I see how one proposed solution will help all that much, the creation of a "well-resourced independent national agency that commands the trust of both the government and the public in matters of health protection and is empowered to take responsibility for mediating in such debates." It may help when it comes to many parents who are on the fence. It is they to whom the arguments of antivaccination activists sound most plausible. However, people like J. B. Handley, who asserts dogmatically and with near certainty that "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" are not swayed by an increasing preponderance of scientific and epidemiological evidence that autism is not caused by mercury exposure. Consequently, the J.B. Handleys of the world are not going to be swayed by such an "independent" agency. Also, it is hard to see how such an agency could ever be truly independent from the government, thus feeding the conspiracy-mongering tendencies among antivaccination activists. More promising, although at this stage vague, is Leach's conclusion:

Official engagement with detailed lay theories of child health and vulnerability such as we describe, which go well beyond medically recognised contraindications, would also appear essential in developing an effective discourse around vaccination that parents and professionals could share, and that might help to rebuild trust relations around this controversial issue.

Of course, the devil is in the details, and how we go about repairing the broken trust without being dismissive of the concerns of parents who are not zealots (like Generation Rescue), will be the challenge.

Immunoblogging has more.

If the Onion wrote about the upcoming David Irving trial, it might look something like this....

I've written before about David Irving's arrest and impending trial for Holocaust denial in Austria and the free speech issues involved. I still think that, as odious as Irving's denial of the Holocaust and apologia for Hitler and the Nazi regime, Irving's arrest and imprisonment for what is in essence free speech is a travesty of justice. Even so, I couldn't help but chuckle when I came across this article, posted by Andrew Mathis (who, by the way, has written a rather interesting piece about whether there can be too much discussion of the Holocaust) to a discussion forum and written by a mutually known fellow traveller in the fight against Holocaust denial. It's something I wish I could have written and reminds me of how David Irving's recent admission that, well, golly yes indeed, there really were gas chambers at Auschwitz might be handled by The Onion. I've taken the liberty of adding a few explanatory links where appropriate, but have not otherwise altered the text:

Special report from the VARANGIAN NEWS NETWORK:

DAVID IRVING CONVERTS

VIENNA, January 5, VNN: In the latest twist in a career that has more twists than a left-handed corkscrew, disgraced author of historical fiction and international panhandler David Irving today announced from his jail cell in Vienna that he has converted to Judaism. Irving was arrested on November 11 when he illegally entered Austria is awaiting trial on charges arising from his denial that the Holocaust occurred. On two occasions in 1989 in Austria Irving claimed there were no gas chambers at Auschwitz, the notorious Nazi concentration camp, and that no Jews were murdered there.

Subsequent to his arrest, Irving astounded both his critics and his supporters by announcing that sometime in the 1990s his research had revealed that, contrary to his previous claim, that the universally accepted account of the gas chambers was correct. Convinced that the Holocaust had occurred, Irving also announced his intention to plead guilty to the charges and ask the court to take his change of heart and remorse into account when he is sentenced.

Irving denied that this jailhouse religious conversion had been influenced in any way by his current predicament. "I have been contemplating becoming a Jew for a long time," Irving explained, "ever since my matchless research had revealed that the Holocaust happened, I have been considering ways to correct the artificial depletion of International Jewry caused by the inexcusable actions of some of the Fuhrer's subordinates. Since all the Jewesses I know have refused to procreate with me, I decided that the best course was to become a Jew myself."

The shower room of the prison in which Irving is being held served as an improvised mikvah for the ritual. A fellow inmate who refused to give his name presided over the ceremony. While the man admitted that he was not a rabbi, he was quick to add "but I frequently play one in confidence games." Another unnamed inmate acted as the mohel using a shiv improvised from a kitchen utensil to perform his duties. Also present at the ritual were two Turkish drug smugglers who were using the shower for recreational purposes. Both men identified themselves as "Johan Schmidt" but claimed that they were just casual acquaintances.

After the ceremony an ebullient, but bow-legged, Irving proudly announced "Today I am a person of Hebraic persuasion. I can't wait to sit down with Deborah Lipstadt and kvetch about the mamzers who deny the Holocaust."

Irving was adamant that his conversion was unrelated to the predicament in which he currently finds himself or the charges on which he will be tried in February. "I didn't do this to impress the judge." Irving insisted. "Frankly I don't care about his opinion. I did it to clear my conscience." Then Irving paused. "Of course, I am sure that the judge, like any man of conscience, will realize that a long prison sentence will delay the pilgrimage I am now planning to Eretz Israel to daven at the Wailing Wall."

The news of Irving's conversion has spread rapidly among his supporters. The consensus of Irving's friends and associates was shock and anger. Although many would not speak for attribution because "the ADL is watching," most of Irving's fellow "revisionists" were convinced that his conversion was the esult of coercion from a team of "Mossad interrogators" using, according to Robert Countess, "the same techniques outlined in the Talmud that made the Spanish Inquisition so necessary." As Ernst Zündel, an Irving supporter facing criminal charges in Germany for denying that the Holocaust occurred, explained: "Even the strongest Aryan will can break when you are strapped to a chair and forced to watch 'Yentl' over and over again." Mark Weber, director of a neo-nazi research institute proclaimed: "We all know that the perpetrators of the Holocaust lie use torture to get their victims to say the 'right' things. That's what happened to Rudolf Hoess." This sentiment was echoed by Carlos Porter, a self-styled Holocaust "scholar": 'HE WAS TORTURED! LIKE RUDOLF HESS!"

Not all of Irving's supporters agree with this position. The dissenters include Michael Hoffman II, who claims that he is the "foremost expert on Judaism in North America." "He was a mole," Hoffman proclaimed. "He was a Jew all the time. I was the first to discover that Moms Mabely was really a Jewess and I just knew 'David Irving' was Jewish. His name gave it away."

Ingrid Rimland, wife of Ernst Zundel, had no comment. When informed of Irving's purported conversion to Judaism, she curled up in a fetal position around an empty bottle of Prozac and moaned "they want Ernie too!" over and over again.

Whatever the reaction of his fellow travelers, Irving seems be optimistic about his future. He is planning an appeal for funds to the Jewish community. "Jews are always generous when another Jew is in need," Irving said. "I'm sure that most will consider it a belated bar mitzvah present."

(Link)

Stupid fundamentalist tricks

More wacky pronouncements from fundamentalists, this time, a fundamentalist Muslim:

An Egyptian cleric's controversial fatwa claiming that nudity during sexual intercourse invalidates a marriage has uncovered a rift among Islamic scholars.

According to the religious edict issued by Rashad Hassan Khalil, a former dean of Al-Azhar University's faculty of Sharia (or Islamic law), "being completely naked during the act of coitus annuls the marriage."

The religious decree sparked a hot debate on the private satellite network Dream's popular religious talk show and on the front page of Al-Masri Al-Yom, Egypt's leading independent daily newspaper.

Suad Saleh, who heads the women's department of Al-Azhar's Islamic studies faculty, pleaded for "anything that can bring spouses closer to each other" and rejected the claim that nudity during intercourse could invalidate a union.

During the live televised debate, Islamic scholar Abdel Muti dismissed the fatwa: "Nothing is prohibited during marital sex, except of course sodomy."

For his part, Al-Azhar's fatwa committee chairman Abdullah Megawar argued that married couples could see each other naked but should not look at each other's genitalia and suggested they cover up with a blanket during sex.

These guys sure know how to take the fun out of everything, don't they? I wonder if leaving a ring or a watch on would cover the not being "completely" naked part. Perhaps the couple could both wear hats or keep their socks on...

How is academic medicine perceived by community practitioners?

I sort of feel as though I was being picked on over the last couple of days, while I've been a bit preoccupied. No, not me personally, but academic physicians in general. Actually, it's a bit lonely being an academic physician with a laboratory and a practice blogging. I have yet to encounter another one, although there are plenty of doctors who blog, as any brief perusal of my right sidebar will show (except on Internet Explorer, on which the right sidebar frequently shifts left and below the center panel). Unfortunately, I've yet to find an academic surgeon blogger. It would be nice to have some company in the blogosphere. In any case, this weekend, Medpundit wrote about the poor rate of compliance among NIH-funded researchers with a request for voluntary submission of journal articles accepted for publication to peer-reviewed journals to PubMed Central to allow public access to them after a reasonable delay of up to 12 months, such that legislation is being proposed to require it as a condition of NIH funding, the penalty for failing to comply being loss of federal funding. Her take on the matter:

Geesh. It's not like they're going to be denied royalties by making their papers available on the internet. If anything, they would get wider recognition. Of course, their methods would also get wider scrutiny as well. Is that what they're afraid of?

My response:

Speaking from the perspective of an NIH-funded researcher, I have to ask: Did you ever consider that it's just plain laziness and dislike of yet another administrative hassle to contend with when it comes to grant paperwork that's accounting for the relatively low rate of participation? Think of how you react to just one more little Medicare paperwork requirement, only this time imagine that there's no penalty for ignoring it. (As you know, if you ignore the Medicare reporting, you don't get paid.)

Another factor is that this is a new rule. A lot of researchers don't know any details about it yet. I know I don't. (I suppose when my first manuscript since I got my new NIH grant goes out in the next few weeks I'll have to learn, though.)

Believe me, it almost certainly has nothing to do with "fear" of scrutiny of our scientific method, just human nature coupled with the rather poor job of explaining the rule by the NIH.

To her credit, Sydney posted my response prominently, and I also rather liked her other suggestion:

I would suggest that public access be taken a step further. Any article that gets press-released to the media should also be available to the public for scrutiny, rather than portrayed in all its glorious positive spin without scrutiny.

Of course, I doubt that having a bunch of nonscientists perusing such papers would turn up methodological flaws any more effectively than happens in the present situation, but it couldn't hurt, and it might help. More important would be the effect that such open access might have on exposing the public to the actual methodology behind the science, particularly the qualifications and caveats about the results that are always included in such papers but only rarely mentioned in the press coverage of them.

