Now that spring is here…

Spring is here, despite this week’s frost (I’m really happy I didn’t get around to planting last weekend). I love being outdoors, but my work keeps me inside a lot. Now that the days are longer, I have more opportunities to take my kiddo outside exploring. Her favorite thing to do is go “hiking”, which essentially means her getting into this kid-carrying backpack I’ve got and riding on my back for several miles of rail-trail.

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Compassion? You don’t KNOW compassion!

We’ve often discussed the tactics favored by denialists, and prominent among these is the ad hominem attack. Physicians who speak out against quackery and speak up for science-based medicine are often often accused of lacking compassion. Orac wrote a little bit about the topic today. (OK, Orac never writes a “little bit” about anything, but it’s worth the read.)

The basic argument is that “conventional” doctors ignore patients’ experiences, deny them care that may work simply because science says it won’t, and a whole bunch of other things I don’t really understand. And while they whine about our lack of compassion, they wish ill on us and our loved ones. I don’t hear a lot of real doctors doing that.

Let me tell you what physicians’ compassion is: it’s listening to a patient, talking to a patient, and formulating a plan for a patient based on science and the doctor’s knowledge of the individual.

What clearly is not compassion is making false promises, and offering miracles. What is not compassion is convincing a patient that you are the only one with access to these miracles, and that everyone else has it wrong. One of the wonders of science-based medicine is that, for the most common and serious problems, most doctors will give you similar advice, and that advice will be based on what is likely to help, and less likely to harm.

Cranks and denialists hate being confronted with truth. An ignorant fool over at some fringe autism website recently launched an attack on a doctor whom he perceives to have wronged him. Orac wrote quite a bit about it, so I won’t repeat his points, but there are a few things that need re-emphasizing.

This anti-vaccination cult leader singled out Dr. David Gorski, a surgeon and scientist who writes for I know this guy. I’ve sat down and broken bread with him. I’ve read his posts over at SBM. This guy does not lack compassion. More importantly, he is a real doctor. He doesn’t promise miracles, and he actually cures cancers (by most conventional definitions). And that requires teamwork. He actually has to be able to work and play well with oncologists, pathologists, radiation oncologists, and the rest of the supporting staff of a modern cancer center. If he can’t cure someone, he won’t lie to them. Would it be more compassionate for him to lie and then perform unnecessary operations?

That is what the cranks and quacks offer: bad information, bad advice, and bad outcomes. But they wrap it in a veneer of pseudo-compassion, as if that makes it OK.

It’s not OK. Real doctors are out there every day preventing and treating disease, and occassionally saving a life. Quacks, at there mildest, offer pipe dreams, at their worst, a clean kill.

Fighting HIV—the boring version

The fight against HIV occurs on several different levels: prevention of transmission and acquisition, treatment of the infection, and prevention and treatment of opportunistic illnesses.

Prevention has been addressed extensively (and perhaps will be again later), and opportunistic illnesses is a huge topic, so first I’ll delve a bit into the origins and biology of the treatment of HIV infection (and of course the usual caveat; this is grossly oversimplified, and Abbie has a whole lot of good, ungrammatical science over at her place).

For better or worse, this requires another short biology primer…
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The Ghost of Henry Ford I

Given Ford’s early track record, this story out of California is rather disturbing. (Via PZ). A SoCal Ford dealership is using prejudice against non-Christians as a prominent selling point for their business.

Henry Ford I was a well-known antisemite, and published the Protocols of the Elders of Zion in his personal rag, the Dearborn Independent. During the pre-war/depression era, Detroit hosted a number of prominent isolationists and antisemites, including Ford and Father Coughlin.

But, if you know your market, intolerance sells, and hard times sometimes bring out the worst in people. Still, it’s rather sad to see my hometown company doing nothing to rein in their renegade dealership. Unless of course, they approve of the marketing tactic of hate and prejudice. Hey, I’m sure they can afford to lose a few customers. The U.S. auto industry is doing well enough to alienate anyone they please. They are an unstoppable juggernaut, dominating the world auto market. I think.

Denialist award—Andrew Schlafly, Esq.

