Bad news on the vaccine front

It looks like vaccine rates are trending downwards in the US:

More parents are opting out of school shots for their kids. In eight states now, more than 1 in 20 public school kindergartners aren’t getting all the vaccines required for attendance, an Associated Press analysis found.

That growing trend among parents seeking vaccine exemptions has health officials worried about outbreaks of diseases that once were all but stamped out.

If this trend continues and gets bad enough, people will begin to die. We’ve already seen that in England as well as throughout pockets in the US. It happens. Really, you anti-vax nuts. It god damn happens.

Some states are worse than others, Alaska being the biggest offender at a 9% exemption rate. Here is my prediction: We will see increased deaths over time in parts of Alaska, and likely even more deaths in more densely populated areas with high rates, such as Colorado (7%). Places like Mississippi, where the exemption rate is basically 0%, will continue to be healthy in regard to these preventable diseases of the past.

And why are people making these bad decisions? Well:

Exemption seekers are often middle-class, college-educated white people, but there are often a mix of views and philosophies. Exemption hot spots like Sedona, Ariz., and rural northeast Washington have concentrations of both alternative medicine-preferring as well as government-fearing libertarians.

If these people were science-preferring and woo-fearing instead, we wouldn’t be heading toward this guaranteed problem.

Steve Jobs and woo

I didn’t especially want to make a serious post about Steve Jobs. The outpouring of grief on Facebook and elsewhere has struck me as disingenuous bandwagon bullshit. Yes, he was a smart guy who by all accounts was a good person who loved his family. I can’t imagine anyone being happy over his death. But he wasn’t some figure who personally touched the hearts of us all. He was a good guy and it’s unfortunate that he died, but I don’t see why he deserves this particular level of grief from complete strangers.

That said, I do want to make a serious post about Jobs after reading this Skepticblog article:

Seven or eight years ago, the news broke that Steve Jobs had been diagnosed with pancreatic cancer, but considering it a private matter, he delayed in informing Apple’s board, and Apple’s board delayed in informing the shareholders. So what. The only delay that really mattered was that Steve, it turned out, had been treating his pancreatic cancer with a special diet and other alternative therapies, prescribed by his naturopath. (I can’t find the original source for this, so I’m striking the statement that his self-treatment by diet had beed (sic) recommended by a naturopath.)

Most pancreatic cancers are aggressive and always terminal, but Steve was lucky (if you can call it that) and had a rare form called an islet cell neuroendocrine tumor, which is actually quite treatable with excellent survival rates — if caught soon enough. The median survival is about a decade, but it depends on how soon it’s removed surgically. Steve caught his very early, and should have expected to survive much longer than a decade. Unfortunately Steve relied on a diet instead of early surgery. There is no evidence that diet has any effect on islet cell carcinoma. As he dieted for nine months, the tumor progressed, and took him from the high end to the low end of the survival rate.

Here are the facts: Steve Jobs had a treatable form of cancer with an expectation of living at least 8 years after removal of the tumor. In his case, he caught it very early plus he had access to the best doctors, so he should have expected to live over 10 years. But instead of getting it removed, he went on an alternative ‘medicine’ diet. He then failed to improve, possibly getting sicker, until he finally turned to the evidenced-based successes of real medicine. His surgery prolonged his life significantly, but damage was probably done.

And here are some more facts: There is a direct correlation between when pancreatic cancer is detected/removed and how long a patient will live. Jobs detected it early, but did not have it removed right away. We can’t say what’s what in his exact case, but we do know that if every person with his type of cancer followed his path – waiting 9 months before taking real action – survival rates would drop. That is, if people wait to treat their cancer, they will die earlier than if they seek out established medical treatment.

The only positive thing to take from all of this is that Jobs was a very private person. He never did interviews to talk about himself (only speaking to reporters and the public on behalf of Apple), so we can be thankful he never promoted any unproven cancer treatments. In fact, we can infer from his abandonment of his ‘alternative’ diet in favor of surgery and real medical care that he would be unlikely to promote such treatments were he still alive today.

