Real vs. perceived risks

Amy Wallace in Wired on Dr Paul Offit and the Anti-Vaccination Movement: Superb, Engaging Science Journalism

terrasig — Sun, 25 Oct 2009 13:26:29 +0000

Amy Wallace in Wired on Dr Paul Offit and the Anti-Vaccination Movement: Superb, Engaging Science Journalism

One of the most engaging and clearly-written pieces of science journalism over the last year or so was published in Wired magazine last week. Amy Wallace's, "An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All," is part interview with rotavirus vaccine developer, pediatric infectious disease physician, Dr Paul Offit, and description of the anti-vaccination movement in the United States.

Wallace's work is the centerpiece of a collection of smaller articles providing science-based information about vaccination that also refutes common anti-vaccination myths including "How To Win An Argument About Vaccines" and "The Misinformants: Prominent Voices in the Anti-Vaccine Crusade".

Wired's follow-up discussion of the issue includes, "A Short History of Vaccine Panic," for those of us who "have a day job" and not enough time to read Paul Offit's 2008 book, "Autism's False Prophets."

I have to admit that it wasn't until I began blogging four years ago that I realized just how vocal the anti-vaccination movement was in the United States. I come from a time (just on the tail end of the Baby Boom) where I still have relatives who were afflicted with polio and other now-preventable infectious diseases. The devastation of these childhood illnesses makes the risks (yes, I agree there are some risks) of vaccination itself inconsequential.

Vaccination is a risk-benefit proposition but one where someone else's view affects us all. Lack of vaccination compromises "herd immunity" that keeps us all safe, for example, from diseases like smallpox that have been eliminated from the face of the earth. For example, I wrote most recently about a whooping cough outbreak in southwestern Colorado and prior calls in Durango for vaccination as a socially responsible act, much like cutting brush on one's property to protect a neighbor's house in a wildfire.

Others, such as my colleague, Orac, have commented on Wallace's article for its scientific and medical accuracy. However, I wanted to focus on the effectiveness of the writing as a scientific communication tool because much of the article gives the reader a concise view of issues and psychology that often take typical bloggers thousands of words to express (and still less effectively!).

The Motives of Paul Offit

Wallace does a terrific job of showing us just how scary life is for Paul Offit and his family (with death threats reminiscent of those by animal rights and anti-abortion activists). He is a doc at the Children's Hospital in Philadelphia and, as mentioned earlier, is one of the developers of a vaccine for rotavirus sold commercially as RotaTeq®. While not particularly deadly (although the parents of the 20-60 dead US infants and toddlers annually may beg to differ - as well as those of the half million worldwide), rotavirus causes a severe form of acute diarrhea in several hundred thousand US kids annually under age 5. If you've had a kid with it, you wish they didn't have to endure it if a vaccine would prevent the infection and sequelae.

Wallace also describes how Offit was in the hospital with kids suffering from polio in the mid-1950s. Hence, unlike many of today's anti-vaccination advocates, Offit was influenced deeply and early by witnessing firsthand the devastation of now-preventable infectious diseases. That's the world in which my parents and grandparents lived.

"It was a pretty lonely, isolating experience," Offit says. "But what was even worse was looking at these other children who were just horribly crippled and disfigured by polio." That memory, he says, was the first thing that drove him toward a career in pediatric infectious diseases.

Wallace goes on to describe a case in 1977 where, as an intern, Offit observed the death of a child from rotavirus, being surprised that the disease still killed kids. I'd say that many of us in science and medicine were influenced similarly in pursuing our respective career tracks.

Anti-vaccination advocates often criticize Offit for being in the pocket of Big Pharma (whatever that really means) because he made $50 million from the development of the RotaTeq vaccine. Offit admits to it being several million - a much more realistic number given what I know about deals made by institutions vs. remaining payouts to individual scientists - and he has every right to benefit from the intellectual property he has developed from his hard work. Offit has a four-bedroom house with his wife (who is also a pediatrician) and they each drive a Toyota Camry. He does not appear to have an extravagant lifestyle and, to be honest, why should we begrudge him if he did?

Offit acknowledges that he received a payout -- "several million dollars, a lot of money" -- when his hospital sold its stake in RotaTeq last year for $182 million. He continues to collect a royalty each year. It's a fluke, he says -- an unexpected outcome. "I'm not embarrassed about it," he says. "It was the product of a lot of work, although it wasn't why I did the work, nor was it, frankly, the reward for the work."

There are plenty of us who have our kids vaccinated for rotavirus and I'm perfectly happy for Offit to collect a royalty. Does this make him evil? In fact, last week the CDC published that the vaccine is already responsible for reducing cases and hospitalizations for rotavirus. If that's the definition of evil then I aspire to be evil.

Wallace also notes indirectly that the anti-vaccination movement is doing just what they accuse Offit of doing: making money off of the situation:

At this year's Autism One conference in Chicago, I flashed more than once on Carl Sagan's idea of the power of an "unsatisfied medical need." Because a massive research effort has yet to reveal the precise causes of autism, pseudo-science has stepped aggressively into the void. In the hallways of the Westin O'Hare hotel, helpful salespeople strove to catch my eye as I walked past a long line of booths pitching everything from vitamins and supplements to gluten-free cookies (some believe a gluten-free diet alleviates the symptoms of autism), hyperbaric chambers, and neuro-feedback machines.

Yes, where the science is not yet complete, pseudoscience (and the attendant money-grubbing hucksters) fill the void. The difference between them and Offit: the product Offit developed has extensive scientific data to back up its effectiveness.

Efficiency of words

But getting back to what impressed me most about Wallace's article was how concisely she presented her content. Here, she sums up one of my discussion points above:

Today, because the looming risk of childhood death is out of sight, it is also largely out of mind, leading a growing number of Americans to worry about what is in fact a much lesser risk: the ill effects of vaccines.

To describe the hypocrisy of an Offit opponent:

Hence the death threats against Paul Offit. Curt Linderman Sr., the host of "Linderman Live!" on AutismOne Radio and the editor of a blog called the Autism File, recently wrote online that it would "be nice" if Offit "was dead."

I'd met Linderman at Autism One. He'd given his card to me as we stood outside the Westin O'Hare talking about his autistic son. "We live in a very toxic world," he'd told me, puffing on a cigarette.

To describe the logical trapping of pseudoscience believers:

. . .the astronomer Carl Sagan reached a similar conclusion: Science loses ground to pseudo-science because the latter seems to offer more comfort. "A great many of these belief systems address real human needs that are not being met by our society," Sagan wrote of certain Americans' embrace of reincarnation, channeling, and extraterrestrials. "There are unsatisfied medical needs, spiritual needs, and needs for communion with the rest of the human community."

Looking back over human history, rationality has been the anomaly. Being rational takes work, education, and a sober determination to avoid making hasty inferences, even when they appear to make perfect sense. Much like infectious diseases themselves -- beaten back by decades of effort to vaccinate the populace -- the irrational lingers just below the surface, waiting for us to let down our guard.

To describe how people evaluate, incorrectly, perceived vs. actual risks:

Perceived risk -- our changing relationship to it and our increasing intolerance of it -- is at the crux of vaccine safety concerns, not to mention related fears of pesticides, genetically modified food, and cloning. Sharon Kaufman, a medical anthropologist at UC San Francisco, observes that our concept of risk has evolved from an external threat that's out of our control (think: statistical probability of a plane crash) to something that can be managed and controlled if we just make the right decisions (eat less fat and you'll live longer).

Most recently, Wired demonstrates that, like the rest of us who employ the scientific method to evaluate data, it's okay to admit (as well as the responsible thing to do) when one makes a mistake and then describe the consequences, or lack thereof, of the misstatement. For example, Wallace's article did mistakenly state that vaccines no longer contain thimerosal, an anti-microbial preservative that has proven safe in over a dozen studies:

An earlier version of this story suggested that no childhood vaccines contain thimerosal; in fact some versions of the influenza vaccine, which is not typically mandated for children's admission to school, does contain the preservative. Go here for a further explanation.

Amy Wallace the journalist

Finally, what I think also impresses me is Amy Wallace herself and her approach to this article. Wallace is not your typical science journalist. The majority of her portfolio is comprised of works on Hollywood and the entertainment industry. She is not a lobbyist or otherwise a representative of the pharmaceutical industry - as you might guess, she is already being accused of being such by anti-vax advocates, In fact, Wired has published a follow-up on Ms. Wallace's background in response to a misinformation campaign about her that has already developed. (Nor this hasn't stopped the anti-vax commenters from stating that the entire Wired feature is a paid hit job for the pharmaceutical industry.)

When the facts don't support an opponent's view on a pharmaceutical or therapeutic issue, the tendency is an intellectually lazy cry of "Pharma Shill."

Wallace's approach to Offit himself is, I think, so effective because she is supremely experienced at writing about personalities, their inner workings, and how they are viewed by the public. As an entertainment writer, she also has to delve into the truths behind the motivations of people and get past appearances and hype. She went above and beyond in giving time and publicity to anti-vaccination advocates, and their websites, and pretty much gave the reader all they need to make up their own minds about the issue.

But most importantly, all of scientists with whom I communicate on blogs and Twitter have agreed that the science reported in Wallace's article is virtually entirely valid and supported by solid, published data (Orac has an issue with her thesis that anti-vaccinationist emerged due to Pharma's high-profile missteps but otherwise applauds her work).

But the combination of scientific validity, her engaging writing style, and historical/psychological commentary on pseudoscience comes together to create an overall win and an example of what science journalism can be.

The record-setting pageviews for Wired and froth in the comments from anti-vaccination activists tells us all we need to know about how influential Ms. Wallace's article is already and will continue to be.

Congratulations, Amy, and thank you.

terrasig Sun, 10/25/2009 - 09:26

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Real vs. perceived risks

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Decreased vaccination rates, and subsequent resurgence of disease are not the only consequences of the anti-vaccine movement. In a lengthy piece at LB/RB, a guest blogger describes a different consequence.

http://leftbrainrightbrain.co.uk/?p=3144

Many thousands of children are being used as guinea pigs in their parents' efforts to "recover" them from "vaccine-induced-autism".

While the article itself is revealing, the comments are even more so. The post attracted some of the more rabid anti-vaxers who were very annoyed that their cosy yahoo group environment had been breached.

