"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
SARS: This week’s New England Journal is full of SARS science. One finding - the concentration of virus is highest in sputum and lowest in feces, which points to a respiratory spread rather than fecal-oral as some had speculated:
Virus was detected in a variety of clinical specimens from patients with SARS but not in controls. High concentrations of viral RNA of up to 100 million molecules per milliliter were found in sputum. Viral RNA was also detected at extremely low concentrations in plasma during the acute phase and in feces during the late convalescent phase.
Second Hand: Mayor Bloomberg may have to reconsider his smoking ban. A study published this week in the BMJ says that second-hand smoke doesn’t cause disease and that other studies claiming that it does were biased:
Most epidemiological studies have found that environmental tobacco smoke has a positive but not statistically significant relation to coronary heart disease and lung cancer. Meta-analyses have combined these inconclusive results to produce statistically significant summary relative risks. However, there are problems inherent in using meta-analysis to establish a causal relation. The epidemiological data are subject to the limitations described above. They have not been collected in a standardised way, and some relative risks have been inappropriately combined. Because it is more likely that positive associations get published, unpublished negative results could reduce the summary relative risks. Also, the meta-analyses of coronary heart disease omitted the published negative results from the large American Cancer Society cancer prevention study (CPS I). We have extended the follow up for the California participants in this cohort, analysed the relation between environmental tobacco smoke and tobacco related diseases, and addressed concerns about this study.
Translation: The other studies that purport to show a link between second hand smoke and traditional diseases of smokers (heart disease and lung cancer) were studies that combined a bunch of data from other studies. All of the individual studies’ results weren’t statistically significant, which means that the findings were just as likely to be due to chance than to an actual cause and effect. And studies that showed no connection between second hand smoke and heart disease or cancer were not included. It would seem to be shaky ground for public policy.
This study followed 120,000 people over forty years and found no increase in smoking-related deaths in non-smoking spouses of smokers. In fact, the only trend they detected was that more non-smokers married to smokers out-survived their spouses:
However, widowhood (widowed as of 1999) increased substantially with the level of smoking in the spouse.
The study is sure to meet with controversy. It runs counter to the current accepted thinking on second-hand smoke among public health policy experts. And it was funded by the tobacco industry:
The British Medical Journal said that Mr Enstrom had received funds from the tobacco industry for research because it was impossible to get the money from other sources.
Now what does that say about the state of medical grants when someone can’t get funding for a study that sets out to investigate the conventional wisdom?
posted by Sydney on
5/16/2003 06:57:00 AM
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Reprieve: Oreos are out from under the gun. The lawyer who planned to have them banned in California has dropped his suit:
The San Francisco attorney who made news earlier this week for suing Kraft Inc. to stop the sale of Oreos to California children because the cookies are high in trans fat plans to drop the suit today.
The reason? He's drawn so much media attention that he says he's accomplished what he set out to do -- raise awareness about trans fat, a hidden but dangerous substance in processed food.
Or maybe he got the message that people despise abuses of the law:
His story and a picture appeared Wednesday in the New York Times. His own Web site, bantransfat.com, went from fewer than 500 hits before the story broke to more than 75,000 two days later. The conservative Drudge Report featured the story, which prompted a flood of anti-lawyer responses from readers who called the suit frivolous.
"I would like to file a lawsuit against all lawyers for being hazardous to our way of life. Problem is I would need a lawyer to argue the case and another lawyer, the judge, to hear it," Ken Hughes e-mailed The Chronicle.
Plus, people love Oreos:
At Kraft headquarters in Northfield, Ill., spokesman Michael Mudd said the company had received 277 calls or e-mails about Oreos, about half of which were in support of the company. Fifteen percent were critical and the rest just wanted factual information.
Population Trends: You can tell the baby boomers have reached the age of arthritis. Their latest obsession is pain. posted by Sydney on
5/15/2003 07:51:00 AM
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Public Health Extremes: Think the health totalitarians here are bad, with their crusades against smoking, eating, and drinking? Well, consider China:
China threatened to execute anyone who causes death or injury by deliberately spreading SARS, as officials on Thursday promised more doctors, hospitals and money to fight the flu-like virus in rural areas.
