Respectful Insolence

I wish I had thought of this one, but I didn’t. However, I never let a little thing like not having thought of an idea first to stop me from discussing it, and this particular idea is definitely worth expanding upon because (1) it’s interesting and (2) it combines two of my interests, alternative medicine and evolution. I agree with parts of the idea, but it’s not without its shortcomings. Indeed, I’d very much welcome any of the evolutionary biologists who read this blog to chime in with their own ideas.

Fellow ScienceBlogger Martin Rundkvist over at Aardvarchaeology has proposed a rather fascinating idea regarding the evolution of alternative medicine in which he argues that alternative medicine evolves according to certain selective pressures. As you may or may not know, evolution is not just for biology, but has been proposed as a mechanism in cultural memes, for example. Since alternative medicine is a cultural phenomenon, it is not unreasonable to look at such non-evidence-based medicine and hypothesize what might be the selective pressures that shape its popularity and evolution. After all, if we’re going to discourage the use of non-evidence-based medicine or even quackery, it’s helpful to understand it. We already know that alt-med terminology has evolved considerably into the current politically correct term “complementary and alternative medicine” (CAM).

Martin primarily considers what the selective pressures are on various alternative medicine modalities and comes to a startling conclusion: Namely, that the selective pressure on such modalities is primarily to select for ineffective treatments. He bases this on two primary forms of negative selection. First, he hypothesizes, there will be selective pressure against modalities that cause obvious harm. According to this concept, such modalities will tend to be eventually recognized as harmful and shied away from by alternative medical practitioners due to fear of lawsuits and government regulations. The second form of selective pressure will come from conventional medicine. In essence, alternative medical therapies that can be shown to have a reasonable degree of efficacy will risk being co-opted by us “conventional” practitioners of evidence-based medicine and thus taken out of the armamentarium of alternative practitioners, whose setting themselves apart from mainstream medicine is very important to their livelihood. This leads Martin to observe that homeopathy is the ultimate CAM therapy:

So, there is evolutionary pressure on alternative therapies to achieve near-zero effect. This is why homeopathy is still around: its main method being the administration to patients of small amounts of clean water, it’s uniquely suited to surviving indefinitely in the alternative-therapy biotope. Homeopathic remedies can neither harm nor benefit patients.

This is a fascinating and lucid insight. Clearly it has some merit. However, it is incomplete. The reason, I would argue, is that the negative selective pressures Martin identified are almost certainly not as potent as he thinks they are, as evidenced by how rare it is for an alternative medical therapy to actually go “extinct.” Indeed, I would argue that selection against harmful or potentially harmful remedies is actually fairly weak and perhaps even nonexistent. After all, black salve is still around after many decades, if not hundreds of years, and it can produce some truly horrifying complications (not for the squeamish). Even though the FDA banned importation of black salve products and they can be demonstrably harmful, they are still around and show no sign of disappearing. Another example is Laetrile. Multiple well-designed clinical trials demonstrated that Laetrile is ineffective against cancer, and it has the well-known potential complication of cyanide toxicity. It, too, shows no signs of disappearing. Of course, perhaps the most popular ineffective CAM therapy that has potentially deadly complications is chelation therapy, which remains widely used among CAM practitioners to treat cardiovascular disease and autism, despite of the extreme biological implausibility of the argument that it should work for either condition and despite there being no good evidence that it does. Indeed, there was even a well-publicized case of an autistic boy who died as a result of hypocalcemia as a result of chelation therapy for autism causing a fatal cardiac arrhythmia. His quack–I mean doctor; no, I mean quack–Dr. Roy Kerry is only now being brought up on charges for his negligence and quackery.

No, there are lots of potentially harmful CAM modalities out there that show no signs of going away.

Let’s look at the flip side of the negative selection, co-optation of “effective” alternative therapies into mainstream medicine. Once again, this is probably a weaker negative selective force than it might seem. Herbal medicines, for example, are probably the most common of the CAM-type modalities to show some evidence of efficacy in randomized clinical trials. This is mainly because they are drugs. Impure and dirty drugs with widely varying levels of active ingredient from lot to lot, but drugs nonetheless. The problem for the co-optation of these drugs by conventional medicine is that practitioners of scientific medicine do not like unpredictability in their drugs. They like drugs with a predictable effect; herbal medicines “in the raw,” so to speak, do not fit the bill, particularly when pure pharmaceutical alternatives that lack the contamination and unpredictability of herbs exist. Even if conventional medicine co-opts an herb, for example, it is usually in the form of the pure active ingredient purified from that herb. For example, if you have breast cancer, you could try to chew on the bark of the Pacific Yew tree for its anticancer properties, but you’d be a whole lot more likely to do better if you took pure Taxol derived from that bark–and took it intravenously. The example of Taxol also suggests that once conventional medicine co-opts an herbal or plant-based remedy, it usually does not supplant the original alternative therapy. After all, all of the “natural goodness” has been extracted from it during the purficiation of the active ingredient! CAM mavens would often rather take the raw herb or the herb chopped up and compressed into an herbal pill because it’s more “natural.”

As for other non-herbal CAM therapies, even when they’re co-opted by modern medicine (although it’s often arguable whether conventional medicine or CAM did the coopting), often an “alternative” version remains. The scientific version will be stripped of all the woo, while the “alternative” version will retain it. Think massage therapy and perhaps even chiropractic, which, as I’ve said before, stripped of its woo is nothing more than physical therapy with delusions of grandeur in the form of claims of being able to cure all manner of illnesses that have nothing to do with the spine or the musculoskeletal system.

Finally, there is one last aspect of Martin’s concept that argues against it. Martin states:

Evidence-based medicine, alternative medicine and weaponry change through time because of selection pressure. This means that they evolve and produce a fossil record of discontinued methods and therapies.

Here’s the problem: There actually is no “fossil record” of discontinued CAM methods and therapies. The reason is simple: CAM does not abandon its methods, regardless of evidence and, to a large degree, regardless of harm. Yes, individual treatment modalities may wax and wane in popularity, but they never go away completely. They never go extinct. Think about it a bit. Can you think of a single “alternative medicine” treatment modality that’s ever been abandoned because it either doesn’t work, is too harmful, or has been co-opted by conventional medicine. I can’t. CAM is, in the words of James Randi, an “unsinkable rubber duck.” It just won’t disappear. Martin is quite correct that homeopathy, for example, has persisted 200 years despite no evidence for its efficacy. Aryuvedic medicine has persisted at least a couple of millennia, despite a similar lack of evidence. Ditto traditional Chinese medicine. Never mind that these systems were developed in a time when very little was known about how the body actually works and are infused with spiritual and religious beliefs. They are still used my many millions, if not billions, of people worldwide. They have left no “fossils.” Of course, as in evolution in biology, this selection, applied over long periods of time, may ultimately eliminate such modalities, but if I were somehow able to call the Doctor to give me a ride in his TARDIS a couple of hundred years in the future, I bet that virtually all of these CAM modalities would still be in use. Part of the reason, I suspect, is that, as Martin pointed out, most CAM modalities do little; there is usually no CAM modality that can supplant existing modalities.

In any discussion of the evolution of CAM, I would be remiss not to look at its primary competition for resources (i.e., patients) in the ecosystem of medicine, namely scientific, evidence-based medicine. EBM has been hugely successful in many areas. Indeed, it can be said to have driven back CAM to a much smaller “ecological” niche than it once occupied. These days, relatively few people rely on CAM modalities when faced with a truly life-threatening illness, such as cancer. The Katie Werneckes, Abraham Cherrixes, and the Chad Jessops of the world (if the latter even had cancer), who treat life threatening cancers with high dose vitamin C, the Hoxsey concoction, or nasty, burning goo like the infamous “black salve,” respectively, are pretty uncommon. The main ecological niches for CAM these days have contracted to two areas. First are “diseases of living.” In other words, CAM has been for the most part relegated to the treatment of what are generally vague complaints that are not exactly diseases or to self-limited conditions. Indeed, one could argue that the strongest positive selective pressure for CAM modalities is how well each one gives the appearance of doing something therapeutic for such conditions, whether it actually does anything or not. In other words, how good of a placebo is it? Or is its timing or method of administration optimally adapted to correlate with the patient’s improvement anyway, allowing the confusion of correlation with causation? The better the adaptation, the more likely a CAM modality will thrive and expand.

The other remaining ecological niche for CAM, I would argue, is in serious diseases for which conventional medicine does not have much to offer. These conditions include diseases such as terminal cancer that has passed beyond our ability to treat it, as well as any manner of chronic diseases for which conventional medicine does not have a cure, such as Parkinson’s disease, chronic pain syndromes, multiple sclerosis, etc. Conventional medicine can treat and often palliate such conditions, but it cannot cure them. In this latter niche, I would argue that the primary positive selective pressure would be how well the CAM modality can inspire belief in its practitioners and hope in its users. The two are related, of course; the more the practitioner believes in the modality the more he or she can sell the patient on it.

Of course, applying evolutionary principles to CAM only goes so far. It’s a highly complex situation, and there are a number of positive and negative selection pressures that one could postulate. Certainly, the marketplace and how much of a feel-good aspect there is to CAM therapies are important. Finally, no doubt, like evolution, there are aspects to CAM proliferation that do not depend upon selection, a CAM equivalent of genetic drift, for example. I’m not sure how far this application of these principles will take us, but I suspect that they can be used, along with other disciplines such as psychology and anthropology, to explain to some extent the insinkable persistence of these non–evidence-based therapies.

ADDENDUM:

  1. Orac: Applying evolutionary principles to alternative medicine again
  2. Steve Novella: Alternative Medicine and the Evolution Analogy

Comments

  1. #1 PalMD
    November 12, 2007

    Wow! Thanks for that. I was hoping someone would expand on the original (saving me the trouble).

    Since I read the original post I’ve been wondering how the profit motive affects the survival of the meme.

  2. #2 DLC
    November 12, 2007

    Remind me if I am ever diagnosed with cancer to refer all who recommend I try CAM-Quackery to your blog. Hopefully your writings will hammer flat their idea. One day I’m going to die. Everyone, sooner or later, must pass through those doors which none wish to enter. As for myself, I have no intention of hastening my trip there by indulging in quackery.

  3. #3 angry doc
    November 12, 2007

    Yup, I tend to think of CAM as ‘living fossils’ which inhabit niches conventional medicine haven’t taken over yet – sort of like how the marsupials were doing pretty well before mammals came along.

    However, as your Friday doses of woo demonstrate, these living fossils can spawn ‘modernised’ hybrids which still retain the characteristics of their ancestors. :)

  4. #4 angry doc
    November 12, 2007

    Yup, I tend to think of CAM as ‘living fossils’ which inhabit niches conventional medicine haven’t taken over yet – sort of like how the marsupials were doing pretty well before mammals came along.

    However, as your Friday doses of woo demonstrate, these living fossils can spawn ‘modernised’ hybrids which still retain the characteristics of their ancestors. :)

  5. #5 Abel Pharmboy
    November 12, 2007

    As an aside, the example of Taxol also effectively neutralizes the conspiratory, anti-pharma bleating “but a naturally-occurring chemical can’t be patented by the money-grubbing Man and would never be developed.” If a natural product actually has real clinical efficacy, a drug company will find a way to protect the intellectual property.

    Taxol is itself the naturally-occurring molecule and while the chemical entity could not be patented, the process to manufacture it by semi-synthesis was instead. Isolating Taxol from yew bark was not cost-effective and harvesting the bark kills the 100- to 300-year-old tree, likely to send the tree into extinction and suppress the population of Northern spotted owls that lived in it.

    Instead, a chemical precursor of Taxol, 10-deacetylbaccatin III) was first identified from a renewable resource, the needles of the related European yew, Taxus baccata. A synthetic route from this precursor was then developed by a Florida State chemist. Hence, BMS was able to “extract” a good deal of cash from this chemical – as the good Dr Orac knows, the active component of Taxol, paclitaxel, has since become available in a generic form but, I believe, is still synthesized.

    A good retrospective on this Taxol story appeared a little while back in C&E News.

  6. #6 doctordebunker
    November 12, 2007

    Of course, perhaps the most popular ineffective CAM therapy that has potentially deadly complications is chelation therapy, which remains widely used among CAM practitioners to treat cardiovascular disease and autism, despite of the extreme biological implausibility of the argument that it should work for either condition and despite there being no good evidence that it does. Indeed, there was even a well-publicized case of an autistic boy who died as a result of hypocalcemia as a result of chelation therapy for autism causing a fatal cardiac arrhythmia. His quack–I mean doctor; no, I mean quack–Dr. Roy Kerry is only now being brought up on charges for his negligence and quackery.

    The unfortunate death of an autistic child was the result of a well documented medication error. Chelation therapy is an extremely safe and effective FDA approved treatment, done with FDA approved medications. The use of the label, quack or quackery, is not approriate, unless applied with the same logic to medication errors in medical practice in general.

    Medication errors happen with alarming frequency. A recent example that hit the news was the 3 year old at Shands who died from an overdose of arginine during a growth hormone challenge test. Sebastian Ferrero was prescribed 5.75 grams of arginine, an amino acid, but a nurse gave him 60 grams, an obvious medication error.

    Using this same Orac logic, Dr. Donald Novak, director of the UF Pediatric Clinics is a quack, and Shands U F was conducting quackery when they killed Sebastian Ferrero with an overdose of arginine. Using Orac’s logic, both should be brought up on charges of quackery and negligence.

    “We take full responsibility for Sebastian’s death and are very, very sorry,” said Dr. Donald Novak, director of the UF Pediatric Clinics, standing beside blown-up pictures of the two nearly empty arginine bottles.

    Orac’s above description bluntly smears chelation therapy as ineffective and biologically implausible. Chelation therapy with various agents has been well documented in the medical literature to work quite well at removing various metal agents in the body, and have been FDA approved for years.

    The most commonly used chelating agent, EDTA is so safe that it is commonly found on food labels at the grocery store as preservative. IV chelation therapy is being done safely and effectively right now throughout many hospitals in the US and elsewhere.

    Chelation therapy used as treatment for cardiovascular disease and autism is an allowed off-label use of an FDA approved medication. Off-label use is widely accepted and commonly used in medical practice. It is unlikely that any additional indications for chelation therapy will ever become FDA approved for the simple reason that the drugs are off patent and there is no further money for FDA studies.

    Documentation of clinical improvement in both cardiovascular disease and autism following treatment with chelation therapy his been well documented over many years in the medical literature.

    Orac’s ignorance on this topic is astounding.

  7. #7 Joe
    November 12, 2007

    @ doctordebunker:

    The Stupid, It Burns.

    Hopefully, Orac will take note, and take you down more articulately than I can on short notice.

  8. #8 Do'C
    November 12, 2007

    “The unfortunate death of an autistic child was the result of a well documented medication error.”

    Not even close Dr. Debunker

    Autism, A Killer App., And A Drug Of Choice
    http://www.autismstreet.org/weblog/?p=84

  9. #9 Martin R
    November 12, 2007

    I’m pleased that you liked my idea and honoured that you’ve expanded upon it!

    As to your skeptical comments, I’d just like to point out that the harmful therapies that do survive despite selection pressure are very rare. Millions of people use homeopathic products, whereas the number of chelation therapy sessions each year in the world would seem to number in the tens. So while a harmful altie meme may never go entirely extinct, it will never be able to proliferate as homeopathy, acupuncture and chiropractic have. Harmful methods can only survive in a small part of the altie biotope, namely the one supported by practitioners who aren’t acting as rational businesspeople.

  10. #10 TheProbe
    November 12, 2007

    Some nitwit said: “Orac’s above description bluntly smears chelation therapy as ineffective and biologically implausible.”

    Something is quackery when it is hyped to treat something where there is no biologivcal basis. Chelation, as Orac has pointed out numerous times, has its place. However, one of the places it does not belong is in the treatment of Autism, since Autism has been shown not to be the result of heavy metal poisoning. Thus, using it is 100% risk vs. 0% benefit. Quackery.

    Of course, your rant fails to stay on topic, and you use the typical moronic diversionary tactics of taking other cases where a bad result occurred to prove that Evidence Based Medicine is no different from the quackery you defend.

    As for chelation being effective for cardiovascular disease, show one study which well documents there is narrowing of the cardiovascular lumina that has been reversed by chelation. Unless the underlying disease process, i.e. narrowing of the lumina, is reversed, the patient remains at risk.

  11. #11 PalMD
    November 12, 2007

    So far, Chelation therapy is an abject failure. There is a large gov’t-funded study underway for chelation and atherosclerosis, but results aren’t due for a year or two. There is no current evidence to support it’s use.
    To call the killing of someone with chelation via hypocalcemia a “medication error” is to strain the bounds of credulity. EDTA causes hypocalcemia. To not take that into account is murder, especially when used in a quack-ish manner.

