"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Fast Food Fantasy: There's a trend in the fast food industry to market their food as healthy. It isn't. Even Subway, which leads with the lowest calorie sandwiches, isn't all that healthy. All of those processed meats aren't "healthy choices." As for the story of Jared, the man who lost weight eating Subway sandwiches, if he only ate two Subway sandwiches a day for a year then he was limiting his caloric intake to about 600 calories a day, a severe restriction that would result in weight loss even if he just sat on the couch all day. posted by Sydney on
5/18/2002 08:35:00 AM
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Malpractice Crisis Update:Medical schools are feeling the pinch of soaring malpractice premiums. The states where schools are considering closing, Pennsylvania, Nevada, and West Virginia, have been particularly hard hit by the malpractice crisis. These states are already losing established physicians because of the rate hikes, and now they'll be deprived of new physicians as well. posted by Sydney on
5/18/2002 08:33:00 AM
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Medical Fascism: The spirit of the anti-tobacco health campaign has infected dermatology. Health officials in Texas and Tennessee are requiring teenagers have parental permission to tan. At least one dermatologist approves:
"The message is, 'A safe tanning bed is like saying there is a safe cigarette. It doesn't exist,'" says Shelley Sekula-Rodriguez, an assistant dermatology professor at the Baylor College of Medicine in Houston, Texas. " ...If a person wants to add color, they should use sunless tanners in a bottle. They are very safe."
Of course, the sun isn’t safe, either:
“On average, a person receives about 80 percent of their lifetime sun exposure by the time he or she is 18, according to the American Academy of Dermatology (ADA). During T-ball tournaments, family beach excursions, theme park forays and physical education classes, children are racking up hours under the sun.”
Luckily, they can’t make laws requiring us to keep our children inside on sunny days, or can they? posted by Sydney on
5/18/2002 08:31:00 AM
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Drug Company Malfeasance? A Canadian addiction center that is heavily funded by the makers of Prozac withdrew a job offer for a renowned psychiatrist after he publicly criticized the drug. He sued them, and the case has been settled to his advantage. Although he says he accepts their word that the drug company had nothing to do with the withdrawal of his job offer, it's pretty clear that someone in the administration of the center at the time feared his remarks would offend their corporate sponsor. He was much sought after by the center before the remarks, and persona non grata after them. posted by Sydney on
5/17/2002 08:01:00 AM
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Suffer the Children: The UN Conference on Children, has come to an end. (link may require registration) Two of the more bizarre aspects of it as reported by The Lancet:
“Early on May 11, the UN General Assembly Special Session on Children unanimously adopted a draft resolution to protect children from disease and poverty after tense negotiations in which the USA, backed by many Islamic nations, was accused of imposing a right-wing agenda. (italics are mine)
and....
”Carol Bellamy, Executive Director of UNICEF, was positive about the session, which marked the first time children were included as delegates and had their own Children's Forum preceding the UN meeting. "I could not imagine meetings that set agendas for children not including them in the future", she commented, citing the "extraordinary difference and vitality felt by their inclusion as official delegates"
Which explains the subheading within the article:
“Children celebrate at the end of the Children's Forum”
Actions Have Consequences: Hindu doctors are avoiding Muslim areas in India. The reason:
“Security concerns for doctors surfaced after individuals posing as patients stabbed and injured a Hindu doctor last month in his clinic in a Muslim neighbourhood. The incident prompted the Ahmedabad Doctors' Forum to urge Hindu doctors not to venture into Muslim localities unless their safety was guaranteed.”
The consequences are that doctors of both faiths are avoiding the Muslim areas:
“Hindu doctors have stopped visiting hospitals in Muslim localities. At the Al Amin Hospital, for example, 70 out of 82 consultants are Hindus. "All but two have stayed away from the hospital for several weeks," Dr Sadiq Kazi, medical superintendent at Al Amin told the BMJ.
Its Muslim consultants have also stopped visiting because of safety concerns about travelling around the city.”