I am giving out a previously non-existent award today to a truly great denialist. Andrew Schlafly, spawn of anti-feminist Phyllis Schlafly and some long-forgotten sperm-donor (ironic, eh?), was not content just being the legal counsel to the uber-crank Association of American Physicians and Surgeons. No, he had to take it one step further, and clog our precious intertubes with Conservaepedia, a repository of all things stupid. In fact, there is so much stupid there, an entire wiki is devoted to documenting it. I was newly enraged when a commenter over at the “blogging on peer-reviewed research” site tried to use this pile of electronic dreck as a legitimate reference.

For those of you who might have forgotten, Conservaepedia hit teh ‘tubes a little over a year ago, with a mission to counter the horrid liberal bias at Wikipedia. Well, no one is going to accuse Conservapaedia of liberal bias. In fact, the entire site is essentially a demented play book for reactionary Christian cults and denialists.

I don’t want to take you too far through the looking glass, but here are some fun examples of reactionary lunacy for you.

Continue reading “Denialist award—Andrew Schlafly, Esq.”

When a patient asks for the unusual

Here’s the conundrum:
Let’s say your patient’s insurance has decided that they will pay for 12 sessions of reiki for, say, back pain. All that the patient needs to have this therapy approved and paid for is their primary care doctor’s referral.

Let’s say that doctor has examined the evidence, and found reiki to be unsupported for any use. You explain to the patient the correct evaluation and treatment of low back pain, and explain that you will not be making the referral.

The patient is angry. She doesn’t want to have to pay for the treatment out of pocket.

What would you do?

Now let’s say you have a patient with cancer. It’s incurable, but the patient is receiving several standard and experimental treatments to prolong his survival. Otherwise, same scenario. Now what?

Another legal tactic from the anti-vaxers

Here’s an interesting one for ya. The Atlanta Journal-Constitution is reporting on a vaccine injury case filed by an Atlanta couple. The story is familiar and sad—a child starts off as a normal baby, and eventually develops a devastating neurologic illness. Based on the fact that symptoms of neurodevelopmental disorders happen to show up around the same time as vaccines are given, the family blames the vaccines.

Here’s the saga:

The Ferrari’s decided to sue. They brought suit against:

[…]nine vaccine manufacturers, eight manufacturers of thimerosal and one manufacturer of a treatment used for mothers when their blood types are incompatible with their fetuses. The Ferraris also sued Georgia Power, claiming that mercury emissions from its power plants also injured their son.

In 2005, a state court judge rightly dismissed the suit against the vaccine manufacturers, given that the Vaccine Injury Compensation Program specifically protects manufacturers. The Appellate Court, based on a precedent regarding a technical issue, disagreed, and now the case is in the Georgia Supreme Court.

The primary issue, is, I believe, whether the National Childhood Vaccine Injury Compensation Act of 1986 preempts state laws. This act was passed specifically because lawsuits, frivolous and otherwise, were causing the cost of vaccines to soar, and creating a potential public health crisis. The suit allows for compensation of injured parties outside the court system (and is much more lenient than the usual courts, as the Hanah Poling case showed). It would seem that the Ferrari’s suit is just the type of thing the law was designed to stop.

According to the AJC:

Bridgers, the Ferraris’ lawyer, told the justices that courts should review vaccine challenges on a case-by-case basis, not bar them completely. Otherwise, complaints must be brought in Washington before the U.S. Court of Claims where there are restrictions on the amount of awards, he said.

“Did Congress really intend to create an opt-out provision that allows the child to be thrown out of court?” Bridgers asked the justices. “I think not.”

Well, apparently Congress intended exactly that, but I guess we’ll have to wait to see what the courts say.

A hint of sanity from McCain

John McCain has succumbed to sanity—or perhaps to political expediency. Either way, he has finally rejected the endorsement of Pastor John Hagee. If you’ll recall, Hagee is one of those wacko cult leaders on the right-hand side of the Evangelical movement (I hope). He hates Catholics, and thinks Jews are just great! (That is, if you think “great” means “responsible for their own near-extermination”, and “founding Israel so that they can hasten the return of Christ and be sucked into Hell at a later date.”)

I suppose I don’t really care what McCain’s motivation was for dumping Hagee—I’m just glad he did.