Wednesday, February 18, 2009

Do Not Mess With Dana Stevens

A few days ago, I wrote a post admiring the writing skills of Dana Stevens, the culture critic at Slate. I then stumbled upon the following review of Stevens, which included such tidbits as,

"The result in Stevens has been some of the most comically overwrought prose this side of an undergraduate civics paper. Two posts by her in, and the Movie Club is the worse for wear....[after quoting Stevens] It’s January 3rd, folks, yet that may be the most inept attempt at a meaningful sentence I digest all year."

I will try (and often fail) to avoid forging ad hominem attacks. However, I am a big believer in defending people, even phantoms whom I've never met, the ones who live in copper wires and fiber optic cables. Thus, I do not draw my own "civility line" at presenting harsh critics in their own words. Therefore, here is more from Freddie DeBoer:
Title of Blog Post from last week:
"The Continuing Fraud of Mickey Kaus"

On Martin Peretz:
"His blog is linked to by mainstream blogs and online magazines. He is a firmly establishment figure. He is also a vulgar and hateful man....he's become a clownish figure..."

And then there are almost 400 earlier blog posts that I don't have the energy to wade through. This all may seem like trying to remove the whips from the sex shop; after all, the civility norms of the internet differ from the general tone of face-to-face conversation or academic journal critique.

However, what irks me is that the following is posted on Freddie De Boer's personal wikipedia page:
"I believe that the irrational anger, out of hand rejection, and defensive zeal with which people on Wikipedia reject postmodernism reveals the degree to which that rejection is the product of doubt and fear...I think nothing can be accomplished without an attempt at genuine dialogue, founded on mutual respect and a good faith understanding of the opponent's viewpoint [words bolded in original]."

As much as I try, I will not always write in a respectful tone. Please call me out on it, as this is something I try to avoid. We all have our bad days. However, if someone mocks people whom I admire, he will be called out on that, as well. We are left with differences of opinion concerning what is respectfully-conducted discourse, and upon whom forceful language is legitimitely proclaimed. Therefore, it's a good thing Freddie's a self-described "post-modernist."

Tuesday, February 17, 2009

What is Bill Maher's Religion?

Larry King interviews Bill Maher, February 14, 2009:

KING: From our blog, Chris writes, "Bill, what is your silver bullet for health care?"

MAHER: Well, eat right would be a good start. Stop eating that crap in the supermarket. I think most health problems are from lifestyle choices. This is something no politician ever talks about, because no politician is going to say, get off the couch; you're fat; you know, ask the doctor if getting off your ass is right for you. But that really is the key to it. People don't catch a cold, they hatch a cold by things they put in their body. We have way too much toxicity and too few nutrients.

KING: Do you get a flu shot?

MAHER: Never. Never.

KING: It's a vaccine against the flu?

MAHER: First of all, that's a huge scam. Even if it worked, and I don't believe it does, by the time the actual flu came around, it would have mutated from whatever they shot into you. That is a good example of the corruption --

KING: You eat nothing in a box or in a can?

MAHER: Things that are in boxes or cans generally are not good. But have some peanut butter tonight if you like, Larry.

Here Bill Maher manages to deny the pathogenic cause of disease, as well as blame victims for acquired viral infections, stating that people "hatch a cold." Does Maher feel the the same way about Dengue Fever? Polio?

This is an example of hyperbole gone wild. Is Maher correct that people with suppressed immune systems are more susceptible to suffer an illness? Yes. Do people develop weaker immune systems by eating unhealthy foods? Perhaps. But Bill Maher's misleading statements imply that dietary intake is the primary cause, or at least an extraordinarily significant cause, of developing viral rhinopharyngitis.

In fact, the extensive National Health and Nutrition Examination Survey suggests that, while obesity is responsible for numerous pathological phenomena, overweight and obesity seem to be protective from death via infections1. (The researchers used a COX model to account for the fact that the obese tend to die earlier from other diseases, before getting a "chance" to die from infections). While one randomized controlled trial (RCT) in mice showed that genetically ob/ob obese rodents were more likely to die from influenza virus than "slim" rodents2, another RCT demonstrated that ob/ob obese mice were more resistant to death from the malarian parasite, Plasmodium berghei3. Thus, the research relating to the link between obesity and infectious disease is insufficient to be considered conclusive, and additional studies should be performed on this topic. However, Maher's conjecture that acute coryza (common cold), or other infectious diseases, are largely "hatched" from dietary choices, is invalid.

