"I know you are, but what am I?"
That's basically the child's version of a familiar logical fallacy known as the tu quoque, which basically means, "You, too!" It's a very simple and simplistic logical fallacy that tries to argue that, if one's trait shares one or more of the same bad traits of the people he is criticizing, then his arguments can be dismissed. It's sometimes very effective in that implied within the fallacy is a charge of hypocrisy. As a diversionary tactic, it can be very effective.
Not too surprisingly, I've found a doozy of an example of just this fallacy over at the other anti-vaccine crank site besides Age of Autism, namely Medical Voices. Remember Medical Voices? It's nowhere near as active as our "friends" at Generation Rescue and Age of Autism, but, being number two, it appears to try harder. Truly, it's a wretched hive of scum and quackery, and the post over there can be characterized as a combination of tu quoque and a massive straw man argument, in which the word "quack" is turned back on defenders of science-based medicine while simultaneously the positions and arguments of used to criticize quacks are misrepresented as straw men that go beyond Burning Man size and in the article produce a conflagration that could consume a small city as they are engulfed by burning stupid.
Of course, being such a wretched hive of scum and anti-vaccine quackery, Medical Voices has provided me, and more recently Mark Crislip, with blogging material. Dr. Crislip has had perhaps the most hilarious take on the anti-vaccine quackery being promoted over at Medical Voices in a three part takedown:
Amusingly, as a result of Nine Questions, Nine Answers, Nick Haas, one of the founders of Medical Voices, decided to emulate all varieties of cranks, including 9/11 Truthers, HIV/AIDS denialists, Holocaust deniers, supporters of "alternative medicine", and believers in ghosts and the paranormal, and challenge Dr. Crislip to a live, online debate. Also not surprisingly, just like Brave, Brave Sir Robin, Mr. Haas ran away from anything other than a "live" debate.
The looniness of Medical Voices Vaccine Information Center (MVVIC) does have an upside, though, and it's an upside that I've unfortunately ignored for a while now. Basically, it, like Age of Autism or NaturalNews.com, should be a copious source of blogging material, and in this case it is. Specifically, it's a massive case of the aforementioned logical fallacy of tu quoque in the form of an article by someone named Suzanne Humphries, MD entitled Quack. In the post, right is left, up is down, and wrong is right. She begins with one of my favorite quack attacks on science:
Mainstream medicine has hit a new low in its war against physicians who have become alternative healers. The battle has been going on for decades, but lately, in bully-like fashion, pharma's minions are ramping up the vilification. They're now discrediting any healing method not based in their version of accepted science - excuse me, I meant their religion of pharmaceutical belief which has been misnamed as "science".
Hilarious! This is an example of the classic strategies of believers in pseudoscience to bring science down to their level by declaring it "religion." After all, if science is nothing more than a religion, then its conclusions can be easily dismissed as having no more substance than the beliefs of a competing religion, much as Christians dismiss the beliefs of Buddhists, Hindus, or Muslims and vice-versa. It's nothing more than doggerel. There are many differences between science and religion, but perhaps the most important is this: Science changes its conclusions on the basis of new evidence. Not only that, it actively seeks evidence that will falsify its current "dogma." This is in marked contrast to religion, which not only doesn't seek disconfirming evidence for its beliefs but actively attacks and rejects such evidence when it is presented. Yes, it's true that scientists may be too fast to reject ideas that are out of the mainstream, but science itself continues. In science, sooner or later, evidence wins out. The process may be messy and contentious, because human beings who do science are, like most human beings, messy and contentious, out of the messiness and contentiousness the explanatory power of science improves. It's a Darwinian process, in which hypotheses that best explain how nature works and make the most accurate predictions survive.
In fact, Humphries gets it totally wrong in so many ways that I almost feel tempted to leave this paragraph as an exercise for the reader:
They demand explanation and evidence when we reject their drugs, yet they never serve up true evidence or proof that drugs do more good than harm. They insist with religious fervor that vaccines are safe, effective and keep people healthy. They preach as gospel that antibiotics are better or safer than homeopathy, herbs, colloidal silver, vitamin D and natural support for non-life threatening infections, despite the fact that antibiotic adverse effects are common and well documented. Serious effects such as anaphylaxis (inflammatory shock), kidney failure, liver failure, Stevens-Johnson syndrome (a life threatening condition where the epidermis separates from the dermis), Clostridium difficile colitis (commonly referred to as C-diff), and the creation of drug resistant super-bacteria are but a few examples. And now, they've recruited some very bright (but not necessarily wise) minds to attack alternative practitioners. Their latest weapon is name calling - most notably, labeling them "quacks".
Oh, hell. I can't resist. First of all, I'm really interested in knowing what the heck Humphries means by "true evidence." Apparently scientific evidence demonstrating that homeopathy is useless, nothing more than sympathetic magic, and her belief that vaccines cause autism doesn't count as "true evidence." One wonders what does to her. Anecdotal evidence? Probably? Revelation from on high? Possibly? Whatever it is, it doesn't appear to be science, and clearly Humphries rejects science. Yes, real medicine has real risks and can produce real complications, but it produces real benefits too. Homeopathy does not. Neither does colloidal silver. Silver salts may have some value in treating superficial infections when applied as part of a cream or paste, the concentration they require to kill bacteria is too high to be useful in treating systemic infections. As for vitamin D, "alt-med" practitioners massively oversell its benefits, while "conventional" practitioners more and more do actually check vitamin D levels and recommend supplementation. The difference is that, unlike practitioners like Dr. Humphries, they're doing it based on science and a realistic assessment of the potential benefits, risks, and the uncertainties involved in those calculations, rather than a pie-in-the-sky set of claims as vitamin D as a panacea.
Of course, what's really hilarious about this entire article is not so much that it's a massive tu quoque fallacy. Yes, that's funny enough in and of itself, but what's really both hilarious and pathetic is that Humphries can't even do a propoer tu quoque fallacy without reinventing the definition of what a quack is. After listing a dictionary definition of "quack," she writes:
But from its current usage, I'd say they've added a new definition:
3. A physician or medical healer who does not profit from creating and maintaining disease, but rather respects the natural tendency of the body to heal itself; one who helps the body eliminate whatever toxins are causing illness, be they environmental, emotional or pharmaceutical; one who uses primarily non-toxic, non-surgical means for routine care, and uses pharmaceutical and surgical medicine as a last resort.
I do like how Humphries has expanded the definition of "toxin" to "emotional toxins." I wonder what that means. Maybe she's an advocate of the German New Medicine or Biologie Totale, where various forms of emotional trauma are postulated to be the cause of all disease, in particular cancer. In any case, Humphries goes far beyond just redefining the word "quack" as she does above, going on to write:
As a matter of fact, it seems a quack is apparently anyone in the healthcare industry who does not believe in and support the unharnessed proliferation of the pharmaceutical industry, with its virtually unlimited profits from its worldwide distribution of toxic medications and vaccines. When a physician has the ethical fortitude to reject these massive operations and label them as destructive, s/he will be considered a quack. And most definitely, any physician who no longer wishes to be a mercenary for the pharma-backed junta that has taken over medical schools and medical institutions will be tagged "quack".
Funny, by this definition, friends of mine could be considered "quacks." Mark Crislip, for instance, has recently written a post describing how he refuses to take anything from pharaceutical companies and has refused to do so for nearly three decades now. On various occasions over the years, I myself have criticized the pharmaceutical and medical device industry. Does that make me a "quack," too? Probably not, I would guess. After all, I still accept the paradigm that science is the best way to guide and improve medical care. Humphries clearly does not.
Her view is a massive straw man as well, although it's a telling one. Clearly the term "quack" stings Humphries more than she lets on. That's why she has to redefine the word "quack" and turn it into a straw man parody in which defenders of science-based medicine are crazed minions of big pharma who desperately want to pump people full of pharmaceuticals in order to increase the profits of pharma to beyond obscene.
Most gratifying, I think, is this next passage, which appears to be evidence that my humble efforts, as well as those of my "friend" and his partners in crime, are having an effect:
This word "quack" has been turned into a weapon, unleashed on those who notice the scores of patients spiraling to their death at the hands of FDA-approved, CDC-sanctioned medical interventions of big pharma and their affiliated institutions. The self proclaimed authorities of "science-based-medicine," the paid pharma bloggers, "Quack Watchers" and many others who proselytize the message of drug companies and attempt to discredit the time-tested healing methods used by alternative practitioners, are destined to fail. I take comfort in the fact that the masses are becoming increasingly disgruntled with the results of their conventional medical options. The public trust and confidence in what pharma and conventional medical doctors have to offer is, thankfully, dying.
Yes! The forces of science-based medicine are pissing off quacks like Dr. Humphries, so much so that she's using the time-honored tactic of people who are losing and they know it:
Those who have attempted to warp our reputations by calling us "quacks" will not succeed. The primal wisdom of the masses is more powerful than all the propaganda promoted by the misnamed "science-based medicine" and "quack watchers." The pillars that support the sick-care industry are cracking and its architects are getting desperate. In due time, the Yellow Pages will be abundant in so-called quacks. Quack watchers really should watch carefully. The revolution has begun.
Sounds as though Humphries is getting set to get a French revolution going with her very own Comité de salut public, if you know what I mean. Talk about delusions of grandeur! On the other hand, it is true that quackery such as the anti-vaccine movement championed by Humphries and MVVIC have seemed to be in ascendance for a while. Although I've been at times rather pessimistic regarding the anti-vaccine movement, of late I've seen encouraging signs of a backlash against Jenny McCarthy and the anti-vaccine movement. Whether that backlash will persist or not, I don't know, but I do view complaints by supporters of quackery like Dr. Humphries to be an encouraging sign that we bloggers who relentlessly harp on medical pseudoscience and quackery are actually having an effect. There have been times when I truly doubted it, when I thought we were lone voices in the wilderness having no effect.
Thanks, Dr. Suzanne Humphries, for showing me that we're having an effect.
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Oh the tribalism. Science has no tribes.
For the past 10 years or so, many naive med students have been encouraged to buy into "integrative medicine." Once there's an investment, it's difficult to back out. So we have our work cut out for us.
If we could get those departments of infiltrative medicine out of our med schools, our jobs would be easier.
Her definition:
If this were true, then anyone who practices, say, cognitive-behavioral therapy (CBT), would be called a quack. Yet, they aren't, simply because there are countless randomized trials that show CBT to be highly effective.
Indeed, in the autism world there's ABA, and while one can debate the quality of the evidence for ABA, ABA practitioners are almost never called quacks. That's because ABA's provenance is scientific.
Yeah, the day I was walking along and saw the Pharma ShillTM recruitment center was the best thing that could've happened to me. I mean, all those checks I get have come in so handy. That reminds me, fellow shills. Party on my private island this Saturday. Remember to use the leeward runway when landing your private jets.
Hey. Walks like a boxy, Plexiglas duck full of blinking lights. Talks like a boxy, Plexiglas duck full of blinking lights...
Quick! Time to buy guillotine shares! I think sales are going to go up as the blades come down. That or she means that there really is going to be a revolution in alternative "medicine" in that they're actually going to start providing, y'know, evidence that it works...
Hey, a kid can dream, can't he?
Orac, remember how you've noted in the past that, as science comes down harder and harder against Wakefield et al, they've responded with a gradual and growing abandonment of even pretending to sound "science-y"?
This looks to be more of the same. It's as if midway through a college football game, the team getting its ass kicked 90-17 decides to pretend that they can stop playing NCAA-regulation football and make up their own rules instead -- rules which they may change at whim to their own benefit, and which allow for repainting the field markers and putting the goalposts on wheels.
If I found the correct Suzanne/Susan Humpries, MD (you have Susan and Suzanne...which is it?), neither has any training in autism as far as I can tell. Suzanne Humphries has a recommendation by Sherri Tenpenny and we all know Sherri's area of expertise. Anti-vaccine quacks band together.
Personally, if I want information about a health problem, I'll seek out someone who is trained in that area. As much as I respect my PCP, I wouldn't ask him in depth about current treatments in breast cancer, just like I wouldn't ask a neurologist about my foot problems (unless they might be nerve related, like neuropathy). Each might have some knowledge, but not specific enough for me.
@Todd W: Hey! Where did you find the Pharma Shill recruitment center? I keep looking for it, and can never find it. The last address I was given turned out to be a Paknpost type place (and they disclaimed any knowledge of Big Pharm or Lord Draconis. Is there a sooper sekrit password I am missing?). I want to get in on the free-flowing cash!
"Thanks, Dr. Susan Humphries, for showing me that we're having an effect."
Unlike homeopathy, he, he.
@MI Dawn
Well, the one I found was right next to the invisible flying dragon store.
One of the favorite defense mechanisms of my Christian friends is that I am not allowed to criticize because of the whole "judge not, let ye be judged" clause. However, they quickly run away in fear and cower under their beds when I point out to them that the principle of that was not to keep everyone from judging others. It was to keep people from being hypocrites.
This is basically the same argument I've heard from the anti-vaxers that have crossed my path. How dare I tell them what to do with their bodies? Would I like it if someone told me what to do?
What to do to be healthy and keep others around me healthy? Yes. I've been allowing that for years, through my doctor, every year, at my yearly physical. "Mr. Najera," he says, "you should really boost your MMR with all the lab work you do. And let's check those hep B titers." Okay, I agree.
No, my friends, the real hypocrites are those who push all that "natural healing without evidence". If they were not being paid a cent, they would not do what they do, or say what they say. AoA and all of them would not say a peep if book deals, private parties, and the adoration of many were not involved. I bet my cat on it.
@Rene,
I think your cat is safe.
The continued fight against science is frightening on many levels. The distrust in some places is nearly universal. In that sense, Mooney is right - science is not being well communicated to the majority of science illiterates - accommodation, however is wrong.
What we need is a PR firm to publicize science breakthroughs using popular media in addition to MSM. Every success touted wildly and with enthusiasm and parties. Lotteries based on the next great discovery. Even every setback considered soberly as the way science advances, self correcting, and able to change. We need cheerleaders.
Just don't give 'em the flu shot.
@MikeMa
I agree, and not just cheerleaders. We need a Twilight-like (or Harry Potter-like) series where the heroes rely on science. Those stories are usually relegated to historical accounts. Humor me here for a bit...
We need the story of a young, somewhat inexperienced epidemiologist who moonlights as a lab tech. One night, while working in the lab, he notices more and more people coming into the ER with the same syndrome. His quick thinking and ability to solve puzzles allows him to stave off an outbreak of some kind. The villains in this story are many, from the old-timer ER doc who will not listen to reason and wants to discharge everyone with a diagnosis of "viral syndrome" (which is correct, but too broad), to the town religious zealot who is convinced that this is the final plague before the return of Jesus Christ. Our hero battles against prejudice and conformity all through the night to figure out the source of what is going on... And the results may very well change the course of human history forever.
The movie would be in 3-D, of course. It will lack the "cheesiness" of "Outbreak" and the implausibility of "The Andromeda Strain". We're talking real diseases, with real consequences, caused by a power so insidious, so deceiving, that it has been right under our noses all along... Ignorance.
I'll compromise and allow Robert Pattinson to play the lead.
@Rene,
Good idea! Secret super lab tech epidemiologist. A science hero is great. McGuyver with a PhD.
