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“...there is no such thing as objective journalism. The phrase itself is a pompous contradiction of terms.” – Dr. Hunter S. Thompson.
Whether we admit it or not all journalism is fraught with opinion. A friend recently forwarded an article from the Post which she thought might make good material for the blog. She was right, it was a really interesting stuff – the kind of stuff I should have been able to sink my teeth into. Should have, but couldn’t. I was unsure of my opinion, I couldn’t find my stand. It turns out that without some sort of subjective stance I have no article to write, therefore proving Dr. Thompson’s quote, which I used to open this blog, particularly relevant.
Rather than allowing the dilatory pace of my own ethical compass to delay sharing the article any longer I decided I would just post it. These are complicated issues that we as a society are going to have to deal with. They are not going away. Read about it. Think about it. Talk about it.
Life in Henry's wake
Saturday, March 27, 2010
Sunday, March 21, 2010
The vaccine question
Imagine if a cure was discovered that would prevent all HIV related deaths. How much impact do you think that would have?
Let’s think even bigger: Imagine if a treatment was discovered which could prevent all deaths from stroke. According to the World Health Organization approximately 5.5 million people die from stroke every year (550 million deaths every one hundred years).
The estimated death count from smallpox in the 20th century ranges between 300-500 million people (1 out of every 7 children in Russia). Since the world population was smaller at the time, smallpox was a bigger killer in the 20th century than stroke is in our current generation. Three hundred million people - roughly the current population of the United States, about 10 times more people than have died from AIDS, 10 times more than died during world war 1 and about 100,000 times as many deaths as attributed to the 911 attack. Only about 1 in 4 are people who contract small pox die from the disease, so the 300–500 million estimate does not include the many survivors were scarred or blinded by the disease. What happened to small pox?
In 1798 Edward Jenner demonstrated that inoculation with cowpox could protect against smallpox initiating the use of vaccination. By the 1950s it was estimated that the infection had decreased to about 50 million cases of smallpox world-wide per year and intense vaccination efforts led to eradication of the disease with the last natural case of small pox documented in Somalia in 1977.
This is probably one of the greatest achievements of medical science to date.
Since the 1930’s Thiomersal, which is a mercury-containing compound, has been used in some vaccines to prevent bacterial and fungal growth. Questions have arisen as to whether the mercury contained in the vaccine preservative could cause health problems, particularly whether it is associated with an increase in autism.
The Lancet, a leading medical journal, published an article written in 1998 by a Dr. Andrew Wakefield suggesting that autism was linked to children receiving mercury containing measles-mumps-rubella vaccine. Despite this study being based on only 12 children (11 males and 1 female) and scientific evidence to the contrary, Britain's child vaccination rates consequently fell by 20% after the study came out and the UK and America has had waves of measles outbreaks. In 1998, the year the study came out, England and Wales had 56 cases of measles; by 2008 the number was 1,370. In 2007, a large outbreak of mumps was set off in Canada after the virus was purportedly imported from the United Kingdom.
It has been discovered that Dr. Wakefield had been paid to conduct his study on children who were clients of a lawyer preparing to initiate a lawsuit. The General Medical Council recently concluded, after a lengthy investigation into Wakefield’s study, that it was fraught with financial and scientific conflicts of interest. The medical community, including 10 of the 13 authors of the original paper, have rejected the validity of the findings years ago. Little to no scientific evidence supports the study’s findings, and subsequent studies have refuted its claims. In February of this year the Lancet officially retracted the paper, something it doesn’t do lightly and an act which officially invalidates the study.
Controversy on both sides of the debate
Shortly after the Lancet’s retraction a scandal was brought to light form the other side of the table. Poul Thorsen, a researcher who was on two important publications discrediting the link between mercury containing preservatives and autism, is allegedly being investigated for potentially forging documents in order to misappropriate 2 million dollars of grant funding.
Dr. Thorsen was not the lead author or involved in collecting the data and the coauthors of the two studies maintain validity of the research. Federal authorities are investigating.