  12. #12 Orac
    November 12, 2007

    Martin,

    I’m afraid you’re very incorrect about chelation therapy, as this article shows:

    “Chelation therapy is practiced and promoted as a form of complementary or alternative medicine in many developed countries,” the authors wrote. “Additional vitamins and mineral supplements are recommended for patients undergoing chelation therapy. In our study both groups received multivitamins; we cannot exclude the possibility that these supplements could be partially responsible for the improvement that we saw in both groups. In the literature, numerous authors have reported positive results in uncontrolled studies.”

    The authors concluded, “Based on exercise time to ischemia, exercise capacity, and quality of life measurements, there is no evidence to support a beneficial effect of chelation therapy in patients with ischemic heart disease, stable angina, and a positive treadmill test for ischemia.”

    They noted that prior estimates have shown that as many as half a million people in the United States are being treated with EDTA chelation therapy for heart disease each year. A Canadian study, they said, indicated that 8% of people who have undergone cardiac catheterization have tried chelation therapy.

    “Assuming 8% of the 1.25 million US residents who have undergone cardiac catheterization have tried chelation therapy, we project that 100 000 have tried chelation therapy. Estimating a cost of $4000 for the usual series of treatments sums to an annual expenditure of approximately $400 million,” the authors wrote, noting that the figures are likely to be significantly higher because not all cardiac patients undergo catheterization.

    The bottom line is that chelation therapy is alive and thriving, even compared to homeopathy. It’s used by probably at least a half a million people a year in the U.S., and likely millions worldwide, which is why it’s incredibly lucrative. At the usual cost of around $100 a session for a course of 30-40 sessions (or even more), the numbers add up quickly. Note that I’m not even counting the probably thousands upon thousands of autistic children being subjected to chelation therapy every year. In fact, there’s a clinic a mere mile or so from my home that advertises chelation therapy “detoxification” for cardiovascular disease and a large variety of other conditions.

    Now, moving on to “doctordebunker,” here are some of my answers (no sense repeating myself again).

    1. Regarding the “efficacy” and biological plausibility (specifically the lack of either) of chelation therapy for cardiovascular disease: Argh! Chelationists are mailing pitches to my office!

    2. Regarding the chelation death of Tariq Abubakar Nadama and the issue of whether it was a “medication error”: The CDC flubs it. (Suffice it to say that giving a drug that does not work and is not indicated for a condition exposes the patient to all the risk and none of the benefit of the drug.)

    3. Regarding the details of the complaint against the killer quack, Dr. Roy Kerry, who administered the deadly dose of EDTA: The complaint against Dr. Roy Kerry, negligent killer of Abubakar Tariq Nadama.

    You know, “doctordebunker,” you really should change your ‘nym. You’re not very good at debunking, and you’re clearly not a doctor.

  13. #13 PalMD
    November 12, 2007

    “You know, “doctordebunker,” you really should change your ‘nym. You’re not very good at debunking, and you’re clearly not a doctor.”

    Yes, but he slices, he dices, he freshens breath, and cures the gout! But wait, there’s more!

  14. #14 doctordebunker
    November 12, 2007

    To call the killing of someone with chelation via hypocalcemia a “medication error” is to strain the bounds of credulity. EDTA causes hypocalcemia. To not take that into account is murder, especially when used in a quack-ish manner.

    Concerning the single death of a child via chelation thereapy. Yes, it was a medication error. The child was given Disodium EDTA instead of Calcium Disodium EDTA. Also it was given by rapid infusion rather than over a 3 hour slow infusion as is the standard infusion techniue. Calcium EDTA via slow infusion over 2-3 hours does not produce symptomatic hypocalcemia.

    There is a right way and a wrong way to administer treatment. This was done with the wrong agent and infused over too short a time frame. The rarity of this type of event indicates it is a result of error. If this was common practice, there would be thousands of such cases, and there arent.

    When chelation therapy is done by the usual technique, Calcium EDTA via slow infusion, IV EDTA is extremey safe with about 350,000 IV treatments given in the US per year with an extremely good safety record. None of these 350,000 infusions with Calcium EDTA produce hypocalcemia during the infusion. Oral EDTA is also commonly used and is safe.

    In terms of efficacy for cardiovascular disease, holding up chelation therapy to require an increase in lumen diameter by imaging (US or angio) is a false standard. Efficacy in terms of reduction in angina, claudication and ABI index has been documented repeatedly over many years. This is excellent documentation of efficacy.

    Elevated metal levels have been documented in autistic kids, and Chelation therapy removes heavy metals, and there are many documented cases of recovery with this treatment. Chelation is only one of a multi system approach to treatment of autism. An excellent source is The Biologic Treatment of Autism by William Shaws.

    If medication error is to be considered quackery then the 100,000 medication errors every year in mainstream medicine means that every board certified MD in the US is a quack, a conclusion which I doubt anyone here would like to make.

    The ad homs noted above highlight the intellectual emptiness on the orac side of the discussion.

    The reason why chelation therapy is so vehemently opposed is because it directly competes economically with stenting and cardiac bypass, a multibilion dollar industry with little in the way of proven efficacy.

    The requirement of DBPC studies has been made here, yet there are no double blind placebo controlled studies showing coronary artery stenting improves mortality.

    Except for the tight LAD lesion, there is very little to NO mortality benefit from cardiac bypass surgery. This has been well documented in the medical literature.

    Chelation Therapy, on the other hand, is more effective and entails less risk to the patient than the invasive stenting which has a 2-5% mortality, and cardiac bypass which carries a 5-10% mortality rate.

    Based on the Orac logic, any MD that is involved in the 10,000 medication errors each year is a quack. The cardiologist is called a quack every time a patient dies on the cath table, and the cardiac surgeon is a quack every time the patient dies on the OR table. These events that happen with predictable regularity, and are considered regrettable, yet acceptable adverse events.

  15. #15 TheProbe
    November 12, 2007

    Dr. Bunker said: “In terms of efficacy for cardiovascular disease, holding up chelation therapy to require an increase in lumen diameter by imaging (US or angio) is a false standard. Efficacy in terms of reduction in angina, claudication and ABI index has been documented repeatedly over many years. This is excellent documentation of efficacy.”

    I see, so symptomatic relief is all that is needed? Bull. If there is a 90% occlusion of the proximal LAD, that person, symptomatic or not, is at high risk for the “Big One”, where flowers are to be sent. I assumethat you have never heard of anyone having an infarction where they were asymptomatic.

    Maroons like you kill people.

  16. #16 TheProbe
    November 12, 2007

    Bunkee said: “Based on the Orac logic, any MD that is involved in the 10,000 medication errors each year is a quack.”

    Bunkee, you omit a significant point in your use of illogic. The medication errors you harp on, are in circumstances where the medication treatment may actually benefit the patient. In chelation for Autism, there is no proven benefit.

  17. #17 doctordebunker
    November 12, 2007

    I see, so symptomatic relief is all that is needed? Bull. If there is a 90% occlusion of the proximal LAD, that person, symptomatic or not, is at high risk for the “Big One”, where flowers are to be sent. I assume that you have never heard of anyone having an infarction where they were asymptomatic.

    If you actually bothered to read the entire post, I mentioned the 90% LAD as a valid reason for cardiac bypass with proven mortality benefit.

    The exact coronary artery anatomy can be easily determined with non-invasive imaging to sort out the tight LAD lesions from the others who can safely go on to chelation therapy.

    The medication errors you harp on, are in circumstances where the medication treatment may actually benefit the patient. In chelation for Autism, there is no proven benefit.

    Proven by what standard? Yours? There are many autism case reports documenting benefit from chelation combined with other biologic treatments.

    In addition as we have seen above, there are many surgical procedures not proven by DBPC studies, why insist on it for chelation therapy for autism. This an unfair a double standard? The treatment is safe, and the meds are FDA approved, and is no different from many oher treatments in medical practice.

    Besides, mainstream medicine will never admit that mercury from thimerosol is the cause of autism. And therefore can never even hint that removel of mercury with chelation can be beneficial. In reality it is benefical for treatment of autism. Transdemal preparations are safe and in wide use. Ask Stephanie Cave or Sherry Tenpenny.

    The major problem with chelation for cardiovascular disease is economic competition with a multibillion dollar cardiac stenting and surgery business. Even the patients know the economic competition is the source of the objections, and that is why they reject the false anti-chelation arguments offered here.

  18. #18 Joseph
    November 12, 2007

    Chelation therapy is not a meme that exists in a vacuum. There is a symbiote causation meme, if you will, which sustains it. In the case of thimerosal there are external pressures at work, such as litigation. That’s why a general CAM evolutionary model doesn’t seem to fit chelation all that well.

  19. #19 N.B.
    November 12, 2007

    TheProbe said:

    I assumethat you have never heard of anyone having an infarction where they were asymptomatic.

    This is definitely a really valid point when it comes to why quackery regarding cardiovascular disease is so prominent.

    Hypertension, dyslipidemia, and even thrombotic events are frequently totally asymptomatic until something absolutely terrible happens. Even when you can show a patient something concrete, like their blood pressure, they rarely seem to take you seriously until they have a stroke, MI, or sudden renal failure. The layman should theoretically be “able to tell” if chelation, or any other therapy, is effectively lowering cholesterol or blood pressure, especially when they self-monitor their BP on a frequent basis.

    The problem is that even when the parameters are as clear-cut as systolic over diastolic it’s possible for people to be fooled. Ever heard of “white coat hypertension?” Some people’s BP raises considerably just because it’s a doctor doing the reading! Insert some long monologue about the value of clinical trials here.

    Even if chelation therapy were a sound therapy for removing atherosclerotic plaques, the data suggests that the risk outweighs the potential benefits. At least the original theory behind using chelation for atherosclerosis kind of made sense initially. The fact that people are clinging to its value for athero and autism despite no proven benefit smacks of willful ignorance.

  20. #20 marcia
    November 12, 2007

    The major problem with chelation for cardiovascular disease is economic competition with a multibillion dollar cardiac stenting and surgery business.

    I think it’s now clear that Debunky is really not interested in whether or not chelation is of any benefit. He obviously appeals to a client’s beliefs or circumstances rather than to the truth or falsity of the proposition.

    Even the patients know the economic competition is the source of the objections.

    How would they know this if you didn’t tell them? I can imagine the office scene wherein the new client (I won’t call them patients), gets walloped with two of an altie’s favorite conspiracy fallacies:

    Appeal to rebellion
    Appeal to the bandwagon effect
    http://warp.povusers.org/grrr/conspiracytheories.html

    Name me one cardiologist who fears decreased income from the likes of you?

  21. #21 PalMD
    November 12, 2007

    I’m sorry to cause a clutter, but the above quack asked at least one ridiculous question and made at least one ridiculous assertion.
    “Proven by what standard? Yours?” and “There are many autism case reports documenting benefit from chelation combined with other biologic treatments.”

    The standard is that of science. Want the preponderance of evidence?

    Anderson TJ. Hubacek J. Wyse DG. Knudtson ML. Effect of chelation therapy on endothelial function in patients with coronary artery disease: PATCH substudy. Journal of the American College of Cardiology. 41(3):420-5, 2003 Feb 5.

    Anonymous. Chelation therapy ineffective as atherosclerosis treatment.Mayo Clinic Health Letter. 20(6):4, 2002 Jun.
    Grier MT. Meyers DG. So much writing, so little science: a review of 37 years of literature on edetate sodium chelation therapy. Annals of Pharmacotherapy. 27(12):1504-9, 1993 Dec.

    Wirebaugh SR. Geraets DR. Apparent failure of edetic acid chelation therapy for the treatment of coronary atherosclerosis. DICP. 24(1):22-5, 1990 Jan.

    McGillem MJ. Mancini GB. Inefficacy of EDTA chelation therapy for coronary atherosclerosis.New England Journal of Medicine. 318(24):1618-9, 1988 Jun 16.

    Merril L. Knudtson, MD; D. George Wyse, MD,PhD; P. Diane Galbraith, BN; Rollin Brant, PhD; Kathy Hildebrand, BN; Diana Paterson, BScN; Deborah Richardson, RN; Connie Burkart, BN; Ellen Burgess, MD; for the Program to Assess Alternative Treatment Strategies to Achieve Cardiac Health (PATCH) Investigators. Chelation Therapy for Ischemic Heart Disease.JAMA. 2002;287:481-486.

    http://www.clinicaltrials.gov/ct/show/NCT00044213?order=1

    Try reading.

  22. #22 The Crack Emcee
    November 12, 2007

    Orac,

    Great post. Lots of stuff to consider there.

    As far as the comments that followed – Wow:

    You guys have gone from “I’ve been wondering how the profit motive affects the survival of the meme.” to “Hypertension, dyslipidemia, and even thrombotic events are frequently totally asymptomatic”.

    Which is all right over my head, so I’ll just scream, “It’s a cult!”, and get out of here,…

  23. #23 andrea
    November 12, 2007

    Even before Taxol was synthesized from yews, there was another highly-popular herbal medication that later became part of the standard pharmacopeia: aspirin, originally derived from willow bark.

    I can think of an example of a treatment method that has fallen by the wayside: x-radiation for hair removal! Thankfully we don’t see that non-radiographic usage of x-rays being advertised any more …

  24. #24 Ahistoricality
    November 12, 2007

    I do think it’s possible to argue that non-scientific medicine is being crowded out just as a non-competitive organism is crowded out. Bloodletting — and the whole theory of humours — comes to mind as a form of pre-scientific medicine which has pretty much completely vanished from the medical ecology.

    In the absence of a catastrophic dinosaur-extinction-asteroid-type event (and could we imagine what kind of event that could be with regard to altie-thought, with the possible exception of universal, high-quality basic education?), alternative therapies are going to continue to exist in niches and especially as parasites (sometimes killing their hosts….) for a long time. Eventually, we’ll invent a kind of mental ddt and emotional quinine…

  25. #25 daedalus2u
    November 12, 2007

    doctor(in)de bunker, There is not a single report in the literature showing people with autism have elevated levels of heavy metals including mercury.

    There is not a single report in the literature of any clinical trial showing improvement in autism symptoms following chelation. Not even an open lable trial.

    There is no plausible mechanism by which mercury could cause the symptoms of autism (for example the larger brains). There are no increases in autism in regions of high mercury exposure (where the victims have smaller brains).

    I know these things because I have looked very carefully at the literature and discuss it on my blog.

    http://daedalus2u.blogspot.com/2007/03/discussion-of-false-mercury-causes.html

    The “mercury causes autism” idea has been proven false. Mercury doesn’t cause autism, people with autism don’t have elevated levels of mercury, chelating autistic people doesn’t remove the mercury that isn’t there and they don’t get better other than by the placebo effect (which I also discuss in my blog).

  26. #26 Chris Noble
    November 13, 2007

    If you regard alternative medicine as an infectious meme then you have to consider the basic reproduction number. That is, on average how many people does the average infected person infect with the meme. If it is more than 1 the meme will survive.

    It doesn’t matter if the meme kills the host as long as the host lives long enough to infect more people.

    The picture is also complicated by the existence of superspreaders, otherwise known as quacks, who manage to infect thousands or millions with the meme.

  27. #27 Schwartz
    November 13, 2007

    Daedalus2u:

    I thought you can’t prove a negative with evidence based medicine? Certainly not with epidemiology studies.

    Perhaps you should state the correct status: There is no existing credible evidence that mercury causes autism.

    There, wasn’t that easy.

  28. #28 Schwartz
    November 13, 2007

    I can think of a few practices that have fallen away out of favour:

    Pulling out tonsils for sore throats.
    Prescribing cough medicine to toddlers
    Hormone Replacement Therapy

    I guess those were all quackery too? If that’s your definition, then Alternative Medicine is hardly alone in the quackery camp.

  29. #29 schwartz
    November 13, 2007

    This gets even better… How about any doctor giving out the flu shot? There is little to no evidence of efficacy there and the reviews on it have been comprehensive.

    http://www.bmj.com/cgi/content/short/333/7574/912?ehom=&eaf

    So all these doctors are exposing their patients to known risks (albeit small) for no proven benefit.

    Hmmm, the list of quacks is growing quickly.

    Perhaps, your ridiculous little exercise has infected the whole medical world as well? Except instead of the primary selective pressure being a hidden desire to promote non-efficacious treatments for ridiculous reasoning like preventing another group from co-opting it, the selective pressure might actually be… profit. But the result is the same isn’t it?

  30. #30 Chris Noble
    November 13, 2007

    I can think of a few practices that have fallen away out of favour:

    They fell out of favour through the application of evidence based medicine. It is likely that other medical practises will also fall out of favour as new evidence is gathered.

    Real doctors alter their practices based on evidence. The same can’t be said about sCAM artists.