How can you tell if someone deliberately spread SARS? They breathed near someone?
posted by Sydney on
5/15/2003 06:57:00 AM
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Plague Scandal: The Texas researcher who lied about missing plague vials in his lab has been indicted. Turns out he's not a very honest guy to begin with - cheating on his taxes, taking over $100,000 from drug companies and not reporting it, and ignoring necessary paperwork and precautions to transport plague specimens:
According to the charges against him, Butler knowingly shipped 30 vials of YP [Yersinia pestis, the plague organism - ss.] the via Federal Express to Tanzania without properly identifying the specimens and without an export license in September 2002.
The article doesn't say why he shipped the specimens to Tanzania, but he showed a shocking lack of concern for Federal Express employees who had to handle the stuff.
Expired: Dr. Alice says it's safe to ignore the expiration date on medicine bottles (except nitroglycerine). Trust her, she's a doctor. Plus, she speaks from experience. posted by Sydney on
5/15/2003 06:33:00 AM
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Addiction: Chris Rangel has an excellent rant on why eating isn't an addiction. A key point which is often overlooked by health food crusaders:
The other problem with calling obesity an addiction is that there are numerous other reasons why people are obese. Many obese patients simply are unaware that their dietary habits are horrible or that their caloric intake is excessive. Or they are in denial. Or they are depressed for numerous other reasons. Or they get next to no physical exertion. Or they are unable to be physically active because of other medical problems. Or because they have grown up in a family or social situation where everyone else eats excessively and is overweight. Or their significant other or others in their lives prefer them to be overweight. Or eating is the only pleasure that they get in life. posted by Sydney on
5/15/2003 06:28:00 AM
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Universal Healthcare: I haven’t had a chance to look at Dean’s proposal for universal healthcare, but over at Asymmetrical Information, Jane Galt and her readers are having a lively discussion about socialized medicine. Start here, then go here and here.
China Health: Claudia Rosett writing about communism, healthcare, and SARS, shares this revelation about healthcare in China:
...China's regime has spent decades providing incentives for its citizens to lie to officials and to utterly mistrust what might loosely be called the healthcare system.
That's not solely because salaries are so low, and incentives so twisted, that the quality of surgery in China is widely described as being a direct function of the size of the bribe paid to the surgical team. There's also the matter that China's government has for years poured medical resources into the state's one-child policy, with its penalties, forced abortions and sterilizations.
In recent years, enforcement has been breaking down, thanks both to the power of bribes and the ability of China's increasingly mobile population to evade the authorities. This, a China-born demographer tells me, has produced an underworld of pregnant women on the lam, a class significant enough to merit its own name in Chinese slang: Chaosheng youjidui, or "birth-quota-breaking guerrillas."
Heart Matters II: A doctor in Cleveland advocates severe diets to control heart disease. He bases his theory on the low incidence of heart disease in the Third World:
As he reviewed research, he found what he described as a ``virtual absence'' of coronary artery disease in certain cultures where plant-based diets are standard. These include certain populations of northern Mexico, New Guinea, rural China and central Africa.
The life expectancy in central Africa is in the mid-30's. In New Guinea, it’s 52. Overall life expectancy in Mexico is around 68, but northern Mexico is one of the most impoverished regions of that country. And, although I wasn’t able to find a life expectancy number for that region, you can bet it’s lower than the nation’s overall age. Ditto rural China. Of course they’re going to have low rates of coronrary artery disease. They don’t live long enough to develop it.
The doctor’s own study isn’t very encouraging, either:
During his study, Esselstyn followed 18 patients who had collectively experienced 49 coronary events in the eight years prior to going on his eating plan. These events included everything from heart attacks to worsening stress-test results.
Originally, 24 patients had joined the study. But in six months to a year, six were released because they didn't comply with the diet.
Here is what happened: The six people who left the study had a total of 13 new coronary events over the next 12 years. Of the 18 who stayed with the diet, and took cholesterol-lowering medication, only one -- a man who had strayed from the diet and needed bypass surgery -- had a new problem.
Commented Esselstyn: ``We had 100 percent annihilation of disease progression in all compliant patients.''
All those who followed the regimen, plus took cholesterol-lowering medication, he said, met the study goal of a cholesterol level no higher than 150, and an LDL cholesterol of no higher than 80.