Even if we were to discover a causal link between eating habits and symptomatic coryza infection,4how does Maher know that "toxins" are the culprits, rather than excess fat? Which specific toxins are responsible? Additionally, on what basis does Maher believe that "nutrients" inoculate people from the common cold?

Indeed, many Americans ought to lose weight for other reasons, so at least this embellishment likely has mild consequences.

But then Maher moves on to vaccines.

An estimated 20,000 Americans die from influenza every year. So, if Maher convinces people to avoid a efficacious inoculant, he is behaving very irresponsibly.

Several randomized controlled trials demonstrate the effectiveness of the flu vaccine in children and non-elderly adults, and no scientific study seems to have refuted this. For example, according to the CDC:

A 4-year randomized, placebo-controlled trial of children aged 1-15 years found vaccine effectiveness ranging from 77% to 91%, following only one dose of vaccine given to previously unvaccinated children3."

There is a bit of controversy regarding the efficacy of the flu vaccine in the elderly population. While most well-designed cohort studies have shown that the flu vaccines reduce incidence of influenza infection and death for this demographic 4, these data has been contested in a few other studies 5. However, let's say we did discontinue vaccination of the elderly. We should then employ even greater care to vaccinate children, in order to decrease the probability of elderly exposure to the virus. (The authors of the Canadian study that challenges the usefulness of vaccination for the elderly, indeed noted, "Placebo-controlled randomised trials show influenza vaccine is effective in younger adults.")

Even if Maher, for some wacky reason, does not recognize the validity of such studies, why does he believe that the findings published in these journals amount to a "huge scam," a fabrication intended to hoodwink the public, and an example of "corruption"? These articles all seem to me like the expected process that takes place to advance scientific knowledge, rather than some large conspiracy. In order to save lives, we rely on the best evidence we have, concerning the costs and benefits of every preventative measure and treatment.

We already know that Maher views religious people unfavorably, and that he maintains staunch views on a whole gamut of topics. However, if Maher distrusts both theological doctrine and scientific research, which Higher Authority does he rely on as his arbiter of truth?

1. Katherine M. Flegal and Barry Graubard, et. al. "Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity" JAMA. 2007;298(17):2028-2037.

2.Alexia Smith, Patricia Sheridan, et. al. "Diet-Induced Obese Mice Have Increased Mortality and Altered Immune Responses When Infected with Influenza Virus." Nutritional Immunology137:1236-1243, May 2007

3. Vincent Robert, Catherine Bourgouin, et. al. "Malaria and obesity: obese mice are resistant to cerebral malaria" Malaria Journal 2008, 7:81

4. Please note that infection with the Influenza virus is always the primary etiology. By "causal link" I mean that dietary habits might lead to increased rate of clinical disease from infection, or decreased ability to kill off the virus.

5. Kathleen Neuzil and William Dupont, et. al. "Efficacy of inactivated and cold-adapted vaccines against influenza A infection, 1985 to 1990: The Pediatric Experience." The Pediatric Infectious Disease Journal:Volume 20(8)August 2001pp 733-740
CDC link that review some of the evidence about flu vaccines is at

6. Most of the research in this area seems to have been

Peter A. Gross, Alicia W. Hermogenes, et. al. "The Efficacy of Influenza Vaccine in Elderly Persons: A Meta-Analysis and Review of the Literature." Annals of Internal Medicine. Volume 123 (7) October 1995 pp. 518-527

See also a randomized controlled trial at

One study involved a Swedish cohort study of 260,000 age 65 or older. The researchers state, "The relative risks of mortality among vaccinated versus unvaccinated individuals were estimated using Cox's proportional hazards regression adjusted for, and stratified by, demographic factors and comorbid conditions." They found that they needed to vaccinate 297 in 1998/1999, 158 in 1999/2000 and 743 in 2001/2002 (the vaccine was not so great that year) in order to prevent one vaccine related death among the group, let alone prevent incidence of developing an influenza infection.
a. Ortqvist, F. Granath. "Influenza vaccination and mortality: prospective cohort study of the elderly in a large geographical area." Eur Respir J. 2007 Sep;30(3):407-8.