  31. #31 Schwartz
    November 13, 2007

    Wait, there is another practise, which is on it’s way to join the dinosaurs. Water Fluoridation. It is slowly working it’s way through, but people are finally noticing the evidence that only topical fluoridation provides benefits for tooth decay and not systemic ingestion. Systemic ingestion actually has a lot of known problems, so here we have a clear case of mass quackery on the parts of medical, dental and governmental organizations.

    There is plenty of evidence posted on this, and many professionals are now calling for a cessation of this practise country wide.

    http://www.fluorideaction.org/professionals.statement.2007.pdf

    That is certainly mass quackery in the extreme if I’ve ever heard of any. What do you think the selective pressure was here? Aside from profit, perhaps a secondary pressure is the propensity to refuse to alter long held medical “truisms” or perhaps faith in ancient study results in the face of overwhelming conflicting evidence?

  32. #32 Schwartz
    November 13, 2007

    Chris,

    You are correct. SCAM artists are indeed guilty of it. IBut you can’t smear all alternative therapy with the same brush as is happening here.

    Where is the evidence that every single one of these alternative practioners do not alter their practises in the face of evidence? That is what this piece is ridiculously proposing. Clearly many of the medical practises I noted, were practised for long periods of time and some of them very recently, long after the advent of evidence based medicine.

    So by your logic, these current doctors, were all applying these widespread therapys without good evidence. Why would they wait for evidence of harm when there was no evidence of efficacy to start with? That pretty much makes them quacks by the definition here.

    Thus, you’ve effectively grouped most of the medical community in with the quacks.

  33. #33 Freddy the Pig
    November 13, 2007

    Schwartz just shot him/herself in foot with the list of conventional medicine practices such as routine tonsillectomies that have been abandoned.

    This is the difference between EBM and CAM – in the former practices that are ineffective or have a bad risk benifit ratio are eventually abandoned. Maybe not as soon as they should be, but they are eventually abandoned. EMB seems to be getting better at catching these things as well. In CAM ineffective and/or harmful modalities usually persist forever.

  34. #34 Michael Suttkus, II
    November 13, 2007

    Some alternative medicines have died.

    Nobody sells snake oil, at least under that name, anymore. Just after radiation was discovered, the quack medics reacted quickly to hype the “all-natural” curing powers of radioactive substances, and had people downing radium and uranium pills to cure everything imaginable. However, radation went from “All natural goodness” in the 30′s to “man-made and horrific” by the mid fifties, and the quacks pulled out of it, even as real doctors found ways to use it…

    I thought Orgone energy was dead, but I heard someone resurrecting it the other day. Go figure.

    Is anyone still pushing the Victorian water cures? You know, walking barefoot through dew-covered grass and all that rot?

  35. #35 Chris Noble
    November 13, 2007

    You are correct. SCAM artists are indeed guilty of it. IBut you can’t smear all alternative therapy with the same brush as is happening here.

    Can you provide a single example of an alternative or complementary medicine “modality” where the practioners have looked at the evidence and said “shucks, maybe it doesn’t work afterall”?

  36. #36 Chris Noble
    November 13, 2007

    http://www.fluorideaction.org/professionals.statement.2007.pdf

    It would be interesting to do a statistic analysis on the overlap between the various lists of scientists who deny evolution, HIV causing AIDS, vaccines protect from illness and who claim that 911 was conspiracy.

    I recognise several of the names on the antifluoride list from the HIV denial list.

    Is there a list that Lynn Margulis hasn’t signed?

  37. #37 Orac
    November 13, 2007

    Mike,

    I’m not sure you can label those radiation “cures” as “alternative,” given that mainstream medicine foolishly adopted them too. (Radiation for acne, anyone? Sure it worked, but think of the later skin cancer!) As for the “water cure,” there are all sorts of variations of such “cures” that have–shall we say?–evolved since then.

    Orgone energy is definitely not dead. Indeed, the other day I saw a website saying that its “discoverer” is regaining scientific respectability and should get the Nobel Prize.

    Alternative medicines do evolve, but a lot of modalities you see today are little different from what they were decades or even hundreds of years ago.

    As for our new troll schwartz, perhaps he can tell us how alternative medical practitioners substantively change the way they practice based on new scientific evidence that a therapy doesn’t work. That’s what real doctors do. As someone else said, it may often take longer than it should, and the process may not be pretty, but scientific medicine changes and improves based on basic and clinical science.

  38. #38 David Marjanović
    November 13, 2007

    sort of like how the marsupials were doing pretty well before mammals came along.

    Bad example. Marsupials are mammals, and they have been doing well on several continents in the presence of placentals.

    The most commonly used chelating agent, EDTA is so safe that it is commonly found on food labels at the grocery store as preservative.

    In what amounts?

    Yes, it was a medication error. The child was given Disodium EDTA instead of Calcium Disodium EDTA. Also it was given by rapid infusion rather than over a 3 hour slow infusion as is the standard infusion techniue. Calcium EDTA via slow infusion over 2-3 hours does not produce symptomatic hypocalcemia.

    OK — but it’s hard to imagine that calcium disodium EDTA can chelate mercury or in fact anything. The space is occupied by the calcium; the mercury might be bound more strongly to the EDTA, but considering the vast excess of calcium (and magnesium!) over mercury in anyone’s blood, it’s hard to imagine the equilibrium lies on the side of mercury disodium EDTA.

    I thought you can’t prove a negative with evidence based medicine?

    Please explain. Science can only disprove, not prove.

    Is anyone still pushing the Victorian water cures? You know, walking barefoot through dew-covered grass and all that rot?

    The Kneipp cure (walking barefoot through cold streams, not some wimpish grass) has never fallen out of fashion. But then, it isn’t marketed as a cure, it’s considered a part of wellness nowadays, and few if any people pay for it.

  39. #39 David Marjanović
    November 13, 2007

    the mercury might be bound more strongly to the EDTA

    That is, once it has managed to kick the calcium out. The point of the rest of that sentence is that, statistically, this won’t happen.

    Aren’t there any special mercury indicators that could be used to specifically chelate mercury and only mercury? For lots of metals, light and heavy, such substances exist and are used in analytical chemistry. EDTA sticks to just about everything.

  40. #40 Schwartz
    November 13, 2007

    Orac,

    I also provided evidence of two therapies/medications currently in widespread use despite the lack of evidence of efficacy. You can hardly call me a troll without addressing those.

    As far as I understand it, there is a particular neck manipulation that is no longer recommended for use by Chiropracters due to evidence of elevated risks.

    Additionally, I know there are numerous needling techniques that are much higher risk in acupuncture that are not practised by the vast majority of practitioners, and in places where they are regulated, these practitioners would face sanctions, just like a medical practitioner would if not following the current standards.

    Western medicine does not uniformly cease certain treatments once they have been proven to be harmful, or non-efficacious. It often takes a long time for these things to phase out (often as long as it takes the old doctors to die or stop practising, so slow changes in practise again are consistent across the board in medicine.

    As for Mr. Pig. My illustration of failed medical practises just shows that western medicine is indeed guilty of your definition of quackery, because it practises therapies without any credible evidence of benefit. That means that there are therapies/treatments right now that are quackery in western medicine, no different from alternative therapies.

    So your argument basically rests on one single premise: That only western medicine alters treatments (previously not found to be efficacious, but widely used anyways…) based on evidence to the contrary, even if it takes a really long time after the evidence is presented.

    So if I find more examples of changes in Alternative Medical therapies ONLY AFTER someone has performed double blinded placebo trials proving non-efficacy (because this is the standard the western medicine has set — start a treatment based on non-credible evidence until proven by double blind placebo trials that it is harmful or non-effective) your whole argument goes down the drain?

    Are you going to be ignorant enough to claim that every alternative medical practition today has not modified any form of treatment over the past 50 years based on feedback and analysis? I’m sure some of them have not, but you can hardly place all of them in the same bucket.

  41. #41 Orac
    November 13, 2007

    So if I find more examples of changes in Alternative Medical therapies ONLY AFTER someone has performed double blinded placebo trials proving non-efficacy (because this is the standard the western medicine has set — start a treatment based on non-credible evidence until proven by double blind placebo trials that it is harmful or non-effective) your whole argument goes down the drain?

    So find alternative medical therapies that were discarded after good scientific evidence showed they didn’t work, not just tinkering with the woo, so to speak.

    I’ll wait.

    In the meantime, don’t forget to enjoy part 2 of my speculatively applying evolutionary principles to alt med (not to mention Steve Novella’s take on the issue), and let me also point out that you’re attacking an obvious straw man. I never said that alties didn’t tinker around the edges with their favored woo (as in your acupuncture example). Clearly they do. What I said is that they damned near never abandon a treatment that has been shown to be not efficacious (homeopathy and reiki come to mind). Chiropractors may abandon one type of manipulation only after evidence that it can cause stroke is thrown in their face many times, but they don’t give up on manipulation itself. NCCAM, despite throwing nearly a billion dollars at studies of CAM modalities, has yet to state unequivocally that any single CAM therapy does not work (or, as scientists usually and more properly put it, that the evidence does not support any efficacy for it).

  42. #42 TheProbe
    November 13, 2007

    Bunkee said: “In addition as we have seen above, there are many surgical procedures not proven by DBPC studies, why insist on it for chelation therapy for autism. This an unfair a double standard?”

    Bunkee, can you explain how a double blind placebo controlled study of a surgical procedure can be set up? Of course, you cannot, since it is not possible. Once that scapel makes the first incision….

    With chelation, a DBPC study is possible. However, that was not the standard I mentioned. I would like chelation to be proven effective by angiographic evidence of decreased narrowing of the arteries. That would demonstrate the reversal of the disease process, and not just some symptomatic relief, which may even be placebo.

  43. #43 Schwartz
    November 13, 2007

    Orac,

    There are acupuncture treatments that have been shown to be effective (knee pain and reduction of nausea comes to mind) vs placebo, but are not shown to be effective for other types of ailments (sham is just as effective as real acupuncture, though both are better than none).

    So you may have a type of practise that works for certain ailments, and not for others. Just because it isn’t effective for a type of ailment, doesn’t mean the whole treatment is ineffective across all treatments. Not to say that certain modalities are completely useless, I agree that exists, but again, you can’t loop all alternative medicine into this bucket, because you haven’t disproven every type of treatment, nor can you invalidate the science of every type of treatment (some yes, I do agree).

    So given that there are treatments for which acupuncture are effective, we have a good example of a therapy that is changing over time, and is proven to be effective for certain therapies. Ironically, it is also being adopted by mainstream medicine in some places (including the US), so that goes against your hypothesis.

    As for Chiropractors, I was not aware that you think that every type of treatment by these folks is ineffective. I’ll do more research tonight to see what I find there.

    As for charletons never disappearing, alas, the world will always have scam artists, so you’ll always win that argument. But I would argue the scam artists fall outside the regulated alternative medicines just like scam artist doctors do.

    If you want to throw around anecdotes like billions of dollars, I wonder if you can tell me how much money has been and continues to be wasted on mass flu vaccinations despite a growing body of evidence against it’s effectiveness. How about ~70 years of water fluoridation? Wasted money abounds. At least my tax money is not supporting the vast majority of alternative therapies. Far more has been wasted on my two examples (which are still in widespread practise despite evidence against them).

    I do take very slight offense at being called a troll, as I enjoy your posts even if I disagree with elements of them.

  44. #44 Schwartz
    November 13, 2007

    Orac,

    “NCCAM, despite throwing nearly a billion dollars at studies of CAM modalities, has yet to state unequivocally that any single CAM therapy does not work (or, as scientists usually and more properly put it, that the evidence does not support any efficacy for it).”

    So it seems like you’re adjusting your argument a bit. Is your complaint that they never admit that certain treatments don’t work for specific ailments, or that every single treatment has been proven to be non-effective (which is what your original post implies)? If you’re adjusting your position, then we can easily go back to the argument used to defend western medicine. It may take a long time to adjust treatments even in the face of conflicting evidence.

    “Conventional medicine can treat and often palliate such conditions, but it cannot cure them. In this latter niche, I would argue that the primary positive selective pressure would be how well the CAM modality can inspire belief in its practitioners and hope in its users. The two are related, of course; the more the practitioner believes in the modality the more he or she can sell the patient on it.”

    I have a couple of thoughts here. If the practitioner is able to achieve a sense of satisfaction or improved the quality of life of the patient, then they may certainly have achieved a similar level of efficacy as western medicine in these cases given the change in objective.

    As for the selective pressure in these cases, I would argue that the increase in communication and the internet would lessen this type of selective pressure and that efficacy itself will definately play a strong role because of word of mouth.

  45. #45 Orac
    November 13, 2007

    If you want to throw around anecdotes like billions of dollars, I wonder if you can tell me how much money has been and continues to be wasted on mass flu vaccinations despite a growing body of evidence against it’s effectiveness.

    Now I know you’re talking B.S.

    As for the flu vaccine canard, I recommend listening to these podcasts for a lovely deconstruction of it:

    Skepticast #118 10/24/2007
    Influenza myths

    Two beautiful summaries by Dr. Mark Crislip, an infectious disease specialist and a podcaster.

    By the way, Pal MD over at White Coat Underground has a challenge for you similar to the one I issued in the comments.

  46. #46 daedalus2u
    November 13, 2007

    No matter how good a chelating agent EDTA is, it cannot remove mercury (or any other heavy metal) that is not present. If people with autism had mercury poisoning, it would be trivial to measure elevated mercury, chelation would then remove it, and if elevated mercury were the “cause”, they would then get better. The “problem” with the “mercury causes autism” idea is that there is no elevated mercury level to start with.

    Blaming autism on mercury which is not present is the same as blaming autism on kryptonite which is not present either.

  47. #47 Martin R
    November 13, 2007

    There’s a third kind of pressure on altie medicine to do nothing. Many evidence-based functional therapies incorporate drugs and procedures that can be dangerous if used in the wrong way. In order to be effective, a method must be pretty potent, and all power can be misused. Thus, an altie practitioner can never recommend a potent beneficial method due to the risk of patients ODing and dying.

  48. #48 Mojo
    November 13, 2007

    We already know that alt-med terminology has evolved considerably into the current politically correct term “complementary and alternative medicine” (CAM).

    Shouldn’t that be “Supplementary, Complementary and Alternative Medicine”?

  49. #49 Michael Suttkus, II
    November 13, 2007

    Marsupials are, in some ways, quite superior to placental mammals, and the success of placental mammals seems, in many respects, to be due to luck: They evolved on the good continents while the Marsupials evolved in less fertile regions. (And had one of their continents obliterated by an ice sheet on top of that!) The history of the conflict between them will become clearer as more fossil excavations are done in South America.

  50. #50 Schwartz
    November 14, 2007

    I suppose when I was a university student, I might have found that podcast entertaining, but seriously, you expect me to accept that as proof of anything?

    First of all, the only discussion of Vaccines were occurred after a couple of minutes of boring dribble about nothing, when he discussed Vaccines and Autism. Either you misread my post, or you purposefully changed the topic, because my evidence is that the flu vaccine is not effective against the flu! No discussion of Autism here.

    Then he talks a bit about religious exemption, where he makes inaccurate statements. Specifically he accuses people of lying to get exemptions, when in fact in several states, religious exemption is described broadly to include philosophical exemption. So not everyone is lying as he stated as if it were fact (which it obviously is not). He was also very vague about herd immunity numbers, which happen to be very specific to the disease in question. Something else he completely glosses over with generalities. His accuracy is hardly convincing.

    Now, let’s go to his next discussion about vaccines (specifically the flu vaccine… phew) around 30-45 minutes in — after a painful discussion about creationism (I honestly don’t understand why you guys even bother wasting your time on that) — where he answers 2 specific questions about the flu vaccine:

    1) Is humanity losing it’s ability to fight off flus by weakening the their immune systems?
    2) Are the proliferation of vaccines causing

    Again, you seem to be misreading my post… or again you’re purposefully changing the topic from my post. I was not advocating either of these misinformation points.

    I provided credible evidence that there is no credible evidence of flu vaccine efficacy, and in fact, there is evidence to the contrary. Given the evidence, your government and medical establishment continue to promote a treatment that has no scientific evidence to support it. That sure sounds like quackery by your own definition.

    As for his answers, I don’t see the relevance of discussing anti-biotics when talking about flu vaccines (since the flu is a virus). If he was intending to explain that anti-biotics cause superbugs, he never actually explains that anywhere.

    His lack of accuracy when discussion immune strength is extremely general, and somewhat misleading because he implies that vaccines exercise the whole immune system, when really their primary purpose in this case are anti-body production. That is only exercising one specific aspect of the immune system, and vaccine immunity is not the same as natural immunity, which is what he would like to imply.

