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Archive for November, 2011

“It is demonstrable that things cannot be otherwise as they are; for as all things have been created for some end, they must necessarily be created for the best end.” –Pangloss

Tragedy struck on December 27, 2008 when a prominent AIDS denialist succumbed to complications from her disease. Christine Maggiore had a long and successful career denying the HIV virus causes AIDS, with a high point surely her advisory role in South Africa’s temporary block on government funded AIDS medical treatment (estimated to have cost the lives of 330,000 people), or perhaps the founding of “Alive and Well AIDS Alternatives,” an organization dedicated to encouraging HIV infected people to avoid HIV medications and treatment in favor of naturopathic remedies. I don’t personally believe she was a good person, but one can’t deny she suffered because of her beliefs and the choices she made considering them. To be equally fair one must also consider how they affected the lives of the people closest to her.

Great controversy was created with the publicizing of her choice to breast feed her children despite being tested HIV positive. Her public stance to not take antiretroviral medication while doing so increased the likelihood of transmission to her daughter. These drugs have been shown to reduce this risk, with the drug AZT thought to reduce it by at least 23% [1]. At the age of three, her daughter Eliza Jane fell ill with Pneumonia-like symptoms and her mother’s continued refusal to have her tested for HIV made matters worse. After doctor shopping, she eventually chose a sympathetic holistic practitioner connected with her organization for treatment who claimed her daughter was “only mildly ill.” A month later she was dead. Autopsy reports revealed a more disturbing picture showing that she was seriously underweight, had pronounced atrophy of the thymus and lymphatic organs and her lungs were infected with an opportunistic pathogen called Pneumocystis jiroveci (#1 cause of death in pediatric AIDS cases), all of which are considered classic indicators of AIDS. Furthermore, it revealed HIV protein components in her brain tissue, which is an indicator of HIV encephalitis. Maggiore rejected the conclusions alleging fraud and incompetence, choosing instead to rely of the review of an animal pathologist close to her organization. Predictably, his findings described her death as attributed to a poor interaction from amoxicillin, a claim dismissed as preposterous by professionals in the field. Ultimately, Maggiore would not have long to consider the nature of her daughter’s death, as her own health began to take a severe turn for the worse.

I don’t believe there is anything funny or ironic in this tragedy, just sadness and pity. A three year old is dead and died needlessly, infected as a direct result of her mother’s inconsiderate beliefs. Thousands more died as a result of her enterprise and even more are continually mislead into unsafe and disreputable treatments, hampering real efforts to contain and manage the disease. What went so wrong, that would force her to ignore all medical evidence regarding her condition? What made the collective body of evidence so thoroughly unconvincing, so unbelievable that she would gamble the lives of her children upon this rhetoric? The inability to convince the majority of people or to provide a successful, publicly accepted counter-argument to this surely is a great collective failure of medicine today. Despite its successes treating injury and establishing a biological basis for disease there are many that whether of stubborn obstinance or more likely lacking a clear description of the science behind it find it inconsistent or at worst disreputable.

Anti-vaccinationists, for example, despite years of successful treatment and the virtual eradication of diseases like small pox and polio

Old cows still say moo.

in the western world, still pose arguments of the dangers and inefficacy of the treatment. Religious and personal freedom based arguments posed reach back well over 100 years to echo the originals. However, arguments alleging the dangers of it are finding fresh audiences despite both empirical and otherwise anecdotal evidence to the contrary. Peter Morrell, a UK homeopath, wrote in a scathing editorial in 2000[2]:

“It does not work; it is unnatural, that the human race has survived healthily for countless generations without them and that homeopathy provides a better alternative that is both safer and effective…One can see the dangers and pitfalls of vaccination as another Russian roulette game not worth the risk.”

This is probably safe.

Perhaps if the collective medical profession relied upon a farcical theory like homeopathy’s “water memory,” then the comparison to gambling would be apt, but this is not the case. Though it is impossible to account for every possibility, medications and treatments are tested for both safety and effectiveness. Furthermore, results are verified by repeated testing to further clarify specific effect from lucky incidence. The double blind trial developed in the early 1900’s further limited sources of error such as observer bias and experimenter effects. It did more to help the sick in 100 years, than ostensibly “better alternatives” did in 200, by allowing the measurement of an effect to be defined and separated from statistical placebo effects. If homeopathy truly provides a better alternative, then results from studies [3][4] would clearly show benefit beyond placebo and experiments with positive correlation would be repeatable by other parties. After all, what good is a treatment that works only for some or some of the time for a few lucky people? If we’re seriously going to make the allusion to gambling, wouldn’t it be better to side with the hand the yields a consistent and high rate of return?