Not only is it a very small study - too small to make any generalizations about diet and heart disease - but it’s impossible to say whether the better outcome is from diet or from cholesterol medication.
It’s a very strict diet, too, requiring patients to consume far less fat than is typically found in our food. So strict, that the doctor feels compelled to state on his website:
Consultations with Dr. Esselstyn are limited to patients who are committed to abolish disease progression, and are not merely seeking a temporary solution.
He must have had a lot of contentious patient encounters over his recommendations. He isn’t too charitable to his fellow physicians, either:
Esselstyn's diet is far more limited in fat than guidelines you typically see for heart patients, who commonly eat lean meat and cheese, for example, with their doctor's approval. Esselstyn's response is that most doctors aren't literate in nutrition and that agencies that issue guidelines might agree more with him, if not for political and industry pressures.
Sure sign of junk science - the belief that the establishment is trying to suppress one's theory for ulterior motives.
But this nutritionist’s take on the diet sounds about right:
”It's very hard for people to turn into grass-eaters. You can't put people in plastic bubbles when they're trying to maintain a lifestyle and work. I don't have the absolute truth. I look at what's the best fit, both eating and exercising, to improve a person's health. It's like giving them both a healthy and a happy heart.''
And that, in the end, is what matters. Striking the balance between a healthy and a happy heart. posted by Sydney on
5/14/2003 08:42:00 AM
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Heart Matters: There's apparently a bit of controversy in the cardiac surgeon world over how best to do coronary bypass surgery:
Each year, 300,000 Americans have bypass surgery to improve blood flow to their hearts. Most of the operations succeed. But a minority of patients leave the hospital confused or forgetful, unable to think clearly or unable to concentrate.
"Pumpheads," some doctors privately call those patients, and the information shows that a third or more may be affected. As the term implies, doctors attributed the problems to the pump, the heart-lung machine that takes over during surgery when doctors literally stop a heart from beating so that they can repair its blocked vessels.
Doctors theorize that something about the pump — little fat fragments or tiny clots that may be thrown into the blood or maybe blood pressure levels in the brain that are too high or too low — may be causing damage.
Doctors also thought they had a solution to the problem, avoiding the pump altogether with surgical tours de force in which they actually operate on a slippery blood-coated beating heart.
The older, more established method of doing coronary bypass surgery involves stopping the beating heart and rerouting the blood through a heart-lungmachine. The pump serves not only as a pump, but as a lung, filtering out the carbon dioxide from the blood and adding oxygen before returning it to the body. The newer method keeps the heart beating throughout the operation, but it does require some machinery of its own. (A detailed comparison can be found here.)
In theory, the newer method should be less traumatic to the heart. The heart doesn’t have to be jump-started at the end of the surgery since it’s never been stopped. And, the blood is kept in the safer environment of the body rather than being filtered through a man-made machine. But, theory doesn’t always translate well into real life, and some surgeons have found the new method less beneficial than they expected:
Dr. Felix Hernandez Jr. of the Eastern Maine Medical Center in Bangor said he had the ability to learn off-pump surgery and took the time to do so. Soon, he said, he was using it for 90 percent of his bypasses.
Then he began to have second thoughts. Small studies were inconclusive on the whole, he said. But a study from Johns Hopkins raised questions about whether the problem should be called pumphead or atherosclerosis-head.
That study, by Dr. William A. Baumgartner, chief of cardiac surgery at Hopkins, and his colleagues compared 140 patients who had standard bypasses with heart-lung machines to 92 closely matched patients who had severe heart disease but no operations.
All had detailed neuropsychiatric assessments at the start of the study, before any patients had their operations, and three months after the surgery and again a year later.
Patients in each group declined in their mental abilities, Dr. Baumgartner found. But there was no difference in the rate or extent of decline in those who had the surgery as compared to those who did not.
Most likely, he said, the declines stemmed from aging and chronic diseases like diabetes and high blood pressure and the effects of blocked blood vessels that supply the heart and brain.
