October 2008 – Denialism

Artificial Arbitration at American Apparel?

Jezebel proclaims: Dov Charney May Be More of a Scumbag than Anyone Realized, and I agree if the reporting on a sexual harassment case, Mary Nelson v. American Apparel, rings true (the opinion is unpublished, and I haven’t obtained a copy yet). Charney is the founder of American Apparel, and has been the focus of several sexual harassment suits over the years for allegedly maintaining a sexually-charged work atmosphere.

Over at Conde Nast, Karen Donovan reports:

Female employees have filed three sexual harassment lawsuits against Charney. The last active suit was settled earlier this year, but details about it had not been disclosed until a California appellate court released a decision this week.

The decision, however, also describes a bizarre piece of theater concocted as part of the settlement proposal. In exchange for paying the former employee $1.3 million, she and her lawyers agreed to a sham “arbitration.” A retired judge picked by American Apparel would agree to stipulated facts and make a finding in the company’s favor.

[…]

The appellate decision lays out the sham arbitration of the settlement. It stipulated that the arbitrator would absolve Charney of the sexual harassment claims…[on First Amendment grounds]

[…]

Charney, to be sure, is all for the First Amendment. So much so that the settlement would have included this press release to be issued: “The arbitrator ruled that the marketing materials, sexual speech and much of the conduct about which Nelson complained are protected under the First Amendment’s guarantee of free speech and would not form the basis for any claim.”

Wow! We all knew that arbitration runs the risk of being tilted toward business interests, but to agree in advance to have an entirely artificial arbitration process in order to whitewash an executive’s behavior? That’s priceless. What would one call this? AstroArbitration? It makes a mockery of a mockery.

If the arbitrators have any ethics, they’ll quickly adopt rules finding that such arrangements are unethical. We’ll see.

East meets West at Beth Israel—Cage Match!

When those of us who practice real medicine write about implausible medical claims, we are often accused of lacking compassion, as if offering false hope is the same as compassion. We are also accused of turning away from therapies that “couldn’t hurt”. After all, if someone wants to use aromatherapy, what’s the harm?

The truth is that improbable medical claims are dangerous, and not just for the obvious reasons (i.e. dangerous practices such as chelation therapy). They also turn people away from real therapy. I’ve previously introduced you to the concept that there is no such thing as “alternative medicine”. When the Chinese herb artemisin was found to cure malaria and became widely used by modern doctors, it became by definition not alternative. If something “altie” like massage makes someone feel better, it’s neither altie nor “mainstream”—it’s just nice; go and do it. Yoga probably falls into the latter category, of a practice that may give comfort to some people, but is unlikely to affect objective measures of health and disease.

As reported (quite well) by the Times:

A foundation run by Donna Karan, creator of…the much-imitated DKNY line of clothing, has donated $850,000 for a yearlong experiment combining Eastern and Western healing methods at Beth Israel Medical Center. Instead of just letting a celebrated donor adopt a hospital wing, renovate it and have her name embossed on a plaque, the Karan-Beth Israel project will have a celebrated donor turn a hospital into a testing ground for a trendy, medically controversial notion: that yoga, meditation and aromatherapy can enhance regimens of chemotherapy and radiation.

I’ll stipulate that by “Eastern and Western healing methods” they mean credulous Americans’ impression of what is done in “the East” vs. science-based medicine as it is practiced around the world (the Eastern and Western bits).

Why invest so much in bringing relaxation techniques to the hospital? According to Beth Israel’s CEO:

“While we are giving patients traditional medicine, we are not going to exclude patients’ values and beliefs,” said Dr. David Shulkin, the chief executive of Beth Israel, noting that a third of Americans seek alternative treatments. “To make care accessible to these third of Americans, we’re trying to embrace care that makes them more comfortable.”

What is 15% of cancer patients were seeking euthanasia? What if they wanted methamphetamine? Should we integrate these practices into our modern cancer centers? I suspect the motives are both financial and compassionate, but the compassion is misguided. Providing cancer patients undergoing treatments with relaxation techniques, treatment of pain and anxiety, spiritual care, and other comforts is hardly alternative. To claim that they help people with cancer get better is the big leap. (And let’s set aside the possibility that an “Eastern” outfitted cancer center may not groove with everyone’s sense of spirituality).

Some of Ms. Karan’s stated goals are worthy:

Continue reading “East meets West at Beth Israel—Cage Match!”