I, too, thought the Amy Wallace piece was clear, direct and well-written. More science writing should have this kind of immediacy, because a depressingly large number of well-educated people have been lured away from rational medicine and this, I think, is what it will take to bring them back.

For all that I fanboy over Ben Goldacre, I think he needs to offer a - partial - apology to humanities graduates. They're obviously not all flaky and scientifically illiterate. In fact ms Wallace demonstrates - as you say - that she know how to communicate.

And for the record I read the Wired piece when Ben linked to it, so he knows. (Here via Cosmic Variance.)

Sean Carroll's article in Discover continues to draw comments from JB Handley, who started by brushing off criticism of his "rape" remark:

I receive more hate mail in a day than Ms. Wallace has probably gotten in her lifetime. Unlike Ms. Wallace an Paul Offit, I just donât whine about it.

Just for reference, I looked it up in the dictionary:

shameless, (shÄm-lÉs) adj., See Handley, JB

Her piece was great if you like one sided journalism that didn't interview one single doctor (and there are many) who are against many vaccinations... My God could she kiss Offit's ass any more than she did?

I think not.

erin, it seems that Wallace took the approach of talking with many doctors and experts, attending Autism One conference and speaking to people there, and presenting facts based on the preponderance of medical evidence. Yes, there are doctors who oppose vaccination but most who do are not guided by scientific facts and/or have a poor understanding of experimental design, epidemiology, and biostatistics.

Objectively regarding Offit, I thought this was the first account where we gain an excellent insight into Offit the physician, his guiding forces, motivations, and approach to science (recall that he was a lone and vocal opponent to smallpox vaccination in the post-9/11 anthrax days).

I'm sorry that you felt otherwise but I appreciate you weighing in here.

I think Erin's comment (http://scienceblogs.com/terrasig/2009/10/one_of_the_most_engaging.php?u…) above illustrates a key problem in this debate: those who insist on viewing it as an argument from authority where one authority is pitted against another and their credentials thrown against one another and the ad hominems flow like water.

The point is that science issues don't hinge on arguments from authority. Science does not demand faith, only diligence. This means that someone like Erin would better invest her time by READING the literature herself; if she is not sufficiently educated to do so, her next step should be to gain further education so that she can empower herself to understand the studies rather than put her trust in an authority with an agenda for interpret it on her behalf.

Science is "open source", after all. No secrets.

It's also worth pointing out that, in cases where a deep divide exists as to the facts of a case, it is next to impossible to maintain impartiality without descending into a farcical pretense of quoting both sides equally.

In science reporting, a journalist is obliged to seek the truth, not balance.

If Paul Offit is correct in saying that vaccines do vastly more good than harm -- and make no mistake, this is an issue of fact, not opinion -- then he deserves praise for standing up to the anti-vaccine movement, including doctors who may oppose vaccination, because that movement and those doctors are wrong on the facts.

It might still be reasonable to criticize Amy Wallace as not having researched the anti-vaccine argument, or not having talked with vaccine opponents. But it is clear from the article that she did do that research, and talked with those people. But she did not agree with them -- and that, in a science reporter, is no sin.

It is also worth noting that an exhaustive survey of the evidence regarding vaccines and autism is available free from the National Academies Press. That report reviewed a huge volume of primary research on vaccines and autism, and considered statements arguing for and against an effect. That's the way science and health policy should be discussed, and until Amy Wallace's critics start doing it themselves, it's hard to take their accusations of bias very seriously.

This means that someone like Erin would better invest her time by READING the literature herself; if she is not sufficiently educated to do so, her next step should be to gain ..

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The ever-improving sophistication of spambots continues to amaze me; but, then, I'm easily amazed.

From jre: "It is also worth noting that an exhaustive survey of the evidence regarding vaccines and autism is available free from the National Academies Press. That report reviewed a huge volume of primary research on vaccines and autism, and considered statements arguing for and against an effect. That's the way science and health policy should be discussed, and until Amy Wallace's critics start doing it themselves, it's hard to take their accusations of bias very seriously."

If you read the conclusions of and recommendations made by the National Academies (back in 2004), you will find a refreshingly logical and rational assessment of this issue:
1) Regarding MMR: "The committee concludes that the evidence favors rejection of a causal relationship at the population level between measles-mumps-rubella (MMR) vaccine and autistic spectrum disorders (ASD). However, this conclusion does not exclude the possibility that MMR vaccine could contribute to ASD in a small number of children." They conclude that further research is warranted to assess whether a small number of children have some sensitivity to the MMR vaccine.
2)Regarding Thimerosal: "The committee concludes that although the hypothesis that exposure to thimerosal-containing vaccines could be associated with neurodevelopmental disorders is not established and rests on indirect and incomplete information, primarily from analogies with methylmercury and levels of maximum mercury exposure from vaccines given in children, the hypothesis is biologically plausible.
The committee also concludes that the evidence is inadequate to accept or reject a causal relationship between thimerosal exposures from childhood vaccines and the neurodevelopmental disorders of autism, ADHD, and speech or language delay...The committee recommends the use of the thimerosal-free DTaP, Hib, and hepatitis B vaccines in the United States, despite the fact that there might be remaining supplies of thimerosal-containing vaccine available...The committee recommends research to identify a safe, effective, and inexpensive alternative to thimerosal for countries that decide they need to switch from using thimerosal as a preservative."
There are many different lines of arguments here:

-There is greater risk to the population at large associated with forgoing vaccinations. Ie. people should vaccinate their kids.
-Yet is impossible to prove that something is safe (for everyone), so more research should be done to uncover the mechanism(s) of autism and of adverse effects of vaccination, such that they may be mitigated (to improve the risk-benefit ratio).
-Evidence implicating thimerosal is weak, yet mercury compounds are known neurotoxins. The existence of mercury-free alternatives makes it possible to forgo the risk and switch to the alternatives. The cost of this is a financial cost to certain parties in the loss of existing thimerosal-containing vaccines, a cost that the National Academies (and presumably the general public, as well as health professionals) deem acceptable.
-That epidemiological studies find no association between MMR and autism onset does not preclude a causal relationship between MMR and the onset of autism in a small proportion of children. Further study of children with autism may uncover biomarkers that could enable an epidemiological look at a sample enriched for those who show this biomarker.
More knowledge of the etiology of a disease like autism can improve(and define) diagnosis, prevention and treatment, as well as inform on the possible causal influences of something like vaccination.

Why the PharmKid will get her flu vaccine

terrasig — Fri, 18 Sep 2009 12:02:25 +0000

Why the PharmKid will get her flu vaccine

Prof Tara Smith thought it important enough to come back from her hiatus to explain why she's doing the same for her kids.

That's why.

Addendum (20 Sept 2009): In my rush to put up a very quick post on Friday, I just saw that Revere at Effect Measure put up a detailed post on why we should always get the regular seasonal flu vaccine regardless of the current H1N1 pandemic.

terrasig Fri, 09/18/2009 - 08:02

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Blogging community

infectious diseases

Kids' stuff

Real vs. perceived risks

My whole family will be getting poked. I'm not going to rely on 'herd immunity' to keep me or my family safe. I can't afford to miss 7 days of work as the Minnesota Health Department is suggesting in the event of infection (H1N1 or other).

Aw, thanks for the plug, Abel. Hope you're all doing well!

As of today our whole family is vaccinated against seasonal flu so we will be eligible for h1n1 vaccine as soon as our respective priority groups are called. I want no part of spreading either disease.

Oprah teaming with Jenny McCarthy will kill children

terrasig — Tue, 05 May 2009 21:15:29 +0000

Oprah teaming with Jenny McCarthy will kill children

I wanted to contribute to today's discussion of anti-vaccinationist, pseudoscience-pawning Jenny McCarthy being given not only an appearance on Oprah but, as reported by Orac, a deal with Oprah's production company for her own show.

The public attention that Jenny McCarthy's rants have gotten were bad enough. But, now, to have the soapbox of one of the most influential names in society?

I had to go outside the science blogging community with this. So, I wrote to the Philadelphia attorney who writes the award-winning blog, Field Negro.

Good evening, Counselor,

I know that your view of Oprah has modulated over the years but I'm hoping to get your take on this. I believe you thought her squarely in the house but you recently said (April 19) in your post explaining to yuppie black friends the Malcolm X field negro/house negro speech: "Note, since this post I have changed my opinion [since three years ago] about Oprah. I think girlfriend is on the patio now and has at least one leg in the fields."

Well, you may want to reassess after today.

Today, many in the network at ScienceBlogs have blogposts on the threat to human health by Oprah parading anti-vaccination, pseudoscience wackaloon, Jenny McCarthy. ScienceBlogs.com's frontpage will have links but you are a very busy man.

This one post by my physician colleague will give you all you need to know:
http://scienceblogs.com/insolence/2009/05/the_best_snark_at_oprah_winfrey.php

To give McCarthy the bully pulpit that is Oprah's show is to sentence thousands of children to death from childhood diseases for which we have low-cost protection in vaccines. Moreover, by encouraging parents not to vaccinate their children, other children may be put at risk - a practice I consider to be a form of biological terrorism.

I'm not being overly dramatic, Counselor. As a scientist of a certain age, I have relatives that were afflicted with polio and ancestors that died of measles and smallpox. Today, these diseases are preventable. However, the hysteria created by Jenny McCarthy now being given the high-profile imprimatur of Oprah cannot do anything but cause vaccines to be withheld from children and deadly diseases to return and flourish.

Given your own platform, I humbly request that you publicize this public health travesty to HFNs, Afrospear, and other readers to protest Oprah's complicity in this unconscionable anti-vaccination movement. This is not just a science issue, it is a societal issue - one that will irreversibly affect the futures of large numbers of children with debilitating and fatal diseases that are easily prevented.

Respectfully submitted,
Abel Pharmboy
Terra Sigillata
http://scienceblogs.com/terrasig
This e-mail is: [X]blogable [ ]ask first [ ]private

UPDATE (6 May 1:15 pm EDT) : This post has been Twittered this morning by Suzanne Somers.

Also, Arthur Allen just put up a great article in Slate, "Say It Ain't So, O," that closes with the following:

What's a little sad about this episode is the fact that once upon a time, big stars like Humphrey Bogart, Louis Armstrong, and Elvis Presley stood up for vaccination campaigns to protect the lives of children. (Actress Amanda Peet recently stepped up to counter McCarthy's message, saying that people should get their advice on autism and vaccines from doctors, not actresses. But Peet seems to lack McCarthy's entrepreneurial verve and hasn't drawn the same level of attention.)