    One other minor point is that his unequivocal statements about vaccines never causing mutations and the like, although accurate, does ommit a possible related effect of certain vaccine strategies. Specifically, the strategy of targeting X common strains out of Y possible strains, because they are found in people and deemed to be most likely to cause a particular ailment (Prevnar and Gardasil are examples of this). There is some evidence (hardly conclusive) that by eliminating this X common strains, that they get replaced by other strains. There is no proof that the replacement strains are less harmful than the original. So although his statements were technically correct, again, they ommited a lot of details.

    Next time, you should read the evidence presented, and give me some evidence to support a different position. And even then, provide me something that contains references, or at least more detail, rather than some basement studio with some people backslapping each other while bashing creationists. That’s like shooting fish in a barrel.

    He also makes sweeping statements about

  51. #51 pat
    November 14, 2007

    I have a friend who is a severe asthmatic and one of her sons also. For years they had tried everything the arsenal had in stock only to find themselves hanging off face masks for the greater part of the day without any relief from their torment. The mother eventually studied medicine and after that went on to study homeopathy. They are now both doing better by leagues and also don’t “feel” crippled by the sheer amount of medicines they use to take. Although I too am an asthmatic and found my relief in Ventolin, I will not in a million years try to discourage them from “alternative” medicine simply because there is no written “evidence” for it. The evidence is in their airways. Psychosomatic? Who knows but they feel great and that is what “evidence based” is up against: very real experience. Now I know the plural of anecdote is not evidence but the plural of anecdote is definitly a guide: how else would we know what to study? Were we to discourage everything lacking “evidence” we would be throwing away a greater part of the arsenal. Our collective knowledge, compared to what is yet to discover, is quite pathetic so throwing stuff out simply because we have no evidence may be throwing the baby out with the bathwater.

  52. #52 PalMD
    November 14, 2007

    Because it’s been studied and it doesn’t work, nor does it have a plausible explanation.

    And I have found that “face mask” people usually, but not always, suffer from severe psychological problems pre-dating whatever physical disorder they claim to have.

  53. #53 thyme-aerosol
    November 14, 2007


    The “mercury causes autism” idea has been proven false. Mercury doesn’t cause autism, people with autism don’t have elevated levels of mercury, chelating autistic people doesn’t remove the mercury that isn’t there and they don’t get better other than by the placebo effect (which I also discuss in my blog).
    .
    No matter how good a chelating agent EDTA is, it cannot remove mercury (or any other heavy metal) that is not present. If people with autism had mercury poisoning, it would be trivial to measure elevated mercury, chelation would then remove it, and if elevated mercury were the “cause”, they would then get better. The “problem” with the “mercury causes autism” idea is that there is no elevated mercury level to start with.
    .
    Blaming autism on mercury which is not present is the same as blaming autism on kryptonite which is not present either.

    The following article reviews the medical literature and U.S. government data which shows mercury causes autism.

    Autism: A Unique Type of Mercury Poisoning
    by Sallie Bernard Albert Enayati, Teresa Binstock Heidi Roger Lyn Redwood Woody McGinnis, M.D. Copyright (c) 2000 by ARC Research 14 Commerce Drive Cranford, NJ 07016 April 3, 2000 Revision of April 21, 2000

    ABSTRACT, Autism is a syndrome characterized by impairments in social relatedness, language and communication, a need for routine and sameness, abnormal movements, and sensory dysfunction.

    Mercury (Hg) is a toxic metal that can exist as a pure element or in a variety of inorganic and organic forms and can cause immune, sensory, neurological, motor, and behavioral dysfunctions similar to traits defining or associated with autism.

    Thimerosal, a preservative frequently added to childhood vaccines, has become a major source of Hg in human infants and toddlers.

    According to the FDA and the American Academy of Pediatricians, fully vaccinated children now receive, within their first two years, Hg levels that exceed safety limits established by the FDA and other supervisory agencies.

    A thorough review of medical literature and U.S. government data indicates

    (i) that many and perhaps most cases of idiopathic autism, in which an extended period of developmental normalcy is followed by an emergence of symptoms, are induced by early exposure to Hg;

    (ii) that this type of autism represents a unique form of Hg poisoning (HgP);

    (iii) that excessive Hg exposure from thimerosal in vaccine injections is an etiological mechanism for causing the traits of autism;

    (iv) that certain genetic and non-genetic factors establish a predisposition whereby thimerosal’s adverse effects occur only in some children; and

    (v) that vaccinal Hg in thimerosal is causing a heretofore unrecognized mercurial syndrome.

  54. #54 Orac
    November 14, 2007

    Heh. You’ll have to do better than quoting Sallie Bernard and a loonie antivaccination website from seven years ago. Amusingly, all the studies done since then have failed to find a link between vaccines and autism or mercury and autism.

  55. #55 daedalus2u
    November 14, 2007

    If you actually read the Bernard hypothesis paper you see that it doesn’t show that mercury is at all related to autism. It makes the assertion and then tries to pretend it is credible with shoddy and disingenuous comparisons.

    The most serious problem with the idea that mercury causes autism is that there is no data to support it and much data to refute it. 7 years ago, it perhaps was a reasonable hypothesis. Since then, the hypothesis has been repeatedly tested, and it has repeatedly failed. People with autism do not have the most important and diagnostic symptom of mercury poisoning, an elevated level of mercury.

    Without an elevated level of mercury, a diagnosis of mercury poisoning is a misdiagnosis. There remains not a single demonstration of an elevated level of mercury in a person with autism, who recovers when that mercury is removed via chelation. The vast majority of people with autism do not have elevated mercury levels.

    There is lots of woo, people testing urine at the peak of mercury excretion following chelation, no doubt that contributes to the placebo effect.

    The quantities of mercury in vaccines are small, on the same order as are in a single can of tuna.

    http://www.cfsan.fda.gov/~frf/sea-mehg.html

    In canned albacore tuna there is 0.353 ppm mercury (mean of 399 samples). 100 grams of tuna (about 3 ounces) contains 35 micrograms. The total mercury exposure via vaccinations reported in the Bernard paper is 237.5 micrograms over 2 years. About 1 can every 3.5 months.

    None of the examples in the Bernard paper show actual elevated levels of mercury. The mercury excretion examples show a total mercury excretion (via chelation) of a few tens of micrograms, the same order as one would get from eating a can of tuna.

    How can chelation remove mercury that is not present? Easy, it can’t, and it doesn’t. Tiny increments in mercury excretion would be expected with chelation challenge. A tiny increase (less than what is in a can of tuna) is insignificant.

    People with real mercury poisoning have actually elevated levels of mercury in every tissue compartment. These levels are trivial to measure. The tragic case of the woman who died from methylmercury exposure (which I discuss in my blog), had over 1,000 ppm mercury in her hair while having no symptoms for 5 months following a lethal exposure. Prompt symptoms following vaccination are not consistent with mercury poisoning. They are consistent with immune system mediated effects. The reason that vaccines are given in the first place.

    It is time to stop beating the dead horse that is the “mercury causes autism” idea. It isn’t a “hypothesis” any more because a “hypothesis” must be consistent with what is well known. The mercury causes autism idea is not consistent with much that is well known about mercury physiology. It is a failed hypothesis. It is time to move on and find the real cause of autism and stop wasting effort on woo.

    In any case, mercury has been removed from most vaccines and there is no reduction in the cases of autism. The proponents of the “mercury causes autism” idea have now expanded their net to include a host of other “causes”, but being careful now to be vague about what they actually are. No doubt so the woo can continue to be sold regardless of what science may say in the future.

  56. #56 Schwartz
    November 14, 2007

    Well, I’ll admit, I can’t think of a failed therapy that has been abandonned — possibly because I’m not sure where to look mind you. I’m guessing there isn’t a lot of historical interest in failed therapies and I’m certainly not a student of alternative medical failures.

    However, upon thinking about this, the comparison of non-alternative therapies being discarded to western medicine discarding treatments that aren’t evidence based isn’t quite comparing apples to apples. Perhaps we need to clarify further, the boundary of Western Medicine and we need to investigate further the kinds of treatments that are abandonned.

    Clearly failed drugs treatments are more commonly abandoned in recent memory. But this isn’t really a fair comparison to CAM treatments that don’t cause harm, even if they have no scientific efficacy. I also can’t think of a medical treatment that was abandonned that didn’t cause some sort of harm. Perhaps you can come up with a few?

    If you want to compare homeopathy, or even sham acupuncture to western medicine, then you need to show evidence that western medicine stopped pracising harmless no-risk treatments that had no efficacy. I think that’s pretty rare if they even exist, and I can’t think of any cases myself. Every abandonned western treatment in memory has always had some sort of harm or risk associated with it.

    I might be mistaken, but your arguments against homeopathy or acupuncture aren’t supported by scientic evidence of increased risk or harm, only lack of efficacy. I would like to see a western medicine comparison that actually passes that test.

    Also, do you consider physio-therapy western medicine? How about some of the more specialized kinds like Muscle Activation Therapy etc?

  57. #57 daedalus2u
    November 14, 2007

    How about antibiotics for viral diseases?

    Vitamin supplements beyond normal requirements.

    Silicone breast implants.

    Thimerosal as a preservative in vaccines.
    Maggots were once used extensively for wound debridement, they fell out of use when antibiotics became common. They are making a resurgence because for some wounds (diabetic wounds for example) they work better than anything else.

    There is no evidence of harm from any of those practices, yet they are not part of the standard of care any more.

  58. #58 Schwartz
    November 15, 2007

    There is certainly harm caused by the use Anti-biotics. That’s why we don’t take them all the time. We should take them when the benefit outweighs the harm (when a baterial infection threatens to do damage to the body).

    Additionally, that practise has not yet been abandoned by Western Medicine. I know of lots of people that still get anti-biotics for flu and cold like symptoms all the time.

    I never knew of a time where doctors prescribed huge doses of vitamins. In fact, I think that was an artifact of naturopathy. Even still that sounds a lot more like “fine tuning the woo” as Orac said earlier. Vitamins are still prescribed all the time, by both Doctors and naturopathists.

    Thimerosal is still being used in vaccines. Not abandoned. There is not enough credible safety data to draw any conclusions about it’s safety — and I’m not talking about Autism either.

    You just stated that maggots are still being used. Clearly it has not been abandoned. It also sounds exactly like the type of treatment that Orac would consider wooish. Where are the studies that show it’s efficacy? If not, why is it even being used. Most of the evidence is anecdotal from what I understand?

    Silicon Breast implants are still in use all across Europe.

    Interesting that you use the term “Standard Care”, yet Orac’s challenge states never used. Why do you insist on a different criteria?

    I didn’t realize Black Salve was part of anyone’s standard care.

    You still haven’t provided a valid western medical practise (or drug) that has ceased usage that didn’t cause any harm.

    I think you need to try again. None of those met the bar that was set by Orac.

  59. #59 Schwartz
    November 15, 2007

    Oh, and BTW, silicon breast implants do have known published negative effects. Just not the neurological and cancerous ones alleged by the lawsuits (and eventually thrown out).

    From the IOM

    “They conclude that although silicone breast implants may be responsible for localized problems such as hardening or scarring of breast tissue, implants do not cause any major diseases such as lupus or rheumatoid arthritis.”

    Again, I understand it is still in widespread use across Europe, and there are well studied negative effects. For a cosmetic treatment, it’s not a great tradeoff.

  60. #60 Schwartz
    November 15, 2007

    Daedalus2,

    I just can’t believe you included Thimerosal. Since when was it removed for reasons of lack of efficacy? Additionally, it has known side effects, including severe reactions in people that have allergies.

    Your examples are looking worse and worse.

  61. #61 daedalus2u
    November 15, 2007

    The reason thimerosal was removed from many vaccines had nothing to do with the harm known to be caused in very rare instances. It was not removed because of any demonstrable harm. It was removed purely as a “precaution” and likely to limit potential legal liability. Similarly, silicone breast implants were not removed because of the known very minor demonstrable harm.

    If we make the criteria “lack of [greatest] efficacy”, old drugs and treatments are abandoned all the time when newer more effective drugs and treatments are developed. It isn’t that the abandoned drugs have zero efficacy, rather they have lower efficacy than what replaces them.

    Maggot therapy was once the standard of care. It fell out of fashion not because it wasn’t effective.

    http://care.diabetesjournals.org/cgi/content/full/26/2/446

    I suspect it was the “yuck” factor and because no pharmaceutical company wanted to supply them. I suspect that had to do with limited demand and as living organisms they had a very limited shelf-life. It had nothing to do with a lack of efficacy.

    “Standard of care” is how medicine is defined. I have no doubt you could find someone who has an MD degree, and is licensed to practice who does prescribe woo-like things like black salve or chelation for autism. That doesn’t make black salve a part of medicine. Similarly, because you can find people who prescribe antibiotics for viral diseases doesn’t make it an acceptable practice. Prescribing chelation for autism isn’t a part of medicine either, even though lots of people who call themselves doctors do it. Just because someone is a “doctor”, and “does something”, doesn’t make what they do a part of medicine.

    200 years ago, homeopathy may have been a part of the standard of care. It isn’t any more. If it ever was, it has been replaced by treatments with greater efficacy (i.e. non-zero).

  62. #62 thyme_aerosol
    November 15, 2007

    The most serious problem with the idea that mercury causes autism is that there is no data to support it and much data to refute it. 7 years ago, it perhaps was a reasonable hypothesis. Since then, the hypothesis has been repeatedly tested, and it has repeatedly failed. People with autism do not have the most important and diagnostic symptom of mercury poisoning, an elevated level of mercury. Without an elevated level of mercury, a diagnosis of mercury poisoning is a misdiagnosis. There remains not a single demonstration of an elevated level of mercury in a person with autism, who recovers when that mercury is removed via chelation. The vast majority of people with autism do not have elevated mercury levels. There is lots of woo, people testing urine at the peak of mercury excretion following chelation, no doubt that contributes to the placebo effect.

    Here are two recent vintage publications which implicate heavy metals, and mercury as the culprit in autism. They indicate elevated mercury levels in autistic kids as demonstrated by porphryn markers, and from measurements of mercury from challeges with chelating agents.

    The connection between mercury, thimerosol containing vaccines and autism is stronger each year, not weaker.

    A Case Series of Children with Apparent Mercury Toxic Encephalopathies Manifesting with Clinical Symptoms of Regressive Autistic Disorders David A. Geier Mark R. Geier

    Journal of Toxicology and Environmental Health, Part A, 70: 837-851, 2007

    A case series of nine patients who presented to the Genetic Centers of America for a genetic/developmental evaluation are discussed. Eight of nine patients (one patient was
    found to have an ASD due to Rett’s syndrome)

    (a) had regressive ASDs;

    (b) had elevated levels of androgens;

    (c) excreted significant amounts of mercury post chelation challenge;

    (d) had biochemical evidence of decreased function in their glutathione pathways;

    (e) had no known significant mercury exposure except from Thimerosal-
    containing vaccines/Rho(D)-immune globulin preparations; and

    (f) had alternate causes for their regressive ASDs ruled out. There was a significant dose-response relationship between the severity of the regressive ASDs observed and the total mercury dose children received from Thimerosal-containing vaccines/Rho (D)- immune globulin preparations.

    Based upon differential diagnoses, 8 of 9 patients examined were exposed to significant mercury from Thimerosal-containing biologic/vaccine preparations during their fetal/infant developmental periods, and subsequently, between 12 and 24 mo of age, these previously normally developing children suffered mercury toxic encephalopathies that manifested with clinical symptoms consistent with regressive ASDs.

    Porphyrinuria in childhood autistic disorder: Implications for environmental toxicity

    Robert Nataf a, Corinne Skorupka b, Lorene Amet b, Alain Lam a, Anthea Springbett c, Richard Lathe d, Laboratoire Philippe Auguste, Paris, France Association ARIANE, Clichy, France c Department of Statistics, Roslin Institute, Roslin, UK d Pieta Research, PO Box 27069, Edinburgh EH10 5YW, UK Received 13 February 2006; revised 23 March 2006; accepted 5 April 2006

    Toxicology and Applied Pharmacology 214 (2006) 99-108

    Abstract
    To address a possible environmental contribution to autism, we carried out a retrospective study on urinary porphyrin levels, a biomarker of environmental toxicity, in 269 children with neurodevelopmental and related disorders referred to a Paris clinic (2002-2004), including 106 with
    autistic disorder.

    Urinary porphyrin levels determined by high-performance liquid chromatography were compared between diagnostic groups including internal and external control groups.

    Coproporphyrin levels were elevated in children with autistic disorder relative to control groups.

    Elevation was maintained on normalization for age or to a control heme pathway metabolite (uroporphyrin) in the same samples. The elevation was significant (P b 0.001).