Not enough though. Movies, comedies, dramas, TV, online games, everything considered. It has to be a daily march of progress. Something new, something exciting, something tangible. Advances in medicine, physics, chemistry. New proposed studies and where the results might lead. Abbie (ERV) needs to do some of the editing because, like Orac, she can take the most obscure science and make it a party with knowledge as the party favor.
Something must be done to restore reason and science to its place of honor.
Don't alternative "therapists" ever have repeat business? I mean, Chiropractors seem to live by the dictum "visit early, visit often" - yet it is MDs who are accused of maintaining sickness for profit.
Penelope Dingle reportedly visited and called her homeopath more than once a week for two years in an attempt to cure her rectal cancer until finally submitting (to late) to colorectal surgery. But it's the medical profession that's only in it for profit? WTF?
#12 --- "too late" (damn!)
For some reason, reading that made me immediately think of Sarah Palin.
"Whoever undertakes to set himself up as a judge of Truth and Knowledge is shipwrecked by the laughter of the gods."
~Albert Einstein
This whole thing feels like a schoolyard brawl. How about injecting some civil discourse and listening from both sides? Parochialism seems to run rampant on both sides of the issue. Let's not hide behind "evidence is on my side" arguments, but examine and present the evidence and discuss its merits and gaps in a scientific manner. Are we trying to come to a resolution of the argument or, as the author gleefully points out, to get more fodder for blogging?
@Marya
The problem is that we've been asking for evidence from alternative "medicine" practitioners for years, and years, and years. And they have yet to present anything of quality. I'm willing to wager that anyone here would happily change their stance if sufficient science-based evidence were presented to support the claims of those like Dr. Humphries.
Marya,
I suspect you haven't been here long. Orac DOES routinely analyze the evidence on the issues he discusses. In this case, however, Humphries presents such vague generalities that your charge is not meaningful.
The bit I bolded there is really very impressive.
If antibiotics are bad, then why is it so bad that use of antibiotics can lead to the emergence of bacteria that are ... immune to antibiotics?
I mean, even leaving out the complete misunderstanding of evolution illustrated by that phrase (not just the word 'creation', but also the magical thinking that's indicated in there) ... either antibiotics are good and thus the fact they stop working is bad, or they're bad, and thus the fact they stop working DOESN'T MATTER!
Marya, right after quoting Einstein in a context she doesn't fully understand then commits a golden mean fallacy in attempting to become the arbitrator of truth and knowledge.
Might want read up why your piece of reasoning is so ridiculous:
http://tvtropes.org/pmwiki/pmwiki.php/Main/GoldenMeanFallacy
We follow the evidence. You seem to enjoy forming straw-men and being a mediocre concern troll.
Rene,
only if someone teaches RPatz how to hold a pipette before they start filming. I am still trying to get over the bad job that Sigourney Weaver did in Avatar....
Yupp, I need to sign up to "I am such a scientist anonymous"
@Catherina
I almost walked out of "Outbreak" because of all the BS. CDC cannot just walk into a town and do what they did. The ER doctor asked to call CDC right away? The State health dept. has to ask CDC to come in and help... That was one of many glaring mistakes.
And Renee Russo only had a welt on her nose after being exposed to the virus while others died a violent death in minutes? What?!
Sigh. I too am too much of an analyst to enjoy science fiction.
Rene, come on! Everyone knows that marksmanship and helicopter piloting is an essential part of medical microbiology training!
Even though it was a ridiculous movie, I was at least happy to see lab docs portrayed as action figures rather than nerds.
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Shills and Min . . .
Oh, nevermind. It's just too easy.
Carry on with your evil plans, etc., etc. yrs vry trly.
Lord Draconis Zeneca, VC, iH7L
PharmaCOM Orbital HQ
0010101101001
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You're obviously new here, aren't you?
Hint: I do examine the evidence and discuss its "merits and gaps in a scientific manner." In fact, I do it frequently. I just don't do it each and every post. Sometimes I come across idiocy that deserves to be called idiocy. Like Suzanne Humphries' article.
@Todd: Agree that we need better evidence. Issue is made more complicated by the lack of adequate tools currently to collect such evidence, however. E.g., vaccinations: overall a very useful public health intervention under certain circumstances (life-threatening diseases, high contagion potential), safe when examined as single exposures. It is difficult to study potential interactions with other exposures, be it vaccines or something else, as well as long-term consequences. So, while some conclusions are warranted others are less obvious.
@Scott: Thanks, I am new here. But is it not worth it to keep equanimity instead of spiraling into personal attacks, no matter how stupid and venomous the other guy seems?
@Dalek: Thanks for the link -- an interesting read.
@Orac: Thanks for the discussion. I still think that a sober discussion of the evidence is the higher road, no matter how stupid or venomous the other side seems. I do have to confess that I do not always practice what I preach, though -- this is certainly an emotional issue.
Marya,
Ask pseudoscience promoters for evidence, you get crickets chirping, or anecdote. Show them evidence, you get accusations of dishonesty, and name-calling. That's if they don't just change the subject altogether. You ask for civil discussion, but for any discussion to remain completely civil you need both sides to stay that way. And all the civility you can give them from the science side doesn't keep them from going off the rails and getting nasty.
Oracio: "This is an example of the classic strategies of believers in pseudoscience to bring science down to their level by declaring it "religion."
Huge straw man argument you're trying to put together here. Scientism exists and it is here on this website. Science is separate from scientism.
"There are many differences between science and religion, but perhaps the most important is this: Science changes its conclusions on the basis of new evidence."
This common defense needs to be looked into and scrutinized more. The main problem with this defense is in the difference in the way the term "science" is used and interchanged to fit the defenders argument. More on this one later because this statement has confused SBMers.
"In science, sooner or later, evidence wins out."
Yes and what you say today can be wrong in 50 years according the history of medical science. But today you will steadfastly claim it as truth and knowledge in the name of science. If it is true today then it should be true in 50 years. If it were really "scientific" 50 years ago then it should be "scientific" today. The problem is science doesn't say a lot of things that people say it says. Instead a group of people shove their hand up science's ass and make it speak for it like a puppet.
Ventrila-science.
Sometimes yes, sometimes no. That's why it's good to have a range of voices discussing these topics, with a range of styles. Orac tends to be insolent insolent. The blog his "friend" posts at tends to maintain a more professional tone.
Bad Dalek-you should preface any link to tvtropes with the obligatory warning-"Tvtropes can take over your life, Enter at your peril"
"And all the civility you can give them from the science side doesn't keep them from going off the rails and getting nasty."
It goes both ways chriskid. Read these blogs for evidence. RI is a popular blog because emotions can't be checked by those claiming to objectively use logic and evidence. It's an excuse to take the low road. It's hypocritical really. But I believe Orac's right. You can't win this argument by using evidence alone. You HAVE to resort to emotional tactics and/logical fallacies to persuade.
Marya:"This whole thing feels like a schoolyard brawl. How about injecting some civil discourse and listening from both sides? Parochialism seems to run rampant on both sides of the issue. Let's not hide behind "evidence is on my side" arguments, but examine and present the evidence and discuss its merits and gaps in a scientific manner."
Marya - read on the one hand read Medical Voices' Dr. Humphries going on about "the primal wisdom of the masses", and contrast that with the reasoned, evidence-based response by Dr. Crislip (linked to in the above article) to Medical Voices' antivax nonsense ("Nine Questions, Nine Answers") and tell us who's being "parochial" and foolish - pro-vaccine advocates or antivaxers.
"You're both behaving badly" is not a reasonable conclusion.
augustine troll @ 27:
Granny Weatherwax would have a thing or two to say about your ought/is confusion.
Reading that took me back to yesterday when I was reading the Yahoo News comments on a story about a drug that they were considering pulling as a treatment for breast cancer. Oh, the cranks! According to many of them The Cure for cancer has already been discovered but is kept locked away so that Big Pharma can make money off ineffective drugs. Because, ya know, if Big Pharma had The Cure for cancer, they wouldn't be able to market it and sell it. One person commentating said she was in medical school precisely because she wanted to find out this big secret cure and make sure the world could access it. Ummmmm . . . Yes, because cancer doctors are just greedy bastards who like to see people suffering so they can make money. Sheesh. It's scary to think I share a planet with these people.
Yes, because in the history of those who hide the Cure for Cancer (because it's just one disease don't you know) there has never been one fame-whore who worked on that secret, thus resulting in the the Cure for Cancer being safe from the masses.
Commenting, sorry, long night with a sick kid. Anyway, I am sure that The Cure for Cancer was probably developed by a Brave Maverick Doctor . . . who nonetheless was bought off by a conspiracy between Big Pharma and the FDA, because the US government is actively seeking to keep The Cure silent, because, er, it's in their best interest to keep people sick because, umm . . . well, if I have to connect all the dots for you, you are obviously a Big Pharma shill . . .
Yes Yes, bought off or something even more malicious, because Big Pharma, the FDA and the WHO want the world to be in their clutches and subdued by the fear of cancer and by keeping them sick... Gotta love those who have figured out our Big Pharma conspiracy...
Speaking of which, I still haven't received my shill pay...
I find these attacks on evidence-based medicine frankly monotonous and boring. It should be apparent to any discerning member of the public that it is evidence-based medicine that is constantly challenging it's beliefs based on new evidence. At times we have to eat humble-pie (as in the recommendations for prophylactic ASA for those without evidence of vascular disease) and change our recommendations. Every recommendation is based on the best evidence to date and if you wait for 100% certainty many would suffer for the occasional time when new evidence calls for a meaningful change of direction.
If we are to be accused of being shills for big-pharma please give me the details of the huge profits I should be seeing. I guess they truly believe that we let our parents, spouses and children die, all the time knowing our treatments are toxic and useless, all in the name of profit. Yes it must be a conspiracy millions strong, one of which the mafia would be proud for the total absence of a leak.
Who has the conflict of interest in their treatments, the physician who gains not a penny from the prescriptions they write or the "practitioner" who makes the recommendation, and by good fortune just has it available to sell you?
The fact is it shouldn't be that hard for any doubters to make up their own minds. The simple fact that alternative practitioners seem to have no treatments for acute illnesses with clear outcomes if not effectively treated should be enough. What are their treatments for the truly ill; those with acute septicemia, bacterial pneumonia, heart failure, status epilepticus, malignant hypertension, anaphylactic shock to name a few. For these conditions where the lack of definitive treatment is obvious (death), they seem to have no answer, but give us the walking well with vague symptoms just ripe for a placebo benefit and now you're talking their language.
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Shills etc.
I thought we had dealt with this Augustine rebel several chapters ago. He returns with the dreadful inevitability of an unloved season. No matter, the Sooper Seekrit⢠Kancer Kure is in a safe spot here in orbit. The vault is in the middle of the most dangerous place on the station: the hatchling creche. It's festooned with colorful scenes depicting hatchlings merrily disemboweling and toying with their favorite food . . . rebels.
No need to search medical schools or pharmaceutical laboratories for it. We paid that brave, delicious, maverick scientist for it and we're not giving it back until we're done with Operation: Monkey Brain Shrink. Then we shall sit back and enjoy our vast army of strapping, brainless and cancer free primates.
Marya dear, you are new here, aren't you. This isn't venom. If you want to see venom, ask The Gregarious Misanthrope to show you the video of his clown act at our last PharmaPicnic. Now that's venom. Remember darling, you taste just like chicken . . . or is it cherry? I can never remember.
In any case, Cindy asks me to let you all know that sign ups for the Karaoke Contest are now closed. Thanks for your enthusiastic response.
Now back to work, Markuze is loose on Facebook.
Lord Draconis Zeneca, VC, iH7L
PharmaCOM Orbital HQ
0010101101001
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I like how you never mentioned that Dr Humphries is a physicist, Internist and Nephrologist. I wonder why you left her credentials out of the discussion. What are you guys so afraid of. Why won't you debate on a public forum. They want a public forum because Dr Tenpenny gets edited out of taped programs. Why are you folks so afraid to debate them? come out of the shadows, pick your battle with worthy opponents, and not just parents trying to defent their children's lives on Matt lauers facebook page, and using Jenny McCarthy against a group of doctors .Shame on Offit, Orac and friends for not taking on the real debate with real doctors.
Ian: "What are their treatments for the truly ill; those with acute septicemia, bacterial pneumonia, heart failure, status epilepticus, malignant hypertension, anaphylactic shock to name a few."
You're making another strawman. Medical treatment has it's place and it's boundaries. Nobody is saying to throw the baby out with the bath water. But it's time to change the dirty water.
If you were truly evidenced based you'd be looking inward instead of outward. All of the combined non allopathic "treatment" in the world does not kill more than "science based medicine does in a year. I know an ad hoc will come next but that'll just support the argument.
zee=Poe?
No one is afraid to debate. The issue, and something you types seem to not be able to grasp, is that science isn't settled on the debate podium. It is settled in peer review, research and the lab.
Period.
Zee you might as well be arguing as a creationist.
Exactly the same piss poor bullshit.
"But but Michael Behe has all kinds of letters after his name!!! You're just afraid to debate him!!!"
"The issue, and something you types seem to not be able to grasp, is that science isn't settled on the debate podium."
Ever heard of Clarence Darrow vs. Willliam Jennings Bryan? What peer reviewed paper were they researching again? Were there any test tubes involved? Where is this famous lab?
only one thing to say....
http://juliagrimesjourney.blogspot.com/
All I have to say.....my vaccine injured daughter.
http://juliagrimesjourney.blogspot.com/
One thing to say, said twice. Brilliant!
If you've ever seen one of their best, stephen barrett, live then you'll know why they don't like live debate.
Articulation, appearance, and connection with an audience probably isn't this group's strong suit. Cynicism, pessimism, and skepticism generally are not endearing qualitities to other human beings. Best to stick with blogging and not show your personalities.
Susan, one vaccine. While it has been a horrible experience for you. It has been noted, and its use for young children is no longer recommended. Plus you did win in Vaccine Court.
It does not mean all vaccines are always bad.
By the way, my kid at about the same age got a trip to the hospital by ambulance because of seizures, and losing consciousnesses. It was over a week after his MMR vaccine, but we knew that was not it. He was sick with something else that did not have a vaccine yet. Oh, and he is still disabled as an adult.
In case you didn't know, diseases also cause problems. Very often. Measles will cause encephalitis one out of a thousand times.
"In case you didn't know, diseases also cause problems."
Now you're insulting her.
augustine:
1. That could have something to do with CAM doing nothing at all. 2. It could also have something to do with the numbers of people getting treated with medicine vs. the number being treated with CAM. And, lastly, it could have a lot to do with the shitty record keeping for CAM.
The Scopes trial settled whether it was legal to teach evolution in Tennessee, not the validity of the science of evolution.
And that's what determines who's right. Right?
@ 27 augustine,
First, science-based medicine does not really change.
Then science changes too much.
And back to the first bunch of misinformation:
The main problem with this defense criticism is in the difference in the way the term "science" is used and interchanged to fit the defenders critic's argument.
No problem with augustine having trouble deciding if he is the pot or the kettle, again.
Maybe you are smoking pot out of a kettle-sized bong. Time to hand over your car keys. You have had way too much.
You appear to be high enough that you actually believe some of what you write.
.
@ 42 Chris,
Posy?
.
Rogue Medic:
:-)
@ 53 Chris,
I just keep thinking about a bowl of petunias . . . and a whale.
Your previous comment being number 42 might have had something to do with that. ;-)
.