7. Lone Simonsen, Roberty Taylor, et. al. "Mortality benefits of influenza vaccination in elderly people: an ongoing controversy."
The Lancet Infectious Diseases, Volume 7, Issue 10, Pages 658 - 666, October 2007.

Saturday, February 14, 2009

Confessions of a Cinemaholic

On days following a horrific exam, I often lounge and loaf and consider a career in frittering and tweeting my time or otherwise "writing stuff on the internet." Then, I occasionally come across something like this,which manages to construct such exemplary commentary on a movie that seems so painfully stupid. I am actually curious about what Dana Stevens has to say about "Gigli" and "Glitter." I am not worthy. Good thing I really enjoy medicine.


Each Friday, my school sends a delegation of medical students out to Juvenile Hall, where we split up in twos, and instruct the kids on rotating topics, such as Decision Making, Dating Violence, Sexually Transmitted Diseases, and Contraception. The teens are aware that, while misbehaving during math class might earn some class cred, acting out during Sex Ed means that one's not man/woman enough to handle the topic. Thus, we enjoy their rapt attention (other than that one fluke pencil-stabbing incident), as we point to Netter illustrations of vas deferens and cervical ora, and pass around examples of dental dams, condoms, and diaphragms.

We thought that we were being all educationally innovative with our "Guess which STD?" Jeopardy game, featuring fun-filled images of condylomata lata and genital warts. However, it seems that we are totally outdone by Derek the Abstinence Clown, with his fun-filled juggling shtick. It is unclear to me what juggling has to do with safe sex (tossing pins leads to tossing machetes leads to, I don't know, neurosyphylis?). Derek has Austin the Seventh Grader balance a phallic symbol cane in one hand, which represents "doing whatever feels right like now." The cane begins to tumble, upon which Austin is summarily chastised.

On Austin's second attempt, Derek asks Austin to focus on his hopes and dreams. He also finally moves out of Austin's way, allowing the kid room to adjust his arm, so that the bottom of the cane can continuously counteract the torque of the top. Newton's Laws and Austin's Hope-Focusing conspire to ensure the cane's successful stability. From this analogy, the junior-high kids learn the imperative of avoiding drugs, alcohol, cigarettes, and especially, pre-marital sex.

Heeeeeere's Derik!!:

Tuesday, February 10, 2009

Don't Look At Me, I Just Work Here

Like Kerry Howley, I believe that when it comes to government regulation of in-vitro fertilization gone wild, the bureaucratic cure could be worse than the infertility cure.

However, Kerry sees a doctor who performs IVF as a morally neutral agent, working like an employee at the One-Hour-Photo Shop, shrugging his shoulders as he develops mementos of adultery and scandal, separating his own duties from his clients' sins.

We ought to distinguish crusades of government, as well as the passive observation of moral indiscretions already committed, from the actions of clinicians who potentially cause significant harm. Carrying octuplets to term would almost certainly lead to low gestational birth ages and weights (the California woman's offspring averaged about 2.5 pounds), as well as a dramatically increased risk of abruptio placenta, congenital malformations, eclampsia, or other events that could lead to long-term adverse effects for the products of this Guinness Book adventure. Indeed, someone might find it precious to ensure the birth of a child with Huntington's Disease, so Junior could be "just like mom," but I would decline the request to preferentially pluck such favored follicles.

Of course, we risk committing "IVF refusal ad absurdam"; We begin with objections to embryos with HD, and end with the dismissal of embryos cursed with my characteristic attached earlobes. Additionally, dramatically increased risk does not equal a guarantee of harm. Thus, I understand why conscientious clinicians might not yet object to the implantation of eight embryos. However, I reject the overall notion that a doctor ought to shove fingers in her ears, ignoring the loud protestations of her ventromedial prefrontal cortex, as it shouts that something is not quite right.