In any case, Medpundit's comment got me thinking a bit about how scientists, specifically, academic physicians, the ones who, like me, try to do both basic or translational research and take care of patients. I added the idea to my list of future topics and made a note to try to get to it in the next week or two. Then, while catching up on some medblogs last night, I saw a piece by Kevin, MD in which he dismissed an article describing how academic physicians are feeling stressed out and depressed because they are being pressured to see more patients and generate more clinical income, thus leaving less time for research and teaching with a sarcastic: "All I can say is - welcome to the real world."

Yes, I was annoyed. Dr. Kevin's coment revealed a misconception of what it is like to work in academic medical centers that is common among physicians in private practice, and I decided to take on this topic today rather than just leaving it in my idea list. If you're in academia for any length of time, you become aware that many private practitioners appear to have some sort of stereotypical picture of us academicians sitting in our "ivory towers" sipping lattes, thinking deep thoughts, reading journals, doing seemingly arcane experiments, and not having to deal with the reality or nitty-gritty of the "real world" of taking care of patients. Would that it were so! Although I happen to be very fortunate in having a position where my superiors are very committed to developing clinician-scientists and helping me to protect my research time, mine is an increasingly rare and precious situation in academic medicine. Indeed, I have news for Dr. Kevin: Medical academicians have been operating in the "real world" for at least a decade now. It began back in the 1980's, when HMOs and managed care rose to become the dominant means of paying for health care, and accelerated throughout the 1990's. Before then, it was quite possible for clinical departments to build up impressive surpluses from clinical revenue that they could devote to research because it was generally accepted that academic institutions were more expensive and less efficient because of their research and teaching missions, and insurers and the government were willing to pay extra. However, as the bottom line became more and more important, as insurers and third party payers ceased to differentiate between academic and nonacademic health care providers, the financial squeeze became more and more pronounced. Worse, because of our research and teaching missions, it is almost impossible for academic medical centers to operate as efficiently as private medical centers, putting them at a competitive disadvantage for managed care contracts, as I've been learning from the prolonged discussions of finances and contracts that dominate nearly every Department of Surgery faculty meeting at my institution. Add to that the responsibility as tertiary care centers to accept and care for the sickest (and therefore often less profitable) patients and the frequently high rate of uninsured patients cared for in university medical centers, and it becomes clear that the "ivory tower" of academic medicine is something that has all but faded into legend. (I suspect that, as with all such nostalgia, it was never really as good in academia as the misconception, but I'm too young to have direct experience with the "golden age" of academic medicine.)

Let's look at some of the findings of the study, as helpfully listed at Health Care Renewal (I've also downloaded the study itself):

• Academic physicians spent an average of 40.7% of their time in direct patient care (up from 23% in a 1984 survey).
• Academic physicians spent less time supervising residents and medical students (15.2%) than they did in 1984 (21%), and overall spent only a little over a quarter of their time overall in teaching and related activities.
• Academic physicians spent less time on research (14.7%) than they did in 1984 (29%).
• One fifth (20.5%) of faculty were clinically depressed as indicated by scores of 16 or greater on the CES-D scale.
• About 11% of faculty had moderate to severe anxiety.
• One quarter (25%) of faculty had salaries completely dependent on their "productivity." More than one-tenth (12.6%) of faculty were contemplating leaving their institution within the next few years. Only 18.5% of faculty thought their institutions were in good financial shape.

It's really striking to me that one out of five are clinically depressed, at least by this instrument. The cause of this discontent is clear to me, as I have seen it again and again in my colleagues and at least two of my friends in other institutions: decreasing funding to support basic research and teaching, resulting in pressure to see ever more patients. Near the end of my fellowship, one friend of mine, who happened to be junior faculty, despaired that he no longer had time to do any research because the administration kept demanding that he generate more clinical income. He was doing promising research on hereditary colon cancer, but found himself spending less and less time in his lab. This resulted in a trap that is very hard to get out of and ensnares all too many young academicians. To advance in academia, young faculty have to do quality research and generate independent external funding to support their research. Failure to do so will mean failure to be promoted. However, doing the sort of high quality research that results in publications in high profile journals and is credible enough to persuade study sections to award grants to support it in an increasingly dismal funding situation. Oh, and young faculty is also expected to teach residents, serve on committees, and a variety of other duties, never forgetting that they are competing for the same research dollars with Ph.D.'s with no patient care responsibility.

My friend ended up leaving the institution and becoming a division chief, where he is more clinician and an administrator and less a researcher than he used to be, although fortunately he still does some research (although he hasn't published since 2002). Another friend of mine is struggling with the uncertainty in his department that led to a long gap without a chairman and increasing clinical responsibility. I fear that he will lose his laboratory because, due to his patient care responsibilities, he simply doesn't have the time to keep it running.

So, am I just an ivory tower type whining because the ivory tower isn't so ivory any more? I'll let the reader be the judge. Although--thankfully!--this doesn't apply to me, given my situation, most private physicians are blissfully unaware that at many private universities (and even some state universities) academic faculty are expected to fund their salary and overhead (secretary, office and clinic rent, and nursing support) from their billings alone--just like them. Then, if these faculty have time left over, they're supposed to do research, publish, compete successfully for extramural funding, do high-quality teaching, and provide service to their institution in the form of committee work, while at the same time attending more and more to the same billing headaches that colleagues like Dr. Kevin have been dealing with in running their businesses. Another example comes to mind of a surgeon I knew from my residency days. He did 500-600 major cases a year and still ran a lab. In fact, he's the one who schooled me a bit on the financial realities of being an academic surgeon over ten years ago. It was a real eye-opener that made me seriously consider abandoning my plan to try to practice surgery and run a lab, and, contrary to what some believe, salary support from grants usually doesn't come close to making up the shortfall in billings due to devoting a chunk of time to research rather than caring for patients, except in the cases of superstar researchers with multiple R01 or larger grants.

So why should you (and even Dr. Kevin) be concerned? Like it or not, academic medical centers and medical schools are the incubators from which major breakthroughs emerge and the major source of new physicians. As the authors of the study, while recognizing the limitations of their study, put it:

If, however, our data prove generalizable, today's medical students are interacting with faculty who have less time to teach them, who are increasingly discontent with their jobs, and who, especially among younger faculty, are increasingly depressed. Can such faculty be the role models they want to be, provide a quality educational experience, and be productive, let alone convey the excitement and privilege of caring for patients? And if faculty have less time for research, how will they continue to address the pressing needs for new clinical knowledge, achieve promotions, and to enhance their institutions with their experience and wisdom?

Despite these problems, all is not bleak, fortunately. Academic medicine still exerts a strong attraction to those of us who love science and want to apply science to improving the treatment of patients, and, as the authors themselves note, scores measuring overall satisfaction with life in general have not decreased significantly--yet. No other profession allows this opportunity or provides the possibility of improving the treatments used by all physicians. And there are still situations that allow something close to the old model in which a large percentage of one's time is reserved for research and scholarly activities, as my own situation demonstrates. It's just that such situations are getting more and more difficult to find, allowing fewer and fewer academic physicians the time and freedom to pursue the research that will form the basis of future therapies. Indeed, universities are tacitly recognizing that the old model of clinician-scientist doing bench research, taking care of patients, and teaching, is no longer tenable, as the evolution of academic career tracks other than the traditional tenure track (for example, the clinician-educator track) that allow academic promotion without nearly as much research commitment or independent funding.

From my perspective, the bottom line is that much of academic medicine is becoming more and more like private practice, leaving physicians increasingly having to deal with all of the headaches of the "real world" in addition to the already formidable task of pursuing science and clinical research and taking care of the sickest patients. One of the attractions of academic medicine was that it partially insulated physicians from the financial and business aspect of medicine. It was a different, but, I would argue, no less arduous career than private practice. If it becomes more arduous than it already was because of financial pressures, more and more young physicians will eschew careers in academia, to the detriment of medical research and the training of the next generation of physicians.

Grand Rounds and a new template

Unfortunately, I was too busy to come up with any new material last night. (Remember the talk I have to give today? The PowerPoint file has ballooned even slightly higher than the 45 MB it was last night. I really must teach my postdoc how to produce smaller photo sizes.) Fortunately, there's this week's Grand Rounds over at Clinical Cases and Images to give you your medblogging fix in my absence.

Oh, and there's the new template. I figure that in the absence of fresh material debuting my latest attempt at not offending the eyes of my readers would at least provide entertainment value. (This isn't the shortest duration for a template here, though. About a year ago, I changed templates for the first time, and that lasted only about a day.) Given all the complaints about the first iteration, I've made a significant modification of the background and color scheme. Hopefully this will be the last major revamp for a while, other than minor tweaking, trying to fix problems, and perfecting the logo. Of course, I'm an incessant tinkerer; so don't be surprised if you periodically notice unannounced minor changes, but, barring a rising up of the blogosphere in disgust to shut down my blog, lest its sheer ugliness or inanity warp the very fabric of the space-time continuum, I don't plan any more major retoolings for a while.

Let the flames begin!

Airborne: Created by a schoolteacher, so it must work!

I was perusing the New York Times yesterday and trying to avoid working on a talk that I have to give on Tuesday (to give you an idea of why, of what a monster I've created thus far, the PowerPoint file is up to about 45 MB of image files of TIFF files of Western blots, graphs, and multicolored confocal microscopy photos, all of which is great in that it means that I have a lot of data to present but all of which also means a lot of work to organize), when I came across this article in the New York Times Magazine. At first, it didn't start out promising. I was half-expecting a gushing, credulous article based on this beginning:

Packages of Airborne, found in the cough-and-cold aisle of major chains like CVS, Rite Aid and Wal-Mart, proudly proclaim that the product was "Created by a School Teacher!" This seems a little odd. Don't we want to fight our seasonal ailments with things created by, for instance, doctors and scientists? Apparently not all of us do; Airborne is extremely successful, and its creation by someone without the slightest medical expertise or qualification is almost certainly a factor in its success.