Wow, this is the most ridiculous pro-vaccine douche-baggery I've ever read, promoting Rockefeller's Standard Oil Company's vaccinations foundation, into the modern I.G. Farben sister company Bayer, spreading AIDS knowingly through their vaccine Factor 8.. type into google "bayer knew aids" also "Merck Vaccines Aids" and "Robert Gallo AIDS" to find the TRUTH about vaccines and what they are really for, depopulation and mutation of nearly every human being on earth, into a sub-human species with all the animal cells, heavy metals and toxic chemicals.
Vaccines, petro-pharmaceuticals, petro-soaps/lotions, bisphenol-a plastics, processed and genetically modified foods are the largest health frauds in modern history!
@ 56 Adam Wiederholt,
You demonstrate an amazing inability to differentiate even among the disparate conspiracy theories you are selling.
.
"I like how you never mentioned that Dr Humphries is a physicist, Internist and Nephrologist."
A regular Doc Savage, that one. Note to zee: I have a degree in physics as well. That doesn't make one a physicist.
@ 58 Otto,
Physicist/Physician/Phrenologist/Phaeomycotic cyst/Phallicist/Phthisis - whatever it takes. It is unfair for people to have to discriminate among these. As long as they sound smart, they must mean smart.
She might even be a quantum physicist. ;-)
.
Otto, Dr. Mark Crislip's undergraduate degree is also in physics. I will take a wild guess that he would agree with you.
Mr. Wiederholt, what planet do you live on?
@Chris
Icketopia?
RANDOM COMMENT HERE TO BE DECONSTRUCTED BY AGUSTINE.
(Yesterday must have been his day off from the looney farm.)
I'm totally looking forward to more insightful comments by Mr. Wiederholt.
I have a degree in physics but I would not call myself a physicist. I am still interested in the topic, I do know a fair bit about particle physics after having worked in the field, but I think physicists are my friends who are still working in physics and to call myself one would be unfair to them. I am something else now.
Sort of off topic, but I did see some good news on the anti-vax front on gawker today:
http://gawker.com/5591547/today-is-the-day-lindsay-lohan-goes-to-jail
Yes and what you say today can be wrong in 50 years according the history of medical science.
As opposed to what augustine says, which is empty BS today, and will still be empty BS in 50 years.
Seriously, this is the most disgusting tactic of the anti-rationalist con-artists: using their opponents' honesty against them, making it a liability, and pretending that our willingness to admit our errors prove we're less realiable than people who consistently lie, make mistakes, and never admit their errors. Obscurantists like augustine are pond-scum, pure and simple(minded).
... that would make a kick-ass anime comic mutant, zombie superpowered army. Maybe a team of plucky anti-science teens can thwart this dastardly master plan.
ragingbee: "Seriously, this is the most disgusting tactic of the anti-rationalist con-artists: using their opponents' honesty against them, making it a liability, and pretending that our willingness to admit our errors prove we're less realiable than people who consistently lie, make mistakes, and never admit their errors."
Talk about the blatant use of a logical fallacy by a SBMer. Using their opponents honesty against them? How about using your arrogance against you.
Admit our errors? YOU will not admit your errors because YOU believe your way is the only way. You will go down guns a blazing. Your descendants will admit your errors for you in the name of science and progress. But today you'll claim "science is on your side." Whatever that means.
@augustoons,
You live in a world of hope but no evidence. Must be tough for you.
Science is not in error ever but scientists are and they, when presented evidence, usually admit it. Even if some scientists cannot accept evidence against them, the community will eventually leave the errors behind. Not so your merry band of faithists.
Do you even know what a product insert is? Try reading one for your favorite vaccine.
You can look up her name via the NPI database:
https://nppes.cms.hhs.gov/NPPES/NPIRegistrySearch.do?subAction=reset&se…
The only one with an MD is a nephrologist in Maine. However, the Dr. Humphries discussed in the post may no longer have a valid license and not appear on the NPI directory.
"Do you even know what a product insert is? Try reading one for your favorite vaccine."
I'm guessing you probably did read the insert(s)...you probably also completely misunderstood the information therein.
Yeah, it's basically a legal disclaimer written by lawyers under rules created by politicians. Are you confusing that with scientific evidence or are you the kind of person that really needs that big warning label on your lawnmower that tells you to not stick your hand in the spinning blades?
@Poogles
He did. Go to his website, but only if you haven't had anything to eat recently. I think I puked a little in my mouth. The dude is really "out there", in my opinion. He couldn't find a definition for "illness", so he made up his own... Richard, I could have saved you a lifetime of Woo...
Let me Google that for you!
Are "non-allopathic" deaths even tracked? I don't think that's possible. In addition to that, there are a couple things you fail to consider: (1) The types of cases that science-based medicine must take on (e.g. when you have a heart-attack, you're not going to be rushed in an ambulance to see a homeopath), and (2) The total number of people treated with each modality.
Didn't we all but kill off allopathy a century ago?
ababa--The product insert is also a list of all the unlikely but possible effects, which even if your doctor or pharmacist had the time to go over with you when they gave you the medicine, you wouldn't remember, but it might be useful later. "Hey, my pee just turned blue, I wonder if it's one of those new meds, and what it means" and you look at the product insert and find that this happens in 4% of patients and seems harmless, or in .3% but stop taking this and call the doctor, or it's not listed in either of them so you call your doctor and ask what to do. That's not legal information (though it might be legally relevant) it's medical.
Once again I have to contend that this has disintegrated into personal attacks without resorting to evidence. I want to be clear that I am very much FOR the practice of EBM. At the same time, I want us to admit (humbly) that what we think we know is not always what is true. Smarter and much more illustrious people than I (though not more so than Orac, I am sure), have indicated that we as humans see the objective through the prism of our own experience. Here is a quote from Sander Greenland of UCLA, who literally wrote the book on Epidemiology (from Greenland S. J Epidemiol Community Health 2009;63:593-8):
"Even though I regard the idea of singular truth as fundamental to science (just as it is to religion), I also think everything we claim to be knowledge is subjective and hence vulnerable to personal bias. This epistemic subjectivity is another harsh fact of life that the health sciences will have to accommodate as they mature. The process requires recognition that the illusion of objectivity is buttressed by rigid statistical conventions that prey upon and feed human cravings for certainty. It also requires recognition that these conventions have profound biases and value judgements (eg, favouring false negatives over false positives) built into their core. These biases and values are not shared by all stakeholders in methodological, subject matter or ethical debates."
And here is more on this from Ted Kaptchuk of Harvard (Kaptchuk TJ. BMJ 2003;326:1453-5):
"Facts do not accumulate on the blank slates of researchersâ minds and data simply do not speak for themselves. Good science inevitably embodies a tension between the empiricism of concrete data and the rationalism of deeply held convictions. Unbiased interpretation of data is as important as performing rigorous experiments. This evaluative process is never totally objective or completely independent of scientistsâ convictions or theoretical apparatus."
The point is that however objective the truth may be, there is always some subjectivity in its interpretation. Hence my contention that we do not always know what we think we know.
So Marya, do you really expect us to take Little Augie and every random person who screams "read the inserts" seriously?
Please, go ahead and reason with them.
Augustine: Heavy on vague criticism, light on facts. Feel free to post your science (or is it scientism?) alternatives for us, buddy. Or get a degree, put the work in, and publish some research. How is it that our knowledge changed in that 50 years again? Was it devine revelation or continued scientific study?
As for Marya... "I want us to admit (humbly) that what we think we know is not always what is true".
No shit. This is the foundation of science, which you claim to know something about. Do you think scientists just sit around looking for confirming evidence constantly? Do you think they just cover their ears and go "LALALALA" when facts that contradict their theories are presented? Do you think we haven't heard this nonsense a thousand times before?
This is for both of you: saying that people in the past were incorrect or that we don't know everything is not an excuse to just speculate however you please. If you believe science is ineffective and defending science-based conclusions is without value, give us a better system. Give us something that comes up with useful answers faster, more effectively, and with less damage done than science does. Please. We'd all love to switch over. Until then, we will continue to vehemently defend science-based conclusions. Are all of them going to be 100% right? No, but the way to figure it out is with more science, not less.
@Chris:
I think that they are getting a lot of mileage out of you here and elsewhere in verbal sparring. Why not use that time and energy to address the actual issues with them? Why is taking the time to throw insults at each other more productive than an honest debate? And please don't say it is because they started it...
Shorter: people who know very little often confuse those who know a bit for those who think they know it all.
@marya
Honest debate? Oh god, you are new. Please, please, please just read up on the history of this "debate".
@Marya
Go back and find where augustine first surfaced on this blog. You will find that some of us did try to converse reasonably with him/her/it. Auggie, however, did not have reasonable discourse in mind. Please, take some time to educate yourself on the history before expounding on what is the best course of action.
That's the most naive comment I've read in a long time. It's completely ridiculous to expect that an anti-vaxer can be reached if you simply provide them with data and well-reasoned insights.
Indeed, none of this is for their benefit.
Please read this post by Orac about "building bridges" to the anti-vax movement.
@Marya
debates or discussions with augustine specificially, and his/her ilk in general, are a Sisyphusian task as best. What you see here now are the structures and protocols built up over time in dealing with he/she on a near-daily basis.
If someone started watching Starship Troopers 3 and said "I don't get it, why don't the humans try and negotiate with the arachnids" it would only make sense if the person was unaware of Starship Trooper 1. Starship Troopers 2 doesn't really add much to the overall storyline and can be skipped over.
Marya @ 79, you are preaching to the choir. We, or most of us anyway, are cognisant of our biases and limitations and strive to minimise those when scrutinising the data. There are numerous discussions here that are heavily scientific and yes, epistemic in nature. You are new here, as you admit, so instead of trying to tell us hicks how you think things should be done, try joining the discussion, staying on topic, and present your particular interpretation.
Again, you're new here and not familiar with the revolving door of 'antis' here. Regular contributors have tried to present people like Augie particular well-supported facts and comments regarding erroneous conclusions and cherry-picked data, but to no avail. Augie prefers to criticise abundantly, but is light on presenting viable alternatives, pretty much the antithesis of the quotes you posted in #79. There are numerous other blogs which may be more to your liking if this one is not.
Because augustine and his ilk are completely unwilling to honestly discuss ANYTHING.
@87
There's a Starship Troopers 3?!? I liked the first one enough to give the sequel a once-through, which was more than it was worth. Is three better?
SM: "We, or most of us anyway, are cognisant of our biases and limitations and strive to minimise those when scrutinising the data."
Really? Seriously? There's no evidence of that on here.
Cherry Picking? Data is data right? If anyone cherry picks it's the SBMers. Talk about suppression of informed consent. Whew.
Marya, I see you did not answer my question. How often in the last few weeks have I even bothered to address Little Augie directly? I actually do not respond to him, but will comment on his style (which involve cherry picking, deliberate mis-interpretation of what people write and general insults).
Now seriously, go back to the first few weeks he appeared. We did try to reason with him, and got no where. So now here you come and try to tell us how to do it. So please, do it already!
I have a proposal: the rest of us continue to ignore augustine and Marya will be the designated person to reason with him. I especially would like to see how far she gets with him. Good luck with that.
@Mike
Starship Troopers 3 is a much more appropriate sequel than Starship Troopers 2 is. They even bust out the battle armor (from the book). Its uh, weird. The movie also acts at times like there actually was a Starship Troopers 2 that fits in the storyline because of the way they refer to some of the characters and events.
It also gets back into the mode of satire that the first one did well.* I don't want to give away the plot, but it deals with religion in a fairly decent manner. The ending is pretty good, really. Which is extra-surprising considering its a movie about people and bugs killing each other in every way possible.
*I'm still plagued with the inability to tell what exactly Heinlein was getting at in the book (was he for all out authoritarianism or was he showing how out of control that sort of thinking can get or did he just want a vehicle to complain about the amount of non-combat personnel in the army or what) in part because of the movie. If there was doubt about the movie's goal, in the director's commentary Verhoeven says something to the effect of "I wasn't sure either so I decided to just be as over the top as I possibly could".
"I have a proposal: the rest of us continue to ignore augustine and Marya will be the designated person to reason with him. I especially would like to see how far she gets with him. Good luck with that."
Maybe she doesn't have a preconceived agenda like the rest Orac's nutswingers
Marya, I would love to know who you would have reasoned with this ! Sometimes she seemed to be advocating violence.
Please tell us how we could have handled that better. Was it all the papers I cited? Did they matter?
@92
I think it's pretty well accepted that Heinlein was not being ironic or satirical in the novel. It seems to be a weird authoritarian utopia novel, that is supposedly anti-communist, but focuses on the importance of putting the needs of the state over the needs of the individual. I'm glad verhoeven went the direction he did because 1) it works way better as satire, because it's ridiculous if taken seriously and 2) the first movie was great.
Just read the wiki on the third (skipping all but the first paragraph about the plot) and it sounds worth a download at least.
Marya,
Judging from the sampling on here, the majority of the bloggers are NOT scientists although they speak for a particular style of science called skeptic science which is only "mostly science" not actually science. It is a systematic worldview that revolves around naturalistic philosophy or some material version thereof.
What makes it confusing and disingenuous is that they've hijacked the term "science" and commonly refer to EBM although they quite often lack the evidence they think they have. What they cling to is theory of what should be expected given xyz. Not ACTUAL evidence.
And you just solidified my point Augie. Well done.
Thanks for all the responses and for the warm welcome. Just because I may disagree with some of the underlying assumptions does not make me the enemy of you, EBM or your side of the debate. My personal opinion is that it is much more fun to actually focus on specific primary evidence and its implications than to insult each other. Forgive me if this feels like I, new to the forum, am telling you how to do things; I would not presume to do that. Perhaps someone (@Science Mom?) can point me to another place where I can have some fun of my brand, where it is the science itself that is being discussed. We do this politely and dispassionately in peer-reviewed literature, but that is not nearly as dynamic as a blog with the opportunity for near-real-time interaction.
And @Orac:Congratulations on creating such a well-attended and followed blog!
Marya:
I agree with you. But that would mean that Orac would have to resort to some draconian moderation in order to remove the distractions from the actual discussions. Do remember this is more like a group of people talking in a pub, not a peer reviewed journal, or the conference room of a hospital discussing cases.
Though you might get a flavor if a medical conference were open to all who wanted to come, and several people who get their medical information from NaturalNews, PrisonPlanet, and the like showed up to shout down the presenter.
Without the moderation you do get a flavor of what kind of debate you can expect from those who will not deal with the evidence. An pertinent example of this is the person who claims to be "Smarter Than You" but only posts diatribes that Orac is a moron, etc. And yes, in his earlier appearances he was asked patiently multiple times to post his evidence. He has not done so, but claims there will be something this fall that will shatter all the evidence we have given him.
I would suspect you might enjoy the ScienceBasedMedicine blog more. Since registration is required, you get fewer of the "post insults and leave" type. There are a few chronic trolls there that after trying multiple times to reason with, are just generally ignored (and links to previous attempts to reason are left for those who are new,). Plus at least one has been banned. And one particular homeopath promoter has been the subject of a few articles.
They had two workshops at TAM 8 in Las Vegas earlier this month. We are only allowed two links, but I would like to mention that many of the bloggers there participated in an Anti-Anti-Vax panel at TAM 7. Go to the JamesRandiFoundation youtube account and look for those videos.
@mike 96
The thing is, some times I wonder how someone could have written such a pro-authoritarianism book and also be considered by many to be a hero of the libertarian movement. I mean, I know people change over time and what have you, but that seems like an odd pair of views on the same person. That said, in one of his short stories, "Coventary", he makes fun of at least extreme libertarianism if nothing else.