This has not prevented writers from attacking any scientific work connected to Dr. Thorsen, particularly Robert Kennedy Jr, an active spokesperson for the autism-Thiomersal link .
There is reason for concern and our attention
Dr. Arnold Relman, editor of the New England Journal of Medicine from 1977 to 1991 claims that, “The commercialization of medicine poses the greatest threat to U.S. health care,” and that “From my experience and perspective, it’s clear that fraudulent, unethical behavior is a more common problem than it used to be.”
Can vaccines be made thiomersal free?
So to summarize, vaccination is scientifically proven improve our bodies immune response and increase our chances of immunity. Yet, the problem is the use of questionable preservatives in the vaccine, and whether they are harmful. Can the vaccines be produced without Thiomersal?
The short answer is yes. Thiomersal use as a preservative was phased out of Canadian vaccines. It is sometimes used in the production of the vaccine, but is later filtered out. The degree to which some trace elements are left in the vaccine is still a point of contention, and it is possible to make the vaccines without the use of Thiomersal at all.
Mercury free MMR vaccines are available and are produced, but have an increased cost of administration, which limits their availability in the developing nations where cost is a factor. Even though the link has been officially discredited, most of the remaining Thiomersal vaccines are now headed for poorer developing nations.
Relevant Links:
http://www.avert.org/worldstats.htm
http://news.medill.northwestern.edu/chicago/news.aspx?id=156969
http://online.wsj.com/article/SB10001424052748704022804575041544115791952.html
http://www.who.int/vaccine_safety/topics/thiomersal/questions/en/index.html
http://www.who.int/cardiovascular_diseases/resources/atlas/en/
http://www.who.int/cardiovascular_diseases/en/cvd_atlas_14_deathHD.pdf
http://www.cbc.ca/health/story/2010/02/02/autism-mmr-lancet-Wakefield.html#ixzz0ioueLfic
http://www.theglobeandmail.com/life/article972665.ece
Let’s think even bigger: Imagine if a treatment was discovered which could prevent all deaths from stroke. According to the World Health Organization approximately 5.5 million people die from stroke every year (550 million deaths every one hundred years).
The estimated death count from smallpox in the 20th century ranges between 300-500 million people (1 out of every 7 children in Russia). Since the world population was smaller at the time, smallpox was a bigger killer in the 20th century than stroke is in our current generation. Three hundred million people - roughly the current population of the United States, about 10 times more people than have died from AIDS, 10 times more than died during world war 1 and about 100,000 times as many deaths as attributed to the 911 attack. Only about 1 in 4 are people who contract small pox die from the disease, so the 300–500 million estimate does not include the many survivors were scarred or blinded by the disease. What happened to small pox?
In 1798 Edward Jenner demonstrated that inoculation with cowpox could protect against smallpox initiating the use of vaccination. By the 1950s it was estimated that the infection had decreased to about 50 million cases of smallpox world-wide per year and intense vaccination efforts led to eradication of the disease with the last natural case of small pox documented in Somalia in 1977.
This is probably one of the greatest achievements of medical science to date.
Since the 1930’s Thiomersal, which is a mercury-containing compound, has been used in some vaccines to prevent bacterial and fungal growth. Questions have arisen as to whether the mercury contained in the vaccine preservative could cause health problems, particularly whether it is associated with an increase in autism.
The Lancet, a leading medical journal, published an article written in 1998 by a Dr. Andrew Wakefield suggesting that autism was linked to children receiving mercury containing measles-mumps-rubella vaccine. Despite this study being based on only 12 children (11 males and 1 female) and scientific evidence to the contrary, Britain's child vaccination rates consequently fell by 20% after the study came out and the UK and America has had waves of measles outbreaks. In 1998, the year the study came out, England and Wales had 56 cases of measles; by 2008 the number was 1,370. In 2007, a large outbreak of mumps was set off in Canada after the virus was purportedly imported from the United Kingdom.