In those days, parents and children clamored for vaccination. Especially children in places like the South Side of Chicago or rural Mississippi (where Oprah was born in 1954), who suffered higher rates of polio in the late 1950s because their parents couldn't afford the new vaccine.

Over the past year, new outbreaks of measles, whooping cough, and other vaccine-preventable diseases have occurred in communities with parents who choose not to vaccinate their kids.

Oprah, think of the children.

terrasig Tue, 05/05/2009 - 17:15

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quackery

Real vs. perceived risks

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You are absolutely right. No one who has their very own television show that has millions (billions?) of viewers should EVER shed light on a controversial subject that could hurt someone- let alone allow someone to assess some facts on their own and make their own decisions!

The fact is that Oprah can't hurt anyone by her illumination of ANY controversial subject. If people go out and (god forbid) do their own research on a medical subject and don't just take a doctor's advice based on blind faith, then we might all be a little better for it.

Kerri Knox, RN
http://www.easy-immune-health.com

Oprah = HuffPost.

Spreading falsehoods is part of that "illumination" process, Kerri?

@Kerri: The problem is that McCarthy et al are NOT encouraging people to go out and do their own research. They are saying "The doctors and scientists are all liars don't believe anything they say, go buy MY book or one by someone I agree with and indoctrinate yourself with our ideology". This is not helping anyone but them.

But then I see you're just like them. The doctors and big pharma are evil villains out to take the money from these uninformed people, whereas you are a benevolent caregiver who wants to take their money. Totally different.

So what is a Functional Medicine Practitioner (FMP)? Never having heard of this before I had to google a bit. It turns out you to could be an FMP too, just take the online course at Functional Medicine University.com (not .edu)

Kerry, the point is that this is a disservice to public health. There is no drug or vaccine that is 100% safe and I will be the first one to say that. However, we have decided as a society that we are willing to risk, say, 200 or even 2000 adverse events for a therapy that can save the lives of millions of children.

Automobile accidents kill more people each year than died in the entire Vietnam War. yet we do not outlaw automobiles or go on Oprah and say that automobiles are useless and a conspiracy by automakers to kill people or give kids autism. Instead, we recognize the societal benefits of automobiles and do all we can to make them safer. Here, the benefits outweigh the risks.

I do not intend to be insensitive to anyone whose family has been adversely affected by true, documented reactions to vaccines or vaccine byproducts. However, there is no controversy, in science at least, that these adverse events include autism; in fact, we are now learning via studies with twins that there is a strong genetic contribution to spectrum disorders. Moreover, McCarthy's message completely ignores the reality that vaccines save 100,000-fold more lives than adverse events.

Oprah viewers will not get this information from Jenny McCarthy and the vast majority will not look any further than the program or, at best, McCarthy's books and ill-informed viewpoints not based in science and medicine.

@ Bobh #5,

"Functional Medicine - New Kid on the Block" http://www.sciencebasedmedicine.org/?p=271

Among other things, it embraces "âPersonalized medicineâ ... a code for leeway for departure from proved methods ..." and "âunderlying causesâ imply[ing] ... that a special kind of medicine is required - which the FM physician happens to have."

Keri,

I can't believe that a nurse would post such a narrow minded statement.

I am not going to debate the science behind vaccines because that has been done in many other places by people much more well read than I.

What I will say is this, people don't want to do research on their own. They want to be told what is good for them and what is not. Whether or not the person is an expert has no bearing on this. Normally I would say it is the person's own fault and they get what they deserve for listening to an air-headed model for medical advice. However, this time, it is not them being put at risk, it is their kids and worse off, other, more responsible people's kids.

I will also refer to the previous poster about the fact that Jenny will NOT be presenting a balanced informed debate of a controversial issue...just her one side of the story with the Oprah seal of approval.

Kenneth Sherry RN

Sorry, I did not follow your link. I apologize for thinking that you were naive. You are obviously not, You are much worse. To be selling the snake oil that others do and try and use your nursing license to do it is reprehensible.

I mean really, a doctor's office can't do a CMP...Really?

Abel -- actually, the number of annual automobile fatalities in the US is somewhere around 41,000, versus the 57,000-some Americans who died in the Vietnam War.

Which has nothing to do with the validity of your highly-justified broadside against Oprah. I just don't want the anti-vaxers to be able to jump all over you and discount what you say because of such trivia.

Over at Millard Fillmore's Bathtub I occasionally get a nice hoax to debunk -- the story that Millard Fillmore put the first bathtub in the White House was a hoax, you know.

And so, when I first saw the claims about Gardasil being deadly, I tracked it down. Turned out the anti-Gardasil people had listed every death recorded in the trials as a death caused by Gardasil -- but that wasn't the case. In fact the data from CDC and Merck were freely available. Of the nearly two dozen deaths, 7 were by automobile accident, and those were split nearly evenly between the Gardasil recipients and those who got placebos. In other words, the Gardasil critics were claiming Gardasil had caused deaths to people who had never had Gardasil, and who died in completely unrelated ways where the proximate cause of death was quite clearly NOT Gardasil.

Recently I noticed another slam at Gardasil, and checked it out. The claim from an anti-science guy was that Gardasil has killed 32 women since the vaccine was approved for public use. CDC's figures show 32 deaths among people who got Gardasil (out of 23 million), but says none of those deaths can be connected to Gardasil. Damn. 23 million people and only 32 died? Sounds like an elixir of life, doesn't it?

But the anti-science types persist in saying Gardasil's a threat.

Counting automobile deaths as due to a vaccine, even a vaccine that the dead never got? Saying deaths are due to a vaccine, when the doctors who did the treatments say they don't think so? How much hoaxing does it take from the anti-vaccine types before someone gets skeptical about their claims?

University of Colorado student died of opium tea overdose

terrasig — Sat, 21 Mar 2009 07:55:20 +0000

University of Colorado student died of opium tea overdose

After writing this post, I came across Alex's obituary and guestbook on Legacy.com. By all accounts, Alex was a great kid - loved and admired by many - an accomplished hockey player and musician with a love for the mountains. This could have been you or I, or worse, one of our own children.

Breaking my heart this morning is news from Boulder that last month's death of 20-year-old CU student, Alexander McGuiggan, was from consumption of "opium tea."

Police department spokeswoman Sarah Huntley said investigators believe McGuiggan and others had acquired poppy plants -- which are available legally over the Internet -- and were boiling pods to make intoxicating tea.

Police believe McGuiggan knew that the tea he was drinking was made of opiates, Huntley said.

"What he may not have been as aware of was the dangers of what he was ingesting," she said.

The Boulder County Drug Task Force is investigating other people who may have been involved in "the procurement of the tea, and the making of the tea," Huntley said. Those people could face charges, she said.

A previous report has been that the student and friends were boiling up poppy seeds, but I was suspicious as those lack significant amounts of opiates. Instead, as Ryan Morgan of The Boulder Daily Camera reports accurately, the students appear to have obtained seeds for Papaver somniferum, and grown plants, and extracted the latex from mature pods. Opium is an alcoholic tincture of the pod latex and is comprised of approximately 10% morphine, 0.5% codeine, and other lesser naturally-occurring opioids (the plant synthesizes these opiates of the "benzomorphan" class in a biosythetic pathway beginning with the amino acid, L-tyrosine.).

The sad fact is that we've known for over 200 years that this is a bad idea: based upon growing conditions, harvest time, and extraction method, the resulting concoction can provide an extremely variable dose of these compounds. Used medicinally as one of the strongest analgesics ("painkillers") we know, in higher doses the opiates can impart a warming sense of euphoria but, at even higher doses, suppresses the respiratory control center of the brain stem, resulting in death.

This is an illustration of the German chemist/pharmacist, Friedrich Wilhelm Sertürner, from a fabulous 1965 book entitled, "Great Moments in the History of Pharmacy." The then-Parke-Davis drug company commissioned artist Robert Thom to draft this one of 16 illustrations telling the ancient and recent history of drugs and is, in fact, the source of my blog name, Terra Sigillata.

Sertürner's place in pharmaceutical history comes from his realization that while opium extract was a superb analgesic, the dose could not be controlled well. He then experimented with extraction techniques in the search for the pure chemical compounds made by the plant that confer the painkilling, euphoric, and sedating activities. As a result, he first isolated morphine from opium in 1806, deriving the name from the Greek god of sleep, Morpheus, and the suffix, -ine, to indicate the alkaloid quality of the compound.

Hence, Sertürner created the first standardized drug from a plant extract.

Today, one can still purchase various plant materials and chemical extracts as herbal medicines at the local grocery, pharmacy, or health food store. But these remedies fails to acknowledge the principles of pharmaceutical chemistry that Sertürner taught us 200 years ago. However, most herbal medicines have a wide margin of safety and the wide range of potency of these concoctions is rarely a real problem.

However, morphine and other opiates have what is called a narrow therapeutic index - that is, a very small range between their therapeutic effects and toxic effects. Yes, my friends, natural medicines can be toxic.

Sadly, Alexander McGuiggan and his college buds were playing with fire when making opium extract teas. Not that I condone any kinds of illegal use of scheduled, controlled substances, but it would have been safer to procure a pharmaceutical product on the streets of Boulder or Denver since these diverted pills would at least have had a known quantity of compound that could then be looked up in any online or print prescription drug reference source.

I don't mean to make light of this tragedy but I am reminded of the quote from the late Isaac Hayes' character, Chef, from South Park - a show set in a town based on Fairplay, Colorado (known as during the Gold Rush days as South Park City), about 100 miles from Boulder:

''There's a time and a place for everything, and it's called college.''

Young adults in college are going to experiment with the increments of knowledge they gain and experiment with recreational drugs.

This case is not a time for prosecution - it is a time for education.

President Benson: if you or members of your office are reading, I know of a CU President's Teaching Scholar who'd love to come back and give a few lectures on recreational drug use and risks.

terrasig Sat, 03/21/2009 - 03:55

sorry for a small correction: opium is the dried latex that contains about 10% of morphine among lots of other stuff; and its only partially soluble. The alcohol tincture is properly called laudanum. But what these dudes were doing was a tea from poppy straw - the empty pods. The poppy straw is quite rich source of opiates (unlike the poppy seeds) and in fact the emty pods are the main commercial source for pharma morphine and codeine. (Collecting real opium is too labor intensive for Western companies)

The main problem with eating/drinking opium preparations is that the effects of intoxication are delayed; when smoking opium pipe the effects are nearly instant so the user can judge somewhat how high he has got already and stop (or in the worst case, pass out).