    Porphyrin levels were unchanged in Asperger’s disorder, distinguishing it from autistic disorder. The atypical molecule precoproporphyrin, a specific indicator of heavy metal toxicity, was also elevated in autistic disorder (P b 0.001) but not significantly in Asperger’s.

    A subgroup with autistic disorder was treated with oral dimercaptosuccinic acid (DMSA) with a view to heavy metal removal.

    Following DMSA there was a significant (P = 0.002) drop in urinary porphyrin excretion. These data implicate environmental toxicity in childhood autistic disorder.

  63. #63 Schwartz
    November 15, 2007

    Daedelus2,

    The criteria is extinction as stated by Orac in today’s post, not removal from Standard care. And it has to go extinct because the procedure has no evidence of efficacy.

    We can further refine the criteria to not count modifications of existing treatments as he disregarded my example of a specific manipulation that is no longer supported by Chiropractors.

    So again, how does Thimerosal meet the criteria when 1) it’s still in use today 2) it does cause harm. You’ll again note that I never stated in my post that it was removed for safety reasons. To be clear however, it was removed because the combined exposure to infants was greater than the recommended amount by the EPA. Vaccine manufacturers have been granted immunity from liability, so that argument doesn’t fly either.

    I am still not aware of any harm from homeopathic medicines (since you all point out there is nothing in them). There is still some harm from breast implants, and I can’t judge how serious they are, since I don’t have numbers or severity data. Do you have any to support your statement?
    Anyways, they’re still in widespread use in Europe, so it still doesn’t qualify.

    As for Maggots, I’m impressed that people are using them and studying them. But unfortunately, that means it is disqualified as a valid example, because it has not been abaondoned, and is certainly not extinct. It’s also efficacious (amazingly simple really), so again, it is not a valid analog at all.

    I think you’re missing the point of my counter-challenge here. Orac is complaining that CAM treatments that are shown to have no efficacy continue to be practised. He is asserting that non-efficacious treatments never go extinct, UNLIKE in western medicine, where treatments that are proven to be non-effective are abandoned completely.

    So I am countering, that the driver of abandoned western medicine treatments is not driven by efficacy, but by safety issues. All of the recent examples of this behavior by western medicine falls in this category. I have yet to see someone raise an example where a western medical treatment that did not have harm associated with it (like homeopathic medicines) that was abandonned for reasons of lack of efficacy.

    No examples yet.

  64. #64 Orac
    November 15, 2007

    So again, how does Thimerosal meet the criteria when 1) it’s still in use today 2) it does cause harm.

    #2 is an invalid premise. There is no evidence that it causes autism, as you assert that it does.

    Citing little case series by the Geiers is not good evidence. Believe me. I’ve dealt with the Geiers’ bad science many times before, although not that specific paper. However, I believe that Prometheus has dealt with the autism quackery that is the use of porphyrins as “diagnostic” of mercury poisoning and autism, as have others.

  65. #65 Schwartz
    November 17, 2007

    Orac,

    There are children that react with it. It has known risks to a segment of the population. From where I come from that’s harm.

    Again, you put words in my mouth. Never did I mention autism or Geiers. Additionally, the CDC removed it from childhood vaccines because the combined doses resulted in a higher than recommended exposure of mercury to infants. It’s really quite simple.

    Additionally, it still doesn’t support your argument of a therapy eraticated. I’m still waiting for a valid example.

    I’m sensing there isn’t one coming. So you see, your challenge is pretty pointless, since you can’t really argue that efficacy pressures western medicine to drop treatments. I will continue to assert that money is the pressure that drives western medicine (and probably alternative therapy) and that efficacy does have an input into the money pressure.

    However, only harm appears to cause a cessation of treatments in either case.

  66. #66 daedalus2u
    November 17, 2007

    thyme_aerosol, I have read the Geier paper, and it is complete crap. They consistently misuse the term “significant”. In scientific terms, “significant” has a specific meaning. It means sufficiently different than something else that a result by chance is unlikely. It does not mean “important”, or “causal”, or “relevant”, or “associated with”, or “substantial”. It merely means that the instruments used to measure that parameter were of sufficient sensitivity and that a deviation from an expected result was measured.

    http://en.wikipedia.org/wiki/Significance

    A single measurement (which is what they report on their various cases) doesn’t have a “significance” attached to it because “significance” is a statistical measurement. There can’t be any “statistics” about n=1 events.

    In any case the “reference values” they refer to are not from a citation. What exactly are they? Normal values of individuals with no known exposure history? Highest value where mercury toxicity is not observed? Lowest level where mercury toxicity is observed? What is the standard distribution of these “reference values”? In other words, how many individuals without symptoms of mercury poisoning have these same mercury levels? Without knowing what mercury levels individuals with and without actual symptoms of mercury poisoning have, it is impossible to infer mercury poisoning by measuring a mercury level. They also show “provoked” case results but use “unprovoked” reference values. When a chelation agent is given, there is an increase in mercury in urine, even in individuals with no signs or symptoms of mercury poisoning, even in individuals with no exposure to elevated mercury. A “provoked” test will always show a higher mercury level than an unprovoked test. That they call such a comparison “significant” is deceptive and disingenuous, bordering on fraudulent. A “real” scientist would never make such a deceptive comparison. Deceptive comparisons like this are signs of quacks and frauds, not of scientists.

    Their own data shows low mercury levels in hair. If there is low mercury level in hair, there is no mercury poisoning. The threshold for actual mercury toxicity measured in hair is tens of ppm. At less than 1 ppm in hair there is conclusive proof that mercury toxicity is not present. 7 of 8 children showed low mercury in their hair (less than 1 ppm) results for the remaining child were not reported.

    They make a big deal of mercury levels in hair going up (very modestly) following treatment via chelation. Perhaps their tests have poor reproducibility; perhaps the chelating agents they were using were actually contaminated with mercury, perhaps the child’s diet changed. In any case, the quantities of mercury removed via chelation were tiny. The levels in hair before and after are enormously below toxic levels.

    They report mercury excretions of 31, 15, 15, 8, 47, 8.9, 15 micrograms/g creatinine. Normal creatinine excretion is 15-25 mg/kg per day. Assuming a 20 kg child this would be about 0.4 g creatinine per day. The total urinary mercury excretions are then 12.4, 6, 6, 3.2, 18.8, 3.56, and 6 micrograms/day respectively. Albacore tuna fish in cans has about 0.353 ppm mercury (see reference in earlier comment). A 3 ounce serving is about 100 grams, and so contains about 35 ppm mercury. Is the removal of half (or 1/10th) the mercury in a can of tuna therapeutically significant? If it was, then eating half a can of tuna should induce mercury poisoning. Does eating half a can of tuna induce mercury poisoning? If so, then no one has reported it. The largest best done studies show essentially no observable effects of mercury until hair levels exceed ~20 ppm in children. What effects would be expected at the sub ppm levels observed by the Geiers? Zero, nothing that could be distinguished from normal human variation.

    I notice they make a big deal out of thimerosal exposure, but have no data on fish consumption. A few cans of tuna would exceed the mercury exposure from thimerosal. What about the mercury content of other food consumed? We know it isn’t zero. Nothing on this planet has zero mercury in it. Why do they make a big deal of thimerosal and ignore dietary sources? All you have to do is follow the money. The Geier’s have made a business out of “expert” testimony. Thimerosal is in vaccines, vaccines are made by pharmaceutical companies, pharmaceutical companies have deep pockets. Tuna fish companies don’t. Following the money also explains why they make the bogus comparison of “provoked” excretion of mercury with “unprovoked” reference values. The “purpose” is to defraud the court and trick them into finding that “mercury causes autism”, even if it doesn’t.

    To summarize, the Geiers show no data to support their assertion that mercury toxicity is associated with autism. Their data quite strongly shows that there is no association of elevated mercury with autism. They do not show a single measurement of mercury that is abnormal or indicative of mercury poisoning. Not before symptoms develop, not after symptoms develop, they show no substantial removal of mercury via chelation (indicating no excess was there to start with). Mercury levels do go down, but because the ASD symptoms were not caused by elevated mercury, those symptoms do not resolve. Very strong evidence that autism is completely unrelated to mercury. If this is the best that they have, they have nothing.

  67. #67 daedalus2u
    November 17, 2007

    thyme_aerosol, I notice that your ID links to the Generation Rescue web site where they have a number of papers available for download, including the infamous paper by Wakefield that has since been retracted by 10 of the 12 co-authors that could be contacted.

    http://www.thelancet.com/journals/lancet/article/PIIS0140673604157152/fulltext

    It is dishonest and deceptive to cite an article after it has been retracted without also citing the retraction. That Generation Rescue does such a thing proves that Generation Rescue is not being honest, and doesn’t care about being honest.

  68. #68 daedalus2u
    November 17, 2007

    How about a truss as a treatment for hernia. It doesn’t do any harm, but it isn’t used any more because surgical repair is so much better.

  69. #69 Schwartz
    November 18, 2007

    Truss is getting better for sure. I’m impressed. But it still isn’t a valid analogy for two reasons:

    1) They are still in use today for minor hernias where surgery isn’t desired or advised.

    http://www.medem.com/search/article_display.cfm?path=%5C%5Ctanqueray%5Cm_contentitem&mstr=/m_contentitem/zzzesg4twac.html&soc=ama&srch_typ=nav_serch

    2) It was actually effective in treating the problem (albeit not the best method)

    We’re looking for ineffective treatments — as you all assert these CAM treatments have no efficacy

  70. #70 Schwartz
    November 18, 2007

    Daedalus2u,

    A question about honesty:

    Do you feel it’s important to cite critical analysis/letter of a study referenced? Especially if it is published in the same journal?

    I’m honestly curious. Clearly you are correct regarding retractions, but all too often I see papers referenced, and then when researching them, find letters raising significant issues that are never addressed.

  71. #71 thyme_aerosol
    November 18, 2007

    daedalus2,

    Their own data shows low mercury levels in hair. If there is low mercury level in hair, there is no mercury poisoning. The threshold for actual mercury toxicity measured in hair is tens of ppm. At less than 1 ppm in hair there is conclusive proof that mercury toxicity is not present. 7 of 8 children showed low mercury in their hair (less than 1 ppm) results for the remaining child were not reported.

    According to various mercury experts such as Boyd Haley, the low level of Hg in the hair of autistic kids indicates inability to eliminate the Hg because of enzyme deficiencies in various biochemical pathways. This is commonly found and is an important feature of the syndrome.

    If it was, then eating half a can of tuna should induce mercury poisoning. Does eating half a can of tuna induce mercury poisoning?

    The major difference is oral ingestion vs Injection of the mercury, and age of the patient. Oral ingestion results in less HG being absorbed and transported across the BBB, than the HG injected into babies.

    including the infamous paper by Wakefield that has since been retracted by 10 of the 12 co-authors that could be contacted.

    This paper deals with PCR detection of vaccine strain measles virus in gut biopsies of autistic kids. This finding has been confirmed by later investigators. So retraction by 10 of 12 authors may have been political pressure. 2 of the authors did not retract the paper.

    Not only that, but it is now well known that many current polio virus outbreaks are from the vaccine strain polio, so it is not surprising that measles vaccine strain virus can persist in humans as well.

    Autism has been increasing exponentially and is now 1 per 100 male births. This is a problem of enormous magnitude which is costing billions. Consider the impact on recruitment of males for our armed forces or any other job area. You want austistic spectrum kids driving tanks in Iraq? This is a serious problem which impacts an entire male generation. What is your explanation other than to shrug your shoulders and deny the obvious?

  72. #72 Orac
    November 18, 2007

    This finding has been confirmed by later investigators.

    No, it has not. Period. Wakefield’s attempt to link MMR to autism was shoddy science at its worst.

    In the recent Autism Omnibus hearing for the first test case PCR expert Stephen Bustin savaged the sloppy techniques used by Wakefield and his crew. Any real scientist would be downright ashamed, but Wakefield is apparently beyond shame.

    As for the whole “hair excretion” thing, I think Prometheus demolished that myth quite nicely a few months ago.

    Finally, Boyd Haley a “mercury expert”? That’s pretty funny. Frikkin’ hilarious, actually.

  73. #73 daedalus2u
    November 18, 2007

    The “explanation” of low mercury excretion is a completely bogus ad hoc idea to rationalize the belief that mercury causes autism with the observation that mercury cannot be measured. What enzyme system is disrupted that interferes with mercury in hair? By what mechanism? What other symptoms does disruption of this enzyme system(s) lead to? I have a decent explanation of how the “low mercury excretion” idea is wrong in so many different ways in my blog.

    http://daedalus2u.blogspot.com/2007/03/discussion-of-false-mercury-causes.html

    In a nut shell, in the body, mercury attaches to thiols, and is transported around as mercury-thiol adducts, such as a mercury-cysteine adduct and as a mercury-glutathione adduct. Those mercury-thiol adducts are treated pretty much “the same” as the parent thiol for some biological pathways. That is how mercury-cysteine adduct gets incorporated into hair. Hair has a lot of cysteine; the mercury-cysteine content of hair reflects the ratio of mercury-cysteine to mercury-free cysteine at the time of hair growth.

    For “mercury efflux disorder” to be an actual condition, an organism would have to distinguish mercury containing thiols from mercury free thiols in the very important (and multiply redundant) amino acid transporters that are used to transport thiol containing amino acids into hair. This is a condition that has never been observed in any other study of mercury transport in any organism. There are numerous, large, well done studies that show excellent correspondence between blood mercury and hair mercury, with not a single outlier. “Mercury efflux disorder” would show up as an outlier 3 or 4 orders of magnitude out of sync with the others. Have there been any outliers observed in any organism? No, there haven’t been. If there were, it would be an astounding result, which any researcher would want to understand (if they actually observed it).

    An absence of amino acid transporters that could transport mercury thiol adducts would most likely be fatal in utero. We don’t really know because no one has ever observed it.

    An extremely important metabolic and excretion pathway is the attachment of glutathione and then excretion of that glutathione adduct in the bile. A large number of xenobiotic chemicals are metabolized this way, as are a large number of products of normal metabolism. This is the main excretion route for mercury, it is excreted in the bile as the glutathione adduct, and is metabolized by gut bacteria into something that is not absorbed (thought mostly to be metallic mercury or mercury sulfide). Disruption of this glutathione excretion pathway would be fatal. Is it disrupted in ASD children? No, we know it isn’t because they are still alive.

    Regarding Wakefield and PCR, what hole have you been hiding in? Remove the blindfold you have been wearing. Didn’t you follow the Autism Omnibus hearings? Wakefield’s PCR “data”, was shown to all be completely bogus by Stephen Bustin a “real” expert in PCR, who went back to the original data and quite conclusively showed all the “positive” results were due to DNA contamination, and so could not have been from measles RNA. Orac had a good analysis of it, there were many more on the web.

    http://scienceblogs.com/insolence/2007/06/the_autism_omnibus_the_difference_betwee.php

    There was testimony that Wakefield was told the results were false positives and went ahead anyway and published the article as if they were real (causing real injuries and real harm). The bottom line is there is zero credible evidence that measles vaccine virus has ever caused any long term infection.

    I am concerned about autism and ASDs. I do want to find the real cause, and to fix it. I have my own ideas which I discuss in my blog. I think I am right, but I want the “real” answer to be found more than I want to be believed to be correct. In my opinion the largest impediment to genuine autism research right now is the lies and disinformation put out by crank organizations such as Generation Rescue and the other “mercury causes autism” cranks. They don’t care about the real answer; all they want is a shot at winning the “legal lottery” by suing vaccine manufacturers.

    The only “data” supporting “mercury efflux disorder” is that people with autism don’t have high levels of mercury in any tissue compartment that can be measured. The “believer” thinks that means that the one tissue compartment that can’t be measured (the brain) must have 3 or 4 orders of magnitude higher levels of mercury than what a “normal” mercury physiology would predict. Everyone else thinks the correlation between mercury levels in what can be measured and what can’t probably close those seen in every animal that has ever been studied, and in every human that has been studied post mortem, unless there is some evidence to the contrary.

    A deviation of 3 or 4 orders of magnitude from what is “normal” is an extraordinary claim. Extraordinary claims require extraordinary evidence. There isn’t even ordinary evidence, or even any evidence that the idea is correct.

  74. #74 daedalus2u
    November 18, 2007

    Schwartz, when you cite a paper, you are vouching for the accuracy and credibility of the results that you cite it for. If you don’t agree with the results, then you should never cite it. Science isn’t like a court of law, where tricking the court or the jury is sometimes considered “good lawyering”. Trickery is always bad science. Lying is always bad science. Citing discredited results is always bad science. Citing results out of the context they are given in is always bad science. Those who do it are bad scientists, or non-scientists.