In an effort to not go any further offtopic I will agree with you that had the first movie not been satire it would have been about as big a train wreck as I can imagine.
I would definitely download the third one and if you really like it buy a copy, which can probably be had for virtually nothing :p
@ 99 Marya,
You might enjoy the blog more if you were to skip over the comments that are written by augustine (he just happens to be the current troll of the month) or addressing a comment by augustine. Many of us will put in some sort of salutation that identifies what comment/commenter we are responding to.
You may find that your reading of the comments goes more quickly and is more productive.
There is valuable scientific comment on this blog. It is just a matter of being able to discriminate among the various degrees of quality.
You choose what you pay attention to.
.
Yeh Marya,
If you read Augustine, you'll miss the heaping mounds of hard science that is presented on Respectful Insolence.
Actually you'll only miss mounds of ad hominem commentary on Orac's quack dejour.
@augustine:
Please expand on this and explain, preferably with concrete examples (even if the examples are hypothetical).
Also, augustine, I'm interested in what kind of medicine (or medicines) you use in addition to (or instead of) EMB/"allopathy".
@104 Cline, Matthew
$700 billion dollars are wasted each year on conventional medicine treatments that don't work or do what they claim. Not only do they not work they put peoples lives and health at risk.
Those of you who attack non conventional "medicine" based on the "they steal money" argument aren't going to get far with credibility on this one unless you can come up with something close to $700 billion.
The "pseudoscience cranks are dangerous" arguments aren't going to get very far either if you don't put your time in where most of the danger occurs and that is the unnecessary deaths in conventional medicine. That's not a congruent argument. But the vast majority of the time spent here by bloggers is attacking their ideological enemies, because it is an emotional release, rather than intellectually examining their own ethics, practices, beliefs, and EVIDENCE.
I think using EBM can be a useful tool when deciding on treatment options but THIS is not a real EBM blogging site. This is a skeptic indoctrination website. aka atheist network.
Have you ever questioned stents, CABG, statin drug theory, antibiotics for strep throat, bone density tests, psychiatric medicine, etc,? Not that I can see. And even if you gave lip service to it we could easily log the number of blog entries dedicated to the topic vs. quack attacks. It's more fun to call yourself science based and attack other for not thinking like yourself.
If you were were truly Evidenced based then you wouldn't even have the time to chase alternate practices and theories because you'd be working at eliminating 1/3 of the current practices of status quo medicine. Probably the most insidious 1/3.
When you live in glass houses you shouldn't throw stones.
@105
I told you, NONE.
As I recall from reading Starship Troopers many years ago, it seemed pretty clear to me that Heinlein was arguing in favor of a form of government where only those who were willing to give up something significant (potentially their lives) to earn it were allowed to be citizens. Since the majority of U.S. citizens have chosen not to exercise the foremost right of citizenship, i.e. voting in most recent elections, there may even be a silent consensus in support of that. But, I doubt it.
The bug aliens in the war existed mainly to give a hard and dirty setting to discuss that philosophical theme. I haven't read Verhoeven's comments and don't have any of the DVD's, so I may be wrong. But, since philosphical themes don't translate easily onto the silver screen, I would guess that Verhoeven just chose to leave them out and simply make a shoot-em-up special effects sci-fi action movie which would get a good audience and make money.
Although most of Heinlein's works are very human-centric, he did write a few that involved intelligent, communicative and plausible aliens (several of his Mars books like Stranger in a Strange Land, for instance). The bug aliens in Starship Troopers are there simply to provide an implacable foe that necessitates a response, like the Borg in Star Trek or the aliens in Alien/Aliens, etc.
Unfotunately, some of the commenters on this and other blogs are similarly uncommunicative, never getting around to explicitly stating what they think or support and never giving a coherent explanation of why.
Fortunately, a few of them are occasionally amusing and the others are much more easily ignored.
My recollection is that:
1) Only those who had served in the military were allowed to vote or hold office.
2) Anyone who volunteered for military service would be allowed to serve. You could be a blind and deaf quadriplegic with a severe learning disability and they'd still find some way for you to serve.
Since little augie still has nothing of relevance to say that isn't stuffed full of projection and hypocrisy, I think I'll address the question about Heinlein.
IIRC from reading Heinlein's own comments about Starship Troopers, his goal wasn't in any way to describe his "ideal" society, but rather a society that was different, but hypothetically feasible. It was meant as more of an example of "here is another way that a society might function" and not as an example of how it should function.
The bug aliens in the war existed mainly to give a hard and dirty setting to discuss that philosophical theme. I haven't read Verhoeven's comments and don't have any of the DVD's, so I may be wrong. But, since philosphical themes don't translate easily onto the silver screen, I would guess that Verhoeven just chose to leave them out and simply make a shoot-em-up special effects sci-fi action movie which would get a good audience and make money.
@Matthew Cline,
1. Yes. Perhaps I was a little too indirect in referring to it as being "willing to give up something significant (potentially their lives)", but that is what I was thinking of. Also, as I recall, they had to wait until after they served to become citizens.
2. I forget what the medical requirements were. It's been a few years since I read it. (:;) So, you're probably right. I know that a lot of people were allowed to serve in non-combat positions in order to earn their citizenship, but they were at least available for other duties if needed. I did something similar during my military career.
Zetetic, I'll take your word for it. I don't remember reading that, but it might be in a book of his collected miscellaneous writings I have buried away somewhere. I'll have to add it to my reading pile if I can find it.
@109, Was that an echo?
To try to get a little closer to the topic of this blog, I think that, having experienced medicine as it was practiced from the 30's through the 80's, Robert Heinlein would support the improvements achieved by science-based medicine. I know in the 70's he became a strong advocate for blood donation. Having worked on several blood drives when I was in college, I was lucky enough to qualify to get him to sign a few of his books when I met him at a local science fiction convention.
@augustine
Your accusations are disingenuous. This is a strictly evidence based medicine site. You constantly harp on us for not being open to new ideas and paradigms outside our spectrum of medical knowledge, yet you never provide specific things that you believe in or evidence for them. You occasionally snipe at vaccines, but you ignore criticisms of your evidence. What you advocate is not being more "open-minded" but rather lowering our standards for evidence. You constantly bring up non-sequitors ($700 billion wasted) while dishonestly leaving out context (evidence based medicine strives to eliminate therapies that don't work, Orac posts about this very thing here and elsewhere). It's been said before auggie, but it's time you put up or shut up. Tell us how to improve, what therapies and modalities we should accept, and provide the best evidence for them. You do a lot of criticizing, but provide very little substance.
@marya
I feel like I was a bit harsh yesterday and it mostly has to do with 1) lumping you in with our own little obnoxious troll and 2) being frustrated with your condescension. I think it's rude to come to an established forum and tell people how to do things (better to find a forum that already suits you), but you seem generally curious and polite.
@auggie cont.
also, most of us would be pretty honest about our level of science education and our jobs. I'm a production chemist, which makes me not that much of a scientist, but there's nothing about being a non-scientist that prevents one from being science-literate. I've taken mostly undergraduate level biology, physics, chemistry, and geology courses of various types, done independent studies in geology and physics, and generally kept up with science news and studied independently when I can. I've been interested in science for almost my entire life, and consider myself pretty well versed in the methodology, though I have the utmost reverance for those who do the really interesting stuff. I'd like to get my masters in some variety of biology sometime in the next 5 years and work in a research field. Do you have any interest in being as forthcoming with us?
@Marya
There are several types of articles that Orac writes. Some, such as this one, respond to articles written by others that contain no evidence to support their opinions. In the absence of evidence to discuss, it seems perfectly fine to comment on what was presented. In other articles, Orac takes on evidentiary claims and talks about the science (or lack of) behind the claims. For example, he has discussed the scientific evidence for and against various cancer treatments.
As for the comments, we generally try to keep on the same topic of the post, though sometimes we do get derailed. When it comes to some people, like augustine, we may appear overly harsh or closed-minded to them. This is generally due to past experience with the individual. In augustine's case, as I mentioned, several of us tried reasoning with him/her/it. We asked for evidence and all we got in return were (incorrect) accusations of logical fallacies. Zetetic in particular had a long back-and-forth with augustine and got nothing of substance from him/her/it.
So, just some friendly advice, if you see some manner of bickering between certain commenters, either do a little homework and look back at the history or ask what the background is. There's usually a pretty valid reason. In general, I agree with you. I typically start with a new person by discussing the science behind something, and will try to stick to it even when they show that they are only interested in arguing and do not want to have an honest discussion. After a while of that, I finally give up on the person. If they aren't willing to talk civilly, then I feel no need to interact with them.
If you want someplace that focuses more on the science and has less snark, as Chris mentioned, the Science-Based Medicine blog would be a good place.
This might be a Poe, but if it's not... "petro-soaps/lotion"? Is that Vaseline? Detergent?
Vaccine theory is based on Edward Jenner's research. Who here has even read and understood HIS work? Even the name of the original virus he used has been lost. It was replaced with another virus. I want to see the original evidence that antibodies equate with immunity as antibodies are not always present in order to recover from disease. Show me that the original research is without fault, then show me that there has been no faults or conflicts of interest in the new research from which subsequent vaccines are based, and I will support modern vaccine science.
Mikerattlesnake "This is a strictly evidence based medicine site."
I'll keep that in mind for when the next blogger starts harping away on personal opinion or ideologies in lieu of evidence or intertwined with facts. Trust me it won't take long. Orac will probably provide.
Why don't you ask more specific questions for those topics you don't understand? As it is, it's no one's job to convince you of anything, particularly since you have such a ludicrous expectation of what the scientific method is.
"I want to see the original evidence"
What do you mean by 'original evidence'?
Why is current evidence not sufficient?
"that antibodies equate with immunity"
What do you mean by 'equates with immunity'?
"as antibodies are not always present in order to recover from disease."
I'm not aware of where any claim has been made that they need to be. This seems to be beside the point.
"Show me that the original research is without fault,"
Why should we do your work for you? Why should the 'original research' be without fault in order to have any value?
"then show me that there has been no faults or conflicts of interest in the new research"
Why should there be no faults or COI's in order for this research to have value?
"and I will support modern vaccine science."
How about you piss off and find out for yourself?
If you want us to work for you, you will be billed at professional rates.
Or you could do the work yourself.
@106
I'm curious about what in particular you want questioned about using antibiotics to treat strep throat? Do you believe that they're ineffective? Overused? That there's a better treatment? That strep is not sufficiently dangerous to be worth treating (despite being painful, contagious, having serious side effects such as rheumatic fever, and occasionally fatal)?
@Tabitha Little
Unfortunately, the original research notes are probably lost to time, not to mention that even if they aren't, the average reader here probably does not have access to it any more than you do.
This is an impossible standard. No human endeavor is 100% without fault. Instead, you should be asking for evidence that is reasonably without fault.
Again, the "no faults" standard is impossibly high. As to conflicts of interest, I'm curious to know how you define it. Often, it seems like those who are opposed to vaccines define COIs as having even the most tenuous connection to Big PharmaTM.
Although there may not be direct evidence showing that certain titer counts are 100% accurate indications of immunity, there have been numerous studies showing that such surrogate markers are relatively reliable. There have even been some vaccine studies that have used placebos and exposed the subjects to the bacteria/viruses that cause the disease under investigation.
A good place you may want to look for more information is the Topic-Based Reference at Science-Based Medicine blog (the tab is at the upper right). Most of the info you're looking for is in the "Vaccines and Autism" section (the most fleshed-out portion so far). You should also think about contacting a university or medical school that has an infectious disease or epidemiology department. See if you can ask a researcher for more information (e.g., Dr. Mark Crislip at SBM is an infectious disease specialist). Searching PubMed, PLoS and perhaps even clinicaltrials.gov could also turn up more information.
Hope this helps.
@Mephistopheles O'Brien
I was wondering about that, too. As someone who has contracted strep many, many times, I am quite thankful for the antibiotics I received that prevented my developing more serious complications.
Edward Jenner's work was during the 1700's when pilgrams were fleeing religious persecution in Great Britain. He conducted research for the Royal Society. His writings are readily available on the internet to all those who wish to read it. He wrote several papers on smallpox and cowpox. He was an avid bird watcher as well, however, he wasn't really a physician. It was an honorary title given to him because of the work he did. The whole basis for vaccine theory is based on his research, and every subsequent vaccine is based on previous vaccines. It is always advisable to seek knowledge from primary sources. Many chose to walk through life with minimum standards or assume that some standards are too far out of reach. That is their choice and I will not try to persuade anyone from making that choice if that is where their heart lies. I am, however,going to side against the beliefs of the multitude here, despite the hateful name calling.
...and verified by subsequent research
...and developed and verified by subsequent research.
...and verify by subsequent research. Ever heard of reproducibility?
"It is always advisable to seek knowledge from primary sources."
Primary sources refers to the sources that generated the data. It is not used in the way you appear to be using it.
One can easily look at later sources for additional valid data on vaccine and immunology.
This is pure distraction, and you know it. Stop it.
"I am, however,going to side against the beliefs of the multitude here, despite the hateful name calling."
And, as long as you behave in the way you do now, the name calling will be both accurate and fully deserved.
Don't try your dirty tricks here. You will be called out on them.
Now, kindly substantiate your requests and provide an address to which the charges can be billed, or go away and do your own work.
What Tabitha probably means is that, in science, it's always a good idea to understand the provenance of a theory or hypothesis. If the provenance is non-scientific (think astrology or homeopathy) then it's highly likely that the theory or hypothesis is pseudo-scientific as well.
Of course, none of this applies to immunology at all, whose provenance seems to be a bit more complex than Tabitha would have us believe.
You do not have to have antibodies to recover from disease. Vaccine efficacy is based on their ability to cause production of antibodies. Reproducibility of antibodies does not mean one is saved from disease.
@Tabitha Little
I'm curious. What is your explanation for how one recovers from, say, pertussis? What process occurs in the body? After infection with B. pertussis, what is it that keeps a person from developing the disease again if exposed to the bacteria a year later?
I'm guessing that you are responding to T. Bruce McNeely here. By "reproducibility", he did not mean reproduction of antibodies, but rather that the findings of one research team were reproduced by other research teams, thereby increasing the validity of the original hypothesis.
@Tabitha,
I'll bite. What disease are you talking about where you recover without antibodies? How did you ascertain that there were no antibodies? Were there UFOs involved?
"You do not have to have antibodies to recover from disease."
I'm not aware of anyone saying you do.
Disease refers to a lot more than just anti-gen infection. You should know this.
"Vaccine efficacy is based on their ability to cause production of antibodies."
Err, no, it's based on reduction in cases over time in a population, generally speaking - the reduction of health lost due to illness and aftereffects. It's generally related to anti-body production, hencewhy it can be used as an indicator in individuals.
"Reproducibility of antibodies does not mean one is saved from disease."
Of course not. I'm not aware of anyone that has said this.
Immunologists and vaccinologists are fully aware of these factors, and - had you bothered to actually ask properly - this could have been pointed out to you from the start.
As it is, you still have to point out what is wrong with the various efficacy measures used in modern research.
This is a large misunderstanding of how science works. You seem to think that if the original research is in some way flawed, that flaw will propagate through all future research. However, further research will (eventually) correct any initial flaws.