Bureaucratic Euthanasia: The majority of Belgian doctors oppose Belgium's proposed euthanasia law. They say they have no plans to take advantage of it. Some question the entire set up:
"This will be a typically bureaucratic and unworkable Belgian commission, because 50% have to be pro-life members and the other half pro-euthanasia, while to bring a prosecution the law requires a two-thirds majority," said Herman Mys, professor of medical law at Leuven University.”
In other words, they stacked the cards so that no one will ever be approved for euthanasia. Why did they bother with making a law permitting it to begin with? Did the Belgian politicians just not have the courage to say they think euthanasia is wrong?
CORRECTION: A reader pointed out that I misread the Belgian euthanasia story. They're talking about needing a two-thirds majority to prosecute someone for euthanasia, not to OK euthanasia.
"Humanitarian" doctor and worker arrested: Two US citizens have been arrested by Israel as suspected terrorists. They claim they were there to set up medical relief services for Palestinians, but this little tidbit reveals the reasons for Israeli suspicion:
"The pair were both members of the Holy Land Foundation, which had its assets frozen in December after US President George W. Bush's administration charged it as being a front for the militant Palestinian organization Hamas."
Drug Rep Malpractice: The makers of Neurontin, an anti-seizure drug, have been sending salespeople into exam rooms to influence doctor's prescribing. What kind of a doctor would go along with this? It's ludicrous to allow a salesman with no background in medicine beyond what he's memorized about his product to "advise" you on what to prescribe a patient. It's clearly a violation of patient confidentiality to allow a salesman to look at patient records and sit in on exams. These people aren't medical professionals, they're salesmen for crying out loud. posted by Sydney on
5/16/2002 07:29:00 AM
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More Mystery Fever: British officials are speculating that the mystery fever infecting their troops in Afghanistan may be typhoid. When I first heard the story I wondered if they were coming down with the Greek mystery virus from a few weeks ago, but the symptoms don’t sound the same. I’m surprised that British troops would come down with typhoid. Typhoid is transmitted from contaminated food and water. I thought modern military hygiene was good enough to keep such things at bay. I also thought that soldiers were immunized against it before being sent overseas, but I could be wrong. posted by Sydney on
5/16/2002 07:29:00 AM
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Doobie Doobie Do: You just can't satisfy some people. The government-furnished marijuana used in California's therapuetic pot program is either too potent or too weak, depending on where you live. In San Mateo, they think it's nothing more than "ditch weed", but in La Jolla, it's knocking them on their butts. It all boils down to expectations. The La Jolla patients are just looking for some pain relief. It doesn't say what the San Mateo patients are looking for, but judging from their complaints, they expect at least a little buzz. posted by Sydney on
5/16/2002 05:30:00 AM
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Smallpox Vaccine: The ever cogent Michelle Cottle has a piece on smallpox vaccine in The New Republic. She argues for letting each individual decide whether or not they want to have the vaccine. I couldn't agree with her more. I, too, find it offensive that the administration is debating the issue among themselves on whether or not we should all be offered it, as if we were all wards of the state.
I keep reading in popular media reports about the awful side effects of the vaccine, but those side effects are rare. Maybe it's because I'm old enough to remember being vaccinated against smallpox myself that I'm not so concerned about side effects. All of my contemporaries were vaccinated, too. It was compulsory in the late 1960's. The only thing it left me with was a scar on my arm, and I don't remember any of my classmates dying or developing horrible rashes. Of course, today we have more people with compromised immune systems, both from drugs they take (chemotherapy, some arthritis medications) and from disease (HIV, leukemia). A mass immunization effort would mean that these people would have to take special care to avoid the recently immunized, for they would be at risk for catching the virus even from an immunized person. One other risk group that doesn't fall into the usual risk category for easy infection is people with eczema. For some reason they are also prone to developing smallpox after exposure to someone who has been vaccinated. It may be fear of litigation from these groups of people that is giving the adminstration pause. They could, after all, be unknowingly exposed to someone in public places. But, if they are exposed to a smallpox attack, it would be far worse for them. At some point we have to decide that the public good outweighs the concerns of a few.