The article implies that the off-pump method is being used as a marketing tool. That might be true at some centers. Few CEO’s can resist the urge to brag that their hospitals are providing state-of-the-art, cutting edge medical care. But, overall, the method used probably depends on which method the surgeon is most comfortable with. The few studies that have been done suggest the two methods are equivocal. Open heart surgery is an inherently risky surgery. It requires prolonged anesthesia, and it involves opening the chest cavity, a cavity that is designed to work as a vacuum. It isn’t all that surprising that people with known atherosclerotic arteries will have some small neurological changes afterwards. Atherosclerosis doesn’t limit itself to the heart. If the arteries in the heart are bad, you can bet the ones in the brain and elsewhere are, too. And it only takes a small insult in the brain to cause noticeable problems.
If faced with the need for coronary bypass surgery, the method is probably the least important consideration. Far more important is the skill of the surgeon and the experience of his support staff. posted by Sydney on
5/14/2003 08:12:00 AM
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"People have been frying foods since Jesus was on this planet, and there is always going to be greasy, fried, salty, sugary food. It is up to the individual to walk in and say, I don't want those fries today. I have 40 pounds to lose. It is not the fault of the fast food people, and anyone who's trying to sue the fast food places needs a therapist, not an attorney. You have to make your own decisions. That's what the freedom in America is all about
Prior Emerging Infections: The history of HIV-2, a version of HIV that’s more common in Africa than in the United States, and which appears to be less virulent, is becoming better understood:
An international team of researchers studying the genetic code of two subtypes of HIV-2 reported that one type first entered the human population before 1940 and the other before 1945...
...A previous analysis of the evolutionary tree of HIV-1 indicated it moved into humans around 1930.
Government Knows Best: The British are planning to fluoridate their water:
Ministers are planning to allow fluoride to be added to all drinking water in England and Wales it is being reported.
The move is being considered to help reduce tooth decay among children in "deprived" areas, according to The Sunday Times.
Such a measure would prove controversial as critics fear fluoride could be linked to increased risks of cancer, hip fractures, kidney trouble and birth defects.
But the government has previously insisted there is no evidence to support claims of health risks from adding chemicals to drinking water.
Fluoride has been added to the water in the U.S. since 1945, yet there haven't been any documented cases of poisonings from drinking the water. Most fluoride poisonings have been the result of rodenticide and pesticide ingestion. What's more, flouride, like other elements, is ubiquitous. We can't escape exposure to it. And, in the right dose it's therapeutic, not toxic:
Observational studies by Dean and colleagues during the 1930s identified reductions in dental caries at a naturally occurring fluoride concentration of 1 mg per L. This level of fluoride resulted in a decrease in the prevalence of dental caries, without objectionable levels of dental fluorosis, prompting the adoption of this concentration as an optimal level. In 1993, the National Research Council concluded that there was not sufficient evidence to support changing the upper limit of 1.2 ppm of fluoride in drinking water. More recently, the U.S. Public Health Service reviewed this drinking water standard and reaffirmed optimal levels of 0.7 to 1.2 ppm fluoride (dependent on annual average of maximum daily air temperatures) to yield an average of 1 mg per day of consumed fluoride.6 Where the fluoride content of drinking water is naturally increased, the Environmental Protection Agency (EPA) recommends reductions to a level of 2.0 ppm. Water sources with fluoride levels of zero to 0.3 ppm are considered to be nonfluoridated.
Dosage is everything. And judging from the English actors I've seen on television, the nation could benefit from a good dose of flouride. But, the argument that opponents in Britain are making is a compelling one. What gives the government the right to medicate people without their permission? posted by Sydney on
5/13/2003 07:15:00 AM
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SARS has stumped scientists and public health experts the world over, but not, apparently, the Leaflady.
Her Web site is one of more than 40 that are receiving warnings from U.S. and Canadian officials for touting bogus SARS remedies like personal air purifiers and oregano oil.
Well, I'm safe. The oregano in my garden is growing gangbusters.
But this story, forwarded by a reader, is discouraging. Looks like we aren't doing a very good job of screening people returning from Asia.
On a more encouraging note, the private market has been remarkably responsive, and quick, in developing a diagnostic test for the virus:
The UN health agency has been surprised by private industry's rapid response for diagnostic tests, McNab said.
"Several companies have given us free diagnostic kits for testing. Most are based on the same principles, so the trick is sorting them all out and seeing which ones really work.
"Diagnostics for SARS have come very far, very fast," she said, "especially when compared to other emerging diseases."
Food safety expert Dr. Lester Crawford, deputy commissioner of the Food and Drug Administration, said that a direct diagnostic test for SARS is being developed and in the final stages leading to FDA approval.