University of Westminster gets rid of naturopathy

PZ has a post about quackery at two different universities. One is his own university, and he has a pretty good take down. The other is the University of Westminster where alternative ‘medicine’ degrees have been getting phased out over the years:

At the end of 2006, Westminster was offering 14 different BSc degrees in seven flavours of junk medicine. In October 2008, it was eleven. This year it’s eight, and next year only four degrees in two subjects. Since “Integrated Health” was ‘merged’ with Biological Sciences in May 2010, two of the original courses have been dropped each year. This September there will be a final intake for Nutrition Therapy and Naturopathy. That leaves only two, Chinese Medicine (acupuncture and (Western) Herbal Medicine.

I’m particularly happy about the demise of the courses in naturopathy given my familiarity with that non-science subject, but I’m just as happy about to hear the other programs that are getting shut down. I just wish more American universities and states would start putting bans on the spread of all this malarkey. It’s silly stuff that is based upon magical thinking. It needs to go.

The danger of false beliefs

A few months ago Wendy Pollack went to cause harm to people in Tanzania by providing them with false hope. She led sick people – specifically those with HIV – to believe that unproven and even blatantly discredited ‘medicine’ could help them become healthier. It was an awful tragedy and we can all be thankful that she has finally left Africa all together. She still practices her form of harm in America, but she at least faces some regulations here. (A complete outlawing of her shenanigans would be preferable.) It is easier to combat the misinformation of chiropractors and other sham-practitioners in a developed nation, even if they still manage to cause damage. Unfortunately, places like Tanzania do not have the institutions or medical infrastructure to implement procedures to protect its people, so even with people like Pollack safely thousands of miles away, alternative medicine practices still run rampant:

Hundreds of albinos are thought to have been killed for black magic purposes in Tanzania and albino girls are being raped because of a belief they offer a cure for AIDS, a Canadian rights group said on Thursday.

At least 63 albinos, including children, are known to have been killed, mostly in the remote northwest of the country.

“We believe there are hundreds and hundreds of killings in Tanzania, but only a small number are being reported to the police,” Peter Ash, founder and director of Under The Same Sun (UTSS), told Reuters.

This is a tragedy exactly along the same lines as what the entire alt-med crowd does. These random and inane – and often dangerous – faith-based ideas take off within a certain population and real human lives are put at risk. There is no evidence to back up any of these stupid and harmful beliefs, but evidence matters less and less as people get sicker and sicker. That’s one reason homeopaths are so successful in ripping people off.

What is happening in Tanzania right now rises to a level slightly above what most alt-med people do, but it really isn’t that far and away different. Remember Lawrence Stowe? He bankrupted sick people, drawing them away from real treatment. Many of those people died as a result of his actions – and he knew they would. Even where the people were terminal and could not be cured, he hastened death and increased pain. It’s standard practice for the alt-med crowd and I see no difference between that and what’s going on in Tanzania right now.

Thought of the day

It’s true: Of all the mysteries ever solved, not one has been because of magic.

A homeopathic solution I can support

From YH&C:

As a skeptic, I see the National Center for Complimentary and Alternative Medicine as a pure waste of about $121 million in taxes annually and would jump on any chance to eliminate the department.

Now, realistically I know this department is the baby of Tom Harkin (D-Iowa) and as a part of his reputation is tied up in it’s success he will fight for it’s survival. His interest is concentrated, while the interest of the public to save a little more money is spread out. So elimination is a tough fight that our side can’t expect to win.

But I think I have a compromise. Following the principles of homeopathy, where a substance gets more powerful if you dilute it in water and shake it up a little between steps, we should dilute the NCCAM funding down to $12.1 million. How’s that for shaking things up?

This may be the first homeopathic plan I can really support. It certainly would help decrease the number of people who are needlessly sick.