Or, lets say that if the original research in a certain scientific field was flawed, that flaw would propagate to all subsequent research. In that case, even if the first piece of research was 100% flawless, what if the second piece of research had flaws? Wouldn't those flaws propagate to subsequent research? And if the first two pieces of research were flawless, what if the third piece of research had flaws? If you demand that the first piece of research has to be flawless, wouldn't the logical conclusion be to demand that all research be flawless, and that scientists never, ever make any mistakes?
Why would we need to? Any knowledge gained through his research is incorporated into the general field of immunology. I mean, it's of historical interest, but that's it.
This seems a bit of a non-sequitur from discussion about Jenner, since he didn't know anything about antibodies. Anyways, when it comes to adaptive/acquired immunity, what you want to measure is the proliferation of memory B cells and memory T cells that respond to a certain antigen. However, doing so directly is difficult, so measuring antibodies is the next best thing.
The innate part of the immune system can attack pathogens, and produces no antibodies since antibodies are part of the adaptive immune system. Even the adaptive immune system has parts which can attack pathogens without the use of antibodies. So it's possible for an infection to be defeated with the production of so little antibodies that they can be detected. However, antibody production helps a lot when it's present.
"Err, no, it's based on reduction in cases over time in a population, generally speaking - the reduction of health lost due to illness and aftereffects. It's generally related to anti-body production, hencewhy it can be used as an indicator in individuals."
@Dedj
Then how is ever possible to release an effective vaccine to the population per FDA standards? Clinical trial data would be insufficient to measure long-term disease reduction, etc. Wouldn't you have to first give it to the population to see if it is effective over time? Or, is this an admission that the population serve as guinea pigs? I'm sorry, but your opinion holds no weight.
statement: "Vaccine efficacy is based on their ability to cause production of antibodies."
Dejd: "Err, no, it's based on reduction in cases over time in a population, generally speaking - the reduction of health lost due to illness and aftereffects. It's generally related to anti-body production, hencewhy it can be used as an indicator in individuals."
-------------------------------------------
Dejd,
Wrong! Efficacy IS based on antibody production. If you going to try the "err, no" sarcasm then you better know your facts. Otherwise it makes you look like a fool.
You've confused efficacy with effectiveness.
Can you see where multiple confounders come into play with your definition of effectiveness?
@Tabitha Little
Vaccines are tested for years before (if) they are approved for market. That's generally enough to give us an idea of their general safety profile and initial efficacy. Once it is approved, the vaccine is studied further to determine safety and efficacy over a longer period and in a larger population.
As with all medical products, the initial testing that is done to comply with Federal regulations will not be 100% applicable to what will happen once it is in the general population. Even if you enrolled half the population of the U.S. in a clinical trial (an unfeasibly large amount and far too costly), it still would not be 100% accurate as to what would happen once approved and used in the general population. Over the course of development, from Phase I trials through Phase III, researchers use thousands of volunteers in various sites and with a variety of ethnic backgrounds. Depending on the design of the study, this gives a good approximation of what to expect once it hits the market. Phase IV (post-market surveillance) then gathers more data, such as those adverse events that are so rare that only use in the full population will ever find them.
I'm still interested in your answers to my questions:
Care to share with us?
God, or whoever you believe put us here, alone, gave us the tools to fight disease with the immune system. Immunity from B. pertussis is not lifelong- through vaccination or natural disease. You can again become ill after re-exposure.
From Wikipedia:
From Tabitha:
Antibodies don't equate with immunity (see cellular immunity), but they certainly help.
@Tabitha
Okay, but what happens in the body? You said that antibodies are not required to recover from disease. So, please explain what happens when you are infected with something like pertussis (or measles, if you prefer).
True. I never said it was life-long. However, one is generally immune for about 4 years on the low end, up to 10-20 years on the high end (depending on how immunity was developed). If you prefer, use measles instead of pertussis in explaining how one remains immune for a given time frame. So how does one become immune to reinfection?
Tabitha do you hold every aspect of life to this same standard or just issues pertaining to global health?
@Tabitha Little: considering that before the 20th century "god" or whoever allowed the average life span to be only in the 40's and 20% of all infants died before their first birthday, those tools he/she/it gave us really sucked.
Evolution didn't care...as long as enough people lived to reproduce that's all that matters with evolution.
Have you read any 18th/19th century literature? Those writers FEARED measles, mumps, scarlet fever, pertussis, diptheria...they KNEW those disease were killers.
I'd rather use the tools that science has given us to prevent infectious diseases that killed 1 in 5 babies, killed many in their first 5 years of life and others before they were adults.
@Marya
I like your attitude of dispassionate examination of data. I also like to kick ideas around and see what the end result of discussion yields. I say welcome.
@JohnV, I do my best to use high standards in every aspect of life. It works unbelievably well.
@MI Dawn Misinterpreting Hippocrates for 1500 years or so proved to be unreliable, I assume the same must be true for other writings as well.
@Tabitha
I was right! UFOs were involved!
Your body, whether god given, evolved or whatever, has mechanisms to fight diseases. It is a constant arms race though.
1. New or recurrent disease spreads
2. Lots of deaths
3. Immune system finally kicks in and reduces outbreak
4. Repeat
Vaccines prevent that 'Lots of deaths' step. Does it matter, really, how the vaccine, drug or treatment works? You believe in a sky fairy. Vaccine function should be way easier to accept since there's all kinds of, you know, evidence and reduced outbreaks where they are used.
Look, don't vaccinate if you don't want to. It is a markedly anti-social, regressive thing to do but it is your choice. Don't go looking for false reasons to justify that stupid choice.
@MI Dawn
You reminded me of something I meant to say:
Tools like the intelligence to develop vaccines. Vaccines are tools that use the immune system to prevent morbity and mortality from diseases.
The augustine troll's comment @ 106 re: amount of money 'wasted' is meaningless without a discussion of context.
What is the proportion of 'wasted' money vs money spent? What is the source of the waste? Health care in the US involves an enormous amount of bean-counting, which leads to a lot of money spent on administration which could certainly be described as wasteful.
Where did the number come from, anyway?
Without all this information, how does one come to the conclusion that money is being wasted? I'm not saying it's not - medicine is a human endeavour and as such there will be errors and wastage. But we need more than just augustine's say-so.
As far as money pits go, though, real medicine has nothing on sCAM 'remedies': Americans apparently blew $34 billion on CAM in 2007. Courtesy of http://blog.naturalstandard.com/natural_standard_blog/2009/08/americans…, which apparently got this info from CDC's NHIS (http://www.cdc.gov/nchs/nhis.htm).
So if I were looking to save health-care dollars by eliminating ineffective treatments, I would probably start by convincing Americans to stop wasting their money on CAM.
@Todd W. "Tools like the intelligence to develop vaccines. Vaccines are tools that use the immune system to prevent morbity and mortality from diseases."
...Based on the work of the "honorary" physician, Edward Jenner. Therein lies the problem.
But I am all for gaining knowledge and accepting the choices of others. It's up to each individual to decipher the information and make their own choices.
Tabitha,
You may be for a lot of things but 'gaining knowledge' is not one of them.
@Tabitha if you will forgive my descent into absurdity:
Presumably you've seen all the key engineering research for automobiles (assuming you drive/ride in them)? Going back to uhhh 1890-something? Airplanes too, yes? You've done more than watch the video of the Kittyhawk, presumably you double checked the Wright brother's numbers in order to make sure that DC-7 you flew in last month wasn't going to drop out of the sky?
How about your house? Did you check the original research into architecture (1000 years worth? i dunno) in order to make sure that your house won't collapse on you?
How about the computer you're using? How do you know you can trust the data it produces? Presumably you've seen IBM's original literature about transistors and what-have-you?
Science, and everything else, builds upon what came before it. Thats the whole damn point of progress.
Of course, for my dissertation I did manage to locate and cite the original publication from 1892 describing the bacterium I was using. It really didn't contribute anything to the projects I was on or my understanding of the subject matter.
Tabitha, as far as I can see the only misinterpreting of literature going on in the conversation between MI Dawn and you is being done by you.
@ Tabitha Little: don't you rather think we've gone beyond Jenner as well as Hippocrites? Science has progressed in many ways since them...even since the time my grandfather began practicing in the 1930's. And Jenner was NOT the only person who used a version of cowpox to prevent smallpox, he is just the name that most people in the West recognize. The Chinese were vaccinating long before Jenner published his paper. IIRC, there were other Englishmen and some Dutch who also vaccinated, but kept it within family.
As for Jenner not being a doctor...well, a lot of people didn't use the term doctor back then, even if they did provide some sort of care for people. Shall we not call them doctor? Or shall we just lump them all in with Dr Dee? I think you will agree that he was a doctor....of sorts.
I don't know how old you are. I am old enough to recall most of the common childhood diseases. I remember when my grandfather, a physician, got shingles for the first time and he was miserable for months. The man who delighted in the hugs of his family could not bear to allow anyone touch him. I had chickenpox and fear shingles in my future. As soon as I am old enough, you can bet I will get the vaccine.
As far as accepting choices: they are fine when you make them for yourself and they have no effect on anyone but yourself. When you make them for another person (a child), then you need to consider not only the child but other children. The community affects the child and the child affects the community. YOU affect the community so you need to take the effect on the community into your decision then.
@Tabitha
So it appears to be your opinion that the science of vaccines today is exactly the same as what Jenner used, that it has not progressed at all. Is that your opinion? If so, you should, perhaps, read something a bit more recent than the 18th century. I would suggest looking at research published within the last 5-10 years for a better idea of the current understanding of how the immune system and vaccines work.
Oh, and I'm still interested in answers to my questions, since you haven't actually answered them:
What is your explanation for how one recovers from, say, pertussis (or measles)? What process occurs in the body? After infection with B. pertussis (or measles virus), what is it that keeps a person from developing the disease again if exposed to the bacteria (or virus) a year later?
@tabitha
You have been provided with a whole host of facts about current research on vaccines, your errors of understanding about the scientific/medical process, etc. and asked pointed, specific, meaningful questions about your positions on vaccinations. You have offered up pithy, substanceless, non-answers in reply. Until you can do better, I think we can file you in the crank/loon bin.
@Tabitha Little:
God (presumably) also gave us the intelligence to make medical developments like vaccines. Or, for some reason, are we not supposed to use our intelligence to improve our health?
Misinterpreting what part of Hippocrates' writings, and misinterpreting it how?
"The Chinese were vaccinating long before Jenner published his paper."
Yes,in the East, they were the first to begin innoculating against the smallpox, however, they did not use cowpox to do so. Please keep in mind that it isn't actual cowpox that was being used by Jenner because the name of the virus he used, after mixing it with horse grease and cow flesh, was lost over the years. In my eye, his work doesn't add up.
As for the benefit of the community at large, herd immunity theory has yet to be proven as well. Read the chickenpox vaccine insert and you will find that reduction of circulating wild-type varicella through vaccination will increase the chances of a chickenpox outbreak due to waning immunity in a highly vaccinated population.
Why is it that people who make seemingly-reasonable statements like this never seem to be applying them to issues where they ACTUALLY make sense? For example, whether white or wheat makes better French toast?
Fact of the matter is, there is only one conclusion an informed rational person considering the facts about vaccines can possibly reach - that they are safe and effective. Any other conclusion is necessarily the result of ignorance and/or irrationality.
Tabitha, do you also advocate that individuals should "decipher the information and make their own choices" about whether jumping off a cliff is detrimental to one's health? Or whether making a bonfire out of dollar bills is a good retirement plan?
If the name of Jenner's virus has been lost over the years, how can you be 100% confident (that seems to be your standard) that it wasn't cowpox?
And what do you do to protect your own health, and how thoroughly have you researched those methods? Can you 100% prove, with reference back to the earliest research, that it's a better idea to eat fresh food than rotten? Do you use any medicines at all (pills, herbs, unguents, anything)? If you pray, chant, fast, meditate, or exercise, what's the pedigree of research supporting those methods? How do you know to wear clothes when the outside temperature is below freezing, or to protect yourself from sunburn?
@Tabitha Little:
Back then they didn't know about the existence of viruses, and didn't have the technology to isolate or observe them, so they didn't have any name for the virus to be lost in the first place. Maybe you're objecting to the fact that the exact same method wasn't used for all vaccinations, so the results of Jenner's experiments involving cowpox pus + cow flesh + horse grease don't apply to situations where only the pus was used? Anyways, mixing cowpox pus with cow flesh and horse grease, the result would still contain cowpox virus, unless you're claiming that the mixing somehow changed the cowpox virus into a different virus.
So do you think that he was the only person to do experiments regarding the relationship between cowpox exposure and smallpox resistance? Or do you think that any flaws in his experiments somehow "infected" subsequent experiments?
Tabitha:
Why are you so fixated on Jenner? It doesn't make any sense.
If you got bitten by a rabid animal, would you refuse the vaccine because Pasteur was not a medical doctor?
Do you reject the theory of evolution because Darwin's education was in theology?
If the smallpox vaccine is based on a falsehood, why is smallpox virus extinct?
You and augie seem to ignore statements and questions that you find uncomfortable. This is not the way to convince anyone except your fellow inhabitants of the Desert Island of Delusion.
One of the favorite jokes:
A flood has swept through town. A man has perched himself on top of his roof to survive.
A boat comes by and offers him a ride. "God will save me," he says, and the boat goes on its way.
Now the water is higher, he is standing next to the chimney. Another boat offers him an escape, but he declines. "God will save me!"
Now the water is up to his chimney and he is balancing on that. A helicopter overhead lowers a rope. "GOD WILL SAVE ME!" he shouts and waves the copter off.
The waters come up and the man dies. He goes to Heaven and meets God. "Why didn't You save me?" he demands.
God shrugs His shoulders. "Hey, I sent you two boats and a helicopter."
Heheheh, I love that joke.
@Tabitha: I'd recommend a PubMed or Google Scholar search.
@Marya
See what's going on with Tabitha here? She wanders in and makes insane claims and is responded to in a variety of tones and manners. Her questions are responded to and questions are asked of her. She ignores most questions to her and produces more insanity. This is a cycle that will repeat itself. This is the typical pattern that happens when a crank arrives. Eventually it turns into the situation with auggie that you're not fond of.
If you, or Chris Mooney or anyone else, can think of a way to get through to these people, by all means, let us know. At times I feel like we're trying to communicate with aliens by a variety of means, none of which are working. Think Close Encounters of the Third Kind or Independence Day. If they could just give us a cipher, like the aliens did in Contact (was more elaborate in the book than in the movie), it would make things much easier.
Can I squeeze any more sci-fi references into 1 thread?
" At times I feel like we're trying to communicate with aliens by a variety of means, none of which are working. Think ... Independence Day."
I can't help but think of the "welcome to earth!" scene as a nice metaphor for the rhetorical smackdown these loons get upon posting here.
Nah, the Black Knight's a much better analogy. Particularly in the willful denial of reality.
I think the airplane analogy is very effective here. We've seen the development of simple gliders, to powered-flight, to jets, to sending men to the moon & probes even further.
In the development of modern medicine (which really only came about in the mid-19th Century), we find the same process - a basic beginning and further research and refinement over the years - with an increasingly lifespan & overall increase in public health being the result.
Has it been a linear process? Have mistakes and missteps been made in the past? Of course, and part of recognizing those errors contribute to the overall betterment of the process (not making the same mistakes twice or thrice).