Upon public outbursts, such as "How could doctors let her bring so many babies to term?," Kerry counters with
"If there is a problem here, I’m pretty sure it is not that doctors are insufficiently judgmental in matters of female reproduction. Fertility specialists are medical service providers, not religious counselors, not ethicists. I would no more ask a GP whether it is ethical to bring 8 babies to term than I would ask her to hold forth on the existence of souls."
The problem is, the critic does not necessarily esteem the doctor an expert on ethical matters, but merely objects to the doctor's violation of said critic's own ethical views. I'm not concerned with the accountant's opinions on the ethics of tax fraud. But I will denounce him when he unscrupulously helps people cheat.

Friday, February 6, 2009

Some of These Things Are Not Like the Others

Some statements to start off your Sunday:

1) "The theory of evolution is a myth."
2) "The government should not fund stem cell research."
3) "Vaccinations cause autism."
4) "Funding for the NSF does not belong in a stimulus bill."
5) "We should repeal the Clean Air Act."
6) "Climate Change is a hoax."

Let's start with the easy question: What is similar about all of these statements?

Answer: They are beliefs commonly touted by many conservatives, and are mocked, in turn, by liberals- (although some liberals also agree with statement "3").

Ok, now what is a major difference among these statements?

Answer: Statements 1, 3, and 6 (Group A) are all contradicted by scientific evidence and are not factual. People who believe in them, either don't know or don't care about the empirical findings of scientific research. Statements 2, 4, and 5 (Group B), however, are merely political arguments. There is perhaps a strong correlation between belief in 1, 3, and 6 AND advocacy for 2, 4, and 5, but this does not mean that the two categories are equivalent.

And I believe that this distinction is essential.

If you've read the "Republican War on Science" or many of the posts on Scienceblogs, people will blithely cite, within the same post or sentence, statements from both categories A and B as evidence of the shear philistinism of conservatives or Republicans.

The problem is, people who understand both the possibilities and limitations of science should know better than to conflate these two categories. A true empiricist ought to realize that a fellow empiricist, no matter how seemingly unsuitable his political beliefs, can, at least theoretically, reject Group A while accepting Group B. For example, one might oppose government funding of stem cell research on moral grounds. Or he may not be morally opposed to stem cell research, but believes that public policy should defer to the opinions those who oppose such research. Or perhaps such funding simply conflicts with his views about the proper role of government. The notion that "Legitimate human life morally starts only starts after 'such and such' time," is non-falsifiable, as "legitimate human life" is personally, rather than scientifically, defined. Thus, there is no reason to believe that someone's opinions about the ethics of abortion, stem cell research, and arguably even birth control has anything to do with science, so long as one does not justify such beliefs with unscientific claims.

Some people, for whatever reason, might not believe that the Clean Air Act was a good law. I am reluctant to list such reasons, for one, because I know nothing about the law, but, more importantly, because heated counter-arguments would obfuscate my main point, which is: One's political beliefs, no matter how objectionable, are not necessarily related to one's recognition of the value of the scientific method, empirically-derived knowledge, Reason, or objective standards of evidence. Information derived from Science might help inform our opinions about morality or politics, but our conclusions are ultimately based on personally-formulated ethical "first principles" (i.e. "Do no harm," "Government is a good/bad tool for solving social problems" etc.).

So eager are some scientists to denounce their ideological foes, such scientists betray the public by implying that "science says" that certain legislation ought to be passed, or that certain moral opinions ought to be espoused by all defenders of Reason. They do a disservice to their readers, making it seem as if non-falsifiable statements fall under the purview of science. Thus, the public's understanding of the way science works diminishes. "Politicizing" science can exist on both sides of the aisle.