In the Bush World, Regulation is Deregulatory

In the last days of the Bush Administration, expect it to engage in lots of rulemaking. Many businesses will seek new rules for their industries now, fearing that less favorable outcomes will occur if they chance it with the Obama Administration. This business-initiated regulation will seek “ceiling preemption,” meaning that the federal rules will supersede and cap strong state regulations.

Preemption has a profound effect on consumer protection, because frankly speaking, Congress rarely takes the time to pass consumer protection laws. It has other important business, and there is a horde of lobbyists who get upset when consumer laws are even considered.

In light of a new report released by Rep. Waxman’s Committee on Government Reform, Alicia Mundy writes in the Journal that preemption became very popular in FDA rulemakings:

The administration began adding language to more than 50 regulatory rulings that pre-empt state standards and lawsuits at several agencies in 2005.

The first such ruling at the FDA appeared in January 2006, surprising outside observers because the language hadn’t appeared in earlier public drafts.

The report finds that:

…key FDA career officials strongly objected to Bush Administration drug labeling regulations that would preempt state liability lawsuits, asserting that the central justifications for the regulations were “false and misleading” and warning that the changes would deprive consumers of timely information about drug hazards.

No surprise. And expect much more of this. It will be difficult to clean this up. Practically speaking, undoing these rules will only be possible where there is political will to do so. So many other important issues will take priority first.

Tagged!

Arghhh! I hate blog memes, but rules are rules. As Robert Service said, “a promise made is a debt unpaid, and the trail has its own stern code,” and although I’m not sure how that applies, I’m forced to respond. From Abel over at TerraSig comes a random blog meme…literally.

For the uninitiated a blog meme is sort of a meme but not really. A meme is a unit of information passed though learning or behavior, rather than genetics. A blog meme is a set of questions passed from blogger to blogger until it finally peters out. It gives bloggers a chance to connect to each other and to connect their readers to other blogs.

And for today’s meme, the rules:

1. Link to the person who tagged you.

2. Post the rules on your blog.

3. Write six random things about yourself.

4. Tag six people at the end of your post and link to them.

5. Let each person know they’ve been tagged and leave a comment on their blog.

6. Let the tagger know when your entry is up.

Six random things about me:

1. I am an expert flatwater canoeist, and made both of the things in this photo (although I had help with one of them).

2. My Hebrew name is a composite of “heals/healer” and a suffix referring to “God”.

3. I’m phobic of spiders (although I can appreciate them intellectually).

4. I grow tomatoes and chilis and make my own salsa.

5. I like to listen to NPR while I sleep.

6. My maternal great-grandfather was the constable of Boston, and when my grandfather was born, he was given a locket reportedly by this man, a locket my mother still has.

OK, fine. I’ve done it. On to the next victims.

Ames, over at Submitted to a Candid World, you’re it.

Martin, at the Lay Scientist.

Bing McGhandi, for having a great name.

Bronze dog…he’s usually a sport.

Perky Skeptic…she seems a nice sort who won’t kill me for tagging her.

Oh, and Blake, who I hope to meet at ScienceOnline09.

Im kvelling!

I told you earlier about Proposal 2, a proposed constitutional amendment here in Michigan. The lies being spread about this proposal are thick and vicious. Orac also goes into a bit of detail about the dishonest tactics being used, mostly by religious groups, to try and stop this prop.

Just to remind you, Prop 2 would prevent the state and local governments in Michigan from passing laws against human embryonic stem cell (hESC) research that are any more restrictive than federal law. That’s about it. The law does not set up any government agencies, taxes, fees or mandates. It only keeps Michigan safe from theocratic laws that inhibit research funded by non-governmental agencies. hESC research is a growing and important field, which has the potential to give significant insights into human disease, and perhaps some day, treatments as well. hESC’s are different from other stem cells used in laboratories. They are derived as a byproduct of infertility treatment. When harvesting eggs from a woman, there are inevitably more embryos produced than can be safely implanted in the patient, and unused embryos (each of which is a microscopic blob of cells) are usually discarded. If the parents wish, they can donate these cell clusters to science.

These are not fetuses. This is not abortion. The cell clusters have no arms and legs, no faces, nothing to identify them as anything that could grow into an animal. Any arguments that equate stem cell research with abortion are patently false.

Now some religious folks have moral objections to stem cell research, mostly those who believe that “life” begins at conception. It is unlikely that any of these people will support Prop 2, and they have an honest, albeit misguided reason for doing so.

What really gets my goat is the campaign of lies that is hiding this religious motive. Commercials are saying that Prop 2 will require government spending, will encourage selling of human parts, and all manner of weird accusations (including the man-cow hybrid thinggie).