It has been discovered that Dr. Wakefield had been paid to conduct his study on children who were clients of a lawyer preparing to initiate a lawsuit. The General Medical Council recently concluded, after a lengthy investigation into Wakefield’s study, that it was fraught with financial and scientific conflicts of interest. The medical community, including 10 of the 13 authors of the original paper, have rejected the validity of the findings years ago. Little to no scientific evidence supports the study’s findings, and subsequent studies have refuted its claims. In February of this year the Lancet officially retracted the paper, something it doesn’t do lightly and an act which officially invalidates the study.
Controversy on both sides of the debate
Shortly after the Lancet’s retraction a scandal was brought to light form the other side of the table. Poul Thorsen, a researcher who was on two important publications discrediting the link between mercury containing preservatives and autism, is allegedly being investigated for potentially forging documents in order to misappropriate 2 million dollars of grant funding.
Dr. Thorsen was not the lead author or involved in collecting the data and the coauthors of the two studies maintain validity of the research. Federal authorities are investigating.
This has not prevented writers from attacking any scientific work connected to Dr. Thorsen, particularly Robert Kennedy Jr, an active spokesperson for the autism-Thiomersal link .
There is reason for concern and our attention
Dr. Arnold Relman, editor of the New England Journal of Medicine from 1977 to 1991 claims that, “The commercialization of medicine poses the greatest threat to U.S. health care,” and that “From my experience and perspective, it’s clear that fraudulent, unethical behavior is a more common problem than it used to be.”
Can vaccines be made thiomersal free?
So to summarize, vaccination is scientifically proven improve our bodies immune response and increase our chances of immunity. Yet, the problem is the use of questionable preservatives in the vaccine, and whether they are harmful. Can the vaccines be produced without Thiomersal?
The short answer is yes. Thiomersal use as a preservative was phased out of Canadian vaccines. It is sometimes used in the production of the vaccine, but is later filtered out. The degree to which some trace elements are left in the vaccine is still a point of contention, and it is possible to make the vaccines without the use of Thiomersal at all.
Mercury free MMR vaccines are available and are produced, but have an increased cost of administration, which limits their availability in the developing nations where cost is a factor. Even though the link has been officially discredited, most of the remaining Thiomersal vaccines are now headed for poorer developing nations.
Relevant Links:
http://www.avert.org/worldstats.htm
http://news.medill.northwestern.edu/chicago/news.aspx?id=156969
http://online.wsj.com/article/SB10001424052748704022804575041544115791952.html
http://www.who.int/vaccine_safety/topics/thiomersal/questions/en/index.html
http://www.who.int/cardiovascular_diseases/resources/atlas/en/
http://www.who.int/cardiovascular_diseases/en/cvd_atlas_14_deathHD.pdf
http://www.cbc.ca/health/story/2010/02/02/autism-mmr-lancet-Wakefield.html#ixzz0ioueLfic
http://www.theglobeandmail.com/life/article972665.ece
Tuesday, March 9, 2010
Monday, March 8, 2010
The placebo effect
Scholars don't agree on how it is pronounced, or how it works - but for those who look into it, most agree that it is amazing.
One of my favorite podcasts does a much better job of discussing the placebo than I could do,
check it out here:
One of my favorite podcasts does a much better job of discussing the placebo than I could do,
check it out here:
Tuesday, March 2, 2010
Antidepressants: Myth or Miracle
I lost a close relative to suicide at the end of 2009. This was a very personal reminder of the importance of treating depression. Clinical depression can be a fatal.
I recently came down pretty hard on the lack of evidence for homeopathy treatments. To be fair we need to apply a similar sort of rigor to the question of antidepressant therapy. A recent article in Scientific American is entitled “Antidepressants: Do They 'Work' or Don't They?” highlights some important points.
In January the Journal of the American Medical Association (JAMA) published a paper which questioned the usefulness of antidepressants in patients with mild or moderate depression. Importantly, it did confirm that, “For patients with very severe depression, the benefit of medications over placebo is substantial.”
Lets me be clear about the issues at hand.
Unlike homeopathy treatments, anti-depressants must pass through a rigorous (and expensive) set of tests to demonstrate that they display ‘efficacy’. This means that clinical trials (or experiments) are performed where patients are assigned to receive either drug or a ‘sugar pill’ without either the doctor or the patient knowing which is being administered. After the results of treatment are recorded researchers go back and examine the effects produced by the drug relative to the sugar pill. Anti-depressants which make it to market must perform better than the sugar pill (the placebo).
