"A statement of fact cannot be insolent." The miscellaneous ramblings of a surgeon/scientist on medicine, quackery, science, pseudoscience, history, and pseudohistory (and anything else that interests him)
Orac is the nom de blog of a (not so) humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. (Continued here, along with a DISCLAIMER that you should read before reading any medical discussions here.)
I must admit that, after having taken it easy over the last few days, when the time came to sit down and get back into the swing of things, I had a bit of a hard time. No, it's not just blogging. That's actually a rather minor component of the whole malaise that descended upon me like a shroud. Rather, it's the simple fact that the Labor Day weekend in the U.S. represents the unofficial end of the summer season. After that, it's all back to school, back to work, back to the grind.
Back to real life after summer.
This reluctance, not surprisingly, seeped out of real life and started to permeat blog life. What I needed was something to get me going again with enthusiasm. For a moment, I wished I had held back my post from Sunday, because, despite (or perhaps because of) its being uncharacteristically brief for me it was actually one of my better posts. Fortunately, though, for skeptical bloggers, particularly those who have made the depredations of the anti-vaccine movement one of his favorite topics, there exists a gold mine of anti-vaccine woo that almost never fails to provide fresh meat blogging material for a skeptical blogger to sink his teeth into. There, although there are several bloggers, there is one who is capable of illustrating the arrogance of ignorance better than any other. Yes, I'm referring to Age of Autism as the blog, and the blogger is Mark "Not a Doctor, Not a Scientist" Blaxill, who yesteray was crowing There's a Funny Thing About Evidence: More Support for Autism-Mercury Link. Let's just put it this way. There is a funny thing about evidence. It's just not "funny" in the way Blaxill thinks it is, as the entire AoA crew will find out in the near future and about which I can't say more--for now.
In the meantime, let's take a look first at what Blaxill says about the study that he is presenting as "evidence" that thimerosal in vaccines causes autism, and then at the study itself. It's quite amusing to see someone so talented at so thoroughly deluding himself:
After chilling out for part of the weekend, yesterday I became so engrossed in writing my part of a training grant for my postdoc that, before I knew it, it was way too late to provide you with the Insolence you crave for today. Oh, well. Tomorrow for sure; there's a lot that has been waiting for my attention. Besides, I haven't even really taken a vacation this summer; so I deserve a day or two (or three) off from time to time. In the meantime, I'll post a couple of bits of "classic" (if you can call it that) Insolence. This particular bit of insolence dates back nearly four years, all the way back to November 2006. Remember, if you haven't been reading at least four years, it's new to you! Besides, it's always fun (or disturbing) to me to see how well some of my older material has aged. See you tomorrow. Unfortunately, nothing appears to have changed since I first banged this out on my keyboard. Maybe I should do an update.
If you're a physician, there comes a certain point in your career when you start caring a lot more than you did about the next generations of physicians in the training pipeline. While you're in the middle of training, you are the next generation; besides, you're too worried about just getting through medical school, residency, and Board certification to be all that concerned about those behind you in the pipeline, anyway. Then, when you're early faculty, you're concerned about establishing yourself, getting your career on track, and, if you're in academics, getting promoted. True, physicians who aren't interested in education wouldn't be in academics in the first place, but most of us tend to be far more concerned about resident education, because these are the people who will be replacing us one day in our own specialties. At some point, however, one starts wondering about the next generation of doctors that will not just be replacing one's own specialty, but will be becoming the next generation of primary care doctors, internists, and other specialties aside from one's own. Part of this interest in self-interest. After all, we're all getting older, and aging physicians will need doctors too. More importantly, though, most physicians like to think that their profession is improving and that the next generation of physicians will surpass the present generation, thus insuring continued improvements in the science and art of medicine. We like to see our generation leaving a legacy of improved patient care and part of that legacy is the training of medical students.
Unfortunately, I have seen what may be the future of American medicine, and now I'm very concerned. Dr. R. W. has shown it to me. The American Medical Student Association (AMSA), an organization that should be committed to advocacy of the finest training and the best scientific medicine, is deep into promoting woo among medical students.
After chilling out for part of the weekend, yesterday I became so engrossed in writing my part of a training grant for my postdoc that, before I knew it, it was way too late to provide you with the Insolence you crave. Oh, well. Tomorrow for sure. In the meantime, I'll post a couple of bits of "classic" (if you can call it that) Insolence. This particular bit of insolence dates back nearly four years, all the way back to November 2006. Remember, if you haven't been reading at least four years, it's new to you! Besides, it's always fun (or disturbing) to me to see how well some of my older material has aged. See you tomorrow.
