Respectful Insolence

I really need to rein myself in sometimes.

Yesterday, all pleased as punch with myself for my mad Google skillz and for thinking I figured out just what “alternative” therapy it was that Farrah Fawcett had undergone that had resulted in what sounded for all the world like a rectus sheath hematoma, I wrote about how I thought that Fawcett had been undergoing galvanotherapy in Bad Weissee in southern Germany. Either my mad Google skillz failed me, or I was just too lazy to scroll through a sufficient number of screens to find additional information that would have brought the most likely answer. In any case, I guessed that Fawcett’s rectus sheath hematoma was due to some German woo-meister sticking electrodes into her liver. In reality, I should have paid more attention to this article:

She has been staying in the Leonardis Clinic in Bad Heilbrunn, in the shadow of the Bavarian Alps. American politician Edward Kennedy, who has a brain tumour, has also stayed there.

Farrah sought the treatment in Germany with the help of her friend, Cher, and she has also been to other nearby centres.

In the University Clinic of Frankfurt, she has been treated by Professor Thomas Vogl, 50, who is one of the world’s leading cancer experts. He treated her with a catheter filled with chemotherapy drugs.

And here’s how Dr. Vogl treated her in a video from over a year ago:

So what’s going on in this video?

Well, first I did a PubMed search on Dr. Vogl. He’s definitely a legit doctor, and he’s well-published. Specifically he’s a radiologist who specializes in the treatment of liver metastases by image-guided (as in CT-guided) minimally invasive techniques. Specifically, he appears to specialize in chemoembolization, which is the technique of threading catheters into the hepatic artery and injecting chemotherapy followed little bits of foam embedded (the “emboli”). Because tumors have more blood flow, the chemotherapy and little bits of foam tend to go preferentially to the tumor, lodging in the smaller vessels. The effect is to deliver higher concentrations of chemotherapy to the tumors and to “trap” it there, cutting off the blood flow to the tumors. It’s a technique that is well within the realm of science- and evidence-based medicine.

What confused me about this video is that I couldn’t figure out what’s so unique about Dr. Vogl’s treatments that they are supposedly not available in the United States. What they describe is “laser surgery,” whatever that means. Before I discuss this more, let me just say one thing: This is quite possibly what could explain Farrah Fawcett’s “hematoma,” which, as I’ve pointed out before, sounds suspiciously like a rectus sheath hematoma. Dr. Vogl stuck a probe through the abdominal wall and probably bagged the left superior epigastric artery. Again, it happens. It’s an expected possible complication of any procedure that involves sticking probes through the abdominal wall in that region. That it happened does not mean that Dr. Vogl is incompetent.

What Dr. Vogl also appears to specialize in is what he calls laser-induced thermotherapy of liver metastases, also called laser ablation. Why? Because everything’s better with lasers, of course! Actually, whether or not lasers are any better than any other way of ablating liver tumors, be they primary tumors or metastases is very much an open question. Suffice it to say that, when faced with liver tumors that are not surgically resectable, there are three broad strategies to try to eliminate them: (1) Cut off their blood supply and poison them (chemoembolization); burn or cook them; or freeze them. My current institution has considerable expertise in the last of these strategies, namely freezing them. One of our radiologists is quite skillful at placing cryoprobes into liver tumors (or tumors elsewhere) and delivering liquid N2 temperatures to a tumor, freezing it into an iceball of dead cells. it works. So does burning tumors. Burning tumors can be accomplished by at least two different techniques: radiofrequency ablation or some sort of thermal probe, such as a laser. Radiofrequency ablation involves applying radio waves to the tumor through a percutaneously inserted probe, which results in the heating of the tissue around the probe and, in essence, the “cooking” of the tumor. I’m much less familiar with the use of lasers for such minimally invasive ablations, but perusing the literature doesn’t convince me that it’s any better than radiofrequency ablation or cryoablation at eliminating liver metastases.

Unfortunately, the problem with any of these minimally invasive techniques for ablating tumor metastases is that none of them are permanent. None of them provide permanent elimination of the cancer they freeze or burn. They are all palliative, and the tumors virtually always return eventually. That’s not to say that there isn’t great value in palliating tumor metastases. There is. But, even if this laser method Dr. Vogl is using works as advertised, it’s highly unlikely to be curative. I’m also not clear about what Dr. Vogl might be offering that no one other surgeon or radiologist in the U.S. is offering. Perhaps it’s the “experimental” aspect that’s the appeal. Radiofrequency ablation and cryotherapy, for instance, are no longer considered experimental for liver metastases from colorectal cancer that can’t be surgically resected. I’m also surprised at how brutal a procedure it appears to be, with in essence no anesthesia. The excuse that the patient has to be able to breathe when stillness is needed doesn’t hold water, at least not to me. In fact, a physician doing this procedure could achieve both ends, controlled breathing and a high degree of pain relief, with general anesthesia. After all, the anesthesiologist can simply manually ventilate the patient during parts of the procedure where the radiologist would normally ask the patient to hold her breath and keep the patient still just as effectively, if not more so, than an awake and suffering patient could do for herself.

Anything for laser therapy, I guess.

As much as it pains me to admit to a mistake, I reassure myself by pointing out that I’m not entirely in the wrong. There’s a heck of a lot more woo in southern Germany, and Farrah Fawcett appears to be into many forms of woo:

The Leonardis clinic claims to have one of the highest success rates in Germany. On admission, Farrah’s blood was analysed as part of a ‘special chemo sensitivity test’. ‘This involves using DNA to detect your sensitivity not only to chemos, but also to various herbal and nutritional therapies,’ a clinic source said.

According to sources, Farrah was given liquid shark cartilage to stop angiogenisis (the process by which tumours develop their own blood supply), injections of the mineral selenium, injections of vitamin D and calcium and an amino acid mix to protect her liver from chemotherapy.

A clinic source said: ‘She has been having conventional and alternative treatments, and she remains positive, which is the main thing.