The difference between treatment and sugar pill can be very small at times - but even a small difference can translate into a strong change for the patient since the effect of the placebo itself is very strong. Patients taking just a sugar pill improve about 75% as much as patients taking actual antidepressents (on average). This is why treatments like homeopathy, that haven’t passed rigorous testing, can appear to work – the patient simply believing it will work can have an extremely powerful effect.
To sell treatments that have no real medicinal value while treatments that do have actual medical value exist is unethical at best, and can distract patients from seeking legitimate treatment. Medicine has come a long way from the days where charlatans could make a living selling tonics to treat sickness with no proof that they work. We need to embrace this progress, not fight it.
So what the recent JAMA article concluded makes a lot of sense – the effect of antidepressants is strongest on people who have the most severe depression. Currently the best method we have for quantifying depression is Hamilton Rating Scale for Depression, but as we improve technologies, such as genetic testing and medical imaging, we may provide more accurate methods for both assessing depression and predicting which drug will work best for which patient. The application of personalized medicine will likely improve the treatment of complex syndromes such as depression.
So in the end do anti-depressants work? The answer is sometimes. Do we fully understand how they work or how to predict when they will work? No.
Much more work is needed, but we must remember that in cases of severe depression no treatment, or ineffective treatment can be fatal. We should be proud of the people who have the courage to tackle this problem with the scientific rigor that is required and discourage those who are looking to make money by selling false hopes and unproven therapies.
I recently came down pretty hard on the lack of evidence for homeopathy treatments. To be fair we need to apply a similar sort of rigor to the question of antidepressant therapy. A recent article in Scientific American is entitled “Antidepressants: Do They 'Work' or Don't They?” highlights some important points.
In January the Journal of the American Medical Association (JAMA) published a paper which questioned the usefulness of antidepressants in patients with mild or moderate depression. Importantly, it did confirm that, “For patients with very severe depression, the benefit of medications over placebo is substantial.”
Lets me be clear about the issues at hand.
Unlike homeopathy treatments, anti-depressants must pass through a rigorous (and expensive) set of tests to demonstrate that they display ‘efficacy’. This means that clinical trials (or experiments) are performed where patients are assigned to receive either drug or a ‘sugar pill’ without either the doctor or the patient knowing which is being administered. After the results of treatment are recorded researchers go back and examine the effects produced by the drug relative to the sugar pill. Anti-depressants which make it to market must perform better than the sugar pill (the placebo).
The difference between treatment and sugar pill can be very small at times - but even a small difference can translate into a strong change for the patient since the effect of the placebo itself is very strong. Patients taking just a sugar pill improve about 75% as much as patients taking actual antidepressents (on average). This is why treatments like homeopathy, that haven’t passed rigorous testing, can appear to work – the patient simply believing it will work can have an extremely powerful effect.
To sell treatments that have no real medicinal value while treatments that do have actual medical value exist is unethical at best, and can distract patients from seeking legitimate treatment. Medicine has come a long way from the days where charlatans could make a living selling tonics to treat sickness with no proof that they work. We need to embrace this progress, not fight it.
So what the recent JAMA article concluded makes a lot of sense – the effect of antidepressants is strongest on people who have the most severe depression. Currently the best method we have for quantifying depression is Hamilton Rating Scale for Depression, but as we improve technologies, such as genetic testing and medical imaging, we may provide more accurate methods for both assessing depression and predicting which drug will work best for which patient. The application of personalized medicine will likely improve the treatment of complex syndromes such as depression.
So in the end do anti-depressants work? The answer is sometimes. Do we fully understand how they work or how to predict when they will work? No.
Much more work is needed, but we must remember that in cases of severe depression no treatment, or ineffective treatment can be fatal. We should be proud of the people who have the courage to tackle this problem with the scientific rigor that is required and discourage those who are looking to make money by selling false hopes and unproven therapies.
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