It is clear that these kids were wannabes. Experienced users try to adjust the dose carefully because they know from experience that smaller doses (compensated for the drug tolerance) provides a better euphoria and dreamy states with less sleepiness and skin itching than the high doses.

Abel,

I don't know the circumstances of finding this guy, but I assume appropriate treatment would have been naloxone? I also assume that it would have been effective. Do you think that the ER doc's just didn't know what the person had taken, and thus couldn't administer the antagonist?

This comment has been removed by the administrator.

The main problem with eating/drinking opium preparations is that the effects of intoxication are delayed; when smoking opium pipe the effects are nearly instant so the user can judge somewhat how high he has got already and stop (or in the worst case, pass out).

This holds for marijuana as well. One time I ate a bunch of pot brownies without knowing how much weed was in the brownies and how potent it was. I ended up so fucking high I literally could not get up off the floor for about three hours. Fortunately, my pals kept me supplied with beer as a lied there giggling and mumbling.

CPP, that's a general principle of pharmacology! onset and offest of effect is generally pretty rapid via inhalation for a nice lipophilic drug, which is why smoking allows the user to titrate the dose to desired levels and then stop. onset and offset are delayed orally, but the peak drug levels, when comparing the same dose, are also lower. so you had a massive dose of thc via those brownies, and this unfortunate student had enough opium to halt his respiration. you just had to ride out the psychoactive effects. the only solution for this student would have been to realize what was going on and get himself to the ER for a dose of naloxone.

working class, don't be such a heartless ass. Check out the kid's Legacy.com obit and guestbook and tell me that you'd say that to his suffering family. You should be ashamed of yourself.

milkshake, your comments illustrate why my career has gone a lot better since I took up company with a couple of superb medicinal and synthetic organic chemists. Thanks so much for the insights and corrections.

Doctor Jake and others, I have been trying to find out what exactly happened at the time of the OD. I don't have the reports but my fear is that Alex's compatriots might not have divulged exactly what they were doing and the fact that an antidote might have been administered may be the reasons behind threatening their prosecution.

Perhaps the safety of smoking vs. imbibing a drug would seem counterintuitive to a layperson.

Opium extracted in this way can also contain thebaine, a nasty compound with a propensity to cause seizures and even cardiac arrest.

Here in Tasmania, which is one of a small number of places licenced for growing opium poppies for manufacture of medical opiates, we have to be very aware of the risks of DIY opiate abuse.

And yes, 'working class' is an oxygen thief.

Tassie Devil, that's a great point about thebaine. I knew that it was used as a starting material for the semi-synthesis of other opiates but I had not appreciated fully its unusual neurostimulant effects. Very interesting to also know that down your way is licensed for medicinal poppy growth.

Keep it coming, folks - I'm learning as much as you are.

Yeah, 'working class' has been making similarly offensive and inane comments on my blog...he's millimeters away from being confined to my dungeon.

OMG let's ban the sale of all psychoactive plants because there's a potential someone could do something stupid.

vs.

No culture has every successfully protected people from their own ignorance.

Fight!!

/Life sucks, get a helmet.

One of my teenage friends also died from home-prepared laudanum (as far as I know it was basically vodka soaked with poppy heads).

Please don't do this - as the initial article explains, it is very difficult to get a safe dosage. One of my best teenage friends died very young playing around with this. It was a complete waste

I knew Alex and he was a wonderful kid. I don't have many responses. But to Jake, his roommates found him dead the next morning. It was too late to administer anything to counteract the teas. Thank you to those who stood up for the fact that this was a young student who died and is missed deeply on a daily basis. I have heard of people making this tea before, but never quite grasped it all until now.

Abel,

Just a note regarding your statement: "A previous report has been that the student and friends were boiling up poppy seeds, but I was suspicious as those lack significant amounts of opiates.".

Our son died 6 years ago from exactly the same causes as the man in this case. Except that my did in fact use only poppy seeds, in large amounts. Eventhough there is no Morphine in the seeds, they contain traces from the rest of the plant from the processing/harvesting. We have put up a Web site that includes the coroner's report stating that cause of death was indeed Morphine overdose from poppy seed tea. You can find our Web site at: http://www.poppyseedtea.com/

PharmBoy -
I worked with the DEA and a USA opium processor, testing some new-fangled equipment to measure the yield from raw opium gum.

Having the DEA keeping an eagle eye on me* (they thought I would lick the spatulas?) was not nearly as bad as the splitting headache from the fumes, the smell of the raw opium gum, and trying to deal with the road-tar texture of the stuff. If I had to do it again, I'd insist on HAZMAT gear.

* They collected EVERYTHING we used, including the lab wipes we cleaned the spatulas with, and took it away in black garbage bags.

Even more fun was the testing of various illegal drugs ... we had lots of bags of cocaine, heroin, etc. sitting around waiting to be tested, and a couple SWAT squads surrounding the building. There was a lot of $$$ if it had hit the street. The DEA vacuumed the lab before they left to get all the spillage, with the vacuum cleaner they brought.

Tom, I'm so sorry about your son. Your website will save lives.

someone please tell me there is a way to ban Workingclass.
most inconsiderate person I've ever had to encounter, even on the internet. Is it impossible to consider that some people here might have known Alex, maybe were his friends?

Workingclass, you're pathetic.

Most people who make PST (poppy seed tea) use between 100-300 grams, although some people use pounds at a time. Usually the seeds are "cooked" in hot water. Though inexperienced users may powderize the seeds in a coffee grinder; this is dangerous. The sheer amount of different alkaloids in the seeds is dangerous in its self, some are known toxins. Also if pulverized you get more molrphine extracted as well.

Some people report using pounds of seeds at a time to get high, if he tried to emulate this he could be in trouble.

A much better method is using dried poppy PODS; where does is more regulated and much cleaner. Also, its a better high.

Anyways I would suspect that he had taken some other form of a CNS depressant in concurrence with the tea. Rarely do people die from pure opiate overdose. But simply mixing benadryl with an otherwise non-lethal dose of Opiates, may potentiate the respiratory depression to lethal levels.

Fucking prudes. Don't want to do drugs?? then don't.

But leave everyone else ALONE, including those ostensilbly profiting from your loving pity.

Capice??

would it have been better to evaporate off the liquid like you would do to Ketamine? When you prepare K to be snorted, you double boil it on a pyrex above a boiling pot of water and remove the liquid. Would this have been a better method of dosage control? This way you could do small snorted "bumps" until you got the right amount?

Opium tea just killed a 26 year old in west wales .

Almost 30 years ago I ordered some papaver somniferum seeds from the UK. I was so paranoid, but I had to try it. I grew about 40 square feet of opium poppies, ones that had been bred for ornamentals (they were beautiful), so they weren't super potent. After the petals fell off I waited a week or so, and slit and scraped the pods the old fashioned way to collect opium. I got enough to fill two normal sized gelatin capsules. I took them and got one sweet buzz! But it was a lot of time and work to get high once.

I've never done that again. However, I always heard that for opium tea, you DO NOT want to use the seeds for grinding or brewing! This lore is decades old, and goes back to at least the early 70s. What you want to do is to break up the dried pods, remove the seeds, then grind the pods and brew that, approximately 5-10 pods per cup of tea.

I've not actually done it, so I cannot comment on the technique, but it may be that using the seeds in the grind adds some undesirable things to the brew that is the cause of death in the tragic cases mentioned here. I do know that consuming opium tea (without the seeds) is a practice that's been around for centuries.

Maybe they should just sell the stuff in proper professional doses OTC for pain. Sort of like the old coke/morphine headache,ibs,pms, nasty root canal, hemorrhoid from hell, holy crap the circular saw just took my finger and IT HURTS come hither you sexy bullet you kind of thing.

You know when booze was made illegal I'm sure a large number of novices made,sold, and used awful toxic,dangerous booze too. The same thing is happening here. When there is a demand for something (be it legitimate pain or young foolishness) and you restrict it people who have little to no training or experience with what they are working with will screw up with complex and simple things like...was it 40 grams or mg's? lets go with g's...........beep.........

FLATLINED

So umm yeah how bout you save more lives by making it with accurate machines, smart chemists, and easy to read directions (also en espanol) on a box or bottle instead of having peeps trusting random internet instructions like

Chew up the castor beans really well so the ricin will kill you. Just before you notice an incurable hellish stomach pain begin masturbating to really get off and out.

(please don't do that- 3 days to die is not sounding fun and the hospital people can do nothing to help you on that poison)

You have a lot of facts wrong. Aside from the fact that all drug laws are sumptuary laws, compelling people to abstain from vice, which is a sin, not a CRIME et al... These kids did NOT sit around and grow the poppies and then harvest the opium latex. They got dried poppy heads off the Internet and made the tea. This dude was obviously opiate naive and his system couldn't handle it. Thebaine actually is a stimulant and keeps tea drinkers awake where Heroin users tend to nod off. Poppy tea usually lasts for up to 24 hours against Heroin's 12 hours. Morphine is morphine is morphine. Sweet, sweet morphine...

This is a sad result of an ill informed public. Our film "Poppies: Odyssey of an Opium Eater" is an independent film based the true life of Eric Detzer. We cover his addiction to opium poppies and how he'd acquire them. Opium tea can be deathly powerful! It is apparent that this young man was only experimenting and had absolutely no idea how risky this concoction was. At every Q & A after our film is screened, I always warn the public how dangerous these pods are.

A few things:

** while this may sound scary, as if this article just exposes the "tip of the iceberg," opium tea use is relatively rare, even amongst opiate abusers.

in fact, the majority of opium tea users are former heroin or oxycontin addicts who use the tea as a "maintenance" drug to either maintain or slowly ease off their tolerance.

a quick google search shows that the majority of people asking questions about opium tea are doing so on sites that focus on opiates or drugs in general.

such users are more likely to understand concepts of safety and dosage, even though they abuse potentially dangerous drugs.

college kids overdose all the time. some die, many dont. for every kid dead of an opium tea overdose, there are probably 10 times as many dead of a heroin overdose.

now that I have said that, there are a few facts I wanted to add:

1) legal varieties of p. somniferum, which are essentially the only ones available online in the US, have ridiculously small morphine content (relative). typically less than 0.5% dry weight of straw.

admittedly, this just means it would be hard to manufacture heroin on a large scale using such varieties. this is the likely reason that they are legal at all... because law enforcement believe that they offer little threat.

it would still be easy to grind up 20 pods in a coffee grinder, steep 3x in lemon water, filter through coffee filters, combine filtrates, ingest, and die.