And given the increase in knowledge and technology, it is incredibly stupid to hold "doctors" in the 18th & 19th Centuries to the same standards we hold today (which is what Tabitha seems to be doing). They couldn't possibly know what we now know today, but they did create the building blocks that layed the foundation for what we utilize today - and for the most part, we've been able to replicate and improve on those original ideas and make them more of a reality today.
No one would use Jenner's vaccine today - because we have the knowledge and technology to make it so much better (if we needed to - but thank god, we don't because Smallpox was eradicated in the wild - and perhaps someday we'll convince the CDC & its Russian equivalent to destroy the remaining stocks).
Just because Penicilin was discovered by accident, does that mean we shouldn't use antibiotics at all?
Tabitha - you don't seem to be making much in the way of sense, given the results that we've gotten over the years - lifespan doubled and tripled, historically low mortality rates for children, elimination or mass reduction in diseases worldwide.
So, tell us exactly how this occurred, without the advancement of medical science?
Composer99 @ 143
The press release for this study can be found here.. My breakdown:
1) about 1/3 of total US healthcare spending is considered wasteful
2) about one third of that is due to flaws in our broke-ass healthcare system. Fully half of this category, over $100 billion, is attributable to excess bean-counting, as composer99 surmised. Other contributions are extra costs due to delayed care, and problems stemming from communication errors (including my estimate of the proportion of malpractice suits attributable to communication errors)
3) about one quarter are serious legal issues: fraud and the remaining malpractice cases.
4) the rest (about two fifths) are unnecessary or excessive treatments and testing. This primarily consists of antibiotics given when not indicated because of patient demands, and extra tests to cover the doctor's ass in case of malpractice.
The takehome message is that the waste is not the result of using bad medicine, but rather of misusing good medicine and some inefficiency. Also note that Orac has written on all of these points multiple times (topics such as healthcare reform, evolution of anti-biotic resistance, and screening are quite common here, for example). That is not to say that you shouldn't blog about these issues more often, Orac. A steady diet of red meat sure is tasty, but some more fruits and vegetables for your readers wouldn't go amiss, either.
Thanks to all for the kind comments and suggestions. Please, bear with me through my reasoning.
I am quite simple-minded when it comes to the issues of evidence -- regardless of the theory, does a given treatment work? This is the question of efficacy or effectiveness, which are indeed two separate concepts. Efficacy is a statistical hurdle that a treatment needs to overcome in order to get to market, while effectiveness is what happens in the real world. To the best of my knowledge, regulatory studies of vaccines use surrogate endpoints of antibody production to prove efficacy. Less is known about their effectiveness. What we do know is that once a therapy escapes the "laboratory" of a clinical trial into the messy world of human illness, its performance is rarely as stellar as within that laboratory.
Safety is the other side of the same coin for me. I cannot think of safety as divorced from the disease characteristics or the population it affects. What I mean is that for a drug to treat advanced cancer, for example, we accept a much lower safety threshold than for a pill for headache: the former is meant to stave off a deadly disease in a gravely ill individual, while the latter is aimed at a nuisance symptom in a largely healthy population. Furthermore, what we know about safety of drugs comes from a fairly loose voluntary reporting system, and very little of this information is collected in a systematic manner in post-marketing studies. I think that it is pretty well acknowledged that we need a better handle on long-term safety outcomes for most interventions on the market.
So, in my own mind it may be reasonable to differentiate between pertussis (highly contagious and potentially deadly), chicken pox (highly contagious but less deadly potential) and HPV (highly contagious, but behaviorally determined) vaccines, for example, and it may be completely reasonable to set different safety thresholds for each and to examine the evidence for each separately.
An interesting factoid is that in most states in the US a child can avoid vaccination across the board for religious reasons, but most state laws prohibit selective vaccination due to intellectual objections to some of the inoculations.
@ 160: "If you, or Chris Mooney or anyone else, can think of a way to get through to these people, by all means, let us know. At times I feel like we're trying to communicate with aliens by a variety of means, none of which are working."
John v,
What non- totalitarian solution do you suggest?
"You and augie seem to ignore statements and questions that you find uncomfortable."
Usually because the question is designed to mislead, irrelevant, or asked by a lesser minion of the scienceblog cult who's attempting a logical fallacy.
An example of the wrong questions: If you pray, chant, fast, meditate, or exercise, what's the pedigree of research supporting those methods? How do you know to wear clothes when the outside temperature is below freezing, or to protect yourself from sunburn?
The treatment for smallpox (now known as monkeypox) was mercuric acid wraps and liberal amounts of whiskey for fever and dehydration induced delerium. This treatment accounted for a 70% survival rate when smallpox was at its worst. Should we give whiskey to treat fever since evidence shows that it works? Certainly not!
If we're being completely honest, mistakes and missteps are no doubt also being made as we speak (well, type). The trouble is, while we know that some of what we currently believe to be correct actually isn't, there's no way to tell WHAT bits are wrong. So all we can do is base decisions on the best information currently available, and accept that sometimes we'll be wrong.
@Marya, Sounds like you are off to a good start with your observations. :)
@ Tabitha - what? Exactly how is that related to anything else you've written?
"The take home message is that the waste is not the result of using bad medicine, but rather of misusing good medicine and some inefficiency."
To the patient or dead former patient semantics makes no difference.
Fortunately most of it doesn't kill the patient (although a lot of it does). Unfortunately most patients don't know when the get "bad" medicine.
Tabitha Little Injected:
"The treatment for smallpox (now known as monkeypox) was mercuric acid wraps and liberal amounts of whiskey for fever and dehydration induced delerium. This treatment accounted for a 70% survival rate when smallpox was at its worst. Should we give whiskey to treat fever since evidence shows that it works? Certainly not! "
Um. 1) Smallpox is not monkeypox. Sorry, no dice. There has not been a single naturally aquired case of smallpox since the 1980s in the wild - it has effectively been wiped out by the WHO, and is one of the most stunning victories of Public Health in history.
2) No, the reason we dont give that stuff is because we have better methods, equipment, and medicine. We have lab guided phamacotherapy for dehydration and altered mentation, IV therapy for dehydration and electrolyte replacement, antiviral agents, and antipyretics like Tylenol and Motrin to bring down fever.
BTW: we do give kids whiskey, actually Ethanol, in a pure form for Wood Alcohol and Antifreeze poisoning.
@tabitha
Yep, crank/loon/buffoon/clownshoe. Take yer pick. You either don't understand the things we are saying or you are otherwise lacking/differently-abled in your mental faculties.
Marya,
What you just described is an evidenced based foundation and totally reasonable.
But it has been vehemently argued on here that chickenpox is dangerous and anyone who says different or doesn't get the vaccine is a loon and quack. The same has been argued for measles even when it's been pointed out, using CDC references, that 99.9999+ of U.S citizens will not die or have permanent sequelae of measles.
Why, thanks, @Science Mom (BTW, what kind of science? I have been to your blog, but cannot tell). Care to weigh in on the risk stratification thoughts? Would love to hear how others approach this vis-a-vis different vaccines. Another question I have is how is the decision made to abolish a required vaccination? I mean specifically the case of small pox -- anyone aware of the history and science behind that? How small a risk of disease was deemed small enough to say that we no longer needed to vaccinate? What was the risk benefit trade-off?
Since the mortality rate for smallpox (which is not known as monkeypox) is 30% when it is untreated, a 70% survival rate indicates that this treatment accounted for Sweet F*** All.
Those nasty vaccines have given us zero cases of smallpox in the last 20 years. Mr. Jenner, you have a lot to answer for, you evil evil man.
"Just because Penicilin was discovered by accident, does that mean we shouldn't use antibiotics at all?"
No. Penicillin has saved a lot of lives. Killed a few too.
But to use antibiotics as evidence to support a particular philosophical ideology of science is an error. That's why I pointed out the accidental nature of antibiotic discovery. It could not be discovered using scientific first principles of the day.
Marya @166:
Yes, in a sense HPV is behaviorally mediated: a complete hermit won't get HPV, but they won't get chicken pox either. A person who never has sexual contact with another human being is unlikely to get HPV (though it's not impossible).
The problem with describing HPV as "behaviorally mediated" is that it's all too easy to go from there to "so we don't need to vaccinate" or at best "so we can wait to vaccinate." But it's not one vaccine, it's three, and the behaviors in question are ones that, once people decide to engage in them, they often jump into very quickly. "Wait, we need a condom" and a quick trip to the drugstore" is within a lot more people's self-control than "wait, I have to make three doctor's appointments and get the vaccine my parents didn't want me to have when I was 12."
@Tabitha: Can you think of any reasons why not? Surely, if whiskey were the safest and most effective treatment for fever, don't you think it would be the treatment of choice?
@Marya: yes, exactly. The decision to discontinue the smallpox vaccine came about once there had been no documented cases of the disease for some time (I forget how long). And the fact that AT THAT POINT the risks from getting the vaccine exceeded the risks of getting the disease since there had been no documented cases for X years.
No one denies vaccine risk. However, most of the time, the vaccine risk is much less than the risk of serious adverse effects from the disease. But medicine is not concrete and it is willing to change. If we ever eradicate another disease that is vaccine preventable, I imagine they will stop vaccinating for that disease, too.
Re: HPV - I know this one is controversial because it means parents have to accept that - gulp! - My little girl is going to have sex some day. I've got a 4 year old daughter and believe me, nobody's ever going to be good enough for her (although I'll do my best not to tell her future partner this). But, part of being a parent is letting go and realising that your children will make their own decisions. It helps to frame it in terms of something a bit less emotional: Say there was a vaccine you could give your child that would cut back her odds of ever having a fatal car accident by 70%. Sure, you could say she doesn't need the vaccine because "I've taught her to drive safely" or "I just won't let her drive" but odds are at some point she's going to get behind the wheel. Wouldn't you want to give her the greatest level of protection you could give her?
To say that someone shouldn't have Gardasil because it's a behavorial choice seems unnecessarily punative. Does that mean we shouldn't treat Type II Diabetes because that's caused by behavioral choice? If there was a vaccine for Type II Diabetes would you say it shouldn't be used, because "They just have to eat the right food and exercise more?"
maydijo:
Especially when whose behavior is being punished is fuzzy. Why should a woman has always been monogamous suffer from HPV and cervical cancer because her husband dallied?
Well, obviously, Chris, if she was keeping her husband satisfied at home he wouldn't have had to dally! (While I don't know anyone who has tried to use this excuse, the ex of a friend of mine told her that he cheated on her because she smoked. Never mind that when they met and married she smoked. Suddenly it was a good excuse to have an affair with their 19 year old babysitter.)
"Why should a woman has always been monogamous suffer from HPV and cervical cancer because her husband dallied?"
Do you have verified statistics on this risk group? How many women acquire HPV this way? How many women actually get cervical cancer this way? How many clear the virus without vaccination? How many women die from cervical cancer by this way?
Or do you want it stay an emotional decision?
If you're going to play the Evidenced based Medicine card...then you should be able to base your decision on evidence.
There is no ACTUAL evidence that Gardasil prevents cervical cancer.
Wow, at first I couldn't tell if Tabitha Little was a poe. It is hard to believe someone would decide that no evidence is good enough unless the original research was flawless. Isn't that what medical science itself is for; to test and research current and possible future treatments?
Regarding the HPV vaccine: I don't want to even think about my thirteen year old having sex. We discourage her, and constantly try to relate to her what a huge (and possibly life-changing) decision having sex is (we also teach her about safety and contraceptives). But I am also cognizant of the fact that she isn't mine.
I have been entrusted with keeping her safe and healthy while she grows and teaching her how to be a productive and responsible adult. She belongs to herself, and she will make her decisions. At the same time, if I can do something that might protect her from a possible disaster due to her making a decision I felt was wrong, you can bet I will do it.
I can't help but think of Bristol Palin. Her parents subscribed to the "abstinence only, teaching about contraceptives/vaccinating for HPV will give the message that sex is okay" camp. It didn't work. Is Bristol a bad person? No, she made a stupid teenage mistake. Hopefully my daughter won't make that mistake, but I am not betting her life on it.
Coughcougheradicationofsmallpoxcoughcough
"But medicine is not concrete and it is willing to change."
Because it readily gives up it's dogma? No way. That's inconsistent with the history of medicine and the doctors who practice medicine.
augustine troll notes the following:
The National Cancer Insitute appears to disagree.
From Wikipedia:
The types of HPV specifically targeted by Gardasil, by the way, are types 6, 11, 16, and 18 (per Wikipedia) and these four types of HPV are responsible for a rather large percentage of cervical (and other) cancers and a large percentage of genital warts.
I suppose one could accuse me of making an argument from authority. But on the matter of cancers, I feel safe in assuming that the National Cancer Institute is as good as an authority as any - that they are basing their statements on the available body of evidence.
Lawrence: "lifespan doubled and tripled, historically low mortality rates for children, elimination or mass reduction in diseases worldwide.
So, tell us exactly how this occurred, without the advancement of medical science?"
http://lingli.ccer.edu.cn/he2007/readings/n03_product_1.pdf
The Questionable Contribution of Medical Measures to the Decline of Mortality in
the United States in the Twentieth Century
Composer: "I suppose one could accuse me of making an argument from authority."
You accuse yourself.
I'll say it again LOUDER:
There is no ACTUAL evidence that Gardasil prevents cancer.
You can put faith in your authority all you want. The evidence does not exist. It won't exist until another 20 years. Then you'll see that it was all a psychological scam. After all of the money is spent you won't see much of a difference except for what can be statistically manipulated.
But that's OK. The newblood scienceblogger types will say "see, science changes with evidence. That's how science works!"
Ad hoc.
To sum up Auggie:
Herd Immunity: Not enough evidence
HPV as effective against cervical cancer: not enough evidence
Germ theory: not enough evidence
But:
Autism and vaccines being casually linked: reasonable claim and those that reject the anecdotes are hateful skeptics.
A anthropomorphic cosmic dictator as master of the universe along side his jewish son: A factual and reasonable claim and to question the logic of this belief his hateful and dangerous rhetoric.
dalek: "Autism and vaccines being casually linked: reasonable claim and those that reject the anecdotes are hateful skeptics."
STRAWMAN
"A anthropomorphic cosmic dictator as master of the universe along side his jewish son: A factual and reasonable claim and to question the logic of this belief his hateful and dangerous rhetoric."
STRAWMAN
"HPV as effective against cervical cancer: not enough evidence"
YES. The only thing you wrote that I did say. Do you have any studies that prove that it prevents actual cancer? I didn't think so. Next.
You said it louder. Oh WELL, then.
Follow this, if you can. Cervical carcinoma (as well as some other cancers) are caused by certain genotypes of HPV. Gardasil prevents infections by the most common of these strains. Therefore, it can be reasonably concluded that Gardasil protects against cervical carcinoma.
Will it prevent all cases of cervical carcinoma? No.
Will it reduce the incidence of in situ and invasive cervical carcinoma? Yes, by a lot.
You would have to be irrational to conclude otherwise. But then, we knew that already, didn't we?
An argument from authority is not a logical fallacy if the authority is an expert in the subject under consideration (the National Cancer Institute, to use your example). It's used in courtrooms all the time (expert witnesses).
The fallacy is when an authority in one area is given credence as an authority in another unrelated field, simply because he or she is an "authority" or is famous (Jenny McCarthy and autism).
I assume you know this already, Composer99.
As usual, Augie gets it wrong.