Remaining positive is, without a doubt, important, but there’s no compelling evidence that it will prolong the life of cancer patients. True, a positive attitude can make the life of a patient with advanced cancer much easier, but it won’t prolong it. There’s also certainly no evidence that any sort of “chemo sensitivity” test like the one described above can determine accurately whether a tumor is sensitive to chemotherapy. And forget about shark cartilage and selenium. As for vitamin D, although there is some evidence that it can prevent some kinds of cancer, there’s no evidence that it can fight a preexisting advanced cancer.

As much as I hate to admit a mistake, I was probably wrong about the cause of Fawcett’s recent complication. It probably was not due to woo, at least, as far as I can tell based on more research. I also have considerable sympathy for Fawcett. No one deserves to be dying of stage IV anal cancer–or stage IV any cancer. The problem is that I fear that her movie, whether she lives or dies, will be a paean to dubious therapies “integrated” with scientific medicine.

Comments

  1. #1 Calli Arcale
    April 8, 2009

    Remaining positive may, on average, improve the life expectancy of terminal cancer patients. I can think of several ways: reducing suicide rate, increasing compliance with doctor recommendations (a positive-thinking person is probably more likely to make lifestyle changes such as more exercise), and, less happily, more of a tendency to opt for life-prolonging options when it’s probably time to go for hospice care. Being positive may also reduce the life expectancy by making patients less serious about getting proper care, though, and there we get to the patients who spurn conventional medicine in the often futile hope of curing their cancer some other way. It would be interesting to know whether the life expectancy reduction due to avoiding proper treatment exceeds the life expectancy increase due to not committing suicide, making positive lifestyle changes, etc.

    Interesting to hear that sources say she had shark cartilage, when that other guy was saying she definitely didn’t….. I suspect someone is trying to cover their butt.

  2. #2 TH
    April 8, 2009

    I read the part about the ‘special chemo sensitivity test’ not as a test to see if the cancer would respond but to see if the person would have severe complications/side effects from the chemo. You’re probably right though (and if you aren’t at least you admit your mistakes unlike so many of the Woos).

  3. #3 anon
    April 8, 2009

    The problem is that I fear that her movie, whether she lives or dies, will be a paean to dubious therapies “integrated” with scientific medicine.

    Why did you have to do that? Here I was thinking you were humbled, and perhaps even human.

  4. #4 Pheo
    April 8, 2009

    Chemosensitivity testing involves analyzing the effect of chemotherapy drugs on the tumor tissue.

    I’m a pathologist. One oncologist at my hospital rarely requests the chemosensitivity test when the patient has failed conventional chemotherapy. He knows that the data are iffy (which is why he rarely requests the test), but thinks it can sometimes help guide therapy.

    This morning, someone brought up Farrah Fawcett in our tumor board and our radiation oncologist who was trained at UCLA said, “Celebrities often get poor medical care.” What he meant was that medical professionals sometimes get star struck and fail to advocate for the patients’ best interests.

    Sometimes people ask me to give special attention to a specimen from a VIP, and I tell them that I give the best care to everyone, and that if I deviate from my usual routine, the person may get substandard care.

  5. #5 The Perky Skeptic
    April 8, 2009

    @anon– Not human, a transparent box of blinking lights, of course!!! ;)

    Re: chemosensitivity testing– I can truly see the reason for this. My MIL had such an over-the-top reaction to her chemo that, well, it killed the HECK out of the cancer, to be sure, but it killed it off so incredibly fast that she nearly died of sepsis! She had to have emergency surgery to save her life. Her oncologist said he had never seen anything like it in all his years of practice.

  6. #6 wfjag
    April 8, 2009

    “I’m also not clear about what Dr. Vogl might be offering that no one other surgeon or radiologist in the U.S. is offering.”

    Could either be that what he does is not FDA approved, or, what he does, while it wouldn’t necessarily be contrary to what the FDA allows, is not accepted standard of care in the US. If it’s the former, there’s a lot of what looks like Beta-testing on humans that goes on in Europe, and once sufficient data is amassed to show that a treatment’s or drug’s benefits outweight its adverse consequences, testing (and possibly eventually wide-spread use) is allowed in the US. If that’s the case, what he’s doing is experimental medicine. If it’s the latter, then US medicine has progressed beyond what he’s doing. Still, there’s obvious temptation in receiving treatment in southern Germany that has nothing to do with the quality of the care.

    And, there’s the third possibility when trying to figure out what is meant in a news article — especially when science or medicine is being “reported”: The reporter and editor didn’t have a clue as to what they were talking about and covered that with breathless sensationizing, and as a result, you can’t figure out their nonsense. That may be why you thought it was another woo story. If so, then it’s not the story that’s woo, it’s the reporting.

  7. #7 Karl Withakay
    April 8, 2009

    Isn’t it interesting how the real open-minded don’t hide from the light of truth under a rock or stick their fingers in their ears and shout, “I can’t hear you; I’m still right. na-na-na-na-na-na”, but instead are actually willing to admit when they were wrong?

  8. #8 RossM
    April 8, 2009

    What this is really about, is selling current movies and future editions. Work both sides of the street, and no matter how it turns out there is a story. If the patient lives, woo wins, she will be shown receiving woo (as has been admitted to receiving in addition to), because science and medicine did not work the first round. If the patient dies, medicine loses again, because the conventional part will be highlighted, as has already been shown in part.
    There is no doubt in my mind that the chartered jet to Germany was paid for by a studio, because it looks so glamorous. Film quality first clips are already on Entertainment Tonight. Her return from the referenced ”Mail Online” article appears to be from a commercial flight. lf this seems crass, remember the masterful job of Max Clifford with Jade Goody in the UK. They sold an everyday unfortunate and saddening story for millions of dollars. The confusion and conflicting information is done on purpose.
    So, Orac is not really wrong. He just exposed both sides of the story, on two different days. The difficult part is ascertaining the what, where and how, that is not being shown or said. Those in Hollywood are writing the script. The complete medical truth is not likely to ever be known for sure.