"There is a test available now that basically rules out everything except the coronavirus believed responsible for SARS," he said. "But this new test will be for the coronavirus itself." posted by Sydney on
5/13/2003 07:11:00 AM
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Bagged: The notorious Dr. Germ has surrendered. Among her accomplishments:
Documents seized by United Nations weapons inspectors after the 1991 Gulf war provide a chilling picture of the thoroughness and dedication of her work. In exhaustive reports packed with data, Dr Taha described the successful test-firing of 122mm missiles armed with anthrax-laden warheads into fields full of animals, concluding at one point: "Eighty per cent of the experimental animals have perished."
In the late 1980s Dr Taha's weapons were allegedly tested on human beings, first on prisoners taken during the Iran-Iraq War, who were tied to poles in the desert and sprayed with a variety of lethal agents, and later on political detainees at the notorious Abu Ghraib prison in Baghdad.
What kind of a person devotes her life to this sort of work?
One Unscom member who questioned her in the mid-1990s said that she began to cry and wail when put under pressure. “She was great on theatrics,” he said. “None of us liked her. We could find no redeeming features about her.”
Preparedness: The lack of volunteers for smallpox vaccination means that if there is a bioterror attack, we'll all be playing catch up:
For many jurisdictions, that has meant a greater emphasis on preparing to vaccinate workers in the days after an outbreak begins, further complicating what already would probably be a chaotic, perhaps even panic-ridden, environment.
And because the vaccine can cause so many adverse effects, some officials are worried that those health care workers who wait to be inoculated until after an outbreak starts might not be available when they are needed most.
"We can't afford to have staff on sick leave as a result of minor reactions to the smallpox vaccine," said Frances Phillips, the Anne Arundel County health officer. "We need to have some level of capability right now."
Some officials take solace in the fact that people exposed to smallpox can take the vaccine up to four days later and be safe.
But Lucey said that "assumes you know when you were exposed, which is a big assumption. Some people are putting a lot of faith in that time frame."
An outbreak, he said, is like "a ticking clock. The sand is going down the hourglass, and every hour counts."
Underwater Anthrax: The FBI thinks they've found a lead in the anthrax investigation:
The FBI has developed a new theory on a central mystery of the 2001 anthrax attacks after finding evidence in a Frederick, Md., pond that may suggest how an ingenious criminal could have packed deadly anthrax spores into envelopes without killing or sickening himself, according to sources close to the investigation.
A piece of equipment and other evidence recovered this winter from ice-covered ponds in Frederick Municipal Forest have reinvigorated the 18-month-old case, leading officials to explore a novel theory with shades of science fiction. Some involved in the case believe that the killer may have waded into shallow water to delicately manipulate anthrax bacteria into envelopes, working within a partly submerged airtight chamber. When finished, the killer could have easily hidden the evidence by simply dumping contaminated equipment and clothing into the pond.
...Two sources familiar with the items recovered from the pond described a clear box, with holes that could accommodate gloves to protect the user as he worked. Also recovered were vials wrapped in plastic.
Not everyone involved in the case subscribes to the theory. Some believe that the killer could have completed the task on land and simply dumped materials into the pond to avoid detection.
That would explain why they never found any traces of anthrax in their investigations.
posted by Sydney on
5/12/2003 07:43:00 AM
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Trust Me, I'm a Doctor: People in one area of Ohio are blaming hog farms for their health problems of unknown etiology. Why? Because a local doctor told them so:
Robert Thornell says that five years ago an invisible swirling poison invaded his family farm and the house he had built with his hands. It robbed him of his memory, his balance and his ability to work. It left him with mood swings, a stutter and fistfuls of pills. He went from doctor to doctor, unable to understand what was happening to him.
The 14th doctor finally said he knew the source of the maladies: cesspools the size of football fields belonging to the industrial hog farm a half-mile from the Thornell home.
"I never related it to the hogs at all," said Mr. Thornell, who is now 55.
