Another Open Letter to Jenny McCarthy

Dear Jenny,

Thank you! Thankyouthankyou thank YOU!

You see, my medical education had a few gaps. I was unfortunate enough to do my training during the last couple of decades, which means I never saw measles, pertussis, polio, and many other vaccine-preventable diseases.

Well, last year, I saw three cases of pertussis! Sweet! And it looks like, if I play my cards right, I may get to see some measles.

It’s not that I don’t know anything about measles. I mean, I’ve read Hippocrates, Rhazes, Osler, and all the other ancients. But to see the real thing, to experience the real fear, well, you just can’t buy that kind of education. I’ve never been able to experience the fear that my little girl–who loves to swim— might bring polio home from the lake. How am I supposed to relate to my older patients if I don’t know that fear?

If I were in charge of awards for medical education, I’d give you one. But, alas, I’m not. I guess we’ll have to find some other way to honor all your hard work, education, and expertise. I mean, my four years of undergrad, 4 years of medical school, and 3 years of residency can’t hold a candle to your experience as a Mommy Warrior. I wish we could just bottle that. Or perhaps isolate it in northern Idaho.

Anyway, if you’re on google doing research for your next cult, I have a few suggestions. First, try to find one with UFOs. UFOs are kinda cool. Second, find one that makes you cut off all your ties to the outside world. As much as I’d miss the educational opportunities of your public appearances, I’ll find a way to make up for it.

So thanks, and good luck! Keep up the personal growth! Move on to the next issue!

Please?

Anti-vaccination—old religion writ new

I’m rather angry.

Strike that.

I’m furious. Indescribably outraged. Disgusted.

The rise of the antivaccination cults is finally affecting public health. If you want details, go and read Orac, or Steve Novella, or some of my other writing. I’m too angry to deal with details today.

Infectious diseases have stalked us across the millennia. Centuries of advances, from sewerage to inoculation to vaccination have saved billions of people from death and disability due to infectious agents. Having a child used to mean joy tempered with fear—fear that one of the “men of death” would come for your child, leaving them scarred, paralyzed, deaf, mentally disabled, or dead.

We’ve been largely liberated from these fears. We are now free to fear obesity. We are free to worry about good schools, the environment, poverty. Infectious diseases aren’t the scourge they once were. Who would wish it otherwise?
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Autism and Mitochondria

Prometheus brings us the best article I’ve seen to date on why the new push for a mitochondrial basis for autism is total nonsense.

Once I saw this push from denialists like David Kirby towards a link between mitochondria and autism I knew we were in for a world of trouble. If only because mitochondrial diseases are a relatively new area of study and there are enough unknowns that they’ll be able to milk this nonsense for a decade at least.

Prometheus, however, does an excellent job showing how the likelihood of a mitochondrial explanation for autism is prima facie absurd. This is not surprising given the clear absence of evidence for a maternal pattern of inheritance and the non-progressive nature of autism which is usually described as a “static encephalopathy”.

Keep the link handy for when you start hearing mito-woo from the DAN quacks.

DrPal, tell us more about HPV and cancer

OK, if you insist. This comes with the usual caveat directed at scientists that I know this is oversimplified, but I wish to reach the largest audience possible. Feel free to correct my mistakes, but please don’t bother me about oversimplification.

So here’s the deal. Several decades ago, it became scientifically fashionable to believe that most cancer had a viral cause. This belief coincided with the discovery that some viruses do cause cancer. And while it turns out that most cancers are not caused by viruses (probably), many of them are. Viruses can cause cancers in a number of ways, but since you said you were interested in HPV (human papilloma virus) we can use this as an example.

First, there is no scientific question about the causal relationship between HPV and cervical cancer (and certain oral cancers, anal cancers, and penile cancers, but we’ll use cervical cancer as shorthand for all of them). There is excellent epidemiologic evidence to support this, and virologic evidence that proves it.

Now that we’ve got that out of the way, how does this cancer virus thing work?
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Medscape reversal—Gardasil is great again

Last week, Orac reported on Medscape’s execrable article regarding Gardasil. As a reminder, the article spouted every antivaccination lie imaginable. The link subsequently disappeared, although a poll later appeared that parroted the article’s misinformation.

Well, today Medscape has a new Gardasil article. It’s definitely an improvement, but still has some problems…
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Gardasil idiocy

Orac had a nice takedown of an idiotic piece on Medscape about the Gardasil vaccine. As he reported, the link to the bad article is now dead, perhaps as a result of blograge. Now, on the front page of Medscape is a poll—a poll regarding physician prescribing habits given the “news” about Gardasil:

Serious neurologic, thromboembolic, and autoimmune complications have been reported in a small number of patients who received Merck’s HPV vaccine, prompting a recent joint advisory by the FDA and CDC. But the agencies emphasize that the vaccine is safe. How will this news change your use of the HPV vaccine?

This poll question, along with being just silly, asks a question that begs the question—it assumes that the statement as written is true. Of course, it is not. Lies abound regarding the vaccine.

Look, it’s reasonable to argue about whether HPV vaccines should be mandated, but arguing about the basic science is silly. Several HPV strains cause cancer. These cancers are serious health problems. The vaccine protects against the strains that cause the vast majority of these cancers. The vaccine is safe, and so far, in the post-marketing period, there have been far fewer reports of side-effects than most other vaccines.

These are the facts. A policy debate standing on these facts is useful. All the rest is superstition.

Vaccination and morality

Who has the moral high ground in the vaccination wars?

My initial response is that I do, “I” meaning the medical and public health fields—those of us who prevent disease, disability, and death.

But it’s much more complicated. Many anti-vaccine activists are “true believers”. They really believe that vaccines do more harm than good. But, without getting all Godwin, being a true believer doesn’t insulate one from moral responsibility.
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Where did we go wrong? Framing vaccination

I’ve had a bit of writer’s block lately, but I’ve learned to take my own advice and just wait it out. And so I did. Then, today, I read Orac’s piece on framing the vaccine problem. It set my mind a-whirring, so I’ve put the coffee on, and I’m setting fingers to keyboard.

I don’t care about the whole “framing science” thing. The systematic evaluation of science communication is too far outside my field. I am stuck being a “empiric framer.”

(Jargon alert! Outside of the blogosphere, my communications are basically one-on-one, doctor and patient. My framing is the equivalent of a RCT n=1 trial—I get a chance to intervene with a single subject and evaluate the response, but I don’t get the chance to study larger sample sizes and do statistical analyses of my work. End jargon)

The vaccine problem is currently an n=1 problem. Individual medical professionals work hard every day to educate individual patients. Decades ago, we didn’t need to convince anyone to get vaccinated—the need was so blindingly obvious that people lined up for their shots and prayed there would be enough to go around. Everyone saw polio, saw measles, saw people becoming disabled or dying from infectious diseases. Everyone watched as our public health improved with the wide-spread administration of vaccines. And now we are the victims of our own success—people don’t fear vaccine-preventable diseases because they no longer know them.
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The stupid continues at Channel 7

Right now, I’m looking out my window to see the spreading pall of burning stupid rising over Channel 7’s tower in Southfield. And the stupid isn’t just for Steve Wilson anymore. What reporter Carolyn Clifford lacks in adiposity, she easily makes up for in credulity. Her “investigative report” tonight on the HPV vaccine Gardasil is another example of embarrassingly bad health reporting.

A few preliminaries:

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