  9. #9 Whitecoat Tales
    April 8, 2009

    Gosh I wish I’d posted yesterday, I’d have looked like I knew something. Early in med school I did a little research with RF ablation for kidney tumors, but alot of the early research was done in liver models.

    On Laser ablative therapy – no real evidence its better than RF – RF, Cryo, laser ablation all have the same problem, it’s difficult to tell if you’ve made the border of the tumor nonviable. It’s tough because when you heat up or cool tissue, somewhere during the therapy you get a reactive vasodilation, which carries your heat away, or in the case of cryo, brings some heat back in.

    Incidentally, I’ve seen rectus sheath hematoma from RF ablation catheter placement.

  10. #10 Rogue Medic
    April 8, 2009

    anon,

    The problem is that I fear that her movie, whether she lives or dies, will be a paean to dubious therapies “integrated” with scientific medicine.

    Why did you have to do that? Here I was thinking you were humbled, and perhaps even human.

    He is human. He just doesn’t appear to see any reason to expect the pack of jackals, that make up the alternative medicine field, to not try to make money off of this in whatever way possible.

    This is the way these snake oil salesmen make their money. This is a marketing opportunity for the mountebanks.

    It would be incredibly naive to believe otherwise. Of course, they prey on the naive. They live off of the incredibly naive.

    Orac tries to educate people to protect them from abuse. You suggest that this is not being human. Trying to prevent people from being sacrificed to these barbaric cults is not human? You do not know what you are writing about.

    The anti-vaccine crowd parade autistic children around as if the vaccines had something to do with autism. Vaccines do not cause autism, but Jenny McCarthy causes exploitation of autistic children.

    Let us know when any of these frauds admit any mistake. They line up to defend Dr. Wakefield – the quack, liar, and fraud. His lies encourage parents to harm their children. Where is the humanity of this pro-disease movement?

    These anti-science vermin do not admit their mistakes. They just make excuses and blame others for their problems. These charlatans give bad medical advice. These quacks convince people, who should be treated by real doctors, to make the wrong decisions about their health. Decisions that shorten the lives of those, who trusted the witchdoctors. Where is the humanity of the fake medicine movement?

    Have you witchdoctor worshipers no shame?

    Human sacrifice is not humane.
    .

  11. #11 anon
    April 8, 2009

    Rogue Medic,

    He just doesn’t appear to see any reason to expect the pack of jackals, that make up the alternative medicine field, to not try to make money off of this in whatever way possible.

    There are unscrupulous people everywhere, alternative medicine or otherwise.

    It would be incredibly naive to believe otherwise. Of course, they prey on the naive. They live off of the incredibly naive

    Whilst I think I understand what you are saying here, can’t the same be said of those that question the conflicting authority of a body that is responsible for not only maintaining vaccine uptake but ALSO ensuring safety? Why is this a stretch?

    Let us know when any of these frauds admit any mistake. They line up to defend Dr. Wakefield – the quack, liar, and fraud. His lies encourage parents to harm their children. Where is the humanity of this pro-disease movement?

    I think anytime a person realises error, they are wise to correct it. Why would you think no one that opposes your viewpoint admits error? No offence, but I’m not sure this kind of sensationalism helps matters.

    These anti-science vermin do not admit their mistakes. They just make excuses and blame others for their problems. These charlatans give bad medical advice. These quacks convince people, who should be treated by real doctors, to make the wrong decisions about their health. Decisions that shorten the lives of those, who trusted the witchdoctors. Where is the humanity of the fake medicine movement?

    Honestly, I understand your passion. The problem, is that you cannot take the free will of those you are meaning to convince. A person that opts to take a nutritional approach, or an approach based on *more than one* opinion, and is old enough to understand the risks and benefits associated with their choices may be someone you feel to be misguided… but it’s really none of your business. As it relates to infectious disease transmission, your comment seems to imply that vaccinated people don’t spread disease… sorry… but they do.

  12. #12 Rogue Medic
    April 8, 2009

    anon,

    There are unscrupulous people everywhere, alternative medicine or otherwise.

    That is true. The difference, between the scientific community and these anti-science cults, is that the scientific community will report their own errors publicly. The scientific community will check on the work of others to look for problems. The scientific community will not accept fraud, although they may be temporarily deceived by it.

    The anti-science cults behave in exactly the opposite way. They cover up anything negative, because it is all a sham. They pretend to have all of the answers.

    Whilst I think I understand what you are saying here, can’t the same be said of those that question the conflicting authority of a body that is responsible for not only maintaining vaccine uptake but ALSO ensuring safety? Why is this a stretch?

    A body that requires use of any product, but does not insist on oversight, is irresponsible. There is clear evidence of the overwhelming benefit and safety of vaccines. Compare the death and illness rates from before the introduction of vaccines with after their widespread use.

    Millions of lives are saved by vaccines each year.

    I think anytime a person realises error, they are wise to correct it. Why would you think no one that opposes your viewpoint admits error? No offence, but I’m not sure this kind of sensationalism helps matters.

    Provide some evidence of error correction on the side of anti-science. One of the reasons they are anti-science is that they do not learn from their mistakes. They keep repeating the same errors. They may modify tactics, but they do not use good science. They do not recognize good science.

    Sensationalism is the method of the anti-science cults. I am just pointing out the harm – crippling illnesses and deaths.

    Honestly, I understand your passion. The problem, is that you cannot take the free will of those you are meaning to convince. A person that opts to take a nutritional approach, or an approach based on *more than one* opinion, and is old enough to understand the risks and benefits associated with their choices may be someone you feel to be misguided… but it’s really none of your business. As it relates to infectious disease transmission, your comment seems to imply that vaccinated people don’t spread disease… sorry… but they do.

    If I see someone preparing to release a poison in public, I should ignore it? That is what you are telling me? There is only a difference of degree. You are defending reckless and irresponsible behavior.

    All people spread diseases. Vaccinated people spread far fewer diseases than unvaccinated people. There have been too many cases in the news, lately. The unvaccinated have been causing outbreaks of diseases that were not a problem with higher vaccination rates. People, who have not vaccinated their children, have caused the deaths of children. You think nobody should criticize this?