As an aside, I've recently been reading the The New Letters of Abigail Adams, a book I picked up at a used book sale. She was obsessed with smallpox. She was constantly referring to innoculating her own children and her grandchildren. She even offered to pay for the innoculation of a potential servant to try to entice him to move from Boston to New York when Adams was serving as Vice-President. She obviously knew just how bad smallpox could be. posted by Sydney on
5/16/2002 05:21:00 AM
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My Apologies: A while back I linked to Chris Rangel, MD, another physician blogger, but I screwed up the link and didn't realize it until today. My apologies to Dr. Rangel. He has a great web site, more thoughtful than mine most of the time, and it's amazing how rarely we link to the same things. His site is on the list to the left now, as well as under his memorable quote. posted by Sydney on
5/15/2002 09:02:00 PM
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Trial Lawyers Get Defensive: The Trial Lawyers Association is taking aim at the tort reform legislation that Congress is considering. This diatribe by the president of the Association of Trial Lawyers of America against doctors and insurance companies was circulated yesterday in Knight-Ridder newspapers. He claims that the cause of rising malpractice insurance premiums rests solely on the doctors and on the insurance companies and has nothing at all to do with the costs imposed on the system by frivolous law suits and astronomical financial awards. Some of his more blatant misrepresentations:
“In 1975, California enacted an absolute limit on the amount a citizen jury (you, your friends, neighbors and co-workers) -- after hearing all the evidence -- can order negligent health-care providers to pay patients they injure or the families of those they kill. Now, 27 years later, California doctors pay 20 percent more for medical malpractice coverage than the national average, according the American Medical Association's Physician Socioeconomic Statistics, 2000-2002.”
The California tort reform does not restrict the ability of wronged patients to sue, nor does it inhibit their ability to obtain justice. It only limits the amount that can be rewarded for pain and suffering, not the amount that can be rewarded for economic losses. The pain and suffering was limited to $250,000, not exactly chicken feed. What the reform also did was restrict the contigency fees of the plaintiff’s attorneys, so more money goes to the injured party and less goes to his lawyer. In this respect, it's actually an improvement for the injured party. That one must really stick in the craw of the Trial Lawyer Association. (For a detailed description of California’s tort reform click here.) It simply isn’t true that California doctors pay higher malpractice rates when compared specialty to specialty. In fact, doctors are leaving places like Nevada and moving to California to practice.
“According to the Institute of Medicine's 1999 report, up to 98,000 patients die in U.S. hospitals each year as a result of preventable medical errors. Malpractice is America's eighth-leading cause of death, killing more than breast cancer or automobile crashes.
Most injured patients and their survivors never learn that they or their loved ones were victims of medical malpractice. Only one out of eight instances of malpractice results in a claim, according to a Harvard study.”
The Institute of Medicine’s report on medical errors is by no means a good study, and in fact, has been found to be deeply flawed. It overestimates deaths due to medical errors. The doctors doing the survey could not even agree on what constituted a “deadly medical error.” In some cases they counted adverse reactions to drugs that were the only choice of treatment in a life-threatening situation. As to medical errors being the “eighth leading cause of death,” that is an out and out lie. The National Center for Health Statistics lists Alzheimer’s disease as the eighth leading cause of death in patients of all ages in 2000. It was the same in 1999. Here is the list of leading causes of death in the United States in 2000:
The number five category of accidents is very broad, and includes motor vehicle accidents and every sort of accidental death imaginable. By no stretch of the imagination could medical errors make up the majority of that category, considering that they include homicides, suicides, and firearm accidents as well as sundry other unintentional injuries that result in death. Then, there’s the claim that most injured people never know they were the victim of malpractice. For malpractice to occur there has to be a noticeable injury. If even the patient isn’t aware of it, it can’t really be malpractice. Only a trial lawyer would see injury where no one else can see it.
“The negligence of bad doctors and the bad business decisions of insurance companies are not the fault of patients who are mistreated. Yet it is injured patients who will be punished if insurers and doctors succeed in limiting justice to help solve their self-inflicted troubles.”