Clearly, something has gone wrong with Mr. Thornell neurologically. And believe me, there’s no worse smell in the world than hog manure. But whether or not hog manure vapors cause neurological problems is open to debate, despite what the doctor says:
Dr. Kilburn, who runs a business diagnosing neurological disorders, said that over the last three years he had seen about 50 patients, including Mr. Thornell and his wife, Diane, who had suffered neurological damage he judged to be a result of hydrogen sulfide poisoning from industrial farms. The Thornells are considering a lawsuit based on his work.
"The coincidence of people showing a pattern of impairment and being exposed to hydrogen sulfide arising from lagoons where hog manure is stored and then sprayed on fields or sprayed into the air" makes a connection "practically undeniable," Dr. Kilburn said in an interview.
There are some other factors the doctor may not be considering. The location of the wells these families use, for example. Farmers sometimes have their wells smack dab in the middle of a corn or soybean field, which makes their drinking water vulnerable to run-off of the nitrates and pesticides they use on their crops. Also, collecting sick people from around the country who happen to live down the road from a hog farm isn’t compelling evidence for causation. Now, if everyone (or at least a substantial majority) within a certain radius of a hog farm suffered the same sorts of health problems, that would be a hog of a different color. posted by Sydney on
5/12/2003 07:23:00 AM
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Sunday, May 11, 2003
Suffer the Children: The weeks leading up to Mother’s Day in our town have been predominated by news stories about this family. I’m sure that every community has stories like this that pop up now and then, and they’re always followed by cries of “why didn’t someone do something?”
In this particular case one of the children’s father and stepmother tried to do something, but they were accused of making false reports :
The order, signed by Magistrate Deborah Matz, said that Brady Postlethwaite and his wife had ``previously established a pattern of false reporting'' and that ``such reports are subject to criminal prosecution.''
....Lisa Postlethwaite, her voice cracking with emotion, said: ``We couldn't continue fighting. They threatened to put us in jail. They threatened to take away our other children. What could we do?''
There was a famous case in New York about ten or twelve years ago that made state legislature’s across the nation take note and force people to do something.
Although school teachers can be jailed or sued for failing to report even their suspicion of child abuse, the Ohio legislature never made failing to investigate that same report a crime. That means CSB workers generally can't be sued, the Ohio Supreme Court ruled.
The lawyer in that last link is trying to make it possible to sue child protection agencies when they fail to protect children. But, the problem lies in the first part of the equation. Doctors, school teachers, and daycare providers face stiff penalties if they fail to report suspected child abuse, and people who know this often use it as a weapon in custody disputes. That way, they avoid being accused of filing false accusations themselves. At least, that’s been my experience.
I’ve thankfully only had to report a few cases of suspected abuse (five or six in the past ten years) but only in one case did I suspect true abuse. The others were cases in which a parent brought a child in to be examined for signs of physical abuse - abuse that the child couldn’t describe. And, even though in my heart I know these parents were abusing the system, I still felt compelled to report each case on the remote chance that I might be wrong. One woman was in the habit of doing this on a weekly basis until I finally told her I didn’t believe her. My latest case was a woman who once looked me straight in the face and lied about her cocaine use, even as I held a positive urine screen in my hand. (She said someone must have put it in her fruit juice.) She did a fine job of making sure her child’s father would get investigated. Not only did she come to my office with an allegation and a silent child, but she went to her daughter’s school and asked the teacher to look for signs of abuse, too, thus insuring that two people would be calling the authorities. I never found any signs of injury on the child to substantiate the mother’s claims, but at the end of our encounter the mother asked me if I would be reporting the case to the authorities. Her response to my affirmative answer was cruel little smile.
The upshot is that the social agencies charged with investigating these things get such a barrage of illegitimate reports that they have a hard time investigating them all:
``You have to weed out what's really a salient case,'' he said. ``Nationally, the statistics show that about 20 percent of those cases are bona fide. But you still can't discount totally that other 80 percent. It's got to be in some way examined and looked at beyond just a telephone call.''
Unless people think it’s worth spending enormous sums to investigate bogus claims, a good first step would be to repeal mandatory reporting laws and let teachers and physicians use their judgement in reporting abuse cases. Then, the child protection agencies could actually protect children rather than being used as a weapon between warring parents. posted by Sydney on
5/11/2003 06:37:00 PM
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Readers on SARS: Thought I’d share some reader’s thoughts on SARS:
If you have had SARS once, are you immune after? I suppose that there is no evidence... so what about animal and analogy-to-colds prediction? I've not seen anything about this anywhere. If one does not become immune, then a population could be really reduced in a few years.