  13. #13 sff
    April 8, 2009

    As for the lack of anesthesia: could this possibly be something she asked for? Aren’t there some people who are afraid of general anesthesia and will avoid it if possible?

  14. #14 Ben Dover
    April 8, 2009

    Pheo wrote;

    “This morning, someone brought up Farrah Fawcett in our tumor board and our radiation oncologist who was trained at UCLA said, “Celebrities often get poor medical care.” What he meant was that medical professionals sometimes get star struck and fail to advocate for the patients’ best interests.”

    “Sometimes people ask me to give special attention to a specimen from a VIP, and I tell them that I give the best care to everyone, and that if I deviate from my usual routine, the person may get substandard care.”

    That’s and interesting insight into human nature. I had never realized that there “could” be a “VIP Factor” in administering treatment to patients.

    “As much as I hate to admit a mistake, I was probably wrong about the cause of Fawcett’s recent complication. It probably was not due to woo, at least, as far as I can tell based on more research.”

    “Either my mad Google skillz failed me, or I was just too lazy to scroll through a sufficient number of screens to find additional information that would have brought the most likely answer.”

    See, this Google really can stimulate the A.D.D. trait in all of us. As information technology advances we become less and less patient and sometimes careless.

    You had the answer, then you started looking for the information to support it.

    To err is human…

  15. #15 Joseph C.
    April 8, 2009

    Whilst I think I understand what you are saying here, can’t the same be said of those that question the conflicting authority of a body that is responsible for not only maintaining vaccine uptake but ALSO ensuring safety? Why is this a stretch?

    Actually, it’s mostly the FDA that’s responsible for the vaccine safety since they handle the licensing.

  16. #16 Rogue Medic
    April 9, 2009

    Ben Dover,

    There have been several papers written on VIP medicine. All that I have seen have focused on the problems. There was an excellent paper by a flight surgeon. I don’t remember the name of the doctor, but it was a military journal. I had saved it to a computer, but that computer died and I had not backed it up.

    He wrote about several cases. One was an officer (General, or equivalent in another service), who went for physicals, but was considered to be of too high a rank to be put through the discourtesy of a prostate exam (digital rectal exam). A while later, after the prostate cancer had metastasized, he had symptoms that caused him to be referred to a specialist. At that point, there was nothing the specialist could do to significantly change the outcome. An earlier prostate exam, while unpleasant, could have been life saving.

    This is the biggest problem for VIPs. They are not treated the same as everyone else. They are sometimes treated worse. The fear of offending, or inconveniencing, or over-scheduling, . . . . Not that VIPs are any better at listening to medical advice, but sometimes they are deprived of what the average person takes for granted. Because they are too good for that.

    When President Reagan was shot, he tried to put everyone at ease about treating him. If he had insisted on special care, things might have turned out much worse for him.

    The deaths of Presidents Lincoln, Garfield, and McKinley have been attributed to having care provided by doctors no longer familiar with the then current care of bullet wounds. the doctors caring for them were more involved in trying to do something. If these presidents had not been VIPs, they would have been more likely to have received care from someone much more familiar with then current trauma treatment. Some speculate that all would have survived, although Lincoln probably would have had severe neurological deficits.

    There are patients who will insist that the doctor start their IV. many doctors have not started an IV since they were residents. They start central lines, but that is a very different technique. The nurse will generally do a better job at starting the IV. We have this need to have the best, we just do not really know how to evaluate what is best. We assume that best at one thing means best at everything.

    It is often when we deviate from the routine, that we run into problems.

  17. #17 anon
    April 9, 2009

    Rogue Medic,

    The difference, between the scientific community and these anti-science cults, is that the scientific community will report their own errors publicly. The scientific community will check on the work of others to look for problems. The scientific community will not accept fraud, although they may be temporarily deceived by it.

    I don’t know that I entirely agree with the word cult in this context. Most of the people that I encounter all appreciate Science. I think we’d be a bit naive if we hoist Science upon some sort of pedestal as if those that actually apply Science regularly weren’t subject to compromise by conflict.

    There is clear evidence of the overwhelming benefit and safety of vaccines. Compare the death and illness rates from before the introduction of vaccines with after their widespread use…Millions of lives are saved by vaccines each year.

    Most of the risk benefit analyses I’ve seen relate to cost. I do not disagree that some vaccines are fairly effective at reducing illness that is endemic. Disease incidence is a tricky thing, and this kind of statistic is ripe to be abused. Mortality, to a degree, is as well. But at least prior to vaccine use this statistic can actually be measured somewhat accurately, and in most cases mortality was declining prior to the introduction of the vaccine (too many variables to isolate the reason for this). Your last statement is a bit of a strawman… and a lot of conjecture.

    Provide some evidence of error correction on the side of anti-science. One of the reasons they are anti-science is that they do not learn from their mistakes.

    I’m not even sure how to address your request. I think plenty of people are bull-headed and incapable of letting go of their beliefs. When people project their beliefs upon another, if they are presented as beliefs, they needn’t be based on fact.

    If I see someone preparing to release a poison in public, I should ignore it? That is what you are telling me? There is only a difference of degree. You are defending reckless and irresponsible behavior.

    We are talking about how someone, responsible for their own decisions, cares for themselves. The difference is rather exponential. I’m not defending reckless behavior, I’m defending a person’s right to choose the modality they see fit to treat themselves. Trying to control the free will of others is more than irresponsible, it’s reprehensible – it’s not another’s decision to make… doesn’t matter whether you agree with it or not.

    All people spread diseases. Vaccinated people spread far fewer diseases than unvaccinated people. There have been too many cases in the news, lately. The unvaccinated have been causing outbreaks of diseases that were not a problem with higher vaccination rates. People, who have not vaccinated their children, have caused the deaths of children. You think nobody should criticize this?