Of course it isn’t the fault of the patients, but neither does malpractice tort reform aim to restrict an injured pary's right to obtain justice. It only aims to restrict the profits of malpractice attorneys. You can’t deny that there is a culture of attorneys out there who go trolling for dollars in any sort of injury or accident, as this woman’s story attests. Her case is not unique. I often have patients come to my office after an accident. The honest ones say they feel fine, but their “lawyer told them to get checked out.” Medical malpractice is no different. These guys go looking for injuries. They advertise on television, in newspapers, and on the backs of phone books. They can’t be counted on to reign in their own greed, so tort reform is really the only solution. Just remember, it isn’t the patient who’s the target, it’s the greedy lawyers. posted by Sydney on
5/15/2002 10:18:00 AM
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Unjust Drug Scare: USA Today scares Glucophage users. Yes, Glucophage (a diabetes drug) should be avoided in patients with kidney disease and severe heart failure, but most doctors screen their diabetic patients for these conditions regularly. It's when patients fail to come in for their regular checkups that these things slip through the cracks. The truth is, Glucophage is a very good drug for diabetes. It would be a shame if articles like this one scare patients away from it. posted by Sydney on
5/15/2002 09:07:00 AM
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Treatment Fit for a King (or at least a prince): Prince Charles, scourge of modern architecture is an advocate of alternative medicine. The center described in this article sounds lovely. It's really more of a resort than a doctor's office. This sort of treatment is without a doubt good for people with chronic and severe mental health problems, which I suspect makes up a large part of this clinic's patients. And no doubt art therapy and music therapy helps cancer patients and the depressed. It won’t, however, cure cancer or schizophrenia. The real question is, why should taxpayers foot the bill for this sort of thing? Art lessons and therapeutic work can be obtained easily on ones own.
There is justice in this world, afterall: A recent study shows that telemarketers lose their voices more than other people:
"Sigmon and speech pathologists said telemarketers often speak too loudly or lower the pitch of their voices to sound more authoritative. This strains the larynx muscles."
More Pharm Fraud: This time it's fake Epogen, a drug used to treat severe anemia in patients with kidney failure. There's just too much of this sort of thing going on. You have to be the most depraved of the depraved to cheat sick people out of needed medication, and the penalties for this sort of thing should be high. I hope someone besides the pharmaceutical companies is investigating this. posted by Sydney on
5/14/2002 08:00:00 AM
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Greying of HIV: HIV infection is being found now in the over-65 crowd. Not only do they tend to have unprotected sex (no fear of pregnancy), but we have to remember, they were young adults in the era of free love. posted by Sydney on
5/14/2002 07:59:00 AM
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One Small Step: Researchers have genetically altered mice to cure them of the vermin variety of juvenile diabetes. They're only mice, and it's too early to tell if it will have any relevance to people, but still, it's a small step forward. posted by Sydney on
5/14/2002 07:57:00 AM
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Newton’s Third Law of Medicare Budgets: Every action has an opposite and equal reaction, and every Medicare spending expansion has an opposite and equal spending cut. At least a few responsible congressmen realize this. Providing prescription drug coverage for the elderly may well mean that hospitals and doctors will see even more cuts in Medicare reimbursement. Medicare reimbursements are already so low that further reduction could force some hospitals into bankruptcy, especially those in underserved rural areas. I have to agree with Representative Peterson. From a public health perspective, it's more important to have access to a hospital and a doctor than to have free drugs
We have so many pills for so many ills that by the time a person reaches the age of Medicare benefits they are likely to be on a long list of medications, not all of them necessary. If a patient has to foot the bill for these, that gives him an incentive to work with his physician to try to minimize his drugs. If someone else foots the bill, then there is no incentive to cut back on the drugs or to chose a less expensive, equally effective alternative. I’ve seen this at work in my own practice with insurance plans that require only a five dollar co-pay for prescriptions. A patient will come to me for a sinus infection. I recommend amoxicillin: it costs less than ten dollars, and it’s effective, but you have to take it three times a day. The patient will ask for Zithromax, which costs about $45, but only has to be taken once a day. I explain that the amoxicillin is just as effective, and in some cases more so, and costs a lot less. The reply I get is, “I only pay five dollars no matter what you give me.”