Study: Alternative medicine sometimes causes death

It has been documented again and again where alternative medical treatments have killed people. Rather than respond appropriately (and logically!), the usual woo-man answer is to point out all the deaths that occur as a result of real medicine. This, of course, does nothing to answer the initial concern, and even it was a logically valid point in the given context, it is easily countered by pointing out:

  • Mistakes cause many deaths. This does not count against the efficacy of real medicine.
  • People don’t die at an average age of 45 anymore in large part because of modern medicine. You can say “thank you” anytime.
  • People aren’t dying from an intrinsic property of modern medicine.

The reason I make this point is to get it out of the way so I can make this point: Alternative medicine sometimes kills children.

Australian researchers monitored reports from pediatricians in Australia from 2001 to 2003 looking for suspected side effects from alternative medicines like herbal treatments, vitamin supplements or naturopathic pills. They found 39 reports of side effects including four deaths.

The study was published online Thursday in the journal Archives of Disease in Childhood, a specialist publication of the medical journal BMJ.

Unlike conventional medicines, whose side effects are tracked by national surveillance systems, there are no such systems in place for alternative therapies.

One thing the study didn’t say was that much of the harm from alternative (not real) medicine comes from the non-use of real medicine. When people get sick and decide to use unproven treatments rather than actually have something positive done for their health, they often risk becoming sicker. One medical school professor not involved in the study makes the same point:

“Perhaps the most serious harm occurs when effective therapies are replaced by ineffective alternative therapies,” he said. “In that situation, even an intrinsically harmless medicine, like a homeopathic medicine, can be life-threatening,” [Edzard] Ernst said.

It is difficult to know how many deaths come from replacing real medicine with alternative treatments. We know close to a dozen deaths occur every year as a result of faith healing. But that’s for children. I suspect the number would be higher for adults because older individuals are going to tend to have more underlying conditions than any child. And when we expand our horizon to consider general harm or being sick for longer, I believe the numbers would go up even further.

Alissa Lim of the Royal Children’s Hospital in Melbourne and colleagues wrote that all four deaths they identified were caused by a decision to use alternative therapies instead of conventional medicines.

They described one case of a 10-month-old baby who had severe septic shock after being given naturopathic medicines and was assigned to a special diet to treat eczema. In another case, an infant who suffered multiple seizures and a heart attack died after being given alternative therapies — which the parents had chosen due to their concerns about the side effects of regular medicines.

Ernst said people should recognize the limitations of alternative medicines and that practitioners should be careful not to oversell their benefits.

I think I have a better recommendation than Ernst: Let’s just outlaw it all and start saving the health and lives of people.

Even real doctors can indulge in quackery

My local paper recently ran a piece about a doctor, Dustin Sulak, whose practice has exploded since Maine expanding its medical marijuana laws. While the man is a legitimate doctor – and while I support his efforts to responsibly prescribe marijuana to those who need it – I found a couple of parts of the article tremendously disappointing.

On the wall of Sulak’s examination room, next to his diplomas and state license, are framed certificates naming him a Reiki master and a clinical hypnotherapist.

An advocate for alternative medicine, Sulak gives his patients advice about healthier lifestyle choices, and many of them leave his office with bottles of supplements sold at the reception desk.

There is no evidence for the efficacy of Reiki and it rests on no scientific grounds in any regard. In fact, a major basis for it is the existence of Chakras. And guess what? They’re made up.

As far as hypnotherapy is concerned, I’m told by a psychology graduate student (who has recently received his master’s degree and is on his way to becoming a doctor) that in order for hypnosis to be practiced with any worth, it is generally necessary that the practitioner be a psychologist. I do not believe Dr. Sulak has those credentials, but I am not certain. At any rate, Dr. Sulak may be effective in his use of this practice. (See clarification here.)

Where the article says he is an advocate for alternative medicine and he recommends healthy lifestyle choices, it makes me rather queasy to see the paper trying to associate the two notions. First, if alternative medicine was medicine, we would just call it medicine. Second, any doctor will recommend healthy lifestyle choices. But it is unclear what that means in this context.

I’m also not a fan whatsoever of his anti-sunscreen position. Sunscreen ought to be used whenever long exposure to the sun is likely. That prevents cancer. End of story.