    Vaccinated people simply don’t show symptoms, due to the vaccine. Being subclinical is not the same as NOT spreading disease. If an attending ER physician is met with a child that is not showing classic pertussis symptoms, they won’t look for it and sometimes won’t even consider it due to vaccination status. That’s irresponsible and reckless, somehow this appears to be ok. Outbreak of disease happens in both populations of the herd and always have. Vaccine failures occur all the time. You seem to be under the impression that vaccines don’t cause injury or death in susceptible populations (that appear to be growing due to numerous confounders)… and people don’t seem to care about any of those children. Do you think [other] people shouldn’t criticise this?

    @Joseph

    Actually, it’s mostly the FDA that’s responsible for the vaccine safety since they handle the licensing.

    http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr;sid=c1305c860d37147d5485b0236ae5d630;rgn=div5;view=text;node=21%3A7.0.1.1.1;idno=21;cc=ecfr
    Regulatory oversight is codified in the CFR Title 21. The word safety is defined as “the relative freedom from harmful effect to persons affected, directly or indirectly, by a product when prudently administered, taking into consideration the character of the product in relation to the condition of the recipient at the time.”

    Purity is defined as: “relative freedom from extraneous matter in the finished product, whether or not harmful to the recipient or deleterious to the product. Purity includes but is not limited to relative freedom from residual moisture or other volatile substances and pyrogenic substances.”

    Pretty ambiguous no?

    Adverse events are outlined in 600.80, and waivers appear to be granted during all phases of study and beyond while the vaccine maker gets to choose whether the adverse event that occurred was actually due to the vaccine. Without knowing which manufacturer applied for a waiver, especially during the post-marketing surveillance, it’s fairly impossible to determine with any degree of accuracy what adverse events may or may not follow. AND, those events are anecdotal… leaving the coincidental door open indefinitely does not help convince the masses that these products are well tested.

  18. #18 Ben Dover
    April 9, 2009

    To Rogue Medic

    Interesting, thanks for the feedback.

    Ben Dover

  19. #19 Rogue Medic
    April 9, 2009

    anon,

    Most of the risk benefit analyses I’ve seen relate to cost. I do not disagree that some vaccines are fairly effective at reducing illness that is endemic. Disease incidence is a tricky thing, and this kind of statistic is ripe to be abused. Mortality, to a degree, is as well. But at least prior to vaccine use this statistic can actually be measured somewhat accurately, and in most cases mortality was declining prior to the introduction of the vaccine (too many variables to isolate the reason for this). Your last statement is a bit of a strawman… and a lot of conjecture.

    I have not looked at the financial cost of vaccines. What price do you put on health? Vaccines are the safest route to preserving health.

    You claim that the incidence of disease was declining prior to the introduction of vaccines. Polio was clearly not declining, but increasing. We can only speculate at what direction the polio rate might have headed without the introduction of vaccines.

    The number of cases per year from 1944 to 1973 was:

    1944 – - – 19,029

    1945 – - – 13,624

    1946 – - – 25,698

    1947 – - – 10,827

    1948 – - – 27,726

    1949 – - – 42,033

    1950 – - – 33,300

    1951 – - – 28,386

    1952 – - – 57,879

    1953 – - – 35,592

    1954 – - – 38,476

    1955 – - – 28,985 Salk vaccine licensed.

    1956 – - – 15,140

    1957- – - – 5,485

    1958- – - – 5,787

    1959- – - – 8,425

    1960- – - – 3,190

    1961- – - – 1,312 Sabin vaccine licensed.

    1962- – - – - 910

    1963- – - – - 449

    1964- – - – - 122

    1965 – - – - – 72

    1966- – - – - 113

    1967 – - – - – 41

    1968 – - – - – 53

    1969 – - – - – 20

    1970 – - – - – 33

    1971 – - – - – 21

    1972 – - – - – 31

    1973- – - – - – 8

    After 1973 there were never more than 34 cases on a year.

    The current rate in the US is zero.

    Jenny McCarthy says she wants to change that. She doesn’t think that the vaccines are safe enough. She is dangerous to children everywhere.

    From the CDC:

    table of notifiable diseases 1964-1973
    .

    table of notifiable diseases 1954-1963
    .

    table of notifiable diseases 1944-1953
    .

    I do not see any reason to expect that incidence of this illness would suddenly decrease at the same time as the introduction of the polio vaccine. Look at what the polio vaccine does to the human body. It creates antibodies. Antibodies protect against the spread of disease.

    While Dr. Salk did state that after 1961 most of the cases of polio in the US were due to the vaccine. He was referring to the live vaccine. The live vaccine did cause cases of polio. We went from tens of thousands of cases of polio per year without a vaccine to tens of cases with the vaccine. Eventually the Sabin live vaccine was eliminated in the US. While polio is a horrible side effect from a vaccine, what parent make the choice to avoid the vaccine and have a much greater chance of a natural polio infection? There have been about 2,000 cases of polio in the US, in the almost 50 years after 1961. That is fewer than any single year before that.

    How many of these cases were due to the live vaccine? I do not know. Dr. Salk and Dr. Sabin were very critical of each other. Did Dr. Salk exaggerate? Maybe. As a parent, you could get the killed vaccine, get boosters, and not have to worry about the remote possibility of infection from the live vaccine.

    Look at the rest of the world. The only places that have cases of polio are places that have problems with vaccination. These problems are due to people discouraging the use of vaccines. Polio should have been eliminated years ago, but those preaching against vaccines have prevented polio eradication.

    There are still a few thousand cases of polio each year. This is due to the anti-vaccine movement. The preaching in these countries is not about autism, but about decreased fertility and about infection with AIDS. Why don’t the anti-vaccine preachers in the US use these claims? Just different politics. Fertility and AIDS are much more politically sensitive concerns for parents there. Here autism is the big politically sensitive concern, so Jenny preaches autism. Jenny makes a lot of money preaching autism, too.

    There is no science to support the belief that vaccines cause AIDS.

    There is no science to support the belief that vaccines cause decreased fertility.

    There is no science to support the belief that vaccines cause autism.

    There is a lot of money to be made preaching that vaccines cause autism.