For one thing, it makes for an excellent creation story. In the late 1990's, Victoria Knight-McDowell, an elementary-school teacher in Spreckels, Calif., grew weary of picking up colds from her students and began "researching Chinese and holistic medicine and the use of herbs and vitamins to boost the immune system," an official company history explains. She and her husband then decided to market her "natural formula of 17 ingredients" in 1997. They used the money her husband had made selling a television script. They handed out samples in malls and gradually got distribution in various stores. Kevin Costner became one of many celebrities to declare his confidence in the product. In 2000, Knight-McDowell gave up her teaching gig, and by 2004 annual sales hit $90 million. Along the way, Knight-McDowell appeared on "Dr. Phil," and Airborne was discussed on "Live With Regis and Kelly" and other shows.

In March 2005, Airborne brought in Elise Donahue, a former executive for Prestige Brands and Procter & Gamble, as C.E.O. She says that Airborne buyers feel that "if a schoolteacher who's around germy little kids all the time can find something that keeps her from getting sick," then her solution should work for them too. Similarly, the cartoon characters on the package lend a friendly, almost nonmedicinal aura to the product that stands out in the cough-and-cold aisle.

Oddly enough, I had never seen this product in the drugstore, supermarket, or anywhere else, much less advertised on TV or in any magazine or newspaper. I must lead a sheltered life. After all, back in the summer, when I spent a rare weekday afternoon home waiting for the cable repairman to come and fix the crappy connection to our upstairs TV, that was the first time I ever came across Kevin Trudeau's infomercial and later found out that this obvious scammer had a best-selling book chock full of quackery. (P. T. Barnum was definitely right.) This particular article on Airborne seemed as though it would be just another puff piece about an entrepreneur without any medical experience who nonetheless made it big, complete with the tale of how she overcame various challenges and odds. But then the article continued:

People also must use Airborne because it works, or rather because they believe it works. Technically, Airborne is a dietary supplement (you're supposed to take it "at the first sign of a cold symptom or before entering crowded environments"), meaning that it does not require Food and Drug Administration testing and approval. As the package disclaimer notes, it is "not intended to diagnose, treat, cure or prevent any disease." As with many supplements, there is no independent scientific evidence of Airborne's medicinal value. But many people continue to buy the herbal supplement echinacea, despite many studies (including one in The New England Journal of Medicine) saying it does nothing to ward off or treat colds.

Indeed, I noted this very phenomenon when I wrote about echinacea a few months ago. If people somehow come believe these "remedies" work, no amount of studies or data showing that they are no better than placebo seem able to convince them otherwise. Of course, since colds are generally self-limited within a couple of weeks anyway, because of confirmation bias it's very easy for it to appear as though taking these supplements decreases the duration and severity of colds. Unfortunately, although it would be great if these remedies could actually achieve this, there's seldom any hard evidence to suggest that they do. Airborne is no different. In case I was wrong about Airborne, though, out of curiosity, I checked out Airborne's website to see just what was being claimed and whether there was any evidence presented that this stuff worked. First, here are the claims:

Victoria Knight-McDowell, an elementary school teacher who was sick of catching colds in class and on airplanes*, spent over five years developing AIRBORNE with a team of health professionals. AIRBORNE was created by combining seven herbs** (each with a specific function in Eastern medicine) then putting them through a patented extraction process, and THEN combining them with a unique formulation of amino acids, anti-oxidants and electrolytes. An effervescent carrier was used, as a way to deliver the nutritional benefits of AIRBORNE to the system immediately, and without the bulk of conventional pills. There’s nothing else like it!

I'm sure there is "nothing else like it," but one could say that about almost any concoction. So far, this sounds pretty science- and data-free, don't you agree? Of course, curmudgeon that I am, I can't help but wonder why Ms. Knight-McDowell advertises "invented by a schoolteacher," thus appealing to her customer's mistrust of "conventional medicine," but then says that she developed Airborne with a "team of health professionals." She seems to want to have it both ways, appealing to homespun "practical" knowledge while at the same time appealing to the authority of "health care professionals." (Of course, the blurb above doesn't say just who these "health professionals" are or whether they're even doctors or scientists; they could well be alties like Hulda Clark for all we know.) Also, her experience as a teacher has to be the lamest argument from authority with respect to a health product that I've seen in a long time. Sure, kids are germ factories, and working with children as a teacher is a great way to be regularly exposed to the latest bug going around, but how does that give Ms. Knight-Dowell the expertise to come up with an herbal/supplement concoction to prevent or fight colds? I might buy it if she claimed to have figured out a method of hand-washing that kids can actually do correctly, which would probably go much farther in decreasing the spread of colds in schools than any herbal remedy, but don't see how her experience as a school teacher suddenly qualifies her as a expert in herbal medicine. And, of course, there isn't one whit of scientific evidence or studies from clinical trials to support her claims for Airborne.

Another interesting point to consider is that it is recommended that people take Airborne "at the first sign of a cold symptom or before entering crowded environments." However, "at the first sign of a cold symptom" is a fairly vague criterion, one that's tripped up any number of studies looking at, for example, whether zinc prevents or decreases the severity of colds. Some people cough once or twice and think they're coming down with a cold; if they take Airborne and don't get any further symptoms, they're likely to attribute it to the Airborne rather than to a different cause for their coughing, another example of confirmation bias. Ditto if people take Airborne before going into a "crowded environment" or an airplane and happen not to get a cold.

The pseudoscience gets even worse, though:

There is no known bacterial, viral, or fungal "resistance" to complex herbal formulas. Some of these formulas have been used for thousands of years with no evidence of waning efficacy. The Chinese medicine text, the "Nei Ching" is estimated to have been drafted in 200 a.d., and contains formulas that are still used effectively for infections today. The "resistance to resistance" of Chinese and other herbal formulas, is thought to occur because there are several herbs in each formula, and each herb has many complex plant alkaloids. This complexity is believed to be too much for the "bugs" to process; it is much easier for them to adapt and "outwit" the simpler "one item" pharmaceuticals. According to certain health experts in America and abroad, traditional herbal medicines may soon be our only weapon against bacteria, like staphylococcus--"staph"--that are fast becoming resistant to antibiotics!

Please refer to Wall Street Journal Article 5/8/03: "New Respect for Chinese Herbal Medicine.

Ah, nothing like that noted medical journal, the Wall Street Journal, to set me straight! I rather suspect that the reason there has been no "waning efficacy" over thousands of years is probably because there was never all that much efficacy outside of confirmation bias and placebo effects in the first place. For one thing, there's very little evidence that Chinese herbal formulas have clinical utility against serious (or even not-so-serious) viral illnesses, other than as an adjuct that might help symptoms. What little evidence there is out there is, for the most part, of low quality. However, there is evidence to suggest that some herbal preparations can decrease the levels of antiretroviral drugs and put AIDS patients at risk for recurrence if they use the wrong herb. That is not to say that some herbs or combination of herbs don't have some utility in combatting infectious diseases, but there is simply no scientific basis at present to make such broad and general claims as above, particularly the ridiculously overblown claim that "traditional herbal medicines may soon be our only weapon against bacteria, like staphylococcus--'staph'--that are fast becoming resistant to antibiotics." Natural products derived from herbs or other plants will likely have a role in developing new antibiotics, if efficacy can be demonstrated, but, even if they do, it's unlikely that they will be "our only weapon" (or even our most important weapon) against bacteria.

So what exactly is in this wonder compound? Here's the list:

Serv size 1 tablet. Servings, 10. Amount per serving: Calories 5, Total Fat 0g, Sodium 230mg (10% DV*), Total Carb 0g, Sugars 0g, Protein 0g. Vitamin A (Palmitate) 5,000 I.U. (100% DV*), Vitamin C 1,000mg (1,670% DV*), Vitamin E (Acetate) 30 I.U. (100% DV*), Riboflavin 2.8mg (170% DV*), Magnesium (Oxide & Sulfate) 40mg (10% DV*), Zinc (Sulfate) 8mg (55% DV*), Selenium (Amino Acid Chelate) 15mcg (20% DV*), Manganese (Gluconate) 3mg (150% DV*), Potassium 75mg (2% DV*), Proprietary Blend of Maltodextrin, Lonicera, Forsythia, Schizonepeta, Ginger, Chinese Vitex, Isatis Root, Echinacea 350mg (DV**), Amino Acids (Glutamine as L-Glutamine, Lysine as L-Lysine HCl) 50mg (DV**).

Ah, echinacea is in there. Why am I not surprised? I'll give her a pass on the echinacea, though, since her product was developed before the latest research showing that it doesn't do anything for colds. Let's see. What else is in there? Ginger? No evidence of benefit for colds. Chinese Vitex? No evidence found on PubMed that it does anything for colds Isatis root? No evidence found on PubMed that it does anything for colds. Ditto maltodextrin, lonicera, forsythia, and schizonepeta.

All of the above doesn't necessarily mean that Airborne doesn't work as claimed or have some mild symptomatic benefit in colds, but the onus is on Ms. Knight-McDowell to show that her product does what it says it does. So far, she has not, aside from unsupported claims and celebrity testimonials. She has claimed to have started a small clinical study, but, as this New York Times article from last year states:

Knight-McDowell commissioned a small clinical trial, and the results suggest that the product can fight colds, said Rider McDowell, a co-founder of the company. But the study has not been published in a medical journal. McDowell would not disclose where the study was done.

Anyone want to make a bet that that study still hasn't been published?