2) illegal varieties of poppy (in the US) can have staggeringly high morphine content (wt% of the dry plant material, no seeds):

most range between 12 and 18% morphine by dry weight (these are typically asian varieties which have been selectively bread by botanists or farmers who produce opium and sell it to drug cartels)

one of thousands of refs to prove the value I gave:
http://www.actahort.org/books/132/132_21.htm (11.84-14.74% morphine by dry weight)

staggering. Consider the following:

a field of 1000 poppy plants. each plant can contain more than one pod. lets imagine each plant has (on average) 2 pods. Each pod weighs 4 grams dry (this is pretty average)

(note plants can have 10+ pods)

1000 plants x 2pods/plant x 4 grams/pod x 10% dry weight morphine

800 grams of PURE morphine (with proper extraction/purification)

if properly farmed, such plants should have ~30 cm around them, so lets assume 0.09 m^2 per plant x 1000 plants = 90 m^2 to produce around 800 grams of pure morphine

now you can see why these strains are illegal.

someone could grow these in the middle of a farm somewhere on a 30x30 meter plot and produce nearly a kilogram of pure morphine every season.

1 kilogram of pure morphine, if properly utilized can be worth as much as $300,000 on the street.

"Maybe they should just sell the stuff in proper professional doses OTC for pain"

they do in australia (i think) and the UK. its called Neurofen plus.

~12 mg codeine sulfate + ibuprofen otc

both countries have large problems with addiction to these medications (as is expected with opiates). most of the addicts began using the drugs for completely legitimate purposes (old people trying to sleep, people with injuries, etc), but now are addicted so badly that they would go into horrific withdrawals if they quit cold turkey

interestingly enough, they have realized that putting tylenol (acetaminophen) into these medications is a bad idea.

apparently they have not yet figured this same thing out in the US.

they still put ridiculous amounts of acetaminophen into the vicodin and related hydrocodone medications in the US

10 mg of hydrocodone and, oh I dont know, how about 1000 FUCKING mg OF TYLENOL!?!?!

the smallest amount is 325 mg of acetaminophen, most use 500 or 750 mg of tylenol.

only a few manufacturers make hydrocodone meds with ibuprofen.

The people selling the pods on the internet should put a warning on these, as there is a warning on most substances.I have been a user of heroin for 20 years,done alot of time for it to.I am now on a drug prescribed by a doctor it is called buprenorphine,it works great for opiate addiction. You cannot abuse it, it goes against common sense but if one takes more than 2 pills,nothing happens,I have taken 6 just to see and I wasted my medication,this is a great drug for addicts.Is it not amazing that a person can carry a loaded 357 most any where and not be a criminal,yet get caught with a gram of dope and go to prison,which has the most potential for harm the gun or the gram? A person should be allowed to use any substance they desire,if one just uses common sense and a little knowledge,the use of so called dangerous substances becomes not so dangerous. I know of a woman that drank to much water in a contest and died. What do you all think of that? An over dose form water!Its true,it has happened more than once. Ther are no dangerous drugs,there is the ignorant use of drugs,and thats where the problem is,a lack of knowledge period.Just google drug laws in portugal,you will see a country that has come to its senses 10 years ago, the people say they never want to go back to the old way,puting addicts in prison which by the way ruins thier lives for ever by giving them a felony back ground as I have,just try and get a good job with that.End this futile war on drugs,the drugs have won. Barry.

NIAAA's 'Rethinking Drinking'

terrasig — Mon, 09 Mar 2009 10:58:22 +0000

NIAAA's 'Rethinking Drinking'

I'm very proud today to see one of my formative professors, Dr Fulton Crews, quoted extensively in a USAToday article on a new, web-based alcohol awareness initiative, "Rethinking Drinking," from NIH's National Institute for Alcohol Abuse and Alcoholism (NIAAA) Division of Treatment and Recovery Research.

While many associate heavy drinking with liver problems, it can also increase the risk for heart disease, sleep disorders, depression, stroke and stomach bleeding. Consumed during pregnancy, it can cause fetal brain damage, says Fulton Crews, director of the Bowles Center for Alcohol Studies at the University of North Carolina-Chapel Hill School of Medicine. It's also linked to cancer.

"We know if you're a heavy drinker but not alcohol dependent, your risk of oral cavity cancer and also breast cancer are increased," Crews says.

What I like about this information site is that it's message is not, "drinking is evil and a scourge on the Earth." Rather it addresses "risk reduction" and the reality the alcohol consumption is a life-enhancing social behavior among the majority of Americans by providing resources for drinking responsibly, very similar to our mission statement for The Friday Fermentable, our near-weekly feature on wine and beer.

Among these sections include, "Is your 'lite' beer light in alcohol?," "The Cocktail Content Calculator," and "How many glasses are in a bottle of wine?" The site also has resources for objective determination of at-risk drinking relative to alcoholism.

For more information, visit Rethinking Drinking at NIAAA. Nice job, folks.

terrasig Mon, 03/09/2009 - 06:58

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I could not resist commenting on the BEST, BY FAR, website ("Rethinking Drinking") concerning alcohol abuse that I've ever read! I have never gotten to the point before that I was "convinced" that I had an alcohol abuse problem. After reading the entire article, I am sure that I DO have a problem.

Your website is FULL of wonderful and detailed information and is presented in such a positive and encouraging manner. You also included many helpful "tools" in which to begin the process of "cutting back" or getting to the point of completely "quitting."

I have made a commitment (beginning today) to make a concerted effort to "wean" myself of my alcohol abuse problem.

Thank you again for your most helpful website. May God bless you for all your research and passion for this cause, and for sharing it with the world!

More fallout from New Mexico garbage truck E. coli-gate - up from the comments

terrasig — Mon, 22 Sep 2008 06:22:52 +0000

More fallout from New Mexico garbage truck E. coli-gate - up from the comments

Here's an update on E. coli-gate in Tularosa, NM:

Okay, so it's more than fluid - it's about a pint of sludge left in front of each house where the garbage truck stopped. But this is ridiculous:

[Tularosa resident Ken] Riedlinger took samples from the sludge puddle to the Diagnostic and Technology Center in Alamogordo and they found a huge amount of E. coli, he said.

"The upper tray reported it's infinite, the numbers were too great to count," Riedlinger said. "This is massive, massive E. coli. This is deadly stuff."

E. coli is a bacterium found in the lower intestine of warm-blooded animals, Riedlinger said, reading from an Internet report. Some strains of E. coli can lead to infection and death if ingested.

We here at Terra Sigillata World Headquarters were fortunate to have been visited by, not a garbage truck, but rather a couple of commenters who spoke with great authority on the issues at hand.

I first saw that jre from Lyons, Colorado, also commented at the KRQE-TV website but then also left a comment here:

As sherlock and others have noted, E. coli is a normal component of everyone's intestinal flora. You, me, the mayor of Tularosa -- we all have it. What's disappointing is not that the mayor was unaware of this; it is that the KRQE news team couldn't even spend two minutes researching the subject before releasing this story. From Wikipedia:
Most E. coli strains are harmless, but some, such as serotype O157:H7, can cause serious food poisoning in humans, and are occasionally responsible for costly product recalls. The harmless strains are part of the normal flora of the gut, and can benefit their hosts by producing vitamin or by preventing the establishment of pathogenic bacteria within the intestine.

The distinction between harmful strains of E. coli and the bacterium generally is very important to public health, and the public deserves to be educated on the subject, not falsely alarmed. You [KRQE-TV], a news source who should have known better, let us down on this one.

(I swear that I had recognized those initials, jre, and now remember that he is an old buddy from the early blogging days with whom I held forth on Bristlecone Pine Scenic Area at Windy Ridge in Alma, Colorado, (the real South Park) home to trees aged 1,000 to 4,000 years old.)

And a longer, more detailed comment came from industry technical dude who describes the another poo source (I had said dog and cat poo but had blocked from my mind PharmKid's early days) and the engineering of a garbage truck:

Someone please pass this along:
The likely source of the e coli is not the fruit & vegetable waste, but disposable diapers that are in the mixed waste stream. The "fluid" probably does come from food waste, but the bacteria come from the diapers.

The "crack in the truck" is almost certainly the seam between the tailgate assembly and the truck body, not a crack in the truck body floor, and the refuse company guy probably assumed the city officials understood what he meant.

There is no way to fix that, any more than there's a way to fix the fact that those trucks make a certain amount of noise while going about their work. The tailgate is under pressure from the compressing mechanism, which in today's refuse collection vehicles compresses the load by a factor of 4 to 1 (that is, 100 cubic yards of refuse from the household bins, becomes 25 cubic yards in the truck).

Even with tight tailgate clamps and rubber gaskets between tailgate and body, the fact is that the pressure of the refuse will push on the tailgate and the seal to the body will never be perfect. Thus liquids will always find a way to leak out. This is the case for 100% of refuse collecting vehicles without exception: it's inherent in the nature of the technology.

For comparison, when you stuff your carry-on suitcase with clothes etc. and pack it down to make it all fit, you're typically compressing at a ratio of about 1.3 to 1, and you can see how hard it is to get the darn suitcase to close up properly.

Now imagine squishing poopy diapers and drippy food waste together by a factor of 4:1, and you can see where the problem comes from.

So rather than fire the refuse contractor, I have a better idea. Outlaw those damn disposable diapers altogether, and keep the poo out of the mixed waste stream. People can use cloth diapers, and have diaper services pick up the poopy ones & leave clean ones, just as they did 30 - 40 years ago. Poo does not belong in the mixed waste stream, period. It belongs down the sewer, or in a controlled collection & laundering system that ultimately puts it down the sewer.