    What about smallpox. There is an unimportant disease that was going away on its own. While Dr. Jenner did not test the vaccine in a way that was even close to ethical, the result is not something to discard, just because of unethical origins. If you are looking for a vaccine with danger written all over it, smallpox is your vaccine. The process is nasty. It leaves a scar. The side effects are so severe that the anti-vaccine crowd would be ranting and raving about the extreme dangers.

    They would be partying like it’s 999, or some other date from the Dark Ages. Well, those that would not have been killed off by diseases would be partying. Then again, maybe they would realize that these risks are really not so bad, considering what they protect against.

    Life expectancy back in 999? A time which Jenny McCarthy seems to think is better than now. Jenny McCarthy has already lived beyond the average life expectancy for that time. Part of the reason for her long life, which is not long in modern terms? Vaccines.

    It is only in the current everything must be risk-free world that we make the mistake of choosing to avoid the protection from disease, because of a risk that is not real.

  20. #20 Jon H
    April 9, 2009

    Pheo wrote: “What he meant was that medical professionals sometimes get star struck and fail to advocate for the patients’ best interests.”

    I think the problem is more that the woo doctors know how to prey on the celebs (with their deep pockets) by playing up the “what I do is special, what the other doctors do is common”.

    It’s the same way that high-end spas sell their snake oil. “Angelina Jolie, you simply *must* try our mongoose pus facial!”

    If you want the big bucks from celebrities, as a doctor or a massage therapist, you need to cater to their vanity and self-importance.

  21. #21 Joseph C.
    April 10, 2009

    Anon,

    That bait and switch won’t work with me. In fact, your link just gives further detail to what I said: The FDA regulates vaccine safety.

    Conspiracy theory fail.

  22. #22 anon
    April 10, 2009

    Rogue Medic,

    I have not looked at the financial cost of vaccines. What price do you put on health? Vaccines are the safest route to preserving health.

    I’m referring to the numerous cost/benefit analyses that discuss economical suffering (work missed, hospital usage, etc…) I’ve not tried to put a price on health, have you a suggestion? Can you please support your final statement with evidence?

    You claim that the incidence of disease was declining prior to the introduction of vaccines.

    No, I did not. I stated that *mortality* had declined. Incidence is open to interpretation, best I can tell.

    Polio was clearly not declining, but increasing. We can only speculate at what direction the polio rate might have headed without the introduction of vaccines.

    There is more obfuscation, smoke/mirrors and downright confusion surrounding polio than can even be addressed in a single post. Bringing it up says an awful lot to those paying attention… not to mention, it’s a stellar strawman.

    Jenny McCarthy says she wants to change that. She doesn’t think that the vaccines are safe enough. She is dangerous to children everywhere.

    I have no opinion of her. Amplifying another’s inadequacies is probably not the best approach to reach the public.

    As for the rest of your post, well, you’re all over the place. Bouncing from stats, to history, to polio, to smallpox… I don’t see how this somehow puts your opposing view into the Dark Ages? Context. Confounders.

    Humans have undergone a wide variety of changes over the last 20,000 years. The life span of the ancient human revolved around whether or not he’d wake to one less limb in the morning. Reducing the entire human race to unlimited vaccination based upon the unintended, and rather harsh, consequences of domestication is about as unscientific as you can get.

    @Joseph,

    Bait and switch? Please… do elaborate. You stated that the FDA regulates safety. I supported your assertion for you, and outlined the problems therein. To bait, would be your original post… to switch, would be your second.

  23. #23 Rogue Medic
    April 10, 2009

    anon,

    No other means of attempting to preserve health prevent as many instances of disease. Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States.

    You want mortality data? Here is mortality data.

    There is more obfuscation, smoke/mirrors and downright confusion surrounding polio than can even be addressed in a single post. Bringing it up says an awful lot to those paying attention… not to mention, it’s a stellar strawman.

    How is vaccination against polio not a tremendous success?

    To those paying attention, bringing up polio should demonstrate the effectiveness of vaccines. You prefer to ise innuendo to suggest that there is a problem, when there is not.

    How is describing this success a strawman? A stellar strawman? Do you even know what a strawman is?

    Jenny McCarthy says she wants to change that. She doesn’t think that the vaccines are safe enough. She is dangerous to children everywhere.

    I have no opinion of her. Amplifying another’s inadequacies is probably not the best approach to reach the public.

    No opinion? :-)

    When the ridiculous person is endangering others it is necessary to point out the problems with the source of the dangerous information. She is certainly not relying on science.

    As for the rest of your post, well, you’re all over the place. Bouncing from stats, to history, to polio, to smallpox… I don’t see how this somehow puts your opposing view into the Dark Ages? Context. Confounders.

    I showed some of the successful history of vaccines.

    I showed some of the ways the anti-vaccine movement is reversing that history.

    I referred to Jenny Measles McCarthy’s quote about bringing back diseases. Of course, you state that you have no opinion of her.

    Humans have undergone a wide variety of changes over the last 20,000 years. The life span of the ancient human revolved around whether or not he’d wake to one less limb in the morning. Reducing the entire human race to unlimited vaccination based upon the unintended, and rather harsh, consequences of domestication is about as unscientific as you can get.

    You criticize me for bringing up history, then you go back 20,000 years? You seem to view our current living conditions as worse than 20,000 years ago. Average life expectancy was what? 25 years?

    The life span of the ancient human revolved around whether or not he’d wake to one less limb in the morning.

    See one less limb in the morning? They did not have limbs wander off on their own. Are you referring to infection, animal attack, accident, . . . ? What is this supposed to do, other than distract from the absence of valid scientific criticism of vaccines?

    There is no reducing through vaccination. Vaccination is an improvement. Vaccination helps people to be healthier. Vaccination strengthens the immune system. Why do you want people to have inadequate immune systems? Opposing vaccination endangers people. Opposing vaccination kills people.

    We have evolved the ability to use our minds to protect us from illnesses. The prodisease movement is discouraging us from using that intelligence to help people.