Products like Airborne are yet another indication of a gaping hole in the laws dealing with how we regulate medicines. Ms. Knight-McDowell is clearly making a medical claim for her product, namely that it can prevent or diminish the severity of colds. If I make a claim for a a compound that I develop, I'll have to prove it through clinical studies before I could ever get FDA approval to market it, which takes many years and costs hundreds of millions of dollars. Ms. Knight-McDowell can throw together a concoction of a bunch of vitamins and herbs and make millions. Certainly I'll give her props for her entrepreneurial spirit and willingness to risk everything for her business, but I only wish she could produce some actual evidence that her product does what she claims it does. A randomized, double-blinded study (preferably more than one) would, of course, be the gold standard, but in lieu of that I'd settle for lesser levels of evidence (or, for that matter, any credible evidence at all from a well-designed study, even a preliminary one) to give me some indication that Airborne is something other than a rather elaborate placebo. Medically, it's probably harmless, although we don't know even that for sure, given that some herbal medicines can interact with conventional medicines such as coumadin or anti-HIV retroviral drugs in potentially harmful ways.

But why should she bother? Her success has made it unnecessary to prove her product works, and here's one big reason why:

Apart from the power of the placebo effect, this consumer indifference to scientific proof brings up the critical issue of trust and, perhaps more important, distrust. . . And let's face it, the current reputation of the people who do have expertise in the concoction of remedies is not so great. The astonishing onslaught of consumer advertising for pharmaceuticals in recent years has more recently been followed by an onslaught of safety concerns and lawsuits. Merck, a heroic company just a few years ago, now calls to mind Vioxx lawsuits and trials. Consumer groups paint the pharma giants as shameless profiteers. "We're losing the battle for consumer trust," a top Bayer executive confessed to The Wall Street Journal last year.

Airborne - which, Donahue points out, is positioned as a mainstream product, not as an "alternative medicine" - is not against pharmaceutical companies or anyone else. It is simply for something that happens to have been invented by a nonexpert. But it probably benefits from distrust of medical authority and faith in a certain kind of folk wisdom just the same.

Of course it does. That's what much of alternative medicine relies on, a distrust of "conventional" medicine. Unfortunately, as was pointed out, the pharmaceutical industry and conventional medicine haven't always done as good a job as we should of earning that trust.

But what do I know? I'm just one lone pseudonymous skeptical blogger in the lower reaches of the blogosphere. I'm an anomaly in expecting a bit of supportive evidence, even if it's not the gold standard of a double-blind randomized trial, before I'll take a claim seriously. I don't stand a chance against Oprah, who did a puff piece on Ms. Knight-McDowell and Airborne or Knight-McDowell's other other celebrity boosters, such as Howard Stern or Kevin Costner (although I can't help but think that, if Tom Cruise were a booster, I might have a small chance convincing people that Airborne is probably a waste of money). With them on her side, Ms. Knight-McDowell probably doesn't even need to make the pretense of doing a clinical trial to test Airborne's efficacy in preventing colds after exposure or decreasing the severity of a cold after it starts.

RINO Sightings: Imminent Arrest Edition

The Unabrewer is hosting RINO Sightings this week:

For those not in the know, I am currently in China. Chinese products made for export generally perform better than the items they leave at home.

This is the first, and probably last, RINO carnival I’ll be hosting. No, not because of the work involved. It’s quite fun. And no, not because of any conflicts with submitters. Everyone was quite polite. The problem is that I’m sure to be jailed and/or executed for linking this many subversive Blogspot links. So, I shall quickly post this, then retreat to a safe, undisclosed location.

Damned spammers!

Somehow comment spammers for a site advertising products related to blood pressure devices and medications have managed to get through Blogger's word verification system for comments. Before that, yesterday it was a bunch of spams for a Pink Panther DVD collection. Just this morning, I deleted five comment spams that arrived just this morning since 6 AM, for a rate of about one per hour thus far. (In fact, one arrived while I was typing this short little announcement.) I haven't done it yet, but if this spam mini-flood keeps up, gets worse, and starts to cause a real problem, I may be forced to turn on on comment verification for a while until the spam assault abates.

Just so you all know the reason if I end up deciding sometime in the next couple of days that I need to turn on comment moderation again.

Out of curiosity, has any other blogger been getting these spams?

Birthday roundup

I normally don't post on Sunday that often anymore, but I couldn't let this one pass without a birthday shoutout to my youngest sister. Happy birthday!

My sister happens to share a birthday with a couple of my favorite performers. First, as I pointed out last year, my favorite rock performer of all time, David Bowie (née David Jones) was born on this date in 1947, which means he's turning 59 today. Second, the King of Rock 'n' Roll Elvis Presley was born on this day in 1935, which means he would have been 71 today, had he lived.

My sister gets to share her birthday with such cool celebrities...

The Commissar maps Mr. Robertson's neighborhood

Leave it up to The Commissar. After Pat Robertson's idiotic statements about God striking down Ariel Sharon because he was negotiating a peace deal with the Palestinians that might "divide" the Holy Land, he couldn't resist making up a map of the world as seen by Pat Robertson, complete with a list of some of Pat's loonier statements! (Click the image to be taken there.)

A field guide to quackery and pseudoscience

After a long absence for the holidays, Prometheus is back, with part one of his Field Guide To Quackery and Pseudoscience. An excerpt:

The purpose of scientific jargon (and almost all “real” technical jargon) is to allow people familiar with the field to communicate ideas in an efficient manner. The purpose of pseudoscientific (or quackery) jargon is to obscure meaning and cover a lack of definition.

To illustrate – what, precisely, is meant by the quack term “detoxification”? What is being detoxified, from where and how? The same applies to various “field” and "energy" references in pseudoscience. What are they, how are they generated and how can they be measured?

Pseudoscience (and quackery) jargon serves to allow the promoter to sound scientific without actually having to define their terms or be scientific. They use scientific-sounding words to confuse and distract their audience , whereas the “real” scientific and technical jargon serves to inform and improve communication efficiency. By using terms that are unclear or foreign to their audience, the pseudoscientist or quack is sending the message, “This is too technical for you to understand, but it’s real science – trust me!”

Most of the jargon used in quackery and pseudoscience has roots in real science, so the audience – which is usually no more scientifically literate than the general population (which is to say, not very) - will understand only that they are technical terms. It is unlikely that many members of the audience will understand what the terms actually mean and even less likely that someone will realize that they are being used in a nonsensical fashion.

Good reading, and I look forward to additional entries.

Template fiddling

Since rolling out the new template, I've gotten a lot of comments, with essentially a mixed verdict leaning more negative than positive. I've also noticed things that I liked at first about the template but now don't like as much, and I am starting to appreciate that the circuit board background may be too overpowering. So, if you see the template looking different seemingly at random over the next couple of days, don't worry. It's just me experimenting (and, more importantly, trying to avoid working on my PowerPoint slides for a talk that I have to give on Tuesday, not to mention a paper that desperately needs to be finished and submitted). You may even see a different background popping up soon, or maybe even just a solid background. Hopefully, this process will result in the--shall we say?--the evolution of the present template into a--shall we say?--fitter and more well-adapted template. (I would call it intelligent design, but obviously the intelligence of this particular designer, at least when it comes to web design, is debatable.) In any case, a reader has already helped produce a spiffy new logo to replace the admittedly rather ugly text in the header; so that problem at least should be taken care of very soon.

A couple of layout issues I've noticed. People have told me that the "Webrings" box that should be at the bottom is showing up at the top right for some reason in Firefox. I was able to replicate this on my wife's old computer. As far as I can tell, on the Mac at least, it turns out that it has something to do with Firefox 1.0. Upgrading to Firefox 1.5 eliminated the page rendering problem. The second issue is that, on Internet Explorer at work, I noticed that the text in both the sidebars is center-justified. That was not my intent, and I agree that it doesn't look good that way. My original intent was that the text in the sidebars should be left-justified, and that's the way it shows up in Firefox, Mozilla, Camino, and Safari. I have no idea why this is so. I guess I know just enough HTML to be dangerous but not enough to do serious troubleshooting of browser-specific differences in display. Any help in resolving this issue would be appreciated.

Finally, for those of you who really, really don't like the new format, remember that it could be worse. I could be using the same template this blog uses (found via Pharyngula). In any case, I'm not going back to the old generic template. I'm determined to keep experimenting until I find one that works and is way cool. Basically, it's an excuse for me to learn some HTML and how to use Dreamweaver. Hopefully, I won't cause too much confusion and/or pain in my readership during my learning curve and the evolution of this blog template. Just try to stop me when I finally hit on one that works. I'm an incessant tinkerer and might not be able to recognize it when I've finally gotten it right, leading me to keep working on it and thus screw it up.

ADDENDUM: I decided to apply the new logo and the alterations to the header. (Thanks to C., who wishes not to be given too prominent credit for all her help to me in crafting the header images, lest others ask her to do stuff for their blogs too.) Also, I may have found the cause of the center-justification of the text in the sidebars: A stray "text-align:center" tag in the CSS list for "main." (I can only guess that IE was "listening to" that tag instead of the tag specified for the two sidebars.) I can't determine whether deleting it worked, though, until I get access to a PC. Finally, I widened the center panel and decreased the space between the center panel and the two sidebars. Hopefully this incremental step helps make the background less distracting until I do a more permanent redesign...

Update on Abubakar Tariq Nadama: The autopsy results have been announced

Here's an update on the story of Abubakar Tariq Nadama, the unfortunate 5 year old autistic boy who died while receiving chelation therapy in August. According to the Pittburgh Post-Gazette:

A 5-year-old autistic boy who went into cardiac arrest in his doctor's office died as a result of the controversial chelation therapy he was receiving as a treatment for his autism.

The manner of death of Abubakar Tariq Nadama, of Monroeville, has been listed as accidental while the investigation continues.

The findings released by the Butler County coroner's office don't say whether the treatment itself is dangerous or the child died from the way the treatment was administered.

In layman's terms, the administration of ethylene diamine tetra-acetate, commonly known as chelation, resulted in a lack of oxygen to the brain as well as irreversible heart damage, said Allegheny County Deputy Coroner Ed Strimlan.