For Medicare to cover prescription medications and still remain solvent, they will have to put some limits on what they cover. Perhaps they could just cover generic drugs, or make a rule that they won’t cover anything that is directly marketed to consumers. posted by Sydney on
5/14/2002 07:55:00 AM
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Militant Breastfeeders Update: Health officials in Wales are going to get tough with women who don’t breastfeed:
"In Wales the situation is so bad health ministers are to appoint a 'breastfeeding tsar' is to improve support to new mothers."
CAT Scan Scams: I spent thirty minutes I didn't have today trying to explain to a patient why these heart calcium scans are worthless. I've got another patient I've been trying to reach by phone who sent me a copy of his results, abnormal of course, and I haven't yet figured out what to do with him. Mr. McKenna, the man in the article, had doctors with the same problem. In the end, he regretted having the test:
“I made a mistake. I should never have responded to this advertising,” McKenna says. Insurance won’t pay because his own doctor didn’t order the initial calcium test, he adds: “I feel that this is a scam.”
posted by Sydney on
5/13/2002 10:09:00 PM
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More Cloning News: America’s own renegade fertility specialist, Dr Panayiotis Zavos, who practices in Kentucky, has plans to begin his own reproductive cloning project. He’s a former colleague of Dr. Antinori, the Italian who claims to already have cloned babies in production. Antinori made an odd statement to the media last week:
“But last week, in an interview with an Italian magazine, he said that his patient, thought to be a rich Arab, would give birth to a completely healthy baby and that 85% of its genetic make-up would come from the father and 15% from the mother.”
If this is true, it means that he has done some sort of manipulation of the chromosomes beyond inserting the father’s genetic material into an egg. This whole cloning saga just keeps getting weirder and weirder. posted by Sydney on
5/13/2002 08:20:00 AM
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Resurrection Cloning: A heart-tugging story of people who want to be cloned from the Washington Post.
The saddest cases are the people who want to clone themselves or a dead loved one in the expectation that they’ll have a second chance at life. They try to convince us that this isn’t what they think, but their hearts’ desire comes through loud and clear in their words:
"I don't understand people who want to clone themselves," says Gordon, 42, a lab technician who lives in central Montana and has a doctorate in ethics. But cloning one's dead daughter is different, she said. "I'd trade everything I have today just to have Emily back." ....
...Of course, even cloning won't bring Gordon's daughter back, but Gordon knows that. She knows that cloning replicates nature, not nurture. But that's part of her inspiration.
Emily grew up in difficult circumstances during Gordon's previous marriage, Gordon said, declining to go into details. "But in the end, she turned out wonderfully," Gordon said. "If I could have a child with her predisposition to life, her humor, but have her grow up in this new life I've created for myself, which is much better now. I'm married to an attorney. I have all kinds of things now. . . ." Her voice trails off.”
There is the implication in her statement that a clone of her daughter would be a new, improved version because she can now provide her with material things. Is that what they taught her in her ethics doctorate program?
Then there is the man who thinks that cloning himself will give him a second chance at life:
He was born with cystic fibrosis, an inherited lung disease that could easily kill him within the next decade. There is no cure, but by adding a healthy version of the gene that's defective in CF, scientists have been able to "cure" individual cells taken from patients with the disease. Now Colvin wants scientists to do just that, and a little bit more: Take one of the trillions of cells in his body, fix the tiny molecular mutation that causes the disease, and then clone that single repaired cell to grow a new and literally improved copy of himself -- a newborn Jonathan Colvin who would be free of the disease.
"In some respect, it would give me a second chance at life without CF," Colvin said. "It wouldn't be me, but it would be very similar to me."
I hate to break it to him, but it won’t be his brain in that clone’s body, and it won’t be his life it’s living. posted by Sydney on
5/13/2002 08:17:00 AM
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More Drugs, Please: The lobbying arm of the pharmaceutical industry has been busy funding TV ads to support drug coverage by Medicare. The trouble is, they hid behind another lobbying group called the United Seniors Association:
“Leaders from the United Auto Workers, the Service Employees International Union and other groups wrote a letter asking FTC Commissioner Timothy J. Muris to investigate the Pharmaceutical Research and Manufacturers of America (PhRMA), a trade group for brand-name drug makers, for using the United Seniors Association as "a shell group to promote prescription drug legislation on television."