And yeah, three cheers for scientific literacy. Anyone running for public office ought to have to take a general science & technology exam and post the results for the voters to see. After a brief period during which the anti-science crowd will chuckle as they vote for the obscurantist ticket and then get rewarded with cholera outbreaks and bridges falling down, the public will wise up and throw the ignoramuses out, in favor of people who understand that the world is neither flat nor 6,000 years old.

Though, you have to give the city council guy credit for one thing anyway. At least he understands that germs cause disease. Given some of the people running for public office nowadays, even that much can't be taken for granted!

You gotta love the collective expertise of Terra Sig readers and commenters. I think I really need to get together a CafePress.com shop like DrugMonkey to send out commenter appreciation prizes to contributors like these.

Well, in the meantime, all of this E. coli talk makes me want to wash my hands and wipe off the keyboard.

Perhaps, though, we should send these comments to the mayor and trustees of the town of Tularosa, New Mexico - as well as to the reporters at KQRE-TV in Albuquerque.

terrasig Mon, 09/22/2008 - 02:22

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Praise alleys! This wouldn't happen in my neighborhood. Liquids, and even sludge, would soon disappear in the rocks, gravel and rubble of the alley where few would notice.

As a regular reader, seldom commenter, let me lend my dubious expertise in language the mayor and trustees of Tularosa can understand. Which is to say: layman's language. "If some fluid leaks out of a garbage truck, do not ingest any of it."

(dusts off hands) There! That ought to do it.

To tack on to decrepitoldfool's comment:

"If some fluid leaks out of a garbage truck, do not use it for fertilizer."

I am sure that many of you took microbiology back in the day and should be remembering another aspect of E. coli. It is not that some E. coli strains may be pathogens, it is the presence of E. coli can be an indication of fecal contamination, thus a possible source of other more important pathogens such as Salmonella.

Thanks for the notice, Abel -- it has been a while!

I, too, was highly impressed with industry technical dude's short course on waste transport engineering.

Plant Man of Florida's recent comment is entirely consistent with the emerging theme here, viz.:

As centuries of infectious disease control have taught us, closing the loop between feces and food is a bad idea. E. coli is usually (but not always) an innocent bystander that happens to travel in some very rough company. Rather than flip out at the first sign of this ubiquitous coliform,[1] we should ask: is this a circumstance where no fecal contamination should be expected or tolerated? If so, then find the problem and fix it. If not, then beware of crying "wolf!" Or, in this case, "Pampers!"

[1] Would "The Ubiquitous Coliforms" be a good name for a rock band, I wonder?

E. coli in fluid dripping from New Mexico garbage truck

terrasig — Sat, 20 Sep 2008 11:05:37 +0000

E. coli in fluid dripping from New Mexico garbage truck

Dear PharmMom,

Your daughter-in-law found this one on your local TV news station:

TULAROSA, N. M. (KRQE-KBIM) - Fluid leaking onto city streets from a contract garbage truck has tested positive for the E. coli bacteria, according to the town's mayor.

Alamo Disposal has been picking up the trash for many in Tularosa for the last three years. Recently resident and city officials noticed something leaking from a truck into the middle of the street.

Tularosa Mayor Ray Córdova then inspected the vehicle and smelled something extremely foul coming from it. That's when he told residents to take samples of the fluid so he could send it off to a lab for testing.

Those tests came back positive for the E. coli bacteria. . .

. . .On Thursday Alamo Disposal owner Art Cardiel said the leak came from a crack in the truck. However he also said believes the E. coli is coming from the bacteria in people's trash and not the truck itself.

"In this area, a lot of people grow their own fruit because there's a lot of water," Cardiel said. "Now how am I supposed to have any control over what I put in my truck that comes out of their trash cans?"

"I'm abhorred about it," Córdova said. "I don't like it, and I don't want it. . .

. . ."I spoke to him on the phone and said this has got to stop," CÃ³rdova added. "I said can't even allow your trucks into the city limits if that's what they're doing."

The New Mexico Environmental Department has given the owner 10 days to fix the crack in his truck.

But the mayor and trustees will meet on Sept. 23 to decide if they want to terminate the contract.

There have been no reports of any residents coming down with E. coli from the fluid.

Two sentences: 1) The E. coli is coming from the dog and cat poo that is dumped into household trash. 2) The fluid is harmless unless you drink it or put it on a piece of fruit.

The article is currently followed by 15 comments of various degrees of comedic creativity. For example, when has anyone not smelled a foul odor coming from a garbage truck?

I won't even get into the issue of the strain of E. coli that might be coming from the garbage truck.

Of course, the hysteria resulting from this story reflects our failure to teach science to the public, either in schools or thereafter, and help people understand what is dangerous and what is not. It also doesn't help that KRQE-TV anchor Kim Vallez sensationalized this case by leading into the report with, "Tularosa residents have been exposed to E. coli and it has nothing to do with anything they ate."

I'm sorry to be so crude, but they are also exposed to E. coli every time they wipe their butts.

I'm also disappointed in the reporter, Heather Burke, who did not contact an expert from the Department of Molecular Genetics & Microbiology or Division of Infectious Diseases at University of New Mexico Health Sciences Center and College of Medicine to put the risks in perspective. It took me about 30 seconds to find a couple of scientists and docs, and their phone numbers, who could've certainly gotten an opinion in before the story deadline.

Alamo Disposal owner Mr Art Cardiel might care to consult with one of these experts before the city cancels his company's contract.

Or maybe someone out there should just call my Mom - she'll set those people straight.

Then again, I warn you that you don't want her showing up at the 23 Sept meeting of the mayor and trustees.

Photo credit: Village of Shorewood Hills, Wisconsin, Village Heritage Gallery Photo #29; photographer not identified. Shorewood Hills was the childhood home of Olympic speed skaters, Eric and Beth Heiden.

terrasig Sat, 09/20/2008 - 07:05

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Don't tell the New Mexicans but...there's e. coli in their armpits!

Most Americans don't know their kitchen sink harbors a greater panoply of microbes than their toilet.

But then American science teaching is also in the toilet.

Abel Pharmboy, I hope you write a letter to the news station as well as making this post. You could save the Tularosans a lot of trouble.

I suspect that things are even worse than the good residents fear: the truck's vile exudate almost certainly contains chemicals!

Take a swab from your hands, culture it - you'll find e.coli and a whole bunch of bacterial buddies.

Now go and wash your hands.
Repeat process.
You'll still find e.coli friends, albeit in smaller quantities. I did this in biology class when I was ~14.

We are full of and covered in bacteria. We'd be in serious trouble if we weren't.

If everyone got to play with agar plates in school like I did, then everyone would appreciate that bacteria are everywhere.

geez, it's not like this stuff spontaneously generates inside the confines of the garbage truck. of course it's coming from someone's trash- everyone's trash. now let's just hope this discovery doesn't lead to a witch hunt to find the dirty e.coli disposer. they'd be in for a mighty surprise to find their entire city is contaminated...

Someone please pass this along:

The likely source of the e coli is not the fruit & vegetable waste, but disposable diapers that are in the mixed waste stream. The "fluid" probably does come from food waste, but the bacteria come from the diapers.

The "crack in the truck" is almost certainly the seam between the tailgate assembly and the truck body, not a crack in the truck body floor, and the refuse company guy probably assumed the city officials understood what he meant.

There is no way to fix that, any more than there's a way to fix the fact that those trucks make a certain amount of noise while going about their work. The tailgate is under pressure from the compressing mechanism, which in today's refuse collection vehicles compresses the load by a factor of 4 to 1 (that is, 100 cubic yards of refuse from the household bins, becomes 25 cubic yards in the truck).

Even with tight tailgate clamps and rubber gaskets between tailgate and body, the fact is that the pressure of the refuse will push on the tailgate and the seal to the body will never be perfect. Thus liquids will always find a way to leak out. This is the case for 100% of refuse collecting vehicles without exception: it's inherent in the nature of the technology.

For comparison, when you stuff your carry-on suitcase with clothes etc. and pack it down to make it all fit, you're typically compressing at a ratio of about 1.3 to 1, and you can see how hard it is to get the darn suitcase to close up properly.

Now imagine squishing poopy diapers and drippy food waste together by a factor of 4:1, and you can see where the problem comes from.

So rather than fire the refuse contractor, I have a better idea. Outlaw those damn disposable diapers altogether, and keep the poo out of the mixed waste stream. People can use cloth diapers, and have diaper services pick up the poopy ones & leave clean ones, just as they did 30 - 40 years ago. Poo does not belong in the mixed waste stream, period. It belongs down the sewer, or in a controlled collection & laundering system that ultimately puts it down the sewer.

And yeah, three cheers for scientific literacy. Anyone running for public office ought to have to take a general science & technology exam and post the results for the voters to see. After a brief period during which the anti-science crowd will chuckle as they vote for the obscurantist ticket and then get rewarded with cholera outbreaks and bridges falling down, the public will wise up and throw the ignoramuses out, in favor of people who understand that the world is neither flat nor 6,000 years old.

Though, you have to give the city council guy credit for one thing anyway. At least he understands that germs cause disease. Given some of the people running for public office nowadays, even that much can't be taken for granted!

I left the following comment at KQRE's thread attached to the story. I doubt that it will do much good, but we need to speak up where we can. Thanks, Abel, for the link!

_______________________

As sherlock and others have noted, E. coli is a normal component of everyone's intestinal flora. You, me, the mayor of Tularosa -- we all have it. What's disappointing is not that the mayor was unaware of this; it is that the KRQE news team couldn't even spend two minutes researching the subject before releasing this story. From Wikipedia:

Most E. coli strains are harmless, but some, such as serotype O157:H7, can cause serious food poisoning in humans, and are occasionally responsible for costly product recalls. The harmless strains are part of the normal flora of the gut, and can benefit their hosts by producing vitamin K or by preventing the establishment of pathogenic bacteria within the intestine.

The distinction between harmful strains of E. coli and the bacterium generally is very important to public health, and the public deserves to be educated on the subject, not falsely alarmed. You, a news source who should have known better, let us down on this one.

I think these guys handling other peoples E. coli should be making a hell of a lot more money than they most likely do.

Geez. Of all the crap that can leak out of a garbage truck, E. coli is about the most benign thing I can think of.

ZOMFG!!! Pharmaceutical terrorism!

terrasig — Tue, 10 Jun 2008 11:20:07 +0000

ZOMFG!!! Pharmaceutical terrorism!