@ 116 Tabitha Little,
Perhaps you should read it. Here is a link to the page on Gutenberg.org, where you can get the full text for free. You choose the format.
http://www.gutenberg.org/etext/29414
You seem to be misinterpreting what Jenner wrote.
In this Dairy Country a great number of Cows are kept, and the office of milking is performed indiscriminately by Men and Maid Servants. One of the former having been appointed to apply dressings to the heels of a Horse affected with the Grease, and not paying due attention to cleanliness, incautiously bears his part in milking the Cows, with some particles of the infectious matter adhering to his fingers. When this is the case, it commonly happens that a disease is communicated to the Cows, and from the Cows to the Dairy-maids, which spreads through the farm until most of the cattle and domestics feel its unpleasant consequences. This disease has obtained the name of the Cow Pox.
An Inquiry into the Causes and Effects of the Variolae Vaccinae; a Disease Discovered in some of the Western Counties of England, Particularly Gloucestershire, and Known by the Name of The Cow Pox
1798
Edward Jenner
Horse pox, caused by the cowpox virus, was seen as grease, greasy heels, as well as a disease of the oral mucosa and skin: contagious pustular stomatitis and dermatitis. The disease has only been seen in Europe and is uncommon (Blood and Henderson 1963). Grease, dermatitis of the plantar surface of the pastern, seen primarily in the rear legs, has other causes, as well (see Chapter 15, "Integument").
In earlier times horses were infected by handlers who had cowpox or had been vaccinated with cowpox virus. Other sources of contagion were horses, cows, or housing in cow stalls. The disease can be limited to the pastern or mouth or spread to the nose and over the surface of the body (Cadeac 1899a-c; DeJong 1917; Hutyra and Marek 1920).
The usual course is 10-14 days but may last up to 3-4 weeks. Pustules appear 3-6 days after onset of first signs of pain and reddish flecks in the oral mucosa. The first lesion is a reddish focus, followed by papulae and vesicle formation. The later may have a depressed, dipled center. The vesicle is quickly converted to a pustule, which ruptures with scabbing. A scar may remain. The cells of the stratum spinosum undergo vacuolar degeneration as acute inflammation begins in the dermis. Fluid accumulates in the epidermis, forming the vesicle. With infiltration of neutrophil leukocytes into the dermis and epidermis, the vesicle changes to a pustule. After rupture of the pustule, healing is by epithelization. Scar tissue follows severe lesions (Cohrs 1961).
Equine pathology
1996
James R. Rooney, John L. Robertson
Iowa State University Press
Ames, Iowa 50014
ISBN 0-8138-2334-X
What was lost?
What was replaced?
Robert Koch didn't publish his postulates until about a century later.
You won't find Jenner discussing antibodies at all. The term was also first used about a century later.
You should consider looking at recent research if you want to know how the immune system works. Or read a current textbook.
Original research without fault?
You do not appear to understand research. Research is cumulative. Research builds on earlier research. Research is about learning from earlier mistakes. There is no entropic effect.
You seem to be looking for magic.
Only magic is without fault, because magic is not real.
Maybe you will read what others have written about immunology, but you won't get simple whale.to answers here.
Science requires more than something that fits on a bumper sticker.
.
One problem with catching up with comments at work is that Little Augie isn't killfiled. (sad).
So, instead, I'll answer his claim at #189 with this:
From International Planned Parenthood
Rates of new genital wart infection in Australia have plummeted, research shows, in an early positive sign of the success of mass Gardasil vaccinations.
A study taking in patient data from sexual health clinics across the country has shown up to a 60 per cent drop off in new genital wart cases since 2007, when the anti-cancer vaccine was rolled out.
Gardasil works by preventing the transmission of four strains of the Human papillomavirus (HPV), two of which cause cervical cancer and two which cause genital warts.
Experts say while its effect on cervical cancer rates would take longer to materialise, the vaccine's ability to prevent a less serious though embarrassing problem was now clear.
"Genital warts are distressing to the patient, as well as being difficult and expensive to treat," said Professor Basil Donovan, head of the Sexual Health Program at the University of NSW's National Centre in HIV Epidemiology and Clinical Research.
"While we knew from clinical trials that the vaccine was highly effective, Australia is the first country in the world to document a major benefit for the population as a whole."
Free Gardasil vaccinations were offered to Australian girls and young women, aged 12 to 26 years, and about 80 per cent of those eligible are thought to have taken up the offer.
Researchers pooled data from eight sexual health clinics Australia-wide, covering 110,000 new patients and the period from 2004 to 2009.
About 6000 new cases of genital warts were detected and analysis revealed a 60 per cent drop-off among women aged under 27, while there was no change among older women or gay men.
Heterosexual men recorded a smaller decline in new genital wart cases of just over 30 per cent, the result of increased immunity among their younger female partners.
"The high coverage by the vaccination program has had a large, population-level impact on the incidence of genital warts in young Australian women," the research concluded.
"A more moderate impact for heterosexual men has presumably resulted from herd immunity."
Herd immunity theory proposes that, in diseases passed from person to person, it is more difficult to maintain a chain of infection when large numbers of a population are immune.
The research will be presented this week at an international HPV conference in Montreal.
Source: Sydney Morning Herald, 6 July 2010
I can't get to Dr Rachie's blog (scepticsbook from work since wordpress is blocked entirely, IIRC she has either a post or one of her commenters linked to the report.
Can anyone help me with this?
I didn't see anything recent about HPV. It was mostly Meryl Dorey and the AVN, but here is the link to The Skeptics' Book of Pooh Pooh, her blog:
http://scepticsbook.com/
And, of course, Dr Rachie can be heard on The Skeptic Zone which is here:
http://www.skepticzone.tv/
T. Bruce McNeely @ 190:
Yes, I should have appended 'but such accusations would be unfounded' to my sentence.
I am beginning to think that augustine is the blog thread equivalent of the hoodlums who rioted in Toronto during the G20 summit. Not here to offer solutions to the problems in medicine, not here to defend some particular form of quackery, not here to present any sort of positive vision for improving medicine at all. Just, so it would seam, here to agitate for tearing the whole edifice down.
Augustine engages in logical fallacy! News at 10...
You are applying a double-standard, messieur/madame. You demand of us flawlessly science-based statements, yet do not apply the same standard to yourself.
Wait, no. Perhaps I'm being to quick to judge. You do have scientific evidence to support your assertion, right? Right?
[crickets]
@MI Dawn
On the other hand, he/she/it is a great source for examples of logical fallacies, as well as examples of falsely claiming someone is engaging in a logical fallacy. See, for example, how quickly he/she/it jumped on Composer99's statement about argument from authority, when Composer99 did not actually commit the logical fallacy of argument from authority.
@Todd W:
Having just written the Public Service of Canada's french test (a requirement for certain positions within the federal public service) I need to correct you; it would be monsieur not messieurs as this would be the plural. Although with a troll, who can tell how many personalities are living within?
That's not quite right. If the argument is solely a because-I-say-so argument, then it's an argument from authority, regardless of the relevance of the credentials of the arguer.
Let me see if I can find an authoritative source to support my claim above :)
OK, this treatment of the topic looks very reasonable.
@agashem
Thanks for the correction. I suspected I was wrong (don't speak French, myself), but went ahead anyway. Again, thank you for the correction.
Which reminds me, that's another thing you will not find from augustine: acknowledgment of an error.
In response to the HPV discussion: I am merely indicating that there is a viable alternative to prevention -- discussing safe sexual practices with your child, which is really predicated on the work of establishing a trusting long-term relationship with him/her.
There are a couple of other point about HPV vaccine worth mentioning:
1. Diane Harper of the University of Missouri is a prominent researcher who was heavily involved in the Gardasil development program. Recently she has cast serious doubt on both the cost-effectiveness and the risk-benefit profile of the vaccine. One of the facts she pointed out at the recent 4th International Public Conference on Vaccination in VA was that, though the drug is marketed to girls as young as 11 years old, the vaccine has never been formally evaluated in girls under the age of 16 years. Neither its safety nor efficacy, let alone effectiveness, is known in the younger population.
2. HPV vaccine does not contain all of the serotypes of the virus that are frequent causes of genital warts. So what, right? It does address those that cause warts 70% of the time (if memory serve correctly) right? Well, in a slightly different area, we have successfully reduced the incidence of invasive pneumococcal disease in children over the years using the so-called PCV-7 vaccine, which contains 7 of the frequent culprit serotypes. The alarming thing is that the CDC has reported (http://www.ncbi.nlm.nih.gov/pubmed/19947881) a rise in infections caused by serotype 19A, which is not included in the PCV-7. The alarming aspect is that 19A is highly multidrug resistant and developing new resistance all the time. Granted, the solution is forthcoming with the inclusion of this serotype in the new PCV-13. However, this illustrates the opportunism of microorganisms to fill a vacant niche. Since viral behavior in someways is even more malleable than bacterial, we should be very vigilant for emergence of disease not covered by the current HPV vaccines.
@Marya
You bring up salient points and ones for which we need to keep constantly vigilant, striving at all times to make products safer and more effective. One thing, though:
You can have all the discussions you want, but it will not matter one jot when that child is grown up and has their first encounter, whether before or after getting married. In particular, should the child decide that he or she wants a child of their own, unless they are using IVF, there is going to be some contact and the risk for transmission of the virus.
What I'm trying to say is that although such discussions are good and very important to have, they ultimately will not affect whether the individual becomes infected or not if their partner carries the virus. Arguments like this really do not belong in a discussion over the safety or efficacy of the vaccine; they do not carry enough weight to bear on whether one should or should not get the vaccine.
Just a minor nitpick.
TODD W.: "Which reminds me, that's another thing you will not find from augustine: acknowledgment of an error."
If I make one I'll acknowledge it.
If acknowledgement of mistakes were a hallmark of scientific thinking then ALL pharmaceutical companies and almost ALL medical doctors would be called unscientific quacks. Not saying sorry is often a legal strategy for medical error.
Brucy @192,
"I assume you know this already, Composer99.
As usual, Augie gets it wrong."
You should reread and comprehend more closely before you accuse. composer accused him/herself.
Using faith,aka authority, as a means for truth is a good method (85% of what we are taught before 18 comes from faith/authority) but it relies on the impeccability of the source. The source could be right or could be wrong. Is NCI impeccable? Have they been wrong before? Any COI? Are their agents moral?
You can cite authority but be prepared to answer back the same way if I cited an authority without providing original citations. Fair is fair.
"You would have to be irrational to conclude otherwise. But then, we knew that already, didn't we?"
You use of the term is strictly pejorative.
1) Some;
2) Some;
3) Not all; and --
4) Some.
Put facts 1-4 together, augie, and the fact that the vaccination can prevent the virus and it means the vaccination saves lives. So when you say
you're blowing smoke. The burden of proof is on you to show that Gardasil does not prevent cervical cancer; science has already shown that it does.
John V. @147 "You've done more than watch the video of the Kittyhawk, presumably you double checked the Wright brother's numbers in order to make sure that DC-7 you flew in last month wasn't going to drop out of the sky?"
Sometimes they do.
anyway...
Good luck in trying to prove a negative. Know one knows if the vaccine prevents anything for any single individual. Unless you claim you can predict the future like a prophet.
@Todd W: Actually, since I am bringing up a potential comparator to the HPV vaccine, this is exactly an argument that belongs in the safety/efficacy discussion. What I am not familiar with/aware of is the evidence that compares the two approaches. Are you? One of the issues is funding -- who would fund a study of such intensive personal intervention?
TODD W. "You demand of us flawlessly science-based statements, yet do not apply the same standard to yourself."
You chose your own standards, not me. You will be judged by those standards.
MI Dawn,
You provided no actual evidence that gardasil prevents cervical cancer. You're wasting your time. The evidence does not exist.
avg. age of cervical cancer patient 49. gardasil target age 12. Age of the vaccine 3 years. Now you tell me what the problem is when MERCK implies that it actually does prevent cervical cancer. From an EBM perspective the actual evidence will not be available for 20 years or more.
In theory it should work.In theory a lot of drugs should have worked. But the evidence is not in. If one is coming from an evidence based background then they should realize this instead of speaking of the theory and surrogate endpoints as the ACTUAL evidence.
If you believe this is evidence then that just speaks for your critical thinking ability.
@204 Feldspar,
Are you serious? Some, some, not all? Are you sure you're a science based skeptic?
You just made a mockery of yourself.
Re: Safe sex instruction vs. HPV vaccination.
Why not both?
@auggie
Put up or shut up time again, dude. You are presented with the following:
1) a type of cancer for which a virus is a known risk factor (and not an insubstantial one at that).
2) a vaccine that can vastly reduce cases of that virus and is shown to be safe.
How do you proceed?
Infectious diseases; the nasty kind with (mostly), no cure and no vaccine.
I don't know specifically what the criteria were to discontinue vaccination for smallpox but undoubtedly involved extensive, longitudinal surveillance. It's an interesting topic though and one which you would have no problems finding numerous publications on.
Let's see, risk stratification. Since I read ahead before answering this, I can address your post about HPV and Dr. Harper. When you say 'behaviourally-mediated', yes it is, but think about the particular behaviour and the fact that even stringent condom use doesn't always protect against HPVs, other means of prevention are viable. I agree with Dr. Harper that this vaccine is being too aggressively marketed and some of the claims are over-reaching to date. Given the latency of the virus in terms of cervical cancer, it will be some time before really hard data can be collected. But with the preliminary data that has been collected during clinical trials (efficacy) and post-marketing surveillance for both pre-cancerous lesions and genital wart reduction (partial effectiveness), the only way to gather this information is with long-term, high-uptake.
Varicella: This vaccine was invented in Japan in ~1975 (I believe) for leukaemic children and introduced in the U.S. in 1995 as an optional vaccine. In my opinion, it should have stayed that way. If I recall correctly, the decision to make it mandatory had more to do with economics (parental loss of working days) than serious sequelae of the disease.
The use of PCV is concerning and interesting to me because of the serotype and even genotype replacement that has occurred and the former a possibility (N. meningiditis). Strain 19A is contained in the new PCV-13 but again, surveillance is a must to track the effectiveness and potential for replacement disease given there are >90 S. pneumoniae serotypes.
So yes, not all vaccines should be treated equally and there is certainly 'wiggle room' for some of them. Hep A is another example of a mandatory vaccine that shouldn't be and on the flip side, I would like to see more effort for adolescent/adult uptake of Tdap.
@Marya
Since you are comparing HPV vaccine to PCV-7/PCV-13, let's actually compare the safe sex discussion on whether or not to be vaccinated.
First off, PCV is only recommended for children under 5 (unless they have certain medical conditions or are older than 65), so discussions of a similar nature to the safe sex discussion aren't going to play a role. Let's just assume, though, that you can have the discussion, they can understand it and put into practice what you say.
Suppose that you discuss with your child about proper hand hygiene. You explain and instill in them a respect for properly washing one's hands, for staying home if sick, using their elbow instead of hands to cover their mouth when coughing or sneezing, avoid cigarette smoke and so on. While such a conversation can be had and taking these actions may reduce their risk of contracting pneumonia, if they are exposed to a bacterium, virus or fungus that causes the disease, the discussion isn't going to matter much whether it was a good idea to get the vaccine or not. The discussion will not change their susceptibility to the disease insofar as the vaccine is concerned. The vaccine will lower their risk, regardless of the conversation. Without the vaccine their risk will be higher.