The Allegheny County morgue conducted the autopsy on the child at the request of Butler County Coroner Bill Young.

"We determined there's a direct correlation between the EDTA and the lack of oxygen to the brain and the heart muscle damage. It's a total package, based on the autopsy, the histology [tissue sampling] and the toxicology [blood sampling]," Mr. Strimlan said.

The determination is sure to spark debate among parents, many of whom support chelation as a safe and effective therapy for autism. Others condemn the treatment as voodoo medicine.

The autopsy report indicates the manner of death was accidental. The other categories are natural, suicide and homicide.

No doubt chelation advocates will cry foul, but it looks as though the autopsy definitely indicates that chelation therapy killed the boy. Given the circumstances of the boy's death, it's pretty obvious that the cause was almost certainly hypocalcemia due to EDTA leading to cardiac arrest. At the time, I was afraid that the autopsy findings might not reflect EDTA as the cause of death, mainly because deaths from sudden cardiac arrest due to acute electrolyte abnormalities don't always produce concrete findings that let the pathologist pin down the exact cause. Such a result would have given the chelationists an "out" to claim that it wasn't the EDTA that killed Tariq. Fortunately, that didn't happen in this case. Too bad the parents are highly unlikely to sue Dr. Roy Kerry, the ENT doctor turned alternative medicine practitioner, because he wouldn't have a prayer of winning a malpractice suit against him. (If doctors in this country can be sued and lose for bad outcomes that aren't their fault, one hopes that someone like Dr. Kerry can be sued for bad outcomes that are his fault.) Maybe a big settlement or a big malpractice judgment against one (or, preferably more) of these autism chelationists would be what it would take to cool their love of this particular ineffective autism therapy somewhat.

I'm probably dreaming though.

I'll close with a speculation/prediction: Now that the autopsy report is out, I'm guessing that it probably won't be long before some chelationist somewhere (or perhaps even Dr. Kerry trying to avoid losing his medical license and/or going to jail for causing the death of a young child by giving him a useless treatment for autism) will hire Dr. Mohammed Al-Bayati, the "pathologist" who tried (and failed miserably) to rebut the L.A. County Coroner's autopsy report that concluded that Eliza Jane Scovill (daughter of prominent HIV/AIDS denialist Christine Maggiore) had died of HIV-related complications. After all, doing hack jobs on coroner's reports to try to keep his clients from going to jail is Dr. Al-Bayati's specialty, particularly if he can blame the death on vaccines. I can just see Dr. Al-Bayati exercising his special "skills" (such as they are) on the Nadama autopsy report. I hope I'm wrong, but I wouldn't be at all surprised to see another Al-Bayati hatchet job on the way.

Just wait.


More on this story:

1. Chelation Death: The Coroner Speaks (subtitled: Look Before You Leap)
2. Abubakar's Death: The Coroner's Office Speaks

Orac's picks for the Top 10 best albums of 2005

As you may know, I love music. I love it so much that I have over 1,000 CDs collected over the years (I've lost count), and over 10,000 tunes on my iPod and in my iTunes library. Consequently, as one might expect, I'm a bit of a music critic wannabe. Before blogging, there was no outlet for this tendency. After blogging (in fact, very soon after I started blogging), I couldn't stop myself. So, if you're not interested, feel free to skip this post, but if you're into music join me as I list my picks for the best albums of 2005. One word of caveat is that I don't get exposed to nearly as much music as, say, your average music critic working for a major (or even minor) magazine or newspaper. Consequently, this list is culled only from what I've bought or what I've heard. It's possible that I've missed a fair amount of good music. It's also highly biased. I had meant to finish this list and save it up to be posted during the week between Christmas and New Years, but all the badness that happened sort of got in the way.

Unfortunately, this year wasn't as good as last year as far as music goes. There was nothing as fantastic as the Arcade Fire's Funeral (which is still sitting in my car CD player even now, a year later), as coherent and angry as Green Day's American Idiot, or as satisfyingly, thumpingly loud and Zeppelinesque as Secret Machines. Nonetheless, this year, I've found almost as much that I've really liked. So, without further ado are my picks for the best albums of 2005, in no specific order:

1. Worlds Apart (...And You Will Know Us By The Trail of Dead). Released early this year, Worlds Apart is full of exhilirating anthems that seem custom-made to fill stadiums, even before this band can fill a stadium. Yes, it uses a lot of classic rock tricks, but avoids classic rock cliches.
   
2. Free the Bees (A Band of Bees). I have a soft spot for neopsychedelia, and that's why I like this rollicking romp through the 1960's. It sounds almost as if it could have come from the Summer of Love, but something about it makes it sound contemporary. With echos and influences of The Byrds, The Beatles, and the Small Faces, this is still not just an exercise in nostalgia. These guys borrow from their influences, but fuse them into a sound that's all their own.
   
3. Some Cities (Doves). My initial impression of this album was that it was a comedown from their previous effort, The Last Broadcast, but repeated listenings revealed an evolution to a less highly produced sound that is more direct and more visceral, without sacrificing the shimmering layered sound that I came to love in 2002. Doves are one of my favorite bands.
   
4. The Magic Numbers (The Magic Numbers). Straightforward, softer, harmony-driven, vaguely folky-sounding rock that's impossible to resist. This band, a combination of two brother-sister duos, has been compared to a fusion of the Mamas and the Papas and Flaming Lips. I'm not sure if I agree, but I like their sound.
   
5. The Great Destroyer (Low). Full of slower songs that build to satisfying crescendoes, this represent's Low's most polished and melodic effort yet.
   
6. A Bigger Bang (The Rolling Stones). Sometimes old warhorses still have life in them and can still surprise you. No, the Rolling Stones haven't suddenly gone rap. They still sound like the Stones. But they have released their best album in at least 24 years, as I described when I reviewed the album a couple of months ago.
   
7. Takk (Sigur Rós). I definitely have a soft spot for post-rock, and the biggest, baddest post-rock band of all is Sigur Ros. With a singer with an otherworldly voice who sings songs in a made-up language over layers of synthesized goodness, Sigur Rós doesn't dissapoint. They even find room for horns this time around, which was a bit jarring at first but soon sounded natural.
   
8. Get Behind Me Satan (The White Stripes). Sadly, Get Behind Me Satan was not as good as their last outing, Elephant, but, even so, no band last year did stripped-down garage rock as well as Jack and Meg White. Even though they've expanded the instruments in their armamentarium a little bit this time around, they still retain that simple, urgent sound.
   
9. Frances the Mute (The Mars Volta). What other form of rock do I have a weak spot for? Well, prog rock, for one, and The Mars Volta definitely does prog rock, their protestations otherwise notwithstanding. However, this isn't your father's prog rock, like Jethro Tull, Yes, or Emerson, Lake, & Palmer. Rather than grafting symphonic noodlings onto a more conventional rock core, the core of much of Mars Volta's prog rock is borderline speed metal in some places. Besides, any band that can do multi-movement suites of rock songs, some of which have Spanish lyrics can't be all bad. (Well, maybe they can be, but Mars Volta can't.)
   
10. Employment (The Kaiser Chefs). Just straight ahead working class bar rock, and we all need some of that every now and then. (At least I do.)

And, my pick for the best compilation released last year:

Children of Nuggets: Original Artyfacts from the Second Psychedelic Era 1976-1995. I don't know how Rhino Records does it, but the producers of the Nuggets series just keep putting out fantastic collections of psychedelic garage rock. In the third release in their Nuggets series of compilations of psychelia and garage rock, Rhino has for the first time gone beyond the 1960's into bands from what is described as the "second psychedelic era," a period from 1976 to 1995. Compiling, as the liner notes say, "the good tracks from all those albums that have only one good track," this album covers garage, ska, surf rock, country punk, and the paisley underground. The song choices are outstanding (although with a little overlap with their recent Left of the Dial and No Thanks boxed sets). Nonetheless, this is the best collection of the year.

Well, that's about it. After the bounty of 2005, 2006 was a bit of a letdown, but still produced a lot of good music. Now that they've performed with Bowie, here's hoping Arcade Fire puts out a new release this year. Or, even better yet, now that Bowie has recovered from his angioplasty and been seen performing with Arcade Fire, maybe Bowie will finally put out a new album. (The last I read, in December he said he was working on some new songs in preparation for another "period of experimentation." If that's true, I can't wait.)

Battlestar Galactica is back

Yep, tonight at 10 PM, you know where I'll be, watching the best SF show on the air since Babylon 5 finished up and finding out how the final confrontation between Commander Adama and Admiral Helena Cain turns out.

I can't wait.

More Pat Robertson lunacy

You know, if Pat Robertson didn't exist, skeptical bloggers would probably have to invent him. He provides such a wealth of utter lunacy and bizarre statements on such a regular basis as to provide blog fodder for a million skeptical bloggers. He's a veritable cornucopia of the worst illogic to be found in fundamentalists, whether it be his pronouncement that the citizens of Dover had just "voted God out of their city" for having voted out the school board that had tried to introduce the teaching of intelligent design creationism in their science classrooms (and therefore shouldn't count on God's help if there is a disaster) or his recommendation that Dover citizens "call Charles Darwin" if they have problems and need help. When it comes to sheer, bat-shit crazy, fundamentalist wingnuttery, Pat rarely disappoints, and yesterday wasn't any different.