Naw. This is more likely a case of an older person flushing some old prescription drugs down the toilet:

In a February interview with The Associated Press, Mayor Robert Cluck said trace concentrations of one pharmaceutical had been found in treated drinking water, but he declined to name it. He said revealing the name in the post-9/11 world could cause a terrorist to intentionally release more of the drug, causing harm to residents.

"I don't want to take that chance," Cluck said. "There is no public hazard, and I don't want to create one."

. . .Drinking water in Arlington, Texas, tested positive for trace concentrations of the anti-anxiety medication meprobamate, city officials revealed Monday in response to a series of public records requests. . .

. . .In water samples taken in October 2006, concentrations of the drug measured around 1 part per trillion. [emphasis mine]

The hysteria surrounding "toxins" and "terrorism" derives in large part from the tremendous strides made over the last decade or two in the sensitivity of analytical chemistry instrumentation and methodologies. But just because someone could detect something in the water supply doesn't mean there are toxicity concerns.

What strikes me as odd is that meprobamate is a very old anti-anxiety drug that is barely used today because of safer, more effective alternatives that bring in far more revenue for drug companies. This fact leads me to think that someone was cleaning out their medicine cabinet, maybe for an aged parent who was moving into a retirement community.

You may know meprobamate by its old trade name, Miltown, first marketed in 1955 following its discovery in the late 40s by chemist, Frank Berger. Dr Berger first worked on this compound in England and published in 1946 on the compound's tranquilizing effects in animals. When he moved to the States to work in a New Jersey pharmaceutical company, the drug took on the brand name of Miltown after the nearby township of Milltown (spelled with two Ls).

I consider myself a student of pharmacology history but this story is fresh in my mind because of the news coverage following the death of Dr Berger barely two months ago.

The misled government officials who feared that meprobamate contamination of the water supply might have been intentional terrorism appear to have not considered that the lethal dose of the drug is somewhere between 12 and 20 grams. The drug is still available in 200 mg and 400 mg dosage forms.

So, as PharmGirl queried me when tipping me off to this story, how much meprobamate would a "terrorist" have to add to the Arlington, TX, water supply to have any adverse effect on the population? Would there even be enough meprobamate on the wholesale chemical market in the US, or even the world for that matter, to have even approached any risk of toxic effects. This sounds like a great exercise for Rick's chemistry students over at Science, Shrimp & Grits.

Pharmaceuticals are in our water supply but are these concentrations dangerous? Perhaps the greatest real concern is with regard to estrogens from the urine of women taking oral contraceptives and antibiotics that drain into watersheds from livestock urine and feces.

Mike Nizza at the NYT blog, The Lede, took on this issue back in March with his post entitled, "There Are Drugs in Drinking Water. Now What?"

As the father of toxicology, Paracelsus, is quoted in various translations, "It is the dose that determines the difference between a poison and a remedy."

Arlington, TX officials may care to have read an old toxicology book for guidance. Heck, they might have even found some use in doing a faculty web search for experts at their own University of Texas at Arlington or over at UT-Southwestern Medical School.

Proper disposal of expired or unused medications is advised, usually in solid waste landfills rather than flushing down the toilet. However, even the White House's own drug policy guidelines are confusing on that issue as they state that FDA recommends that certain drugs, many that are controlled substances, actually be flushed.

terrasig Tue, 06/10/2008 - 07:20

Tags

critical thinking

Pharmaceuticals

Real vs. perceived risks

Hrm... at one part per trillion, why, I'd only have to drink around one thousand cubic meters of water to have a fatal dose! This is a grave public safety concern.

Man, meprobamate. You'd think that if terrorists wanted to poison the water supply they'd use something a little more...dangerous. Is there even enough meprobamate being made anymore to contaminate a huge water supply? I bet that the worst that would happen would be that we'd end up with a somewhat more relaxed populace...

I bet that the worst that would happen would be that we'd end up with a somewhat more relaxed populace...

I don't see that as "worse", considering.....

Heck, they might have even found some use in doing a faculty web search for experts at their own University of Texas at Arlington or over at UT-Southwestern Medical School.

Perhaps someone at UT Southwestern like Alfred Gilman, nobel prize winner and author of the pharmacologist's bible Goodman and Gilman?

They have reason to fear the drugs' effects on people. According to the homeopathic law of infinite dillution, the potency of drinking that water would be staggering! If the terrorists ever found out what drug it was, they'd add less next time, and then we'd really be in trouble.

For heaven's sake! I order for the homeopathic preparatiion to work, is has to be properly succussed. Aren't they teaching the kids in school anything these days?

I will go out on a limb (since I don't know how they made the determination) and note that with analyses at parts-per-trillion, false positives happen. That means (for readers, not APB) the result may be coincidental; and not stand up to rigorous investigation. It would take a lot of evidence to convince me, at that concentration.

So, in addition to the fact that, if true, the claim is irrelevant- I doubt the claim. One may detect a chemical at that concentration; however, I am not sure the standard procedures "identify" meprobamate.

NPR's The People's Pharmacy on bisphenol A, endocrine disruptors

terrasig — Fri, 29 Feb 2008 07:28:25 +0000

NPR's The People's Pharmacy on bisphenol A, endocrine disruptors

Bisphenol A (BPA) is currently one of the major lightning rods for controversy in consumer products and public health research. The compound is used in the manufacture of plastic bottles, polycarbonate (PC) in particular, as well as in the lining of many food and beverage cans. The compound has been recognized since the 1930s as having estrogenic activity but it appears to have developmental, carcinogenic, and neurotoxic effects at concentrations well below those at which it binds to the two forms of estrogen receptor.

Confused?

US governmental advisory committees can't even agree on BPA. Public health blogger revere at Effect Measure posted last October about two conflicting reports from the US National Toxicology Program on the developmental risks of BPA - the contentious comment thread following the post is illustrative of the confusion surround BPA even among scientists. This 2005 review in Environmental Health Perspectives makes for a good introduction before delving into the current literature.

So if the scientists are confused, well guess what the public thinks? To shed light on this topic, award-winning medical journalists Joe and Terry Graedon will focus the next two shows of their NPR-syndicated The People's Pharmacy radio show on BPA and the larger issue of endocrine disruptors. This week's (1 March) guests are:

John McLachlan, PhD, Weatherhead Distinguished Professor of Environmental Studies and Professor of Pharmacology at Tulane University and Director of the Tulane-Xavier Center for Bio-Environmental Research.
Randy Jirtle, PhD, Professor of Radiation Oncology at Duke University Medical Center

Frederick Vom Saal, PhD, Professor in the Department of Biological Sciences at the University of Missouri at Columbia, Missouri.

Stations and broadcast times are listed here. For those of you outside the US or in US markets where the show is unavailable, this show index will link to downloadable podcasts of each show.

The guests for next week's show have not yet been announced but are likely to include scientists even more closely involved in the BPA controversy.

In another timely and related issue, fellow blogger and environmental sciences student Karmen Franklin (Chaotic Utopia) just posted yesterday on the ubiquitous distribution of BPA and other estrogens in the pristine waters of Colorado. Karmen has a real gift and passion for writing about issues of the Rocky Mountain West and her current course of study at the University of Colorado at Boulder has provided her with even more opportunities to explore these interests.

terrasig Fri, 02/29/2008 - 02:28

Tags

Real vs. perceived risks

toxicology

I know John McLachlan and Fred vom Saal and I've heard Jirtle speak. This should be one helluva show. These are the big experts in the field. It will be interesting to see where they agree and disagree. Thanks for the heads up, Abel!

Avery Comarow attacked by America's Natural Physician™

terrasig — Mon, 25 Feb 2008 09:02:10 +0000

Avery Comarow attacked by America's Natural Physician™

[Note: I originally posted this last Thursday under another title but it got lost in other events of that day. As I find it ironic that Mr Comarow has been attacked by an alternative medicine practitioner and advocate, I find this story worthy of reposting.]

A few weeks ago the skeptical blogosphere was up in arms about an article in US News & World Report by Avery Comarow on alternative medicine services in US academic medical centers. Mr Comarow is a senior medical writer for USN&WR and best known as editor for the last 18 years of the magazine's annual feature, America's Best Hospitals.

To my med blogger colleagues, Mr Comarow's article came off as unjustifiably sympathetic toward alternative medicine being practiced in major academic medical centers. Mr Comarow has two blog posts of his own on this story, here and here, the latter of which responded to the unanticipated deluge of critical comments on his story.

Truth be told, I was interviewed on background by Mr Comarow and felt that some of my most critical comments did not make it into the piece, due most likely to the complications with citing me as a pseudonymous source. While I am not a physician, I have been involved with integrative or alternative medical centers at four different US academic medical centers. However, my feeling (and my feeling alone) was that his primary intention was to get inside the mind of the patients, understand why they were pursuing alternative therapies, and grasp why major evidence-based medical centers were establishing centers of alternative/integrative medicine whose standards of proof were below that of each respective health system.

Interestingly, the accompanying video commentary on the article (here), was cited by a commenter on Science Based Medicine as follows: "The US News & World Report article has a video segment by the senior health editor. He seems to be more skeptical than the article's author."

The irony: the video segment was done by the same Avery Comarow who wrote the article.

So, you'd think that at least the alternative medicine community would be singing the praises of Mr Comarow's article. You would be wrong. From Bottom Line Secrets:

U.S. News Got it Wrong on Integrative Medicine
Integrated Practice Can and Does Improve Medical Care at Reduced Cost
Mark A. Stengler, ND
La Jolla Whole Health Clinic
. . .A recent major news magazine cover says: "Top hospitals are now embracing such unconventional techniques as acupuncture, homeopathy and energy healing." Sadly, one journalist wants you to be very afraid of this very important movement that has the potential to significantly reduce medical costs and improve the health and wellness of our nation. . .

. . .It has an upbeat title -- "Embracing Alternative Care: Top Hospitals Put Unorthodox Therapies Into Practice" -- but really the article is a thinly veiled CAM-slam. Heavy-handed and bordering on journalistic sensationalism, Comarow's piece is replete with erroneous research conclusions about CAM and sweeping omissions on its documented benefits and efficacy.

Let me begin by stating that "Doctor" Stengler bills himself as America's Natural Physician^TM (yes, he has really trademarked the designation). And unlike medical websites offering support for their practices with clinical trials results or references to peer-reviewed literature, Dr Stengler's La Jolla Whole Health website prominently lists "testimonials", the first choice under 'Home" as the primary support for his healing modalities.