A few days ago, I posted a response to another physician who was not happy with me, no, not happy with me at all. What made him unhappy was the vociferousness with which I criticized the creeping infiltration of woo that is insinuating itself into medical school curricula and expressed dismay at the threat that I see to evidence-based medicine (EBM) from it. He interpreted this vociferousness as "anger," but in reality it is more frustration, a dismay that was exacerbated by his defense of including unproven therapies in his practice. I did not respond so harshly somuch because I think that in his specific case his use of acupuncture does harm, but rather because of the attitude behind it, an attitude that can (and in too many cases does) open the door to less benign forms of woo.
At the risk of turning this into the Solo Practitioner rebuttal blog, I thought I'd have one more go at it because of one further comment he made. SP's misguided analogy does, almost in spite of itself, bring up a a difficult issue, although I resent it a bit that he did so in the context of labeling me and those who have little tolerance for woo as "fanatics":
Let's talk about false hope. Apparently "conventional" medicine is immune from providing this to its patients; however, a study a few years ago found that less than 50% of terminally ill patients with cancer at one of the nation's leading cancer centers, Memorial Sloan-Kettering Cancer Center, were approached with discussions about end-of-life issues, such as a DNR (Do Not Resuscitate) order and a Living Will. Furthermore, most of the therapies used for terminal cancer patients at MSKCC are not EBM, because there hasn't been enough time to study the efficacy of these therapies, or perhaps because these "conventional" doctors have decided that there is little "harm" that can be done with potentially toxic chemotherapy if the person is going to die anyway (as long as the patient consents to a potentially toxic, life-threatening treatment. But what would make a patient consent to such an unproven treatment? Could it be that it provides some hope of a cure?). It seems these doctors believe that they can try experimental, unproven therapies because these patients come to them from other referral centers where their cancers were determined untreatable. These patients are coming for another answer and for HOPE. So are these doctors at MSKCC "quacks" for slipping outside the confines of EBM to try to help the terminally ill? According to Orac, it sounds like no other medicine should be practiced other than EBM.
"Sorry, you've got Stage IV Ovarian CA, go home, get your affairs in order and die, because there are no evidence-based treatments that work," is perhaps what they should tell their patients. That way we're all living in realityland. How is it ok for "conventional" medicine to expose these patients to harmful, toxic treatments that are unproven? It doesn't stand up according to Orac's arguments.
Logical fallacies piled on top of nonsequiturs piled on top of straw men. These have to be dealt with before we get to the issue that he brings up almost by accident, namely the ethics of clinical trials in which terminally ill cancer patients are enrolled.
In case you hadn't guessed, because of the holiday weekend, blogging's been rather slow. This is in general a good thing, a chance to rest and rethink, but occasionally, even while chilling out, I see things that I can't resist mentioning briefly. Things like this.
If there's one thing about "complementary and alternative medicine" (CAM) that has always puzzled me, it's that, at least here in the "West," there seems to be an inordinate fascination with ancient "Eastern" medical systems. These include, of course, traditional Chinese medicine (TCM) and Indian Ayruvedic medicine, both of which are somehow viewed as "superior" to "Western" reductionistic medicine. Of course, some things that are often lumped together with TCM (for instance, reiki) are neither Chinese (reiki was invented by a Japanese man) nor ancient or traditional (although it's existed for centuries, acupuncture as we know now it evolved into its present form mostly in the 20th century, and reiki was first publicized in 1922). Be that as it may, this fetishism of all things "Eastern" by many in the CAM movement leads me to considerable amusement when I see a story like this one, which somehow I missed when it first appeared about a week ago, entitled Japan's medical authorities slam 'absurd' homeopathy:
One of the most frustrating aspects of taking care of cancer patients is that in general, with a handful of specific exceptions, we do not have good curative therapies for patients with stage IV cancer, particularly solid tumors. Consequently, we are forced to view patients with stage IV cancer as "incurable" because, the vast majority of the time, they are incurable. Over the years, we have thrown everything but the kitchen sink at patients with stage IV disease, largely with dissapointing results. That's not to say that the few specific exceptions to which I alluded are not a reason for hope. After all, patients with colorectal cancer and liver metastases used to have a median survival of around 6 months, but these days, with newer chemotherapeutic regimens like FOLFOX plus Avastin, median survival has more than tripled. While expecting to live less than two years is cold comfort to cancer patients with this particular clinical situation, the prognosis is far better than it was.
Of course, I specifically mentioned Avastin because it's been in the news a lot recently with respect to my area of clinical specialty, breast cancer. Specifically, beginning in July there started appearing a spate of stories about the FDA considering revoking the approval of Avastin for advanced breast cancer based on recent studies that demonstrate that it does not prolong survival in these patients. Many lay people and patients find this reconsideration of Avastin to be quite puzzling, given that the drug was granted accelerated approval in 2008 and has since gone on to be used fairly widely. Given that the case of Avastin in breast cancer is rapidly becoming a classic case study of how messy science-based medicine can be when practiced in the public eye and debated among pharmaceutical companies, the government, and patient advocacy groups.