They said that the ads mislead consumers because they do not make it clear that they are financed by the drug industry.
"The fact of the matter is that the organization wouldn't be putting the ads on the market unless the pharmaceutical industry hadn't cut them a $3 million check," said Edward Coyle, executive director of the Alliance for Retired Americans.”
The pharmaceutical industry should think twice before advocating Medicare payments for drugs. Not only will it expand the cost of healthcare for a system that is already having trouble paying its bills, but it will open the door for all sorts of price regulations and standards on drugs. Government-funded medicine isn’t the boon for industry that defense contracting is. Instead of financial windfalls they will end up with a host of oversight bodies and regulations that will stifle them; just like doctors who accept Medicare, and just like the poor NHS phsicians I linked to in the last post.
The other factor they need to consider is that traditional insurance coverage takes its cues from Medicare. When Medicare pays less for something, so do the insurance companies. The only people who will gain from Medicare coverage of drugs are the few people who will be able to get their drugs covered before the whole system goes bankrupt from the financial burden. posted by Sydney on
5/13/2002 08:15:00 AM
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Shackled by Standards: British physicians continue to battle government meddlers. Despite the much ballyhooed efforts to reform the NHS, they still must contend with arbitrary government-set standards. The standards have no basis in the reality of patient care:
"Doctors' leaders called on the government yesterday to free the NHS from the "shackles" of performance targets which distorted clinical decisions and forced them to give the longest waiters priority over the sickest patients.
Ian Bogle, chairman of the British Medical Association, said doctors feared being made the scapegoats for any failure to meet the scores of targets being imposed by ministers to reduce waiting times and improve services to patients.
"The professionals are sick to death of being shackled in this way and having their feelings about clinical priorities overridden by government targets," he said after the BMA council's first discussion of the extra 40bn pounds of NHS spending promised by the chancellor in the Budget.
"They have got to unshackle the NHS and set it free ... The professionals should decide without always having a government target from Whitehall skewing what they are doing locally." Dr Bogle said there was mounting concern that doctors were doing more low priority work at the expense of patients suffering pain and disability."
Whenever I read stories like this I thank God we don't have a national health care system. Trying to work under Medicare and the corporate-socialist model is bad enough, but having a system completely controlled by politicians must be horrible. Even in our system, politicians can't resist meddling with medical decisions. Witness the recent mammogram controversy. posted by Sydney on
5/13/2002 08:02:00 AM
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Sunday, May 12, 2002
Thought for Mother’s Day: Motherhood is the strangest thing, it can be like being one’s own Trojan horse. -Rebecca West posted by Sydney on
5/12/2002 04:38:00 PM
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Vaccinated Vegetables: I'm confused by this story of scientists who have genetically altered carrots to make the Hepatitis B vaccine. They seem to be claiming that eating the carrots would provide protection against Hepatitis B. It seems to me that eating them would destroy the antigen they produce. Even if the digestive juices left the antigen intact I don't think eating it would provide immunity. The vaccine is an injectable one, not an oral one. Would they inject people with carrot juice extract?
UPDATE: I just read a review article on vaccination that explains this story. The part of the hepatitis B virus that induces immunity is produced by the genetically altered carrot. Eating the carrot does seem induce antibodies to that part of the hepatitis B virus. The antibodies are present not only in the gut lining, but in the blood as well. At least, it works for mice who eat such altered potatoes. Don't know if it works with carrots and people, or if it actually protects against disease. posted by Sydney on
5/12/2002 11:48:00 AM
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Celebrity Medical Watch:Julia Roberts goes to bat for Rett Syndrome, a rare neurological disorder. Having a spokesperson who can emote on cue no doubt has its advantages. posted by Sydney on
5/12/2002 11:40:00 AM
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Representative Burton is at it again, according to Steve Milloy'sJunkscience column. Now he's blaming the MMR vaccine for his grandson's autism. posted by Sydney on
5/12/2002 08:02:00 AM
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