What's Pat's most recent craziness? He's has said that Sharon's stroke was God's punishment for his "dividing His land":

I have said last year that Israel was entering into the most dangerous period of its entire existence as a nation. That is intensifying this year with the loss of Sharon. Sharon was personally a very likeable person. I am sad to see him in this condition. But I think we need to look at the Bible and the Book of Joel. The prophet Joel makes it very clear that God has enmity against those who, quote, "divide my land." God considers this land to be his. You read the Bible, he says, "This is my land." And for any prime minister of Israel who decides he going carve it up and give it away, God says, "No. This is mine." And the same thing -- I had a wonderful meeting with Yitzhak Rabin in 1974. He was tragically assassinated, and it was terrible thing that happened, but nevertheless, he was dead. And now Ariel Sharon, who was again a very likeable person, a delightful person to be with. I prayed with him personally. But here he is at the point of death. He was dividing God's land, and I would say woe unto any prime minister of Israel who takes a similar course to appease the EU, the United Nations or United States of America. God said, "This land belongs to me, you better leave it alone."

So let me get this straight. Sharon makes war for decades. He's known as a serious security hawk and is utterly relentless in fighting Israel's enemies for almost his entire career, using sometimes brutal methods that led him to become a controversial figure, even in his own nation. Now, in the twilight of his life, Sharon has become more moderate and has decided that, after decades of war, it is finally time to seek peace with his enemies, and God smites him down? Is this really the God that Pat Robertson worships?

Maybe Robertson is worried that "dividing Israel" might interfere with his plan to build a Biblical theme park in Israel by the Sea of Galilee, where Jesus was thought to have fed 5,000 with five loaves and two fish. As planned, it will feature a garden and nature park, an auditorium, a Holy Land exhibition, outdoor amphitheatres, information centre and a media studio. The land on which this park is to be built on land that was Syrian until the 1967 war, and, along with the Golan Heights, Syria still wants it back. If Sharon was willing to negotiate land for piece with the Palestinians, perhaps he would have done the same with Syria.

More likely, however, Robertson's objection derives from the believe that Fundamentalist Christians have that, in order for Jesus to return again, two preconditions are Jewish control of the land of Israel and the conversion of the Jews to Christianity.

Indeed, that's exactly how some some Israeli Jews view the proposed theme park:

Yossi Sarid, a former government minister and member of the Knesset, said he was wary of the friendship of the American Christian right and projects such as the Galilee centre. He said: "I am not enthusiastic about this cooperation because I have no desire to be cannon fodder for the evangelists.

"As a Jew, they believe I have to vanish before Jesus can make his second appearance. As I have no plans to convert, as an Israeli and a Jew, I find this a provocation. There is something sinister about their embrace."

Indeed there is. It's hard not to think that Pat Robertson and his ilk are somehow trying to "speed along" the coming of the Apocalypse and thus the final Judgment and return of Jesus, first by supporting an "undivided" Biblical Israel, then by planting theme parks in Israel in an effort to convert Jews to Christianity, their promise not to proselytize Jews notwithstanding.

Hat tip: To my wife!

The first Skeptics' Circle of the New Year

The first Skeptics' Circle of the New Year has been posted at the Saga of Runolfr, this time in the form of a medieval meeting of Lords:

Even though it was winter in the north, where the Sun would not rise for many days and snow and ice held the land in a ferocious grip, the great Lords of skeptical thought would not rest. They had searched their realms for the claims of the foolish and credulous, and now they journeyed to the hall of Ulfsheim, where Runolfr, son of Ulf, called the Word Chooser, would host their discussion of matters unproven.

As they entered the hall, servants took their great fur coats and hung them on pegs along the walls. They seated themselves on benches around the great central fire, and more servants brought out drinking horns brimming with mead. They muttered among themselves and sipped from their horns until the last of had arrived, then Lord Runolfr rose from his seat at the head of the hall and raised his arms for silence.

“Great Lords and Ladies of the Realms of Clear Thought. Let our business begin!” he shouted. “The Skeptic Thing has begun! Rise and share your wisdom!”

What other format for the Circle would you expect from a blogger going by the 'nym of Lord Runolfr? Once again, there's more great stuff, showing that skeptics didn't rest (well, not entirely, anyway) over the holidays.

Next up in two weeks is Skeptic Rant. Start getting those skeptical posts ready to submit to Sean by January 18 and join us again two weeks hence on January 19 for more skepticism.

Finally, with the new year upon us, have you considered hosting the Skeptics' Circle? Those of you who have submitted work to the Circle before, have you considered how much fun hosting could be (not to mention the extra traffic it could bring your way)? Anyway, if you're interested in hosting, check out the main Skeptics' Circle archive and schedule to see if it's something you'd like to do and then, if it is, drop me a line at oracknows@gmail.com.

An unexpected analogy

Remember how I said yesterday that I was going to post something today that I had been planning since before Christmas, you know, get back to normal after all the disruption of the last couple of weeks?

Scratch that for the moment.

I came across something that caught my attention and made me change my mind. Fear not, however. One good thing about blogging is that I can always revisit them tomorrow or next week. And, truth be told, what caught my attention earlier today is an article that combines two of the major themes of this blog in a way I hadn't thought about before:

David Irving, the infamous British war historian, is today sitting in an Austrian jail, accused of denying the Nazi Holocaust. So why is an American Jewish academic who dramatically crushed Irving in the British courts saying he should be released?

When you ask Professor Deborah Lipstadt for her thoughts on David Irving's forthcoming trial, the very last thing you expect her to say is: "Let the guy go home. He has spent enough time in prison."

Lipstadt, the American Jewish academic who exposes Holocaust deniers is not exactly David Irving's greatest fan.

But five years after she famously defended her own reputation in the High Court, and in doing so shredded Irving's, she is arguing that the Austrian authorities should probably let him go, saying the far-right will find a martyr if he goes to jail.

David Irving, 67, who made his name as a World War II historian, became infamous for suggesting that the Holocaust didn't happen.

But in November last year he was arrested in Austria for two speeches he made in 1989, during which he allegedly claimed there had been no gas chambers at Auschwitz.

So far, I'm in agreement. As I've written before, as odious as I consider Holocaust deniers and their message, I consider laws that criminalize Holocaust denial (or other forms of "hate speech," for that matter) to be serious infringements upon free speech and do not want to see David Irving, as detestable as he is, in jail for his Holocaust denial. (Of course, his failure to pay the court costs of his failed libel suit against Professor Lipstadt is another matter.) Although I understand that, as some have argued (including Professor Lipstadt, by the way), the history of Austria and Germany made such laws advisable in the early postwar period, I believe that now, over two generations after the end of World War II, these laws no longer serve any useful purpose. Indeed, I consider them more detrimental through their effects on free speech than beneficial in preventing the rise of fascism. All such laws do is to allow Holocaust deniers prosecuted under them to claim the mantle of free speech martyrs. Professor Lipstadt agrees:

"Generally, I don't think Holocaust denial should be a crime," she says. "I am a free speech person, I am against censorship."

"I don't find these laws efficacious. I think they turn Holocaust denial into forbidden fruit, and make it more attractive to people who want to toy with the system or challenge the system."

Now here's where Professor Lipstadt made an unexpected analogy:

"We don't have laws against other kinds of spoken craziness. If you're a medical quack and you hurt someone, there's a law against that.

"But if you're a medical quack and you stand on the street corner preaching that you have an elixir that cures cancer and saves lives, no one throws you in jail."

An analogy between laws against Holocaust denial and quackery! See why I couldn't resist commenting about this?

My first reaction was that I didn't buy the analogy. It struck me as somehow invalid. The reason was that, depending upon the situation, preaching that you have an elixir that cures cancer you can potentially get in trouble with the law, depending upon the situation. Then I thought about it a bit, and, on second thought, Professor Lipstadt's analogy isn't as bad as I first thought. In fact, it's pretty good. Before I begin, though, I feel the need for a preemptive disclaimer, lest you think that Orac has fallen victim to a certain undead dictator with a hankering for brains (unlikely, anyway, since I doubt even the undead Führer likes Plexiglass and circuit boards): I am not saying, implying, or otherwise insinuating that quacks, alties, or alternative medicine practitioners are Holocaust deniers, anti-Semites, or Nazis. Professor Lipstadt's analogy works because advocating quackery is an example of free speech that is not criminalized even though it is potentially quite harmful.

Got that straight? Good. Let's begin.

What needs to be considered in this analogy is the difference between speech and action, as well as the consideration of the likely outcome of that speech. Let's consider the example of Holocaust denial first. One of the arguments for outlawing it, for lumping it in with "hate speech" is it is by its very nature anti-Semitic hate speech, and that it is offensive to the dead and to survivors. Further arguments in support of such laws is that their effect is to demonize a religious/racial group (the Jews) and to promote the rehabilitation of Nazi-ism. What is the likely outcome of such speech? It may offend survivors, and it may contribute to anti-Semitism. Yet these effects are simply emotional (offending survivors) or so nebulous (contributing to anti-Semitism or the rehabilitation of Nazi-ism) that preventing these effects is not not worth the serious infringement of free speech that laws against Holocaust denial produce. Freedom of speech means nothing if offensive speech is not protected. Besides, if the anti-Semitism in Holocaust denial is acted upon (vandalism, assaults, etc.) there are already laws against such crimes. It is not necessary to criminalize the speech, except under very narrow circumstances.