With that background, let's see how he criticizes Mr Comarow, a journalist who has been vilified for being too soft on alternative/integrative medicine:

Right from the get-go, the article's title contains the word "unorthodox" to mean "unconventional" therapies. Most telling about the U.S. News article's intentions is the usage of loaded language about CAM and the "thicket of therapies deemed to fall within CAM's broad reach"... citing "at one extreme" yoga and massage as having "some benefit, if only to lower stress and anxiety" and at the other end, therapies that "even many who applaud CAM's newfound academic popularity call 'woo-woo medicine' because of the sheer implausibility of their rationale," such as homeopathy. In what he calls "the broad middle," Comarow puts acupuncture, herbal medicine and "other CAM approaches that seem to benefit some people with certain conditions." In a dismissive review of CAM's history, he likens CAM's presence in academic centers before the mid-1990s to "a pack of scruffy mutts, noisy and unworthy of notice."

Well first, "unconventional" and "unorthodox" were the exact terms used by Harvard's Dr David Eisenberg in his two New England Journal of Medicine and JAMA articles that alternative practitioners cite most often as evidence of huge public acceptance of alternative therapies. Yet Stengler goes on later in the article to cite data from the very same JAMA article in support of CAM use trends - we call this practice "cherrypicking": only cite that parts of papers that support your contention and discard that which you don't fancy.

The rest of Comarow's assessment of the spectrum of CAM approaches is pretty accurate and one that would be held by most physicians: homeopathy is nothing more than magical thinking while yoga and massage have well-documented effects in the medical literature for reducing anxiety and improving muscle tone and joint flexibility. In fact, some may argue that yoga and massage are not necessarily alternative but are rather extensions of conventional exercise recommended by physicians that have been adopted by CAM advocates as "alternative."

So, I really don't see Dr Stengler's rationale with his objection to the previous passage.

Stengler does try to take issue with the relative safety of prescription drugs relative to dietary supplements. Stengler is indeed correct regarding the large number of deaths associated with the use of prescription drugs in the US but then cites a much lower amount for dietary supplements. However, dietary supplement adverse event reporting mechanisms are in their infancy and nowhere near the complexity and rigor of reporting drug-related actions, nor are dietary supplement manufacturers required to disclose to the FDA such information (as is required of pharma). Moreover, these data do not take into account the number of AERs relative to number of users; finally, most dietary supplements are of insufficient quality to produce positive biological effects and, therefore, are unlikely to produce adverse effects as well.

Stengler also goes on to take Comarow to task for his alleged misrepresentation of the background of naturopathic doctors. While some naturopathic training does indeed included didactic work similar to four-year US medical schools, Comarow is correct in describing the inconsistencies in naturopathic training and the limitations in calling such individuals "physicians," particularly since the quality of naturopathic training varies considerably in North America, including one school that offers correspondence degrees. For a more detailed analysis of naturopathy, the reader should refer to Naturowatch, a page of Quackwatch devoted specifically to the benefits and risks of naturopathic medicine.

There is more in the Stengler article that castigates Mr Comarow for representing statements in his article that are based in fact. So, I leave it to the reader to decide whether Mr Comarow drank the integrative medicine Kool-Aid on one hand or whether he was a ruthless tool of a conventional journalistic enterprise that is hostile toward integrative/alternative medicine.

Having communicated with Mr Comarow throughout the course of his development of the original piece, I understand the difficulties in balancing medical facts with actual health care trends., a challenge for even for such a highly-seasoned reporter. My primary criticism of the final product was that there was an inadequate discussion of the ethics of offering alternative (non-proven) therapies under the masthead of our most highly-respected academic medical centers that enforce the implementation of evidence-based medicine in all other facets of their health systems. My guess is that the latter might not be very entrancing content to the average USN&WR audience, but it is certainly the key issue to medical bloggers critical of the non-critical adopting of CAM by major academic medical centers.

I've watched these exchanges and reactions for a little over a month since Mr Comarow first pre-released his article via his blog. As a result, I can say this: mainstream journalists should not fear for their jobs with the proliferation of sci/med bloggers. I don't believe you could pay me to absorb the amount of grief levied against Mr Comarow who tried to take a contentious and inflammatory area and try to explain the public and medical acceptance of practices so poorly based in evidence. I certainly did not envy him for taking on this task but I respect him for doing so, even if I have some issues with the final product.

So, I'd suggest reading Comarow's original article, the largely scathing comments of CAM skeptics on his blogpost, and this unusual critique of the very same article by America's Natural Physician^TM.

For now, this is Abel Pharmboy, PhD, America's Natural Medicine Blogger^TM.

terrasig Mon, 02/25/2008 - 04:02

Tags

alternative medicine

Bioethics

Blogging community

Botanical/Herbal Medicines

Non-herbal supplements

public health

quackery

Real vs. perceived risks

REPOST (Classic Terra Sig)

Science/medical journalism

Categories

Medicine

MARK STENGLER, ND wrote in a Bottem Line article,
About the ability to conduct a controlled study on individual patients.

"If a patient has migraines, I select from among several dozen homeopathic remedies, taking into account the type and location of his/her migraines, how the weather affects him, his diet and exercise habits, etc. With so many variables influencing the choice of homeopathic remedy and the patient's response to it, I'm not surprised that study results sometimes are inconclusive".

First, the study has to be "blinded." Neither he nor the patient can know what they are administering.

"Doctor" Stengler makes up his treatment solution, which we assume is colorless and tastless, since it essentially has nothing in it, and sends to an independant lab, which transfers it to a new vial and makes up a matching placebo solution. Then a computer generated code numbered label is placed on each identical vial with the "treatment" solution and the placebo, which are returned to "Doctor" Stengler, to administer in any order he wants and record the results. The only perceivable difference is the computer generated number.

If it usually takes, say, 2 weeks to see results, your record the levels of the patients symptoms for 2 weeks (a baseline), then you administer either vile for 2 weeks and record symptom levels, then go off for 2 weeks and record symptom levels. Then repeat with the other vile.

Second, the patients become their own control.

The only variables are the two indistinguishable, except for the code, solutions and a different time, but the same patient.

Repeat this for a number of patients, for statistical significance, and send your results to the independant lab, who will correlate the scores and "treatment" vile codes.

Since both the patient and the "Doctor" have no idea which vile is which, this is a truly double blinded study. Since it's the same patient, it's a controlled study.

WOW! A very inexpensive Double Blind, Controlled Study! This is the gold standard of research.

I'm a retired research physician, and would be happy to provide the outside lab services for FREE!

It's always nice to debunk nonsense, and replace it with science, or to prove something works.

Have "Doctor" Stengler contact me, since he seems to lack the courage to list his email, and I'll be more than happy to assist in the design of a meaningful study.

J R Stewart, MD
JRStewartMD@hotmail.com
(801) 278-2233
6400 Canyon Cove Drive
Salt Lake City, UT 84121-6301

While I do understand the requirements of medical doctors for established controls, etc. etc., homeopathy is an area where it is impossible to duplicate results, simply because no 2 people will have exactly the same problem with all the exact symptoms that homeopathy takes into account. even in the same patient you cannot duplicate results, because once you have a treatment, the symptoms will change, and once improvement is seen with homeopathic medicine the treatment is stopped - or as in chronic conditions, it might be adjusted to a different remedy or dose. I've been using it for 10 years now and am continually amazed at the success with it's treatment. My teenage daughter suffered from migraines, and after going through all the conventional channels of consultation, which offer no hope of a cure - just use of stronger and stronger prophylaxis (like brufen, etc) - she was cured of the migraines that she'd suffered for more than 5 years in just a few months - all with only homeopathic medicine prescribed by a Pakistani homeopath in my area.

Dr. Stengler is a Naturopathic Doctor and one that I trust unquestionably. Ten years ago my youngest daughter at the age of 3 had continual middle ear infections that lasted for 10+ months. She was in the ENT specialists offices at least 2x per month, and they always gave her antihistamines and antibiotics, nose drops sometimes - all to no avail and in the end just made her more sick. Finally 5 (yes, five doctors, I'm not exaggerating) EarNosethroat specialists(ENT) doctors told me she needed surgery - grommets-tubes for the ears, removal of her tonsils and andenoids. I couldn't bear the thought of letting them take a knife to my baby. People kept telling me about different alternative therapies so I started researching and thank God for the day I found Dr. Stengler. We did a telephone consultation since we lived far away, and he sent us all the herbal and homeopathic remedies by mail.He also advised diet/nutrition changes and chiropractic care. I followed all his advice to the letter and within 6 weeks took my girl back to the ENT for a check. He was shocked. No more middle ear fluid remained. After 10 months of constant illness. He said 6 weeks ago this child needed surgery.... what did I do? So I briefed him. I also told the pediatrician. They told me not to tell anyone because it would put them out of business! My family is so much healthier - hardly ever need to see a doctor. The MDs are supposed to be dedictated to patients' health, but the real fact is they have protocols to follow and don't look for other solutions that may be better. I also respected and liked Dr. Stengler because he would send me to a conventional doctor for diagnosis and testing and treatment when needed, and knew how to combine the best of both. By the way, after those 6 weeks, Dr. Stengler prescribed other herbs to heal the damage done by all the antibiotics, about another 2 months, and thereafter, that was it. She has never had a relapse of Middle Ear infection since.

I'm from Missouri - the "show me state" - and there's no doubt in the results. I have all the medical files of my children's cases to prove it too. So what if homeopathy or naturopathy can't be proven by conventional methods - I've seen it work time and again - and as a mother I want nothing more than my children's health and freedom from illness. July 2010

I'd also like to point out that Dr. Stengler is easily found through his clinic in La Jolla, Calif. no way does he lack the courage... just hasn't the time to waste.

"homeopathy is an area where it is impossible to duplicate results, simply because no 2 people will have exactly the same problem with all the exact symptoms that homeopathy takes into account"

I assume this is referring to the individuality of homeopathic treatment, where you and I see a naturopath for the exact same physical ailment but get a different set of herbs because of a difference in our personal history.

Why is it then these highly individualized notions, potions and lotions can be freely purchased off the shelf without prescription in many, many pharmacies?

If you've seen it work, anyone else would too - under any conditions including conventional methods. Missouri is no different.