    …immunization can be credited with saving approximately 9 million lives a year worldwide. A further 16 million deaths a year could be prevented if effective vaccines were deployed against all potentially vaccine-preventable diseases.

    Vaccines save millions of lives.

  24. #24 anon
    April 13, 2009

    Rogue Medic,

    I’ve seen the 2007 JAMA/Roush piece. Do you have a different one that’s not affiliated with the CDC? I mean, the CDC is responsible for ensuring uptake, and within that piece are numerous suppositions that are not entirely supported.

    A strawman is the deflection or verbal attack of a topic (such as the decline of *non-specific* disease incidence) by creating another… (a specific disease decline), that cannot be proven, as a diversion. Especially when that disease carried with it a shift in diagnostic criteria that effectively changed history with the stroke of a pen.

    I’m sorry, but I don’t have an opinion of Jenny McCarthy, there appear to be more than enough people to make up for me lacking though don’t you think?

    You criticize me for bringing up history, then you go back 20,000 years? You seem to view our current living conditions as worse than 20,000 years ago. Average life expectancy was what? 25 years?

    Apologies, perhaps you misunderstood what I was trying to say. I was addressing the vast array of topics you were covering… if in fact you are going to address history, you have to address all of it. You are assuming poor health (or lack of access to vaccines) is the reason for the reduction in life expectancy. Evolutionary speedbumps do in fact catch up with you sooner or later. The introduction of foods that had not been available, the domestication of humans, predators, etc… I simply asked that you keep it all in context, because you aren’t.

    Vaccination is an improvement. Vaccination helps people to be healthier. Vaccination strengthens the immune system. Why do you want people to have inadequate immune systems? Opposing vaccination endangers people. Opposing vaccination kills people.

    You cannot demonstrate that vaccinated people are healthier than their non-vaccinated contemporaries. You cannot demonstrate that vaccination strengthens the immune system any better than natural exposure, or that vaccinated people have stronger immune systems than their unvaccinated peers. You cannot demonstrate that unvaccinated people pose any more of a danger to people than vaccinated (I’d prefer a proper presentation of symptoms…as opposed to an atypical response). Please explain how the use of a mathematical model fits within an evidence based position?

    What is this supposed to do, other than distract from the absence of valid scientific criticism of vaccines?

    I’m not sure I understand what you mean here. I was referring to a nocturnal predator. All too often people discuss how short lived our ancestors were, forgetting where their presence was on the food chain and how humans began to change the environment. (Artificial light, agriculture, etc…) If we are to accurately address the growing susceptibility of the human race, these factors cannot be ignored, to do so would be unscientific.

    Of course the human brain has evolved, did I imply it hadn’t? It’s also grown in size and results in neonates being born gestationally early (I’ve seen it published that gestational maturity should be 21 months)… yet we seem content to vaccinate a human infant during those first 21 months pretty excessively.

  25. #25 epador
    April 17, 2009

    The chemotherapy will always make you greener on the other side of the pond.

    She’s lucky she was covered as she was pushed through the halls in Germany. My observations in excellent German hospitals are that the technology and standard of care is 21st century with a little woo added on for decoration, the patients have no privacy, the physician patient relationship is 19th century (you DO NOT question the doctor or ask questions, just do as you are told)and pain management usually consists of this exchange:

    Doctor, I hurt!

    Gut, it is supposed to .

  26. #26 lizvelrene
    April 30, 2009

    As to chemosensitivity testing, I’m sure it involves something like the KRAS test. That’s rapidly becoming standard of care before administering a particular biologic agent (cetuximab). Not particularly woo-ful, except for the

    Standards of care can indeed be very different in the US and in Europe. It’s not typically a matter of legality but of interpretation and routine; some treatments we do in the US are considered crazy in other parts of the world (one big example would be intraperitoneal chemo). Conversely some US patients do travel internationally for treatments that aren’t strictly illegal in the US, but aren’t habitually administered at the top centers.

  27. #27 Jay Gordon, MD, FAAP
    June 26, 2009

    You guys are absolutely obsesses with vaccination. Amazing. Truly amazing.

    I have looked at this thread objectively: Anon is absolutely and devastatingly kicked your butts.

    Comparing health and disease survival decades or centuries past to what occurs today is terrible science.

    Orac, Thanks for reviving this thread.

    Best,

    Jay

  28. #28 Rogue Medic
    June 26, 2009

    anon,

    Rogue Medic,

    Sorry for the delay in responding. I did not notice this reply. That does not mean that you made any sensible arguments in your comment.

    I’ve seen the 2007 JAMA/Roush piece. Do you have a different one that’s not affiliated with the CDC? I mean, the CDC is responsible for ensuring uptake, and within that piece are numerous suppositions that are not entirely supported.

    The CDC is the agency that deals with epidemics. There is no reason not to accept this study. The CDC are the experts.

    Do you have any studies that refute the data?

    What suppositions are not entirely supported? You make vague accusations, but do not provide anything to support these claims. How about some data?

    A strawman is the deflection or verbal attack of a topic (such as the decline of *non-specific* disease incidence) by creating another… (a specific disease decline), that cannot be proven, as a diversion.

    Using information on a specific disease as an example of something that happens in other specific diseases, which together make up *non-specific* disease incidence, is not a straw man, it is an example.

    Creating a false argument to knock it down, that is a straw man. That is what you are doing.

    Especially when that disease carried with it a shift in diagnostic criteria that effectively changed history with the stroke of a pen.

    Are you suggesting that polio is still a problem in the US?

    Are you really suggesting that the absence of polio is due to a change in diagnostic criteria?

    Or are you suggesting that polio was not a real disease, that is was just something that was due to different diagnostic criteria? Please provide some evidence that polio was not a tremendous success for vaccination.

    I’m sorry, but I don’t have an opinion of Jenny McCarthy, there appear to be more than enough people to make up for me lacking though don’t you think?

    No. We should all oppose her dangerous nonsense.

    You criticize me for bringing up history, then you go back 20,000 years? You seem to view our current living conditions as worse than 20,000 years ago. Average life expectancy was what? 25 years?