Also, he says this about cell phones:

I recommend using speaker phone, or a headset that has a plastic tube or a ferrite bead to prevent transmission of radiation into the ear. Please keep your cell phones away from children’s heads and pregnant mothers’ bellies!

For one of my cancer classes I recall the professor asking us to look into the evidence for a cell phone-cancer link and to let him know what we thought, how we felt about potential bans, etc. I had to say, the evidence was exceedingly weak. We have been using cell phones for a couple decades (we all remember Saved by the Bell), and we’ve been using them heavily for the past decade. Well over 4 billion people are on them daily. We have a load of studies. We have give ample opportunity for cancer to rear its tenacious head; no causative link exists. Let’s be done with this unwarranted fascination until there is some positive evidence to examine. Please.

Dr. Sulak also seems skeptical of vaccines, but he is far from explicit, only posting a few videos critical of the reaction to H1N1. The government’s response was generally appropriate (though we did end up throwing away a lot expired vaccines) and I hope to see something similar if we find ourselves on the brink of another potential – and preventable – epidemic. Besides, the anti-vax crowd has already caused enough deaths.

In summary, I’m rather skeptical of parts of Dr. Sulak’s practice, but virtually none of it could be called quackery. Unfortunately, the key word in that sentence is “virtually”. His use of Reiki is out-and-out, pure quackery. The ‘field’ rests on notions of palm healing, the proposition of fictional Chakras, and it has no physical basis. Reiki is not science and it has no place in real medicine.

Thought of the day

When there is a fraud within science, who exposes him? Other scientists, of course. But for all the frauds about in alternative medicine, do alt-med ‘practitioners’ ever expose each other?

The end of homeopathy?

Probably not, but one can hope.

British homeopaths are celebrating Homeopathy Awareness Week, yet it seems to me there is very little for them to celebrate.

Earlier this year, a report from the Commons Science and Technology Committee concluded that the principles of homeopathy are implausible and that the evidence fails to show that it works better than placebo. The MPs also criticised homeopaths for trying to mislead the public by providing inaccurate information. Their recommendation to government was to stop funding homeopathy on the NHS.

Then the Prince of Wales’s Foundation for Integrated Health, a staunch supporter of homeopathy in the NHS, folded in the midst of a police investigation for fraud and money laundering.

Last month, the British Medical Association described homeopathy as “witchcraft” and called for an end to all funding on the NHS.

A streak of bad luck? Not really. Homeopathy’s fortunes have been crumbling for quite some time. The evidence to suggest that it has effects beyond those of a placebo has become less and less convincing. In 2005, The Lancet even pronounced “the end of homeopathy”.

I suspect there will come a time when homeopathy becomes far less significant in society, but I believe that day to be very far off. People are just too willing to believe the snake oil salesmen out there – and the snake oil salesmen are all too happy to oblige that will to believe.

But there is some immediate good news. (In fact, so immediate, it’s in the past.)

As a result, one of the five NHS-funded homeopathic hospitals had to close. After assessing the science, its NHS trust found that the evidence did not justify any further funding.

Of course, even the homeopaths knew their junk had no evidence. They aren’t interested in any real science. And just to prove that point, they became bold and made their lying all the more public.

Faced with increasing criticism, UK homeopaths become more and more desperate. My team has found that the Society of Homeopaths even appears to have been in breach of its own code of ethics in attempting to promote homeopathy. On the society’s website, numerous statements about efficacy were made that were not backed by science and so were not allowed under its own regulations.

The society’s chief executive commented at the time, in November 2009, that she was grateful to me for highlighting these issues and that the society would investigate and make amendments where appropriate. The website has since changed but many, perhaps even most, members of that organisation continue to make claims that violate their society’s ethical standards.

I don’t for a moment expect the ethical standards of a fundamentally dishonest organization do anything significant with all these violation. Even if they do manage to clean up some of their act, their basis is still magical thinking that has no roots in science. The only way they could ever be called ethical sans a smirk is if shut down their whole operation.