In fact, it could be argued that, if a government were to restrict potentially harmful speech, a much better case can be made for restricting the speech of quacks pushing bogus "cures" than for restricting speech expressing Holocaust denial. As an example, let's look at Professor Lipstadt's example of advocating quackery. In my discussion, I don't mean advocating "alternative" therapies that might have efficacy, but rather advocating clear-cut, down-and-out, undeniable quackery, such as claims to be able to cure all cancers (or AIDS) by killing an intestinal fluke. Again, considering speech versus acting upon the speech to cause harm, there are laws under which quacks can be prosecuted if they actually use unproven or ineffective treatments on patients, particularly if they made exaggerated or impossible promises about them beforehand. But what about if they just advocate quackery? Well, as Professor Lipstadt says, people don't get thrown into jail just for advocating quackery. Indeed, we have the example of Kevin Trudeau, don't we? He's the author of a best-selling book called Natural Cures "They" Don't Want You To Know About, which advocates the worst forms of quackery. This is a book that has also sold over a million copies. Trudeau's book claims that there are cures for cancer and a variety of other serious diseases out there that "they" (meaning the government, the pharmaceutical companies, "conventional" medicine) don't want you to know about, presumably so they can keep getting your money. (Note the similarity between the conspiracy mongering of alties like Trudeau and of Holocaust denials. In the case of Holocaust deniers, it is "the Jews" who "don't want you to know" the "truth" about the Holocaust; in the case of Trudeau, it is the government, big pharma, and conventional medicine that "don't want you to know" the "truth" about all these "cures.") Although Kevin Trudeau has been in a lot of legal trouble before for credit card fraud and for making false claims about a product he was selling, he has managed to sell this book and use his infomercials to advertise his book and website without running afoul of the law. In fact, he has managed to do this, even though he had been forced to sign an agreement with the FTC that

broadly bans him from appearing in, producing, or disseminating future infomercials that advertise any type of product, service, or program to the public, except for truthful infomercials for informational publications. In addition, Trudeau cannot make disease or health benefits claims for any type of product, service, or program in any advertising, including print, radio, Internet, television, and direct mail solicitations, regardless of the format and duration. Trudeau agreed to these prohibitions and to pay the FTC $2 million to settle charges that he falsely claimed that a coral calcium product can cure cancer and other serious diseases and that a purported analgesic called Biotape can permanently cure or relieve severe pain. (FTC press release)

Clearly, what got Trudeau into trouble before was selling a product and making claims about it. So he got around that by simply making claims in a book rather than advertisements. Even then, he couldn't help but use the book to advertise his coral calcium about which he had made claims before that got him into trouble.

What is the effect of such speech about quackery? It's really impossible to quantify it precisely, but, with over a million books in circulation, it's highly likely that many people have eschewed proven therapies in favor of Trudeau's brand of quackery. And, if it isn't Trudeau persuading people to choose useless therapies, there are thousands of others out there pushing similar sorts of medical misinformation and untold numbers of patients who, sadly, fall for it. Indeed, I've written about such patients before, patients such as the Orange Man, who eschewed conventional medicine in favor of coffee enemas and megadoses of carrot juice and paid a heavy price, or women who choose "alternative" medicine over conventional adjuvant therapy for their breast cancer. Where do you think they found out about these dubious therapies? Either from quacks who sell books or run websites promoting their quackery or from their legions of apologists touting either by word-of-mouth, public talks, or Internet postings their ability, for example, to "cure all cancers" or cure AIDS (Hulda Clark) or their recommendations that are claimed to "cure" many diseases (Kevin Trudeau), that's where!

In my book, it can certainly be argued that people claiming to have a cure for all diseases, even if they do not actually treat patients, likely do more direct harm than Holocaust deniers. Holocaust deniers represent a small fringe that few people pay much attention to, whereas "practitioners" pushing dubious "cures" are common, as are their apologists. The potential effects of Holocaust denial (offense to the survivors, promotion of anti-Semitism, rehabilitation of Nazi-ism), though potentially pernicious, are far less concrete than the potential effects of speech that steers patients to ineffective "cures" for serious diseases. Even so, unless they sell products through making false claims for them or directly treat patients, quacks can largely say or publish whatever they want about bogus therapies and make whatever claims they wish about them without fear of the law. Indeed, in Germany, for example, you can buy Kevin Trudeau's book quite freely on Amazon.de and elsewhere, and, as far as I know, Kevin Trudeau doesn't face arrest if he travels to Germany and Austria for his writings and talks.

Professor Lipstadt is correct. There is all manner of speech that is just as dangerous, or arguably more so, than Holocaust denial (albeit in different ways) but is nonetheless not criminalized. Putting up with such speech is part of the price of freedom. As despicable as he is, David Irving has said nothing that warrants prison and particularly not prison for decades, the maximum penalty. Even though he was clearly thumbing his nose at Austrian authorities by going there even though he knew there was a warrant for his arrest, prosecuting Irving for his Holocaust denial was a big mistake. Before his arrest, Irving was justly sinking into well-deserved obscurity, "talking to six people in a basement," as Professor Lipstadt put it. Now he has become a cause célèbre of the far right and finds himself in the news far more than he has been since his failed libel suit agains Professor Lipstadt in 2000. And if you think he's getting a lot of press now (at least in Europe), wait until his trial in February--all thanks to a harmful and misguided law that is almost certainly no longer necessary in a healthy democracy like Austria, its Nazi past notwithstanding.

More reading:

1. Irving? Let the guy go home'
2. Free speech in Europe: it's all or nothing
3. Free Speech and Laws vs. Holocaust Denial
4. Stupidity, Thy Name Is Irving

Tangled Bank

The latest Tangled Bank has been posted at Afarensis.

A blogger cliché: New Years Resolutions

It's a bit of a blogging cliche to do a post expounding New Years resolutions for the coming year, which is why I hadn't originally planned on doing one. However, death always has a way of making me introspective, and when I get introspective, that's a very dangerous thing. I start thinking of things I could do better. Also, as I have recently passed the one year mark with this blog, it looks as though I'll probably be blogging for a while, if not indefinitely. Consequently, before getting back to blogging business (so to speak) tomorrow or Friday starting with one of several posts I have in my list of "Drafts" but somehow never got around to finishing (or, in some cases, even starting), I thought I'd list a few things that I hope to do in 2006 to make it an improvement over 2005. I'll divide them into three areas: Life, Career, and Blog. So that I actually have a chance of keeping these resolutions, I will also keep them few and brief.

So, first, Life:

1. Clean up my act, health-wise. Let's face it, having passed age 40 a couple of years ago, I'm painfully forced to admit that I'm not a spring chicken anymore. I can no longer abuse my body with a sedentary lifestyle, fast-food diet, and 60+ hour work weeks as I have been doing for decades now and pretend that it won't have consequences, something I should have realized years ago. The creakiness in my bones as I get up every morning reminds me of this, as does the exhaustion I feel after doing things that I used to be able to do with no problems when I was in my twenties. Also, the death of my uncle is a sobering reminder to me that the males on my father's side of the family have a tendency towards cardiovascular disease, and I'm entering the age range where I'm starting to worry about it. It's time to do some preventive maintenance, including seeing a doctor to get an exam and get my cholesterol checked, starting to check my own blood pressure regularly, beginning exercise program (even if it's just walking), and a decent diet.
2. Start golfing again. I used to golf, but haven't been on the course in almost two years. If I don't use a cart, it could take care of the exercise component of #1, at least in the summer. 'Nuff said.
3. Diversify my interests outside of work. Let's face it. Blogging has become in essence my only hobby. It's a heck of a lot of fun, but I need other activities. Like #2, for instance, but other things come to mind. For example, there's that huge pile of unread books sitting on my shelf. True, in the winter, nothing fills out an evening like sitting in front of the TV with a laptop for an hour or two and pounding out the Respectful Insolence™ you've all come to know and love (or hate), but there are other things.
   
4. Help my wife out around the house a lot more. Do I need to say more?
   

Now, Career:

1. Submit at least four articles to peer-reviewed scientific journals. This is eminently doable, as I'm already working on two that should have been submitted by the end of last year. (I suppose one could almost consider this cheating, given that half of this resolution is a bit of a carry-over from last year.)
   
2. Submit at least two major grant applications. Sadly, NIH funding is no longer enough, and, given the budget situation, the NIH is even cutting funding for noncompetitive renewals of R01 grants, which means I can't even count on my present budget to be stable. The salaries of my lab personnel continue to increase, and my budget threatens to decrease. If I don't find more money I'll either have to let someone go or be unable to affort supplies within two to three years. Gotta stay hungry. Didn't you know that, once you get a lab of your own, your two main tasks are writing grant proposals and writing papers? Well now you do! Of course, writing the papers and getting them published in good journals makes it more likely you'll succeed in getting more grants..
3. #1 and #2 notwithstanding, get back in the lab more. I love science. I love doing experiments. I'm tired of sitting holed up in my office writing all the time. After this next round of papers and after submitting a grant for the February 1 deadline with my collaborator, I need some serious bench time. This has been building for at least a year now.
   
4. Recertify in general surgery. I have until 2008 to do this, but they let you do it a couple of years early. I could put it off until 2007, but all that would do would be to increase the pressure then. This fall, it will be time to get it out of the way, which means a major review effort to refresh my memory of those areas of surgery that I rarely deal with anymore. My patients can only benefit from my refreshing my memory and reviewing new developments to be ready for the test.
   

And, finally, Blog:

1. Don't feel obligated to post something every day. This goes hand-in-hand with #3 (and, truth be told, under #2 and #4) under Life. If I happen not to have something that I want to say or if I'm too tired, then I should refrain from trying to post. I don't have to spend from 10 PM to 11 PM or midnight every night writing up something. It's that sort of self-imposed pressure to produce that can cause good bloggers to give up blogging or to go on hiatus, as Matt has announced he is doing with Pooflingers Anonymous. I have to learn to realize that it's OK to let a day or two (or three) go by every now and then without posting anything. (Don't worry, I'm still obsessed enough that there will still be posts on most weekdays.) When I go on vacation, I should try to let the blog go silent for a week or two (either that, or find guest bloggers, if possible). I need to be more selective in my topics anyway, mainly because most days there are way more things that I want to write about than there is time to write about them.
   
2. Be more concise. I'm still working on that one. I'll probably be working on that one for a long time. Look for it to be a resolution for 2007, assuming I'm still blogging then.
   
3. Find new ways to publicize the Skeptics' Circle. When St. Nate retired from blogging, he entrusted me with his brainchild. It's doing quite well, with some fantastic editions over the last year. Now, however, is not the time to rest on its laurels. The Circle will be entering its second year in February, and I want to make its second year even better than its first.
4. Be less self-indulgent. Oh, wait. Doing these New Years resolutions was pretty damned self-indulgent. In fact, blogging itself almost by definition is a very self-indulgent activity. Never mind.