    Not all results in the literature are good, and all results should not be given equal weight. There are many wrong conclusions in many papers. Usually the data in papers is good. Sometimes wrong conclusions are drawn from correct data. The example in the Geier paper above is a case in point. Their data shows no evidence of mercury poisoning. The data shows that in these test cases, there is no association of elevated mercury with autism. I would have no trouble citing data from the Geier paper as evidence that there is no elevated mercury in autistic children. Their conclusion that because elevated mercury is not measured, that mercury levels in non-measured tissue compartments must be orders of magnitude higher is delusional and doesn’t follow from their data, or from any data.

    Of course you need to really understand the literature to be able to use data from studies where the conclusions are false (as in the Geier paper). That takes a very high level of understanding and familiarity with the subject matter. I (believe) I have that level of understanding (in autism and mercury) because I have read (and understood) a great deal of the literature on mercury physiology. If the Geier conclusion were correct, lots of the mercury physiology literature would have to be wrong, and wrong in a particular and idiosyncratic direction. That wrongness would spill over into many other areas of physiology, amino acid transport, xenobiotic chemical metabolism, biliary excretion. Hundreds of papers in mercury physiology would have to be discarded, and thousands of papers in other areas would have to be discarded too. That would be an extraordinary occurrence for thousands (or tens of thousands) of papers in the literature to be so wrong and in such an idiosyncratic way for the “mercury efflux disorder” to be credible. Do I discard the work (both data and conclusions) of hundreds or thousands of scientists working independently and decades apart, or do I discard a conclusion (which doesn’t follow from any published data) of a handful of people, all working together, all with the same vested interest in suing vaccine manufacturers?

    Understanding human psychology, while not really a part of science, it useful in understanding cranks. There is a phenomena called “psychological projection”. People have a habit of “projecting” their own motivations onto others. Who is it who is talking of a conspiracy? The cranks who are actually involved in a conspiracy to push the “mercury causes autism” idea so they can defraud vaccine manufacturers.

    http://en.wikipedia.org/wiki/Psychological_projection

    While “follow the money” isn’t a part of good science, it is a part of good fraud busting. Scientists tend to be honest individuals trying to understand extremely complicated things such as physiology. Any answer that is simple and quick is likely to be wrong. Quacks have to have answers that are simple and quick so they can get their money and move on. Good science is really difficult. Fraud is simple.

  75. #75 thyme_aerosol
    November 18, 2007

    Finally, Boyd Haley a “mercury expert”? That’s pretty funny. Frikkin’ hilarious, actually.

    Orac has no respect for his academic superiors.

    Boyd E. Haley’s Selected Publications

    R. R. Drake, R. K. Evans, M. J. Wolf and B. E. Haley, “Synthesis and Properties of 5-Azido-UDP-Glucose: Development of Photoaffinity Probes for Nucleotide Diphosphate Sugar Binding Sites,” J. Biol. Chem., 264, 11928-11933 (1989).

    A. J. Chavan, H. Kim, B. E. Haley and D. S. Watt, “A Photoactive Phosphonamide Derivative of GTP for the Identification of the GTP Binding Domain of beta-Tubulin”, Bioconjugate Chemistry, 1, No. 5, 337-344 (1990).

    S. Campbell, H. Kim, M. Doukas and B. Haley, “Photoaffinity Labeling of ATP and NAD+ Binding Sites on Recombinant Human Interleukin-2,” Proc. Natl. Acad. Sci., 87, 1243-1246 (1990).

    H. Kim and B. Haley, “Identification of Peptides in the Adenine Ring Binding Domain of Glutamate and Lactate Dehydrogenase Using 2-Azido-NAD+,” Bioconjugate Chemistry, 2, 142-147 (1991).

    B. Haley, “Nucleotide Photoaffinity Labeling and Identification of Protein Kinase Subunits,” Meth. Enzymol., 200, 477-487 (1991).

    M. Salvucci, A. Chavan and B. Haley, “Identification of Peptides for the Adenine Binding domains of ATP and AMP in Adenylate Kinase: Isolation of Photoaffinity Labeled Peptides by Metal Chelate Chromatography,” Biochemistry, 31, 4479-4487 (1992).

    M. Shoemaker, P. C. Lin and B. Haley, “Identification of the Guanine Binding Domain Peptide of the GTP Binding Site of Glucagon,” Protein Science, 1, 884-891 (1992).

    A. Chavan, Y. Nemoto, S. Narumiya, S. Kozaki and B. Haley, “NAD+ Binding Site of Clostridium Botulinum C3 ADP-ribosyltransferase: Identification of Peptide in the Adenine Ring Binding Domain Using 2-Azido NAD+,” J. Biol. Chem., 267, 14866-14870 (1992).

    M. Doukas, A. Chavan, C. Gass, T. Boone and B. Haley, “Identification and Characterization of a Nucleotide Binding Site on Recombinant Murine Granulocyte/Macrophase-Colony Stimulating Factor. Bioconjugate Chemistry, in press (1992).

    D. J. Gunnersen and B. E. Haley, “Detection of glutamine Synthetase in the Cerbrospinal Fluid of Alzheimer’s Diseased Patients: A Potential Diagnostic Biochemical Marker,” Proc. Natl. Acad. Sci. USA, accepted (1992).

    M. Shoemaker and B. E. Haley, “Identification of the Guanine Binding Domain Within Glutamate Dehydrogenate,” submitted (1992).

    D. M. Hiestand, B. E. Haley and M. S. Kindy, “Role of Calcium in Inactivation of Calcium/-Calmodulin Dependent Protein Kinase II After Cerebral Ischemia,” Journal of the Neurological Sciences, 113, 31-37 (1992).

    M. E. Salvucci, A. J. Chavan and B. E. Haley, “Identification of Peptides from the Adenine Binding Domains of ATP and AMP in Adenylate Kinase: Isolation of Photoaffinity-Labeled Peptides by Metal Chelate Chromatography,” Biochemistry, 31, 4479-4487 (1992).

    M. Shoemaker, P. C. Lin and B. Haley, “Identification of the Guanine Binding Domain Peptide of the GTP-Binding Site of Glucagon,” Protein Science, 1, 884-891 (1992).

    M. A. Doukas, A. J. Chavan, C. Gass, T. Boone and B. E. Haley, “Identification and Characterization of a Nucleotide Binding Site on Recombinant Murine Granulocyte/-Macrophage-Colony Stimulating Factor,” Bioconjugate Chemistry, 3, 484-492 (1992).

    A. W. Segal, I. West, F. Wientjes, J. H. A. Nugent, A. J. Chavan, B. Haley, R. C. Garcia, H. Rosen and G. Scrace, “Cytochrome b 245 is a Flavocytochrome Containing FAD and the NADPH-Binding Site of the Microbicidal Oxidase of Phagocytes,” Biochem. J., 284, 781-788 (1992).

    D. C. Hammond, B. E. Haley and J. A. Lesnaw, “Identification and Characterization of Serine/Threonine Protein Kinase Activity Intrinsic to the L Protein of Vesicular Stomatitis Virus New Jersey,” Journal of General Virology, 73, 67-75 (1992).

    A. J. Chavan, Y. Nemoto, S. Narumiya, S. Kozaki and B. E. Haley, “NAD+ Binding Site of Clostridium botulinum C3 ADP-ribosyltransferase: Identification of Peptide in the Adenine Ring Binding Domain Using 2-Azido NAD+,” J. Biol. Chem., 267, 14866-14870 (1992).

    D. Gunnersen and B. Haley, “Detection of Glutamine Synthetase in the Cerebrospinal Fluid of Alzheimer’s Diseased Patients: A Potential Diagnostic Biochemical Marker,” Proc. Natl. Acad. Sci. USA, 89, 11949-11953 (1992).

    M. Shoemaker and B. Haley, “Identification of a Guanine Binding Domain Peptide of the GTP Binding Site of Glutamate Dehydrogenase: Isolation with Metal-Chelate Affinity Chromatography,” Biochemistry, 32, 1883-1890 (1993).

    S. B. Churn, B. Sankaran, B. E. Haley and R. J. Delorenzo, “Ischemic Brain Injury Selectively Alters ATP Binding of Calcium and Calmodulin-Dependent Protein Kinase-II,” Biochem. Biophys. Res. Comm., 193(3), 934-940 (1993).

    M. Salvucci, K. Rajagopalan, G. Sievert, B. Haley and D. Watt, “Photoaffinity Labeling of Rubisco Activase with ATP- -benzophenone: Identification of the ATP -Phosphate Binding Domain,” J. Biol. Chem., 268, 14239-14244 (1993).

    K. Rajagopalan, A. Chavan, B. Haley and D. Watt, “Bidentate Cross-Linking Reagents: Non-Hydrolyzable Nucleotide Photoaffinity Probes with Two Photoactive Groups,” J. Biol. Chem., 268, 14245-14253 (1993).

    C. Trad, A. Chavan, J. Clemens and B. Haley, “Identification and Characterization of an NADH Binding Site of Prolactin with 2-Azido-NAD+,” Arch. Biochem. Biophys., 304, 58-64 (1993).

    A. Chavan, C. Ensor, P. Wu, B. Haley and H. Tai, “Photoaffinity Labeling of Human Placental NAD+-Linked 15-Hydroxyprostaglandin Dehydrogenase with [ 32P]-2N3NAD+: Identification of a Peptide in the Adenine Ring Binding Domain,” J. Biol. Chem., 268, 16437-16442 (1993).

    A. Chavan, S. Richardson, H. Kim, B. Haley and D. Watt, “Forskolin Photoaffinity Probes for the Evaluation of Tubulin Binding Sites,” Bioconjugate Chem., 4, 268-274 (1993).

    E. F. Duhr, J. C. Pendergrass, J. T. Selvin and B. Haley, “HgEDTA Complex Inhibits GTP Interactions with the E-Site of Brain -Tubulin,” Toxicology and Applied Pharmacology, 122, 273-288 (1993).

    B. Jayaram and B. Haley, “Identification of Peptides Within the Base Binding Domains of the GTP and ATP Specific Binding Sites of Tubulin,” J. Biol. Chem., 269(5), 3233-3242 (1994).

    A. Chavan, B. Haley, D. Volkin, K. Marfia, A. Verticelli, M. Bruner, J. Draper, C. Burke and R. Middaugh, “Interaction of Nucleotides with Acidic Fibroblast Growth Factor (FGF-1),” Biochemistry, 33, 7193-7202 (1994).

    J. Logan, D. Hiestand, P. Daram, Z. Huang, D. Muccio, J. Hartman, B. Haley, W. Cook and E. Sorscher, “Cystic Fibrosis Transmembrane Conductance Regulator Mutations that Disrupt Nucleotide Binding,” J. Clin. Invest., 94, 228-236 (1994).

    M. Olcott and B. Haley, “Identification of Two Peptides from the ATP-Binding Domain of Creatine Kinase,” Biochemistry, 33, 11935-11941 (1994).

    A. Bhattacharyya, A. Chavan, M. Shuffett, B. Haley and D. Collins, “Photoaffinity Labeling of Rat Liver Microsomal 5 -Reductase by 2-Azido-NADP+,” Steroids, 59, 634-641 (1994).

    M. Salvucci, A. Chavan, R. Klein, K. Rajagopalan and B. Haley, “Photoaffinity Labeling of the ATP Binding Domain of Rubisco Activase and a Separate Domain Involved in the Activation of Ribulose-1,5-Bisphosphate Carboxylase/Oxygenase,” Biochemistry, 33, 14879-14886 (1994).

    J. C. Pendergrass and B. E. Haley, “Mercury-EDTA Complex Specifically Blocks Brain -Tubulin-GTP Interactions: Similarity to Observations in Alzheimer’s Disease,” in Status Quo and Perspective of Amalgam and Other Dental Materials, (International Symposium Proceedings, L. T. Friberg and G. N. Schrauzer, Eds.), Georg Thieme Verlag, Stuttgart-New York, 1995, pp. 98-105.

    M. Doukas, A. Chavan, C. Gass, P. Nickel, T. Boone and B. Haley, “Inhibition of GM-CSF Activity by Suramine and Suramin Analogues is Correlated to Interaction with the GM-CSF Nucleotide Binding Site,” Cancer Research, 55, 5161-5163 (1995).

    A. K. Bhattacharyya, A. J. Chavan, B. Haley, M. F. Taylor and D. C. Collins, “Identification of the NADP(H) Binding Site of Rat Liver Microsomal 5 -Reductase (Isozyme-1): Purification of a Photolabeled Peptide Corresponding to the Adenine Binding Domain,” Biochemistry, 34, 3663-3669 (1995).

    A. Chavan, C. Gass, B. Haley, T. Boone and M. A. Doukas, “Identification of N-Terminus Peptide of Human Granulocyte/Macrophage Colony Stimulating Factor as the Site of Nucleotide Interaction,” Biochem. Biophys. Res. Commun., 208(1), 390-396 (1995).

    M. Shoemaker and B. Haley, “Identification of the Adenine Binding Domain Peptides of the ADP Binding Site of Glutamate Dehydrogenase,” Bioconjugate Chemistry, 7, 302-310 (1996).

    K. Rajagopalan, G. Pavlinkova, S. Levy, R. Pokkuluri, M. Schiffer, B. Haley and H. Kohler,” Novel Unconventional Binding Site in the Variable Region of Immunoglobulins,” Proc. Natl. Acad. Sci., 93, 6019-6024 (1996).

    J. C. Pendergrass and B. E. Haley, “Inhibition of Brain Tubulin-Guanosine 5 -Triphosphate Interactions by Mercury: Similarity to Observations in Alzheimer’s Diseased Brain,” in Metal Ions in Biological Systems V34, Mercury and Its Effects on Environment and Biology, H. Sigel and A. Sigel, Eds., Marcel Dekker, Inc., 270 Madison Avenue, New York, NY, Chapter 16, 10016 (1996).

    M. McGuire, L. J. Carroll, L. Yankie, S. H. Thrall, D. Dunaway-Mariano, O. Hertzberg, B. Jayaram and B. Haley, “Determination of the Nucleotide Binding Site Within Clostridium symbiosum Pyruvate Phosphate Dikinase by Photoaffinity Labeling, Site-Directed Mutagenesis, and Structural Analysis,” Biochemistry, 35, 8544-8552 (1996).

    H. Kohler, G. Pavlinkova and B. Haley, “Immunoglobulin Nucleotide Binding Site: A Possible Superantigen Receptor,” in Human B Cell Superantigens, M. Zouali, Ed., Chapter 13, 1996, pp. 189-194.

    B. Sankaran, A. Chavan and B. E. Haley, “Identification of Adenine Binding Domain Peptides of the NADP+ Active Site Within Porcine Heart NADP+-Dependent Isocitrate Dehydrogenase,” Biochemistry, 35, 13501-13510 (1996).

    G. Pavlinkova, K. Rajagopalan, S. Muller, A. Chavan, G. Sievert, D. Lou, C. O’Tolle, B. Haley and H. Kohler, “Site-Specific Photobiotinylation of Immunoglobins, Fragments and Light Chain Dimers,” J. Immunological Methods, 201, 77-88 (1997).

    B. Sankaran, J. Clemens and B. Haley, “A Comparison of Changes in Nucleotide-Protein Interactions in Striatal, Hippocampus and Paramedian Cortex After Cerebral Ischemia and Reperfusion: Correlations to Regional Vulnerability,” Molecular Brain Research, 47, 237-250 (1997).

    K. Hensley, P. Cole, R. Subramaniam, M. Aksenov, M. Aksenova, P. M. Bummer, B. E. Haley, J. M. Carney and D. A. Butterfield, , “Oxidatively-Induced Structural Alteration of Glutamine Synthetase Assessed by Analysis of Spin Labeled Incorporation Kinetics: Relevance to Alzheimer’s Disease,” J. Neurochem., 68, 2451-2457 (1997).

    J. C. Pendergrass, B. E. Haley, M. J. Vimy, S. A. Winfield and F. L. Lorscheider, “Mercury Vapor Inhalation Inhibits Binding of GTP to Tubulin in Rat Brain: Similarity to a Molecular Lesion in Alzheimer’s Disease Brain,” Neurotoxicology, 18(2), 315-324 (1997).

    M. C. Olcott and B. E. Haley, “Identification of an Adenine-Nucleotide Binding Site on Interferon- 2,” Eur. J. Biochem., 247(3), 762-769 (1997).

    S. David, M. Shoemaker and B. Haley, “Abnormal Properties of Creatine Kinase in Alzhiemer’s Disease Brain: Correlation of Reduced Enzyme Activity and Active Site Photolabeling with Aberrant Cytosol-Membrane Partitioning,” Molecular Brain Research, 54, 276-287 (1998).