    Apologies, perhaps you misunderstood what I was trying to say. I was addressing the vast array of topics you were covering… if in fact you are going to address history, you have to address all of it.

    First, I am including too much information, now I am not including enough.

    You are assuming poor health (or lack of access to vaccines) is the reason for the reduction in life expectancy.

    You do not know if I am assuming anything. You do not know what I am thinking. Vaccination is one important reason for the improvement in life expectancy.

    Science in general is the main reason for the improvement in life expectancy. Improved sanitation, such as the use of sewage systems to avoid diseases transmitted in drinking water. Cholera is the main example here. Cholera was blamed on miasma by the 19th century equivalent of the anti-vaccine mob. They ignored the evidence that it is a water-borne illness and blamed it on bad air.

    The miasma believers fought against changes to the drinking water and delayed measures that would have prevented thousands of deaths. Just as the anti-vaccination mob do.

    One of the prominent miasma proponents, William Cheswick, actually ordered that human waste be dumped into the Thames, where some of the water companies obtained their drinking water. This led to the deaths of thousands, who would not have acquired cholera otherwise, by spreading what should have been just a local outbreak of cholera.

    Perhaps the modern equivalent would be Dr. Gould with his irresponsible preaching of anti-vaccination anti-science to parents. Eventually, some of these parents will come after Dr. Gould in court and it will be clear to all but the craziest of the anti-vaccine mob that vaccines are good for children. Avoiding vaccines kills.

    Evolutionary speedbumps do in fact catch up with you sooner or later.

    Evolutionary speedbumps?

    Have you been listening to Jenny explain science?

    What is an evolutionary speedbumps?

    Do we need to slow evolution down, when approaching one of these?

    The introduction of foods that had not been available, the domestication of humans, predators, etc… I simply asked that you keep it all in context, because you aren’t.

    You were the one criticizing me for giving too much information. Now you want to criticize me for not giving enough. I never denied that science was important in improving the life expectancy of humans. One of the important parts of science is the prevention of disease. Some of that is through the use of vaccines.

    Smallpox used to kill. Not any more.

    Smallpox didn’t just kill a little bit, but an outbreak would kill large percentages of the population.

    Sanitation?

    No.

    Antibiotics?

    No.

    A change in diagnostic criteria?

    No.

    None of your means of misdirection and innuendo will help you explain this away. Where are the current smallpox cases? Enough people have been vaccinated, that we no longer have to use the vaccine. All of you vaccines are evil people need to accept that your actions increase the amount of time that people need to take vaccines. Your spreading of disease delays eradication of diseases.

    You are killing children by your lies.

    Vaccination is an improvement. Vaccination helps people to be healthier. Vaccination strengthens the immune system. Why do you want people to have inadequate immune systems? Opposing vaccination endangers people. Opposing vaccination kills people.

    You cannot demonstrate that vaccinated people are healthier than their non-vaccinated contemporaries.

    Vaccinated people are infected with vaccine preventable diseases at a much lower rate than those who are not vaccinated.

    Those who are not vaccinated are protected from the risks of vaccination, but that risk is tiny compared to the risk of the actual disease.

    You cannot demonstrate that vaccination strengthens the immune system any better than natural exposure,

    The vaccine does not strengthen the immune system more than natural exposure, so you may mislead people into thinking that means that immunization does not strengthen the immune system better than natural exposure.

    Of course vaccination strengthens the immune system better than natural exposure.

    Natural exposure has a risk of death that is thousands of time higher than vaccines.

    Thousands of times higher.

    or that vaccinated people have stronger immune systems than their unvaccinated peers.

    The immune system that has antibodies to more illnesses is stronger.

    If you believe that natural exposure is better, remember that the risk of death is thousands of time higher. Then there is the risk of permanent disability. That does not even include the inconvenience to the child. Who tortures their children by sickening them? Why do you defend this abuse?

    You cannot demonstrate that unvaccinated people pose any more of a danger to people than vaccinated (I’d prefer a proper presentation of symptoms…as opposed to an atypical response). Please explain how the use of a mathematical model fits within an evidence based position?

    Nice doubletalk.

    Outbreaks depend on the drop in the level of immunity below a certain level. That level is different for each disease. Read the newspapers. Read the MMWR (Morbidity and Mortality Weekly Report). These describe the recent outbreaks.

    Outbreaks are due to a lack of vaccination.

    What is this supposed to do, other than distract from the absence of valid scientific criticism of vaccines?

    I’m not sure I understand what you mean here.

    There is no valid scientific criticism of vaccines.

    I was referring to a nocturnal predator. All too often people discuss how short lived our ancestors were, forgetting where their presence was on the food chain and how humans began to change the environment. (Artificial light, agriculture, etc…) If we are to accurately address the growing susceptibility of the human race, these factors cannot be ignored, to do so would be unscientific.

    Vaccines are an important part of the increase in life expectancy. Or are you going to pretend that vaccines do not save millions of live each year?

    Of course the human brain has evolved, did I imply it hadn’t?

    Of course you did. You suggested that we ignore the improvement in disease prevention that is vaccination.

    This is progress due to the evolution of the brain.

    You fight progress.

    It’s also grown in size and results in neonates being born gestationally early (I’ve seen it published that gestational maturity should be 21 months)… yet we seem content to vaccinate a human infant during those first 21 months pretty excessively.

    Golly gee.

    We don’t stay in the womb long enough. We should all be dead due to the shock. Or due to the lack of amniotic fluid. Or some other silly nonsense. This is ridiculous.

    Children receive many vaccines at a young age because the desire is to protect them before they are exposed to vaccine preventable diseases.

    Children would not need to be vaccinated as much if the anti-vaccination anti-science mob would stop lying to parents about the risks of vaccines.

    There are risks.

    The risks are much less than the risks of not vaccinating.

    The risks do not include autism.

    Even if autism were a risk, autism is not worse than death.

    Vaccines are much safer than disease.

The site is undergoing maintenance presently. Commenting has been disabled. Please check back later!