I can think of one circumstance for which the political is inextricably linked to the scientific, in which case the liberal scientist politicos have a legitimate argument. This involves the issue of advancing false statements within the public sphere to gain a preferred political resolution. In this case, the only moral first principle is "Do not lie"- a principle so nearly equivalent to "Embrace science," that I would concede liberal scientists' stances in applicable cases. Such a situation might include advocacy of the teaching of creationism in biology class, within the public schools. Additionally, while there is nothing "unscientific" about opposing a cap-and-trade policy, if one advertises against such a policy by using bogus data to "show" that "climate change doesn't exist," he would be making unscientific, non-factual statements. The same principle applies to someone who conjures up false epidemiological data to "prove" a purported link between abortion and breast cancer. As a "social liberal," I would usually agree with the liberal scientists, in these cases. However, my opinion is that the relationship between scientific reality and political expediency is, nevertheless, quite messy. When otherwise-empirically-sound scientists leave academia and enter think tank headquarters, they occasionally "skew" or "pick and choose" facts and figures, perhaps out of a political or moral belief that the "ends justify the means," or simply due to plain, old cognitive dissonance. In other words, in politics, much more than in science, (nearly) "everybody lies."

The bottom line is- If someone espouses counterfactual information, call him anti-science. However, if he simply opposes your science-related political opinions, call him something else.

Monday, February 2, 2009

Should Medical Students Make Fools of Themselves on the Internet?

Researchers at the University of Florida don't think so. They believe that physicians in training ought to remove those keg party snapshots from Facebook, and instead use social networking sites "to enhance their professional identities." The co-authors deplore the fact that medical students reveal their political preferences, relationship status fluctuations, and unsavory interests (they mention "Texas Chainsaw Massacre") for future patients to see.

The problem is, when virtually every professional-in-training has already gone "1 million strong for Obama/McCain/Barr/Nader/Pigasus" or, (for the more brazen), "I would never sleep with a [insert political party here]," then the definition of "professional" has already been, de facto, redefined. Why get rid of (or clean up) Facebook accounts, utilized by 64% of medical students, when it is so much easier to invite the other 36% to join along?

The article states,
"There is some evidence that students do begin to understand the impact of Facebook as they approach graduation. The study found that while 64 percent of medical students had public Facebook accounts, only 12 percent of resident physicians did."
To me, these statistics don't indicate any panicked account closures en masse, but speak to the flood of Mark Zuckerberg's contemporaries who have recently entered medical school, and collectively just say "meh."

One of the researchers argues that
“Doctors are held to a higher standard...There are stated codes of behavior that are pretty straightforward, and those standards encourage the development of a professional persona.”

If someone simply enjoys doing colonoscopies, and also singing karaoke, must he be a man at home, and a doctor in the street? Should we hold doctors to a "higher standard" when it comes to non-medical matters? Does this concept simply re-enforce the old-fashioned notion that doctors are "different from you and me?"

Granted, there are some things doctors could publicize that would convince me to avoid sitting next to him on a bus, let alone let him perform my cardiac surgery. If some-one joined a fictitious "I Hate My Patients Club" or some other ridiculous group, it might be sensible to choose a different doctor. However, by announcing his opinions on Facebook, rather than simply confiding in his poker buddies, the doctor does me the favor, as now I can cross him off my PPO list.

However, with 21st century snark and sarcasm, we can't interpret the significance of someone's membership in even the most unsavory of medical student groups- such as,“Physicians looking for Trophy Wives in Training” (it is unclear to me this is a dangling modifier, or if the medical students emphasize the "training" of the "trophies" more than their own). In this post-modern generation, we don't know if the students actually aspire to this vision of their futures, or if they're actually mocking a largely passé Dr. 90210 attitude, in which marrying boring women1 is considered desirable.

I suppose that, no matter the intentions, it is still perhaps inappropriate to advertise activities or opinions that would cause offense. But once the details of our lives are inevitably strewn across the internet, someone is going to find something objectionable (My doctor is President of the Barry Manilow Fan Club???) Where would we draw the line? The answer to this might be obvious to some boomers out there, but I can safely say that many of us young folk haven't a clue.

We tend to wistfully look back at those old-fashioned physicians of yore (or at least those of 1960s television)- caring, nurturing, and kind. However, today's doctors can still achieve these qualities without dulling our personas- even "Marcus Welby M.D." opens with Dr. Kiley riding his badass motorcycle.

1. The doc's wife may be intelligent. I've never seen the show.