    Y. Chen, R. C. Haddon, S. Fang, A. M. Rao, P. C. Eklund, W. H. Lee, E. C. Dickey, E. A. Grulke, J. C. Pendergrass, A. Chavan, B. E. Haley and R. E. Smalley, “Chemical Attachment of Organic Functional Groups to Single-Walled Carbon Nanotube Material,” J. Mater. Res., 13, 2423-2431 (1998).

    S. S. M. David, and B. E. Haley, “ATP Nucleotidylation of Creatine Kinase”, Biochemistry 38, 8492-8500 (1999).

    K. Rajagopalan, D. S. Watt, and B. E. Haley, “Orientation of GTP and ADP within their respective binding sites in glutamate dehydrogenase”, Eur. J. Biochem. 265, 564-571 (1999).

  76. #76 Orac
    November 18, 2007

    My academic superior? Ten or fifteen years ago, sure, but not now. Since then, he’s thrown his reputation away in pursuit of pseudoscience.

    Indeed, I notice that none of those articles you cite are less than 8 years old.

    Boyd Haley did start out being a respectable scientist, but then something happened. I don’t know what it was, but sometime in the last several years he became a major crank and cranked out a bunch of highly dubious papers claiming that mercury causes autism, in essence squandering the previous respect that he had earned to get these papers published in journals that would have rejected them out of hand had they not come from Haley. Now, Haley can’t even win a Daubert ruling to be considered a valid “expert” witness in autism cases:

    Undead bad science
    We interrupt this blog for breaking news…
    Armchair science vs. real science
    Daubert: Haley and Geier

  77. #77 thyme_aerosol
    November 18, 2007

    Boyd Haley did start out being a respectable scientist, but then something happened. I don’t know what it was, but sometime in the last several years he became a major crank and cranked out a bunch of highly dubious papers claiming that mercury causes autism

    Court proceedings are a battle between the plaintiff and the defendant, and motions can go either way. One typical ploy is to disqualify the plaintiff’s expert witness as a legal maneuver. Haley is very qualified as seen here, Haley served as (1985-1997 )Professor of Medicinal Chemistry, College of Pharmacy, University of Kentucky, with joint appointments in Biochemistry & Chemistry 1997-present Chairman & Professor, Department of Chemistry with joint appointment in College of Pharmacy. And, Haley has testified before the House Government Reform Committee November 14, 2002.

    What is Orac’s definition of an expert?

    “Anyone who says that mercury doesn’t cause austism”? Thats what.

    What’s Orac’s explanation for the increasing epidemic of autism which is claiming this and subsequent male generations?

    On June 4, 2004, the U.S. Office of Special Counsel forwarded to Congress hundreds of disclosures from private citizens alleging public health concerns about thimerosal in childhood vaccines.

    It is alleged that:

    1. Vaccines containing 25 mcg of mercury per dose continue to be produced and administered.

    2. Some data sets showing a relationship between thimerosal and neurologic disorders no longer exist.

    3. Independent researchers have arbitrarily been denied access to CDC databases.

    It is also alleged that the CDC and the FDA colluded with pharmaceutical companies at a conference in Norcross, Ga., in June 2000 to prevent release of a study showing a statistical correlation between thimerosal exposure and autism, attention deficit disorder, and speech and language delays.

    Instead of releasing the data presented at the conference, the author of the study, Dr. Thomas Verstraeten, later published a different version of the study in the November 2003 issue of Pediatrics, which did not show a statistical correlation. No explanation has been provided for this discrepancy.

    Orac, the sockpuppet of establishment medicine, is closing his eyes to one of the greatest scandals in medical science, the Thimerosol scandal. This is nothing unusual, as we have seen this type of thing before. The tobacco scandal for example was a predecessor.

    Tobacco Science and the Thimerosal Scandal

  78. #78 daedalus2u
    November 18, 2007

    thyme_aerosol, how about some actual data on actual mercury levels? Citing Haley’s papers on unrelated research is of zero informative value.

    If there is zero data to support the “mercury efflux disorder” idea, either gather data, or admit there isn’t any and move on. If Haley has no data to back up his assertion, his assertion is of zero value. If he has data, why isn’t he showing it?

    Thimerosal has been removed from most childhood vaccines and there has been no reduction in autism.

    How low do mercury levels need to go before there is no effect of mercury toxicity?

  79. #79 daedalus2u
    November 18, 2007

    thyme_aerosol, in science, no “expert” is given any credence based solely on their reputation. What counts is data. There is zero data to support the idea that mercury causes autism, and lots of data to refute it.

    The average 100 gram can of tuna fish contains 35 micrograms of mercury. About a million tons of canned tuna fish is produced, sold, and consumed, resulting in 10 billion 35 microgram doses of mercury.

    Unsupported allegations of a conspiracy are not data about mercury. Until there is some data that renders plausible the extraordinary notion that the amount of mercury in a can of tuna can cause autism, it remains the extraordinary claim that it is.

  80. #80 thyme_aerosol
    November 18, 2007

    The average 100 gram can of tuna fish contains 35 micrograms of mercury. About a million tons of canned tuna fish is produced, sold, and consumed, resulting in 10 billion 35 microgram doses of mercury.

    Again you are confusing oral elemental mercury with injection of ethyl mercury. Very different in terms of toxicity.

    tuna and mercury

    James Hammitt, director of the Harvard Center for Risk Analysis “Some very large share of mercury exposure comes from tuna,”

    There are literally tons of data on mercury toxicity:
    look at the cord blood mercury levels for one.

    Public Health and Economic Consequences of Methyl Mercury Toxicity to the Developing Brain

    Methyl mercury is a developmental neurotoxicant. Exposure results principally from consumption by pregnant women of seafood contaminated by mercury from anthropogenic (70%) and natural (30%) sources. Throughout the 1990s, the U.S. Environmental Protection Agency (EPA) made steady progress in reducing mercury emissions from anthropogenic sources, especially from power plants, which account for 41% of anthropogenic emissions. However, the U.S. EPA recently proposed to slow this progress, citing high costs of pollution abatement. To put into perspective the costs of controlling emissions from American power plants, we have estimated the economic costs of methyl mercury toxicity attributable to mercury from these plants. We used an environmentally attributable fraction model and limited our analysis to the neurodevelopmental impacts–specifically
    loss of intelligence. Using national blood mercury prevalence data from the Centers for Disease Control and Prevention,

    we found that between 316,588 and 637,233 children each year have cord blood mercury levels > 5.8 μg/L, a level associated with loss of IQ.

    The resulting loss of intelligence causes diminished economic productivity that persists over the entire lifetime of these children. This lost productivity is the major cost of methyl mercury toxicity, and it amounts to $8.7 billion annually (range, $2.2-43.8 billion; all costs are in 2000 US$). Of this total, $1.3 billion (range, $0.1-6.5 billion) each year is attributable to mercury emissions from American power plants. This significant toll threatens the economic health and security of the United States and should be considered in the debate on mercury pollution controls.

  81. #81 Orac
    November 18, 2007

    Orac, the sockpuppet of establishment medicine, is closing his eyes to one of the greatest scandals in medical science, the Thimerosol scandal. This is nothing unusual, as we have seen this type of thing before. The tobacco scandal for example was a predecessor.

    Tobacco Science and the Thimerosal Scandal

    Citing RFK, Jr. now? You’re going downhill. Crank that he is, he is just too easy to refute:

    From the vaults: RFK, Jr. gets his first ever taste of Respectful Insolence™
    Mercury and autism: RFK Jr. drops another stinky one on the blogosphere
    Robert F. Kennedy Junior’s completely dishonest thimerosal article
    Lies, damn lies, and quote mining
    Simpsonwood, thimerosal, and vaccines (II)
    RFK Jr. is at it again, just not about autism this time
    A myth memorialized (a.k.a. “Simpsonwood Remembered”)
    Robert F. Kennedy, Jr. has declared a crank-off!

    As for the “sockpuppet” line, all I can say is: That’s a very predictable use of the “pharma shill” gambit.

  82. #82 daedalus2u
    November 18, 2007

    I am not sure I understand your point. The study you link to uses a no effect threshold of 3.41 micrograms Hg/L blood. According to the NHANES 1999 survey, that blood level occurs (in children) at a hair level of 1.17 ppm (blood level times 342+/- 20, n=838).

    http://www.ehponline.org/members/2004/7046/7046.html

    For every child in the study you cited by the Geiers every single hair mercury level was a fraction of that level. In some cases a tiny fraction. The study you link to would predict no effect from mercury toxicity for each and every child tested, chelated and then tested again by the Geiers.

    For the children to have any significant mercury toxicity, they would need blood mercury levels on the order of 100 micrograms/L. One child had a hair mercury of less than 0.03 ppm. For that child to have a blood mercury of 100 micrograms/L, their “mercury efflux disorder” would require the ratio of hair mercury to blood mercury to be less than 0.3 instead of 342. A difference of 1000 fold. In the complete absence of any data suggesting that such a thing is physiologically possible, my default position (based on every study on mercury in blood and hair that has ever been done and everything that is well known about mercury and thiol physiology) is that it isn’t. If there is some data to suggest otherwise I would be open to looking at it, but the mere assertion that such an astounding event has occurred is not enough.

  83. #83 howzbayou
    November 18, 2007

    “On June 4, 2004, the U.S. Office of Special Counsel forwarded to Congress hundreds of disclosures from private citizens alleging public health concerns about thimerosal in childhood vaccines.”

    Give me a break. Those “hundreds of disclosures” were generated in a lobbying campaign by their Geiers and their courtroom pals, who got “Bush’s House Homophobe” Scott Bloch to do exactly what they wanted him to do — i.e., turn their allegations into an opportunity to do some grandstanding of his own.

  84. #84 thyme_aerosol
    November 18, 2007

    Citing RFK, Jr. now? You’re going downhill. Crank that he is, he is just too easy to refute:

    This is Orac’s obvious game. RFK Jr or anybody else that doesnt agree with the establishment position (ie Orac) is a crank and is ridiculed. Orac, this is a little too simple for sophisticated readers. The links to other blogs basically do the same thing. That’s no refutation. That’s an admission of failure.

    Orac still has no explanation for the increasing epidemic of autism. And no admission by Orac of the neurotoxicity of methyl and ethyl mercury which is well documented in the medical literature.

    I must say that doesnt exactly instill confidence in the great “Orac”le.

    There is abundant data linking mercury to cognitive, neurological dysfunction.

    Theoretical estimation of blood mercury levels from Thimerosal injections using a one compartment biokinetic model.

    (An analysis to “bound” potential mercury tissue levels)Prepared for the IOM meeting on Thimerosal and Vaccines]
    Boston, July 16, 2001 David R. Brown Sc.D. Public Health Toxicologist Westport Connecticut July 15, 2001

    Here is another study which shows that higher maternal and cord blood mercury levels correlates with lower cognitive function in the infant.

    Effects of prenatal exposure to mercury on cognitive and psychomotor function in one-year-old infants: epidemiologic cohort study in Poland.

    Jedrychowski W, Jankowski J, Flak E, Skarupa A, Mroz E, Sochacka-Tatara E, Lisowska-Miszczyk I, Szpanowska-Wohn A, Rauh V, Skolicki Z, Kaim I, Perera F.

    Chair of Epidemiology and Preventive Medicine, College of Medicine, Jagiellonian University, Krakow, Poland. myjedryc@cyf-kr-edu.pl

    PURPOSE: The aim of the study is to assess the cognitive and psychomotor status of 1-year-old infants whose mothers were exposed to low, but varying, amounts of mercury during pregnancy.

    METHODS: Mercury levels in cord and maternal blood at delivery were used to assess prenatal environmental exposure to mercury. Bayley Scales of Infant Development were used to assess neurobehavioral health outcomes. The cohort consisted of 233 infants who were born at 33 to 42 weeks of gestation between January 2001 and March 2003 to mothers attending ambulatory prenatal clinics in the first and second trimesters of pregnancy. Enrollment included only nonsmoking women with singleton pregnancies between the ages of 18 and 35 years who were free from chronic diseases.

    RESULTS: The geometric mean (GM) for maternal blood mercury level for the group of infants with normal neurocognitive performance was lower (GM = 0.52 mug/L; 95% confidence interval [CI], 0.46-0.58) than that observed in the group with delayed performance (GM = 0.75 mug/L; 95% CI, 0.59-0.94), and this difference was significant (p = 0.010). The GM of cord blood mercury level in the normal group also was lower (GM = 0.85 mug/L; 95% CI, 0.78-0.93) than that observed in the group with delayed performance (GM = 1.05 mug/L; 95% CI, 0.87-1.27), and this difference was of borderline significance (p = 0.070).

    The relative risk (RR) for delayed performance increased more than threefold (RR = 3.58; 95% CI, 1.40-9.14) if cord blood mercury level was greater than 0.80 mug/L.

    Risk for delayed performance in the group of infants with greater maternal mercury levels (>0.50 mug/L) also was significantly greater (RR = 2.82; 95% CI, 1.17-6.79) compared with children whose mothers had mercury levels less than 0.50 mug/L.

    CONCLUSIONS: The results may be of public health importance because delayed psychomotor or mental performance in infants is assumed to be an indicator of later neurocognitive development in children, which may persist into adult life.

    If elevated mercury level in maternal or cord blood is associated with neurocognitive delay in infants, what do you think injecting ethyl mercury in infants is going to do? Oh yeah sure, it is perfectly safe. If you believe that, I’ve got the Brooklyn Bridge to sell you.

    how’s that for a little respectful insolence?

  85. #85 Shiritai
    November 18, 2007

    That first study has lost its data tables :( Also, why use a theoretical study when there are good experimental and observational studies? The second study makes a very good case for not eating fish while pregnant. Also, here for the link. However, comparing continuous exposure to mercury due to diet with single exposure due to thimerosol is comparing apples to oranges. Neither of these studies make your point.

  86. #86 Shiritai
    November 18, 2007

    Dangit, can’t get the link to work. Anyways, the second study can be found here : http://www.mailman.hs.columbia.edu/ccceh/pdf-papers/JedrychowskiAnnalsEpiNov2005.pdf

  87. #87 daedalus2u
    November 18, 2007

    No one has said that injecting or ingesting mercury is good.

    Mercury being bad for one does not mean that mercury causes autism. There is still not a bit of data or evidence that any exposure to mercury has any relationship to autism.

    The data in the Geier paper you cited shows mercury levels well below the levels found in this Polish paper. 6 of 7 children had hair mercury levels indicating blood mercury levels below the 0.8 microgram/L cutoff (using hair/342 = blood).

    This paper would predict no effect of mercury in those children.

  88. #88 Schwartz
    November 18, 2007

    Daedelus2u,

    Wow, the comments just exploded. Thanks for answering the articles question. I am not an academic, although I have a background in science (engineering). I have read several of the medical papers (on my own dime) and I can tell you I’ve read more crap than quality on both sides of the argument, hence the question of references.

    As for understanding the data, that is a whole other issue. The work of the statistician is done secretly and the data isn’t available, so that makes many of these studies hard to evaluate for anyone.

    Your comments about fraud busting are completely valid. I also agree that most of the scientists are honest. However, science is playing only one part of our western medical practise. Politics, profit, and corporate interests also play a big part and following the money here, is equally useful despite continuous denials from blogs like this.

    I have read too many quotes and writeups from these “political” scientists or governmental organizations that reek of many of the fraudulant tactics you accuse the CAM practitioners of doing. My observations are that fraud abounds — to varying degrees admitedly — all over.

    Sorting through the mess is what many of us are attempting to do. Reading this unbalanced blog along many others gives me lots of food for thought. Orac always provides some very good information and links.

  89. #89 daedalus2u
    November 19, 2007

    Schwartz, actually Orac’s blog is pretty balanced, at least for everything that I have expertise in and can evaluate. I have never seen him report something out of context or dubious as being factual. He does exagerate some of the woo, but that is pretty obviously for effect and humor. If he makes a mistake, he does correct it, something that no one in “alternative medicine” ever does.

    To paraphrase, statements of fact are never unbalanced.

  90. #90 ozzy
    November 19, 2007

    Thyme-aerosol:
    “Again you are confusing oral elemental mercury with injection of ethyl mercury. Very different in terms of toxicity.”

    The Hg in tuna is ORGANIC MERCURY, mainly methyl Hg, a breakdown product of ethyl mercury.

    Explain to me:
    Why the incidence of autism is not decreasing with the advent of preservative-free vaccines?

  91. #91 Schwartz
    November 19, 2007

    Daedalus2u,

    I agree that Orac is fairly balanced and rarely makes factual mistakes. But as you said, he will exaggerate the woo, and he often sterotypes everyone with the same brush (you’ll note my posts here are often trying to point that out). He’s also quick to insult people of other opinions and these things lead to a significant imbalance IMO. His reference to the Novella podcast in this thread was a lot of garbage, littered with opinion and insult, and very limited on actual verifiable facts. There were many misleading statements, and even some factual errors. To say it exaggerated things, is an understatement. As you stated earlier, you are vouching for the material if you reference something.