Nearly a month ago, I expressed my dismay and displeasure at the infiltration fo quackademic medicine into what is arguably the premier medical journal in the world, The New England Journal of Medicine (NEJM) in the form of a highly credulous review on the use of acupuncture for low back pain that brought eternal shame on the hallowed pages of a once-great journal. As Mark Crislip put it, trust, once damaged or lost, is very hard to restore, and I definitely lost a lot of trust for the NEJM compared to what I had for it a month ago. Since then, I've been keeping my eyes out for other examples of quackademic medicine infiltrating various peer-reviewed journals. Unfortunately, I have not lacked for examples.
Fresh in my memory, though, remains the stench of quackademic medicine in the NEJM. Unfortunately, just as the faint odor of urine can be revived by hot and humid weather, the stench of quackademic medicine at the NEJM was restored, at least in my memory, by an article that a reader sent to me. Apparently someone was interested in just who some of the writers of the NEJM article were. At the time, when I wrote about the article, I didn't really care too much about any of the authros other than the lead author, Dr. Brian Berman. Apparently this reader thought I should check out at least one of the other authors, which I proceeded to do. I happened to pick Dr. Helene M. Langevin of the University of Vermont. (Who knew Vermont had quackademic medicine?) One thing led to another (PubMed, specifically), and suddenly I found this gem of a quackademic medicine article by Dr. Langevin in, of all places PLoS ONE, entitled Electrical Impedance of Acupuncture Meridians: The Relevance of Subcutaneous Collagenous Bands.
The comment thread for my post last week about how philosophical vaccine exemptions in California are endangering herd immunity is rapidly approaching 500 comments as I write this and may well surpass that number by the time this post "goes live" in the morning. I mention this because buried in the comment thread are a number of comments by our old "friend," that anti-vaccine-sympathetic pediatrician to the stars, Dr. Jay Gordon doing what Dr. Jay does best and basically making a fool of himself on matters of vaccine science through his preference for anecdote over sound epidemiology and clinical trials, his utter insistence that his 30 years of clinical experience trump the aforementioned sound epidemiology and clinical trials (hint to Dr. Jay: they don't), and going about his usual job of insisting that vaccines cause autism and that, despite his extreme distrust of vaccines, his advocacy of not vaccinating for some common childhood diseases because he imagines the vaccines to be more dangerous than th disease, and his consorting with leaders of the anti-vaccine movement like Jenny McCarthy, he really and truly is "not anti-vaccine."
His denials fool no one, least of all me.
The reason I bring up Dr. Jay is because, round about comment #389 in the seemingly endless thread, Dr. Jay wrote:
Just tweeted: AND today's brand new judicial decision must not be exaggerated to the detriment of calm discussion either: http://bit.ly/9kZFhm
Correlation does not prove causation even if I agree with this individual MMR decision. I just think that side-effect-denialists need to calm down, too.
I'll give Dr. Jay credit for "talking the talk" when it comes to giving lip service to the mantra of "correlation does not necessarily equal causation," but unfortunately he never seems to be able to "walk the walk" and stop asserting baldly that "vaccines cause autism" or likening vaccine manufacturers to tobacco companies. Leaving aside for the moment my intense desire, barely held in check, to mock Dr. Jay for his transparent and laughably inappropriate attempt to hijack the term "denialist" for the side of pseudoscience, an attempt so hilariously inapt that I really did laugh when I read it, it turns out that over the last couple of days Dr. Jay is not alone in seemingly wanting to rub my nose in this particular decision, which was reported in the U.K.'s The Daily Mail over the weekend. Basically, it is the story of a young man named Robert Fletcher in the U.K. who is severely disabled and has been awarded £90,000 in compensation by the governement's Vaccine Damage Payment Unit for having been injured by the MMR vaccine back in the early 1990s.
After all, of what use is my having taken so many hours over so many years laying down on a nearly daily basis if my words don't have an impact? Surely I couldn't be so egotistical that I'd do it anyway even if my readership was what it was when I first started out and had not increased to the point where I'm the (alleged) force that I've become in the medical and skeptical blogosphere, would I?
Wait, on second thought, don't answer that.