So my wife, who is a very busy person, took some time out of a very busy day to get the word out. She went to someone’s house to pick up Prop 2 literature, read it, asked questions, and went door-to-door in our neighborhood to spread the word.

She has a lot of reasons for wanting to do this, not the least of which is our nephew, a type I diabetic since the age of four, who may stand to benefit in the future from hESC research. She rightly thinks that he is more important than the “dignity” of a few cells in a dish.

My wife, who is an educator by profession, but not a scientist, did her reading, learned what she needed to, and put together a non-partisan message to bring to our neighbors. It took a lot of chutzpah, and I’m just so darn proud of her.

Antibiotic-associated colitis—a difficile problem

It’s that time of year again—the time of year when everyone gets the sniffles, and everyone wants an antibiotic. Even folks who know better, who know intellectually that an antibiotic isn’t going to fix their viral illness still harbor a strong suspicion that it just might help—and it couldn’t hurt, right?

Well, I’ve got two words for ya’ll: eat shit.

No, I don’t mean that as an insult, I mean it quite literally. But you’ll have to keep reading to see what I’m talking about.

Many readers are aware of the problem of antimicrobial resistance—the phenomenon whereby bacterial diseases become resistant to antibiotics, a problem exacerbated by the profligate and inappropriate use of these agents. Another serious complication of antibiotic therapy is antibiotic-associated colitis (which also goes by the names “pseudomembranous colitis”, “Clostrium difficle colitis“, or simply “C diff colitis”.) This one is nasty. As diseases go, this is one you really, really don’t want. Really. Think I’m kidding? I’ve got two more words for you: toxic megacolon.

OK, let’s get down to details.
Continue reading “Antibiotic-associated colitis—a difficile problem”

Why good medicine requires materialism

I don’t like to repost, but Steve Novella has some great pieces up right now, and this is directly related. –PalMD

s I’ve clearly demonstrated in earlier posts, I’m no philosopher. But I am a doctor, and, I believe, a good one at that, and I find some of this talk about “non-materialist” perspectives in science to be frankly disturbing, and not a little dangerous.
Continue reading “Why good medicine requires materialism”

Do physicians really believe in placebos?

This article is cross-posted at Science-Based Medicine. Check it out. –PalMD

In a previous post, I argued that placebo is an artifact of certain clinical interactions, rather than a treatment that we can exploit. Apparently, there are a whole lot of doctors out there who don’t agree with me. Or are there?

A recent study published in the British Medical Journal is getting
a lot of enk (e-ink) in the blogosphere. As a practicing internist, I have some pretty strong opinions (based in fact, of course) about both this study and placebos in general.

The Study

The current BMJ study defines placebo as “positive clinical outcomes caused by a treatment that is not attributable to its known physical properties or mechanism of action.” I’ve got a lot of problems with this definition, but we’ll get to that later. It also allowed physiologically active medications to “count” as placebos. Oops.

Continue reading “Do physicians really believe in placebos?”

Man-cow hybrids: has the time finally come?

In a little over a week, Michigan voters will be asked to vote on Proposal 2. The proposal is very simple. It is a constitutional amendment that makes Michigan a less hostile place for human embryonic stem cell (HESC) research. It forbids state or local government from passing laws that are more restrictive than federal law. Here’s how it will appear on the ballot:

Continue reading “Man-cow hybrids: has the time finally come?”

Mr. President, We Must Not Allow a Cellphone Gap!

I keep on hearing that the political polls are inaccurate because pollsters do not call wireless phones.

I commission polls at UC Berkeley and we call wireless phones. Seems like a no brainer to me. So, I’ve never quite understood why professional polling firms wouldn’t call cell phones. (I’m an expert in telemarketing laws; survey firms can call cell phones legally so long as it is not a front for marketing.)

Today, I poked around at some prominent pollster’s sites to see whether they call cell phone users:

Gallup: Yes, when it is a “national telephone Gallup Poll” survey.

Zogby: No. Here are their reasons.

Princeton: It looks like yes, but it’s not clear that they always do. Looks like Pew did a study with Princeton on this issue finding:

The Pew Research Center for the People & the Press has conducted three major election surveys with both cell phone and landline samples since the conclusion of the primaries. In each of the surveys, there were only small, and not statistically significant, differences between presidential horserace estimates based on the combined interviews and estimates based on the landline surveys only. Yet a virtually identical pattern is seen across all three surveys: In each case, including cell phone interviews resulted in slightly more support for Obama and slightly less for McCain, a consistent difference of two-to-three points in the margin.

Peter Hart: No statement on the matter.