“Infectious diseases in general have declined massively since 1900…”

It also shouldn’t surprise anyone who has taken a bath recently, that good hygiene is good preventative medicine. Before the advent of sewage systems, cities were severely limited in size, usually by the occurrence of disease. John Snow’s 1854 correlation that the year’s cholera epidemic was caused by contaminated city water (specifically around a single city pump) established a basis for statistical observation in the causes of disease. Though he did not know the exact cause of the cholera, using a map he was able to show that nearly all of the deaths attributed to the epidemic could be traced back to that particular location. It was later shown that the pump was dug too close to a cesspool and it was leaking fecal matter into the drinking water. Cleanliness and proper hygiene have an effect on certain diseases, yet it is important to make a distinction that it does not affect all diseases in the same fashion. This can be seen even today with outbreaks of measles and rubella (etc) among unvaccinated populations in western nations despite the herd immunities largely present and public water purification efforts taken. The MMR vaccine controversy in the 2000’s started with the speculation that the vaccine could cause autism and continues to cause great fears among parents pushing a dip in non-compliance. This dip has been credited with causing a large upsurge in these diseases. The CDC, for example, reported that cases of measles in 2008 were at a 12 year high [5][6]. Publicly, it matters little that the progenitor of this vaccine scare, Dr Andrew Wakefield, has been shown to have altered his data in favor of parties he accepted money from [7][8]. To the public, the fear is real and the accusation is enough to cause panic.

Royal Rife hard at work.

I recently had the pleasure of interviewing a UFO conspiracy theorist. His main argument was that all sciences, except aeronautics, have advanced exponentially[*] since the Roswell UFO landings, perpetuating unearthly advances in science and technology that were previously impossible with our ‘feeble’ intellect. There is a fallacy here that doesn’t revolve around the usual skeptics rallying point, but that there is a strong public belief in the infallibility of science, such that lay people often times, when confronted with the limitations of science, would rather believe in a conspiracy of failures than in the truth: that at any given point science is far from solving the collective mass of problems affecting us at present (“for every problem solved there are hundreds more questions”).  His argument views the discoveries of science as a linear progression, completely ignoring the ‘fallen warriors’ left by the roadside to get to that point.  The theories of phlogiston and geocentrism no longer hold the same philosophic sway they once did, as they have been replaced by more accurate descriptions of the world around us.  Much in the same way, medical science in some ways has been the victim of its own success, in that people seemingly have a genuine expectation that “a disease with a name will have a cure.” This leads to disappointment at its failures and current limited ability to cure and is exemplified by the many conspiracy theories involving “big pharma” holding back “real” treatments for AIDS and cancer. Take for example, author Barry Lynes’ 1987 book “The Cancer Cure that Worked,” about Royal Rife’s supposed cancer curing radionic devices and their subsequent cover-up [8]. Robert Strecker’s work on the alleged manufacture of the HIV at Ft. Dietrick as a tool to limit the industrial growth of Africa, as well as several involving the chemical AL-721 as an AIDs cure too cheap to sell are all examples of this common theme. The secret wish is the promise of success, in that things are as they are, because they are “created for the best end.”

The main issue is that the representatives of science have been sending a mixed message, especially in light of the recent inclusion of “alternative medicines” like homeopathy into the pantheon of medical techniques. The term itself insinuates a duality of being as if the two occupy separate halves of a holistic continuity (good/evil, yin/yang, republican/democrat). This image is only furthered by state required licensure of practitioners, yielding a further sense of legitimacy to these otherwise unproven techniques. This duality, at least in the public eye, gives a degree of plausible deniability. Science may say the evidence shows they work no better than placebos, but they can say (and do) that the scientific method is incompatible with their art. If they’re considered, even just rhetorically at an equivalent level, then it appears as just two rival businesses competing for customers and any debate on the subject is subsequently viewed as a rhetorical advertisement rather than a statement of just the facts. Legitimate studies, whether for or against, are viewed with contempt and as the product of that party’s particular bias. This issue is further compounded as medicine becomes less reliant on the humanistic bedside manner that became a doctor’s stereotypic image in the public eye. The doctor-patient relationship and the trust that comes with it has been eroded by impersonal, corporate business practice and this bubble is being largely filled by alternative medicines. People do not like being treated as a mechanistic collection of systems and holistic imagery relates to them in a way that an impersonal blood test cannot, even if the two are at odds factually. The growing impersonal aspect of modern medicine only encourages people like Maggiore and Morrell, further allowing them a gray area to exploit.
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[1] Basic and Clinical Pharmacology 10th Ed., Bertram G. Katzung, MD, PhD

[2] http://epe.lac-bac.gc.ca/100/201/300…ue-7/10-13.htm

[3] “Homeopathy remains one of the most controversial subjects in therapeutics. This article is an attempt to clarify its effectiveness based on recent systematic reviews. Electronic databases were searched for systematic reviews/meta-analysis on the subject. Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis. Collectively they implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data. Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.”

[4] Another Homeopathy study.

[5] http://www.medpagetoday.com/Infectio…sDisease/10629

[6] “A trend which continues into 2009” was what I wrote, but this appears to be wrong according to the guardian. Touche~

[7] http://www.medpagetoday.com/Pediatrics/Autism/12850

[8] http://www.ncbi.nlm.nih.gov/pubmed/17867721

[*] He was an interesting character. Among other things he believed that a class of human beings were alien-human hybrids and ordinary humans lacked the intellectual fortitude to build the sphinx and pyramids, ascribing a mystical super-scientific power to their magnificence. Aeronautics was supposedly held back, because “they” want to kept us from knowing where we really come from. This is also the reason we haven’t been back to the moon, that and they have a base on the dark side. I enjoyed the interview. He even laughed when I asked if phrenology would benefit greatly from the alien wisdom. These are a different story, though.

[9] description of the book and summary.

Written on April 15, 2009

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