In any case, back in the day I'd write my best snarky skeptical deconstruction of some bit of pseudoscience or another and the target wouldn't notice, namely because my traffic was so low that the blogger didn't notice the incoming traffic and Google didn't pick me up on searches, at least not on the first couple of pages of any search results. As the blog got bigger, though, that happened less and less. In fact, I can pretty much count on most targets of a heapin' helpin' of my special brand of Insolence, Respectful or not-so-Respectful, to notice. Most of the time this is a good thing. After all, why wouldn't I want purveyors of pseudoscience to have a bit of science-based criticism? More importantly, the responses are amusing. On rare occasions they even teach me something.
This is not one of those times.
Way back in March, I took note of a particularly egregious bit of quackademic medicine published in the International Journal of Oncology. True, the IJO is not a top-tier, or even a second-tier, journal, but it is peer-reviewed and in general I never thought of it as a journal that sucked; that is, at least, until March. In contrast to the mediocre journal, the research group that published this study came from one of the two most respected cancer centers in the U.S., namely the M.D. Anderson Cancer Center. Published by Frankelet al and Cytotoxic effects of ultra-diluted remedies on breast cancer cells, the study brought down the righteous wrath (or at least mockery) of Dr. Rachel Dunlop and, of course, yours truly. That's because this was a study of homeopathy and breast cancer. That's right, homeopathy and breast cancer. As Dr. Rachie and I pointed out, the study was riddled with methodological flaws that rendered its conclusions completely unsupported. In fact, the study didn't show what its authors think it showed; in reality what it showed is that alcohol can be toxic to breast cancer cells in solution as certain chemotherapeutic drugs. Well, that, and random noise. Quackademic medicine doesn't get much quackier than that, and this was right at M.D. Anderson, what should be the heart of science-based medicine in the world of oncology. Meanwhile, homeopaths trumpeted that homepathy killed breast cancer cells and was "non-toxic."
In the process of applying the clue-by-four of science to the infiltration of quackademic medicine into the hallowed halls of the M.D. Anderson Cancer Center, Dr. Rachie and I appear to have ticked off a writer at a homeopathy website. The writer, Patricia Maché, decided that she would defend homeopathy and try to refute both Dr. Rachie and yours truly. Her editorial, appearing in the September 2010 issue of "online journal of homeopathy" Interhomeopathy, the "international homeopathic Internet journal," is entitled The never-ending story of Placebo. It's virtually a textbook case in the logical fallacies, bad arguments, magical thinking, and pseudoscience that homeopaths routinely use ot justify their woo, so much so that I just couldn't resist having a little fun providing a bit of my own editorializing. I mean, really. How on earth could I resist?
A frequent lament of members of the anti-vaccine movement is that they are not "anti-vaccine" but rather "pro-safe vaccine." they like to claim that they are not opposed to vaccines in general. Of course, in many, if not most or even all cases, that denial is either a lie or self-delusion. After all, even the most die-hard anti-vaccine zealot realizes that being anti-vaccine is quite correctly viewed by the vast majority of people as not rational.
That's why, in a perverse way, I'm thankful for loons like Mike Adams. Yes, Mike Adams. He lays the crazy out in a way that no one else does. But as utterly insane as his ravings are, at least Mike Adams is honest. Besides being pro-quackery, he is anti-vaccine and proud of it, so much so that he produces videos like this one, entitled Vaccine Zombie:
A friend of mine sent me a link to one of my hometown news stations because he saw something that irritated him. On the front page, there is a poll of such epic burning stupid that it requires an immediate crash. I may not be P.Z., but I have in some instances overcome my previous dislike of poll crashing, especially when it's a poll this stupid:
Do you think immunizations are safe?
Yes
No
As if an Internet poll has any bearing whatsoever on whether vaccines are safe or even on whether people believe vaccines are safe.
The poll is located on the webpage of the Detroit FOX affiliate in the rightmost sidebar about halfway down. Right now, the poll is running 43% yes, 56% no. Go, my mini-horde! You'll have my eternal (or at least for a few hours) thanks.
ADDENDUM: The poll appears to be gone, replaced by a poll about the Lions asking how many games they'll win this year. Hope springs eternal, I guess.
Orac is the nom de blog of a (not so) humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. (Continued 
After chilling out for part of the weekend, yesterday I became so engrossed in writing my part of a training grant for my postdoc that, before I knew it, it was way too late to provide you with the Insolence you crave for today. Oh, well. Tomorrow for sure; there's a lot that has been waiting for my attention. Besides, I haven't even really taken a vacation this summer; so I deserve a day or two (or three) off from time to time. In the meantime, I'll post a couple of bits of "classic" (if you can call it that) Insolence. This particular bit of insolence dates back nearly four years, all the way back to November 2006. Remember, if you haven't been reading at least four years, it's new to you! Besides, it's always fun (or disturbing) to me to see how well some of my older material has aged. See you tomorrow. Unfortunately, nothing appears to have changed since I first banged this out on my keyboard. Maybe I should do an update.