Starting tomorrow, it's back to more conventional topics.

Voting for the 2005 Medical Weblog Awards is now open

Via Medgaget:

Medgadget would like to announce that polling booths have been opened to cast votes for the best med blogs of the year. This is indeed oneof the world's most respected annual prizes, now going into its second year. Last year winners were mentioned in the press, and this year we hope to make it to the front of the New York Times. So, those interested in taking the much respected crown and the winnings, steer your crowd to the booths.

Notice something? All I can say is: Vote early, vote often. That's all...

Ah, who am I kidding? The competition is really stiff, including some of my favorite medblogs, like A Chance to Cut is a Chance to Cure, The Cheerful Oncologist, and RangelMD. Also, Respectful Insolence is probably not quite "medblog enough," given all the other stuff that I like to discuss here. But we'll see...

Grand Rounds, Vol. 2, No. 15

Grand Rounds, Vol. 2, No. 15 has been posted at Random Acts of Reality. The holidays are over; it's time to get back into the swing of things by sampling the best of the medical blogosphere.

Somebody sign the death certificate, already!

I'm still pissed off about something.

Consequently, I still feel the need to get this off my chest, even though I've said from the very beginning that this blog was never meant to be primarily about me or my life, but rather about science, medicine, and skepticism. Despite that intent, sometimes things happen that I have a hard time not venting about, and it's not always possible not to inject a bit of my own personal life into my writing. Also, after all the bad things that happened during my recent trip home, I'm having a hard time getting back to my usual topics. Yes, I'm aware that there's a blogger out there who took the time over the holiday week to write a two-part attack on something I wrote. Yes, I had briefly considered answering his attack. Unfortunately (or perhaps fortunately, depending upon your point of view), my heart just isn't into getting into a blog pissing match at the moment. (And, yes, I know I haven't always been above enthusiastically engaging in such activities occasionally in the past.) Unfortunately, this is festering, and, now that I think about it, it is relevant to the usual topics of this blog, given that it has to do with medicine. So I'm going to write about it.

Please indulge me for one more day. I promise to get back to my usual topics soon, and I haven't forgotten about the plans I had made for this blog's second year.

Here's what pissed me off last week. As I mentioned a few days ago, my uncle died last week after having suffered a massive heart attack the Thursday night before Christmas. It happened at around 2 AM last Wednesday. The doctor on duty declared him dead--and then left for India without signing the death certificate. I don't necessarily blame her for that. Most likely she was covering that night and was scheduled to leave the next morning. It's not at all uncommon for it to take several hours to type up a death certificate to be signed, although many times as a resident I filled out the death certificate myself when I happened to have to declare a patient dead. No, what happened next is what irritated the hell out of me. Perhaps it is the fact that the funeral is tomorrow and I won't be able to attend that brought this to a head today.

They couldn't find any other doctor to sign the death certificate. And without the death certificate the funeral home director couldn't legally take the body from the hospital morgue. The body couldn't legally be cremated according to my uncle's stated wish. The body had to stay in a refrigerated cubicle in the morgue. To add to the indignity, my uncle's family was charged $75 a day for storage and refrigeration of the body! It still makes my blood do a slow boil to picture my uncle's body left there for any longer than was absolutely necessary. All I can envision is his body on a slab in a cold, dark refrigerator, collecting frost.

And if I, as just his nephew, thought about such things, imagine what his wife and daughter were thinking about.

This went on for almost three days. Any hope of having the funeral before the end of the year (while most of the family from out of state--including me--was still around) dissipated. During this difficult time after my uncle's death, his wife and daughter had to deal with this additional problem and try to find out who could sign the death certificate in the absence of the doctor who declared the patient dead. I understand that it's a legal document. In fact, I've even balked at signing a death certificate for one of my partner's patients once before, but that was only because I knew he was in town and not on vacation. If he had been on vacation or out of town, I would have simply asked for the chart to verify the cause of death and then signed the certificate. That's all it should have taken: For one of the doctor's partners (or the attending physician if, as I suspect but don't know, the doctor in question was a resident or a house doctor) to do that. There is no excuse for this doctor's absence to have delayed the signing of the death certificate for more than a few hours at most, holidays or no holidays.

No excuse at all.

Yet, for over two days, my cousin was given what seemed to all of us to be the runaround. She made multiple phone calls, and finally appealed to my mother to get a couple of relatives on her side of the family involved, one of whom happens to be an attending at the very same hospital where my uncle died (but was unfortunately in Florida at the time) and the other of whom is a surgical assistant there. She was given the number of hospital administration, and I hope she gave them hell. The sad thing is, it should never have been necessary for anyone to give anyone hell just to get the death certificate signed!

The lesson of this incident is that little things we doctors do, without even thinking about it, can, without our knowing it or necessarily appreciating it, cause enormous distress in patients or their families. Should I ever be faced with the prospect of having to sign a death certificate for one of my partners when he is unavailable, I won't balk. I'll ask for the chart to verify the cause of death (a death certificate is a legal document, after all, and it's foolish to sign it without some minimal verification), but I won't balk the way I did a couple of years ago.

I'll remember this incident when it comes to other things I do that affect patients. I also hope that my fellow physicians who may read this will consider what I've said and think about how even the seemingly smallest things they do can impact the lives of their patients and/or their families.

The first Skeptics' Circle of 2006

Holy crap! The 25th Meeting of the Skeptics' Circle (and the very first edition of 2006) is slated to appear at The Saga of Runolfr, and I haven't issued my usual call for submissions the Friday before!

Now that the holidays are basically over, it's time to get your best skeptical blogging sent over to Runolfr at lord.runolfr@charter.net. The deadline is Wednesday night, and the Circle will appear on Thursday, January 5.

One thing I noticed today, as I was catching up on all the stuff I put off over the holidays, is that the science blog carnival extraordinaire, Tangled Bank, which (like the Skeptics' Circle) also runs biweekly, took the week between Christmas and New Years off. This was undoubtedly a wise decision, as I noticed that my visit count took a huge plunge that week, as did that of several other blogs I've checked out. (Apparently people had better things to do than read the ramblings of various bloggers; perhaps next year I'll just completely shut down the blog for that week, rather than worrying about stockpiling material to post while I'm gone.) However, that decision means that Tangled Bank is now appearing on the same weeks that the Skeptics' Circle appears. For example, this week's Tangled Bank is appearing at Afarensis on Wednesday, January 4.

I don't know if this will present a problem or not; I used to like the way the Skeptics' Circle and Tangled Bank were staggered, so that you could have great science blogging one week, then skepticism the next, with never more than about a week between fixes. Having both on the same weeks might be too much of a good thing at one time, followed by the long two week break until the next round. There's only one way to find out whether my concerns are valid...

The first RINO sightings of 2006

The first RINO Sightings of 2006 has been posted over at Louisiana Libertarian. There's some good stuff there on the recent Kitzmiller decision on "intelligent design" creationism.

Of course, there's a post about a proposed new law that most males could definitely support...

A new year, a new template

It's finally here.

I've finally gotten up the guts to roll out the new template that I had hoped to roll out back around my first blogiversary. I'm only about three weeks late, but, thanks to Kev and Ali (and spending most of New Years Day fiddling with the template), I managed to get a working version together. I'm still not entirely satisfied with it, but I figured it's time to stop farting around and just apply the damned thing and see what people think. I fully plan on tweaking it to try to improve it. I fully expect that parts of it may not work properly or may not show up optimally on various browsers. I've tested it on Safari, as well as the Mac versions of Firefox and Mozilla, but not on IE. (I'm pretty much Mac only and don't have access to Windows machines at home.) I've also tested it on my 12" PowerBook G4 at a 1024 x 768 resolution, just to see what it looks like on a smaller screen, and it seems to be OK.

If anyone has any comments or suggestions about the new look, now's the time to lay 'em on me. I'll try not to change the template as often as I've seen some bloggers do, but from now on I won't hesitate to adjust my creation to my liking.

I'll get back to regular blogging either later today or tomorrow. The holidays are over, and, surprisingly, stuff has happened that I wished I had had the time to write about. Time to get back to business.

Happy New Years 2006

Happy New Years to all my readers, even the ones who don't like what I have to say very much but, for some inexplicable reason, keep reading my blather. May your 2006 far surpass 2005 in happiness and health, for both you and your families.

I'd also like to take this opportunity to thank all of you who expressed their condolences over the loss of my uncle, especially from Wade Rankin, given that we almost never see eye-to-eye on anything, particularly whether mercury has a role in causing autism. The only way I could think of to repay your kindness is to send some link-love to you at the end of this post.

Finally, I'd like to take this opportunity to thank a couple of folks who helped me produce a new template for this blog, namely Kev and Ali. Kev helped with some layout issues, and Ali went way above and beyond the call in finding a stray Blogger tag that was preventing posts from appearing properly and in fixing a problem that caused the right sidebar to keep getting pushed off to the bottom by the center panel. Note that neither of them have anything to do with the concept or overall design of the new template. So, if, when I roll out the new design, you think it's butt-ugly, don't blame either of them. (Given how visually attractive both of their blogs are, web design-wise, you probably would figure out that neither of them had anything to do with it, anyway.)

And now, some link-love for the New Year, in no particular order:

• Left Brain, Right Brain
• Clamoring to Become Visible
• Immunoblogging
• Living the Scientific Life
• Injecting Sense
• Silly Humans
• Nana's Notions
• Ex-Donkey Blog
• Rockstar's Rambings
• Fat Doctor
• Terra Sigillata
• DocHumburg.com
• Malice Aforethought
• Nolo from Lapplander

This is the list as of this writing. I also want to thank everyone who gave their condolences but don't have a blog for me to return a link to. You know who you are; you're all listed in the comments of this post.

Either tomorrow or Tuesday, normal blogging will resume, although it might take a few days to get back into the swing of things fully.