So, as with the safe sex discussion and HPV vaccine, I agree that it is a good conversation to have, but it does not enter into whether the vaccine is efficacious or not. The facts remain that the vaccine will reduce their risk of infection.
Perhaps you are trying to argue that the HPV vaccine is not a substitute for the conversation, and I'd agree with that. As T. Bruce McNeely said, and as I tried to say earlier, they should both occur.
That was the extent of my nitpick. As I said, the two main points you brought up are good ones and are topics that should be monitored and studied.
Marya, do you have access to some kind of device which can tell me who my daughter will marry in the next ten to twenty years so that I can have that "safe sex practices" talk with him? Since that is not available, she had her HPV series.
I would recommend reading "Inside the Outbreaks" by Mark Pendergrast; it goes into detail about the decades of the smallpox eradication effort.
Chirs: "Marya, do you have access to some kind of device which can tell me who my daughter will marry in the next ten to twenty years so that I can have that "safe sex practices" talk with him? Since that is not available, she had her HPV series."
Chris,
What statistical evidence did you base this on since I've never seen the statistics on monogamously acquired cervical cancer.
I find it interesting and hypocritical (albeit typical) that you can, in the very same post proclaim that the evidence is 20 years out that HPV vaccines can prevent cervical cancers, whilst proclaiming that they conclusively won't.
There are reasonable proxy measurements for HPV vaccine effectiveness, i.e. reduction of pre-cancerous lesions and genital warts, the latter alone, perhaps, being well-worth it to many to justify the vaccines' existence. Yes, it will be several more years before an actual estimate can be made regarding the duration of protection and effectiveness for preventing cervical cancer. So what do you have to support your conclusion again? Ad hoc indeed.
Science Mom, HepA is a food borne virus. Why should the vaccine not be required for that? Since the vaccine has come along we no longer hear news announcements that a food handler in a certain restaurant was diagnosed with HepA, and that anyone eating there needed to see their doctor for an injection of gamma-glo (oh, what ever... it has been years since I heard a news announce, and know that once my husband had to go into the doctor for that injection). I do remember a couple of years ago some were possibly infected at a celebrity party.
Chris@113, I'm fine with having the vaccine (particularly for travellers to and from endemic countries) but it shouldn't be a mandatory school vaccine for children for which it is almost always an asymptomatic or mildly symptomatic illness and very, very rarely results in fulminant liver disease. It is far more serious for adults, so they should be getting it, especially yes, food service employees.
@Science Mom: thanks for your measured and thorough response! I could not agree with you more on every point. I too am under the impression that the Varicella vaccine was mandated for economic expediency rather than for its clinical risk-benefit trade-off. As for HPV vaccination, perhaps we can agree that at this point there is still some room for opinion-based practice, as the base of evidence grows? Although there are discussions in the US to make it mandatory, I do not believe that there is that much excitement behind them yet.
Loving the finely nuanced discussion, thanks!
@Science Mom: interesting thought about HepA. My children had both been vaccinated (as grade school children) against HepB. Child #1 just got a booster when she started a medical program in June and was also required to get HepA since she may come into contact with persons with the disease (actually, probably not the persons but their blood/body fluids). I have not been vaccinated nor have I ever had HepA (had a close enounter with Botulism years ago - the restaurant we had eaten at at lunch had problems with the dinner crowd due to some improper home canning methods).
Should spouse and I speak to our MD about HepA? Spouse has Type II diabetes.
@Marya
On HPV vaccine, I agree that it is premature to make it "required", since we don't know fully what is the long-term effectiveness. I would still recommend it, though, as it does appear to have a pretty good safety profile and, at least short-term, is effective. Seems like a good bit of insurance.
@MI Dawn
Re: HepA. At my last physical, my doctor mentioned that with my previous blood tests, they check both HepB and HepA titers and found that I didn't have evidence of immunity (coupled with the fact that the vaccines weren't around when I was a kid). So, they recommended I get them, even though my risk is relatively low. I'll be finishing up the series shortly. What I'd say is, it wouldn't hurt to discuss it with your doctor. If it isn't recommended, nothing lost.
augustine troll says:
To which an appropriate reply is that augustine's pants are on fire.
In the unlikely event that anyone reading this deep into the thread is not aware of this particular deception, what augustine neglects to mention is that this present happy state of affairs is the result of the measles vaccination program.
So what augustine is doing is arguing against measles vaccination by relying on mortality/morbidity rates that are possible because of measles vaccination.
A better idea of what would happen if we stopped vaccinating for measles can be found here: http://www.iayork.com/MysteryRays/2010/03/19/measles-week-part-v-what-a…
The troll is, politely put, misrepresenting the evidence. Less politely, the troll is making a false statement. Less politely but more satisfying, the troll is lying.
@Todd W: Thanks, Todd. However, given my track record (I had the 3 HepB shots and didn't show immunity when I was tested a few years later when I got pregnant...I have a weird immune system), I'll ask my MD at my annual exam about the 2. I imagine I'll be looking at 6 shots...oh joy. :-(
Thanks, Science Mom. It is completely the opposite than for HepB, which is more dangerous for children and not so much for adults. Though from listening to the This Week in Virology (twiv.tv) podcasts I have learned they are completely different kinds of viruses.
(Composer99, I believe that was pointed out to him a few months back, but it was ignored and/or misinterpreted by him, which is why I ignore him)
Blimey, botulism? One of my fears. Anyway, absolutely, I would talk to your physician about Hep A vaccination (2 dose series). You can have a titre pulled if you want or just go for the jabs.
Chris@220, Yes, Hep B infection in infants and children is much more dire. All of the hepatitis disease are from different genre of viruses. They are just so named due to the disease produced.
@Tabitha Little:
Virologists would tell you that the genomes of smallpox and monkeypox are different enough for them to be different species. But, hey, they're just virologists, what would they know about it?
Composer: "So what augustine is doing is arguing against measles vaccination by relying on mortality/morbidity rates that are possible because of measles vaccination."
Try again. Those are prevaccine statistics.
Not a lie. Not a misrepresentation. Just the fact's ma'am.
You've just feel in your emotional heart that it MUST be worse than that because you've been fed a bunch of propaganda.
Yes Augie, a misrepresentation as you didn't include more relevant statistics. By the way, 99.999+ is an irrelevant number. U.S. pre-vaccine, it could be expected that entire birth cohorts would become infected so ~4 million, of those:
Pneumonia ~25%
Encephalitis ~1:1000 measles cases
Deaths due to measles complications: ~1-3:1000 measles cases
Deaths due to SSPE: ~7-11:100,000
Are you saying that we should end vaccination for measles?
To be precise, those are incidence rate statistics, not prevalence. The distinction matters, because it's misleading to treat the numbers as prevalence. For example, a 1 in 100,000 annual rate doesn't mean that your chances of getting the disease are only 1 in 100,000. That's for 1 year only. Whole population incidence rates can also be misleading in that incidence is probably different at different ages.
@ 207 augustine,
You are a liar, augustine.
You never admit your mistakes, no matter how much evidence is provided.
Do you deny that you make errors out of ignorance, deceit, or some combination of the two?
When corrected, you just change the subject.
This suggests that you are aware of the lies.
.
Augustine's argument would seem more persuasive but for the unfortunate fact that the vast majority of measles cases each year occured among children - before the vaccine almost everyone got measles before they were 15.
Adults would have almost universally had measles before any given date you care to name and would therefore not be at risk (unless they were immunocompromised) of reinfection.
So, I will conclude that I can safely stand behind my conclusion of misrepresentation on augustine's part.
Composer: "Augustine's argument would seem more persuasive but for the unfortunate fact that the vast majority of measles cases each year occured among children - before the vaccine almost everyone got measles before they were 15."
Precisely and they didn't have to get adult boosters either. And, as your point avoided, a U.S. citizen had a 99.999+% of not having permanent sequelae from measles....before the vaccine. Plenty of reason to not get a measles vaccine and be comfortable with the decision.
You gave nothing to counter that.
Pneumonia ~25%
Encephalitis ~1:1000 measles cases
Deaths due to measles complications: ~1-3:1000 measles cases
Deaths due to SSPE: ~7-11:100,000
Might want to recheck your statistics and how those numbers were derived, Science Mom. If not is that your final answer? Are you sure?
BWAHAHAHAHAHAHAHAHAHAHAHAHA!!!!!!!!!!!
You crack me up!
- and well deserved.
Goofus (I made the mistake of not referring to augie by his proper title previously) is committing an interesting fallacy here, called the fallacy of composition. This is the fallacy of decreeing that a trait which is true of the parts of a whole, must be true of the whole as well. Can a Boeing 747 fuselage by itself fly? No. Can a single 747 engine by itself fly? No. Can one wing of a 747 by itself fly? No. So therefore, claims the fallacious arguer, obviously a 747 composed of a fuselage and two wings and multiple engines could never fly!
Similarly, Goofus is arguing here that because for "any single individual" we will never know if the vaccine will keep that individual from getting fatal cervical cancer they would otherwise get, we therefore know nothing about whether any individuals at all will be kept from getting cervical cancer that they would otherwise get.
But again, this is the fallacy of composition. Events that are highly unpredictable on the individual level can be highly predictable en masse; that's a basic fact of probability. You don't know whether any single coin flip is going to come up heads or tails, but you know that the ratio between heads and tails is going to approximate 50/50 closer and closer as the total of flips gets higher. Anyone who tells you "Oh, we can't point to any individual coin flip and say 'that's going to come up tails'; therefore it's totally plausible that we might flip the coin millions of times and it would never come up tails!" is either displaying massive ignorance or just blowing smoke.
And, likewise, anyone who says "Oh, we can't point to any single individual and say 'that's someone who would develop a fatal cancer from an HPV infection if they had not been vaccinated against the infection,' therefore it's totally plausible that out of millions of people who are going to go out and live their lives not one of them would contract an HPV cancer!" ... again, either massively ignorant, or massively dishonest.
I vote both.
@Augustine: That's not a reasonable view. Odds of getting pneumonia after measles are non-trivial. They are at least 3%. Even if pneumonia doesn't kill you, it damages your lungs. Right there you're looking at a decrease in life expectancy.
JOSEPH: "@Augustine: That's not a reasonable view. Odds of getting pneumonia after measles are non-trivial. They are at least 3%. Even if pneumonia doesn't kill you, it damages your lungs. Right there you're looking at a decrease in life expectancy."
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Not reasonable? It's perfectly reasonable to forgo a vaccine for a virus that one's body can handle 99.9999+% of the time. The vaccine is not needed.
So tell me how many people get pneumonia from measles. Citations please. Science mom says 25%. You say 3%. That's a pretty big difference.
A decrease in life expectancy just for getting pneumonia? I've never heard that. Can you reference that also?
In the context of this sentence, it seems as nonsensical to talk about "herd immunity theory" as it does to talk about "chain reaction theory." It's not some rarefied hypothetical occurence, it's what can be deduced by anyone with basic knowledge of the subject and a passing familiarity with the concept "actions have consequences."
What mindless drivel. What in the bloody hell is, "a virus that one's body can handle 99.9999+% of the time." as if it's a mosquito bite. Even an uncomplicated case of measles is most unpleasant. So tell me how many can't 'handle' it and what happens to them?
The U.S. rate is 1-6% http://www.ccjm.org/content/77/3/207.long
You really need this spoonfed to you too? I really don't think that you should be arguing pro-disease when you don't have a clue of disease sequelae.
Considering that pneumonia is a not uncommon cause of death, yes, it most certainly can decrease life expectancy. Yet you don't often hear of people dying of pneumonia; this is because people will instead talk about whatever it was that left them vulnerable to pneumonia. My aunt died of pneumonia -- but really, that was just how her breast cancer ended up killing her. By that time, it was practically a kindness, though pneumonia is really a miserable way to go.
My daughter's had pneumonia, and made a complete recovery. Not everyone does; some get hospitalized, and that carries it's own risks. Sitting around during the illness can cause injury. Chest tubes aren't without risk, even if they do save a life by draining off fluid. Ventilators have their own problems. If alveoli perish, one ends up with reduced lung volume, and that's going to compromise your ability to live a long and healthy life.
Pneumonia ain't just a bad cold. It should always be taken very seriously, and treated promptly.
Little Augie:
Sigh. What a tool.
From http://www.census.gov/prod/99pubs/99statab/sec31.pdf
Year.... Rate per 100000 of measles
1912 . . . 310.0
1920 . . . 480.5
1925 . . . 194.3
1930 . . . 340.8
1935 . . . 584.6
1940 . . . 220.7
1945 . . . 110.2
1950 . . . 210.1
1955 . . . 337.9
1960 . . . 245.4
1965 . . . 135.1
1970 . . . . 23.2
1975 . . . . 11.3
1980 . . . . . 5.9
1985 . . . . . 1.2
1990 . . . . .11.2
1991 . . . . . .3.8
1992 . . . . . .0.9
1993 . . . . . .0.1
1994 . . . . . .0.4
1995 . . . . . .0.1
1996 . . . . . .0.2
1997 . . . . . . 0.1
The preceding are data on the incidence of measles in the USA from 1912 to 1997. Answer this question: What happened between 1960 and 1970? And only that decade, no others.
I though auggie might have left (and maybe they have, I have not seen any posts for a few days). It saddens me to think how much time is wasted in countering these posts, but I understand and think it is good everyone does it.
Sadly, while Calli Arcale makes a good point it is pretty clear augustine will not get it. The reality of diseases is simply not their concern.
Here you go, Augie. I found this citation from the University of Maryland in about 5 minutes, thanks to Google:
I'm surprised that you've never heard this, you being such an expert in infectious disease and all. All sarcasm aside, I'm not surprised at all. I'm also not surprised that you couldn't be arsed to Google it yourself. Dear me, you might learn a fact or two. You can't have that!
@ 245 augustine the unapologetic liar,
Number of deaths for leading causes of death:
1. Heart disease:..............................616,067
2. Cancer:.......................................562,875
3. Stroke (cerebrovascular diseases):..135,952
4. Chronic lower respiratory diseases:.127,924
5. Accidents (unintentional injuries):..123,706
6. Alzheimer's disease:........................74,632
7. Diabetes:......................................71,382
8. Influenza and Pneumonia:..............52,717
9. Nephritis, nephrotic syndrome, and nephrosis:.46,448
10. Septicemia:..................................34,828
Source: Deaths: Final Data for 2007, tables B, D, 7, 30
http://www.cdc.gov/nchs/fastats/deaths.htm
Why would augustine the omniscient not realize that such a lethal disease has an effect on life expectancy?
Probably because augustine appears to filter everything through his biases, before deciding to believe.
augustine rejects the scientific method. The scientific method is a way of minimizing the influence of our biases on our understanding. augustine does not appear to think think that his biases lead to mistakes. Or is it that augustine does not believe that he has any biases?
augustine seems to think that pneumonia is safer than a vaccine.
Will augustine admit this mistake, or admit any of his other mistakes?
I'm not holding my breath.
.
It is called "alternative medicine" because if it wasn't, it would just be called "medicine"!
It is called alternative medicine because it is an alternative to real medicine. This alternative only appeals to those who do not understand medicine.
Real medicine is capable of healing real patients.
Alternative medicine is capable of taking money from people under false pretenses - that is with the expectation that whatever they have will go away on its own or that the placebo effect will help.
If they told customers the truth, would the alternative medicine customers really waste all of that money?
Alternative medicine is fraud.
.
@Rogue I completely agree. That was my lame joke :o]