No one knows yet if immunity develops and lasts. We don’t become immune to colds because: 1) They’re caused by many different viruses, and 2) the viruses involved are capable of changing so much. Influenza mutates a lot, too, but we’ve gotten around that by making new vaccines each year to correspond with the flu strain of the year. The strains of influenza making people sick around the world are tracked, and those most likely to cause problems in each hemisphere are selected for vaccine production. (warning: pdf file) It isn’t clear if the same sort of thing could be done for SARS, because much about its mechanism of action and mutability remains unclear.
Another reader points out, rightly, the economics behind the lack of cold vaccines:
It's true that we don't have a vaccine or treatment for the cold yet, and part of that is because coronaviruses (coronavirii?) are tricky beasts, which is bad news for a potential SARS vaccine, but a lot if the reason is that colds just aren't that big of a deal. There's no point in taking a drug to stop sniffling and sneezing one day sooner if it gives you violent nausea, irritability, and a disgusting rash over 50% of your body while you're on it. As a hypothetical example, of course. Such a drug would probably be acceptable if it cut your chance of dying in the next month from 20% down to 1%.
On a more mercenary note, no one is going to spend $100 for a pill that's only marginally better than a 40 cent over the counter symptom-treater, and drug companies know this and so aren't spending billions on cold remedies. Of course, you also aren't going to spend $100 on a pill if you live in the god-forsaken backwaters of communist China, which appears to be the main place you get SARS these days, so this might be a bit of a wash. posted by Sydney on
5/11/2003 11:27:00 AM
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Witch Hunts: Nicholas Kristof of the New York Times says that HIV researchers are victims of a Republican witch hunt:
Most AIDS scientists are terrified these days. They describe witch hunts by neo-Puritans in and out of the Bush administration, and many are so nervous that in e-mail and research abstracts they avoid using words like "gays," "homosexuals," "anal sex" or "sex workers."
So scientists at the National Institutes of Health and elsewhere are devising their own secret code. I won't give it away, but one term stands for "gay" or "homosexual," another for "anal sex" and so on.
Bloggers Charles Murtaugh (here, too.) and Yuri Guri have covered this before. (Unforunately, Yuri’s permalinks aren’t working. Scroll down to May 1. It’s the very last post on his page, or at least it was as of today at 10:30 EST) It seems that there’s a congressional staffer whose making this his own personal campaign. But, surely, it’s the scientists who are guilty of hysteria:
"I would recommend avoiding all electronic communication to any N.I.H. office," one scientist warned in one of many e-mail notes buzzing among AIDS researchers. "Phone communication does not appear tapped at this time. Even so, I am advising staff to speak `in code' unless an N.I.H. staff member indicates you can speak freely. In short, assume you are living in Stalinist Russia when communicating with the United States government."
Those are words written in anger, not ones that have been given any sort of rational thought. They’re the sort of words you see on doctor email lists when physicians are venting about the new patient privacy laws, or malpractice reform, or Medicare reimbursement. They certainly aren’t the kind of words that should be given to the New York Times and distributed to the entire nation. They make the scientists look, well, like whiney teenagers.
But even Kristof understands what's really going on here:
Some of the upheaval in the research community may be a paranoid overreaction among scientists, who tend to be liberal and secular.
....One reason for the new strategy is that conservatives have had fits about past community outreach efforts. A recent letter from a Congressional subcommittee thundered about the use of federal money to finance "great sex workshops, pointers on where to have anonymous sex in public places, masturbation instructions, `fisting' forums and tips of how to negotiate sex with prostitutes."
Hmm. Defenders say that many at-risk men don't attend meetings on safe sex, so the only way to save their lives is to lure them to picnics or, yes, sex workshops. Still, the efficacy is unclear, and most Americans are unlikely to regard tax dollars as well spent when used to finance gay sex workshops.
So, what kind of "science" is being targeted by conservatives, or at least one zealous Congressional staffer? Not, apparently, the sort of science that involves searching for better HIV drugs or a vaccine, but the softer science that look at things like community workshops and other social interventions. That is, "social science," which many would say isn't a science at all. posted by Sydney on
5/11/2003 10:39:00 AM
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