    Although some of this may come across as humorous in many instances, it can be very misleading to the uneducated — especially the exaggerations, many of which are opinion mixed with fact. Very few things in life as black and white as often portrayed. There is far more than humour lurking there and the attitude is consistent with academic elitism. I would venture to say it is typical of the attitudes that tend to turn people away from the medical profession. If one constantly insults others or exaggerates one’s position it decreases your credibility.

  92. #92 Orac
    November 19, 2007

    There were many misleading statements, and even some factual errors.

    Name a single factual error.

  93. #93 daedalus2u
    November 19, 2007

    Schwartz, I do not at all agree with your characterization of Orac. I don’t look at podcasts, so I can’t vouch for what is on them, but I do frequent Novella’s blog and never have I found him to post something erroneous or gratuitously insulting. I have a different view of the placebo effect that he does, his is the more conservative “standard” view. My own research is in exactly that area (basal nitric oxide), and some of my views haven’t made it into the main stream yet. It is very difficult to break into the mainstream with something that is “far out”, even when it is correct. Scientific peers are extremely conservative. They (rightfully) demand data, and acquiring that data requires funding which requires some degree of acceptance. I am sure that if I had sufficient data, that my NO ideas would be accepted. Getting that data is quite difficult given my circumstances. I can’t expect anyone to accept my ideas without data.

    Most of the things portrayed as black and white actually are. There is zero evidence for virtually all of the CAM treatment modalities. Most of the explanations are completely non-physical and non-physiologic. We know there is no unknown life-force that flows in the body and can be manipulated. It is not an exaggeration to call them on their non-reality based beliefs. Some, such as homeopathy have no credible physiological theory as to why they might work, other than the placebo effect. It is not at all a close call to say they are placebos and only placebos.

    People who believe these things do so for no good reasons, and they are doing actual harm to naive people who could be helped to better health by actual treatments. I have no respect for those who harm others even when it is through ignorance. Those who believe foolish things and use those foolish beliefs to take money from others and harm them in the process are not people who I think are worthy of respect. There is a great deal of very good information available for free, on PubMed. People who don’t avail themselves of it do so only because they wish too remain ignorant.

    Given my understanding of the placebo effect, it is clear to me how and why these things work. Placebos work best on disorders characterized by low NO, precisely the things that I am working on. Some of those disorders also happen to be things that EBM doesn’t do very well on. It really is EBM and woo. Woo that can show itself to achieve therapeutic effects reliably becomes part of evidence based medicine and is no longer woo.

    There is a risk (very slight risk) of abandoning woo-based therapies that have a hint of actual physiology behind them before that physiology is understood. I posted some physiology behind how urine-based therapies might (I repeat might) have physiological effects at White Coat Underground.

    http://whitecoatunderground.com/2007/11/14/if-its-yellow-let-it-mellow/

    Are there real health effects from urine therapy? I don’t know. Do I use urine therapy in any way, shape or form? No, I do not. Would I recommend urine therapy? No I would not. Can I explain positive health effects via nitric oxide from urine therapy if there are any? Yes I can. If so, it has nothing to do with urine, but rather with NO physiology which is better regulated in other ways.

    But often folk treatments can morph into treatments that lose the original physiological basis. I think sauna has done so. Sauna has been practiced for millennia. Often it was the first building put up in a homestead. Virtually every non-tropical culture has the custom of sweat baths. In the last century or so, bathing afterward has become part of the sauna ritual. I think this is actually counter productive. My hypothesis is that sauna developed to release sweat so as to nourish a resident biofilm of autotrophic ammonia oxidizing bacteria, and that these bacteria then set the basal NO and nitrite level. Bathing removes the biofilm and the sweat residues that provide this function. Sauna now may have only a tiny fraction of the health effects it had 2000 years ago when people never bathed in their entire lives.

    Similarly, urine therapy as practiced now with sterile fresh urine applied to clean skin may have none of the effects of urine oxidized to nitrite by a culture of ammonia oxidizing bacteria resident in the clay pot it was stored in and then applied to never-washed skin with a resident biofilm of the same bacteria.

    A culture of these bacteria in synthetic sweat, free of organic so no heterotrophic bacteria can grow is what I am trying to commercialize. I can’t go the woo route because what I have isn’t woo, and I am no good at lying to people. If I could find a CAM program at a medical school that was willing to test what I have, that would be great. But it isn’t urine, so it doesn’t have enough “woo” to be considered.

  94. #94 thyme_aerosol
    November 19, 2007

    Explain to me: Why the incidence of autism is not decreasing with the advent of preservative-free vaccines?

    Explain first why the incidence of autism is increasing, period.

  95. #95 daedalus2u
    November 19, 2007

    Autism is increasing because of reduced basal nitric oxide in utero which skews physiology in the developing fetus to the “high stress” phenotype. In some individuals that means more on the ASD spectrum. The reason for this decline in nitric oxide is the loss of the normal commensal skin bacteria which oxidize ammonia into nitrite.

    I discuss this in more detail on my blog.

    So now tell us: Why the incidence of autism is not decreasing with the advent of preservative-free vaccines?

    The reason is because the increase (or any cases) was never due to mercury or vaccines in the first place.

  96. #96 ozzy
    November 19, 2007

    “Explain first why the incidence of autism is increasing, period.”

    Of course you didn’t answer my question because you can’t. Because the increase isn’t due to thimerasol. Two of the most important Hill causality criteria deal with temporality and dose-response. That being the exposure occurs before the disease and increasing doses result in increasing occurence of disease. In the case of thimerasol, these two important criteria are not met. Children’s exposure to thimerasol is MUCH LESS than it was before 2002 and yet the disease incidence supposedly increases. I say supposedly because it is not definitive that the actual number of people with autism spectrum disorders is increasing but instead the number of people CORRECTLY diagnosed with ASD, according to the 1994 criteria, is increasing and eventually will reach an equilibrium. I think it is clear that the change in diagnostic criteria has played a major role in the number of autistic children increasing. I believe Orac has previously reviewed a paper that looked at the contribution of the new criteria to the “increased” incidence. Remember, a diagnosis of ASD is not a clear cut diagnosis. There is no clearly objective biochemical test that can be performed to definitively demonstrate ASD. This is especially true in children with the “non-classical autism” diagnoses (asperger sp?, etc). It takes a long time for clinicians to be able to recognize these more subtle conditions when in the past these children were written off as “learning disabled” or “antisocial.” Look at the decrease in so called “learning disabled” children during the time of the so called autism epidemic. Where have they all gone? So there is a learning curve in regards to diagnoses and that is why autism is increasing, IMO.

  97. #97 Schwartz
    November 20, 2007

    Daedalus2u,

    The only podcast I ever listened to was the one referenced by Orac in his post to me. I wouldn’t have even cared as much if it had been 5 minutes long, but I had to listen to nearly 60 minutes of drivel to get to the point he referenced. It was mostly insulting garbage attempting to be entertaining. But I’ll put that aside as an anamoly.

    My perspective is not to automatically write off every CAM treatment by default, because I have personally experimented with many of them. Do I think some of them are woo? Absolutely. Can I explain why some of them appear to work? Nope. Did I approach each treatment skeptically? Absolutely. Several of the treatments gave consistently good results, far better results than western medical treatments (usually for things western medicine really has no understanding or treatment for). Could it have been placebo? Possibly, but I am skeptical of that because if the efficacy is consistent for one type of therapy, and not for the others, than the odds of placebo being the only explanation for success are very low. Mind you, the successful treatments all involved some aspect that could easily be proven to have measureable physiological effects, so they are far less woo than the typical type that Orac legitamately complains about.

    However, there is no reason or excuse resorting to unprofessional name calling or insults in any argument. To do so, lowers the quality of the participant’s argument and alienates audiences. That is common sense.

    I can certainly sympathize with your situation on funding. Only the popular or profitable ideas get funding for studies. Same goes for medicine or alternative medicine. There are more studies now on alternative medicine which is good as it has become more popular, but for many years, it was completely ignored, and insulted.

    I would be curious if you would have any better success in Europe? I know my father was involved with an importer of some sort of chemical powder that could be mixed with pig manure to eliminate some of it’s more deleterius properties. Once treated, it could be sprayed on plants without burning them, and it somehow killed a lot of the nasty germs that leach into the water supply. It was apparently environmentally friendly, and not very expensive. I don’t know enough of the chemical processes to explain it properly, but the point is that no one here would even consider using it, unless it underwent a study by a local university/college. Of course, no one would fund a study and so the product won’t ever be used here and no one will ever know if it works. Apparently, a couple local farmers tried it with success.

  98. #98 Schwartz
    November 20, 2007

    Orac,

    On the topic of religious vaccinations.
    “A lot of parents… they just lie and say they have a religious reason to get vaccined”.

    No evidence, and grossly incorrect, because many of the religious exemptions include philosophical reasons.

    “What is really happening is that Pharmaceuticals don’t want to produce vaccines” Again, grossly inaccurate. A huge percentage of Wyeth’s vaccine program makes millions of dollars for the company and has been for several years. There is an explosion in vaccine related research. Factually wrong again.

    No medical harm from silicon implants — again factual error, they concluded that there are minor medical harms.

    And that was from a short 5 minutes segment. 2 factually incorrect exaggerations, and one completely incorrect statement. Not a good score.

    And since you’re cherry picking, I’m still waiting on the credible evidence of Flu vaccine efficacy?

  99. #99 Daedelus2u
    November 20, 2007

    From what I understand, pubmed only publishes abstracts in for free to the general public.

    Clearly abstracts are hardly satisfactory for any reasonable review. These studies are not generally available to the public. Only to acedemia.

  100. #100 MartinM
    November 20, 2007

    No evidence, and grossly incorrect, because many of the religious exemptions include philosophical reasons.

    ‘Many’ is not ‘all.’ You haven’t established that this claim is ‘grossly incorrect,’ largely because it patently isn’t.

  101. #101 daedalus2u
    November 20, 2007

    To the person spoofing my id, stop.

    PubMed links to many articles available for free download. If the spoofer had ever looked at PubMed a single time they would know that. They don’t know, therefore they haven’t looked at PubMed a single time, yet feel competent to spout off about it in their ignorance. A characteristic not uncommon among CAM proponants.

    http://www.ncbi.nlm.nih.gov/sites/entrez

    Similarly, rather than post under their own ID, the spoofer fraudulently spoofed mine while posting disinformation. Again, a characteristic not uncommon among CAM proponants.

    Get over it. Your uninformed opinion about woo is not as reliable as the informed opinion of someone who has studied physiology for years.

  102. #102 thyme_aerosol
    November 20, 2007

    Why is autism increasing?

    It takes a long time for clinicians to be able to recognize these more subtle conditions when in the past these children were written off as “learning disabled” or “antisocial.” Look at the decrease in so called “learning disabled” children during the time of the so called autism epidemic. Where have they all gone? So there is a learning curve in regards to diagnoses and that is why autism is increasing, IMO.

    Bury the head in the sand. This is true denialism.

    Autism is not really increasing.

    We are just making the diagnosis more often on learning disabled kids that were there all the time.

    Hey, if you believe this pile of mule sh_t, Orac has a bridge to sell you.

  103. #103 Schwartz
    November 20, 2007

    Daedelus2u,

    That was me and it was an accident. I cut/paste your name into the wrong place. I didn’t realize it until I just read your/my post. It was too late at night.

    Sorry, no spoofing was intended.

    On the topic of pubmed:

    I went back there again (as I often do), looking for the latest article being described by Do’C and of course it links me somewhere that asks for a subscription. This is always what happens to me when I try to download the full text of any study I’ve ever looked for there. The study commented on by DeSoto (Ip et al) is also not available and it is an older study.

    If I browse randomly I noticed that a few older studies are actually available, but that has never helped me because the ones I want are never free. I have paid for access to a number of them.

  104. #104 Schwartz
    November 20, 2007

    MartinM,

    Doesn’t change the fact that he stated an opinion as fact without any evidence to back it up.

    It is also incorrect. If you have some evidence that lots of people are lying about religious exemptions, I would like to see it. The only evidence I can find is that religious exemptions have risen. People are hypothesizing as to the reasons. Additionally, it is fact that in many cases, religious exemptions include philosophical reasons. Those are the facts. No objective data about lying.

    How about the other two factual errors?

    I also find it interesting that you and Orac imply that you are more than willing to accept misleading statements that don’t have factual errors (I figure you know the difference). How hypocritical, because that podcast is filled with even more of those yet I have seen much whining about CAM supporters guilty of the same thing.

    I stand by my comments. And that was all in one 5 minute segment.

  105. #105 jen_m
    November 20, 2007

    Schwartz – In re: PubMed – if you’re in a city with a medical school, the library has access to many print and electronic journals. The med school libraries I’ve been in have allowed access by the general public to most of their collection in-person (without presenting ID or anything draconian like that) and to at least part of the electronic collection on-line.

    I get my access through my affiliation with a major research institution and its library, but there are papers for which I have to pay, sometimes, even though I’m an academic.

    Overall, though, there is a lot of discussion going on right now about exactly this topic – how to free academic publication from wickedly expensive subscription services, and provide open access so that we can put some ladders up the ivory tower. The Public Library of Science is trying hard to do its part.
    http://www.plos.org/

  106. #106 ozzy
    November 20, 2007

    Thimerasol:

    I am not burying my head in the sand. I am just dealing with reality and not chasing imaginary goblins such as thimerasol in vaccines or vaccines in general. I believe you are in denial.

    First of all, you need to start describing the disease appropriately. It is AUTISM SPECTRUM DISORDER not autism. That is an important distinction to make. Prior to 1994, describing it as autism was accurate but now a host of conditions that are diagnosed as ASD today, WERE NOT diagnosed as autism then. Therefore, we have made our small “autism” net much bigger so when we cast our “autism” net today we will catch alot more kids than prior to 1994. This is playing a major role in the supposed “epidemic.” The Shattuck 2006 Pediatrics paper clearly and strongly backs this up.

    Second, why are you and your kind wasting energy and money chasing a disproven hypothesis when that same energy and money could be used in more productive ways. How about urging the study of diagnosis of ASD in infants and pre-toddlers? Therefore, resources can be directed toward early intensive behavioral/cognitive therapy in children who display these symptoms. In fact, this therapy even when done on older children with pre-1994 autism has been shown to be highly effective in increasing the quality of life in children diagnosed with pre-1994 autism. So it is conceivable that the younger this therapy begins the more effective it may be and it may be very effective on children with the milder conditions along the ASD spectrum.

    I think I know the answer to the second question. If the cause of the “epidemic” was in fact a change in diagnostic criteria this would not be a very effective rallying cry for fund-raising.

  107. #107 Schwartz
    November 20, 2007

    Jen,

    I live in Toronto, and I’m sure that the UofT academic libraries have all the journals and maybe even provide electronic access to them. However, I have 2 kids and a full time job, so I don’t have even a couple hours to spend going to, sitting in, and then driving home from the library.

    I am glad someone is working on the problem, because I think it’s hypocritical for academics and medical professionals to lecture to the public about being ignorant, and yet deny cost effective access to studies that purport to prove the safety and/or efficacy of drugs they insist we should take. I would even pay a couple hundred dollars a year for a subscription, if it was available. Instead it costs $25.00 for 24 hour access to a single study, or thousands of dollars a year for access to a single journal.

    Given the amount of money that Big Pharma makes off of the government, one would think that at least drug related trial information should be made available to the general public.

  108. #108 MartinM
    November 21, 2007

    Doesn’t change the fact that he stated an opinion as fact without any evidence to back it up.

    Which doesn’t make it a factual error. Goalposts are targets, not fun hiking accompaniments.

    It is also incorrect.

    And your evidence for this is?

    If you have some evidence that lots of people are lying about religious exemptions, I would like to see it.

    Then you can start by following the two links I gave you.

    Additionally, it is fact that in many cases, religious exemptions include philosophical reasons.

    Which is utterly irrelevant in the 30 states which offer no philosophical exemption. That you don’t appear to be able to comprehend this is rather telling.

    Those are the facts. No objective data about lying.

    How about the other two factual errors?

    I haven’t even listened to the podcast. I’m merely addressing this one because you’re so egregiously wrong. You’re not even managing basic consistency; you characterize the statement as an opinion without factual support, then insist that it’s incorrect, without presenting any evidence whatsoever against it. Now that’s hypocrisy.

    I also find it interesting that you and Orac imply that you are more than willing to accept misleading statements that don’t have factual errors (I figure you know the difference).

    I’ve made no such implication. Nor has Orac, as far as I can see.

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