Denialism pure and simple (UPDATED)

When I was in college, I took a course on military science. This course talked about the scientific discoveries we have made through war. By trying to kill each other off in a simpler manner, we’ve discovered a lot, from a scientific point of view. During that course, we spent about three weeks focuses completely on the Nazi medical experiments. If you haven’t heard the story, I invite you to go to the Holocaust Museum in DC and take a look at their exhibits. In essence, Nazi medical “researchers” conducted unethical experiments on humans (concentration camp prisoners, prisoners of war, etc.). We discussed for three or four classes whether or not we — the then future scientists — should use any of the knowledge gained from those experiments in order to expand science.

I won’t bore you with the philosophical and ethical discussions that erupted then. No, I will entertain you with the story of the one guy in class who decided that he was going debunk the “myth” of the Holocaust. Actually, it’s a short story; he was kicked out of class at the discretion of the professor. The guy actually wanted to argue with our professor, a Holocaust survivor.

I laughed out loud. That fool of a student.

But it does lead to an interesting question: How do you know what is true to be the truth? How do we know that the Holocaust really did happen? What evidence for and against can we believe?

Of course, this is a non-starter for many people who are reasonable and understand the concepts of historical evidence. There were thousands upon thousands of first-hand accounts of what happened in Nazi-occupied Europe. There are movies and records kept by the Nazis themselves. There are movies and documents from Allied Forces that liberated the concentration camps. In short, the Holocaust happened. There is no doubt about it.

Yet there are those who walk on this earth and deny that the Holocaust happened. Whether or not they believe that it happened is between them and their god. They go around telling everyone they can that it didn’t happen, that’s is a Jewish conspiracy, or that the Holocaust is a misrepresentation of what really happened. (I’m sure it was nothing but kittens and puppies in Auschwitz.)

Then there are those Holocaust deniers who also deny that the HIV virus causes AIDS. Even better, some of them deny that HIV even exists. They say that it’s all an attempt from the pharmaceutical industry to bleed the public dry through the sale of laboratory tests and unnecessary drugs. (I guess all of those dead people in Africa and elsewhere died of kitten and puppy overdoses.)

There is a particularly interesting person out there who goes by the moniker of “Putin Reloaded“. PR is interesting because there is no conspiracy theory that he doesn’t like. For example, this is what he has to say about HIV not being the cause for AIDS:

Antibody tests are not valid surrogates of virus detection, for all antibodies are heterophile and promiscuous. 

If you don’t know what those words mean look it up! 

About 30% of people have at least one “hiv” antibody in their blood, that’s how absurd the assumption is: http://www.ncbi.nlm.nih.gov/pubmed/2230270 Frequency of indeterminate western blot tests in healthy adults at low risk for human immunodeficiency virus infection. ” 32% (low risk controls) had indeterminate Western blot tests, most of which demonstrated a single band of lowintensity. The most common bands were p24 (47%), GAG p17 p55 (34%), and POL p31 p66 (36%); envelope bands were unusual (gp41, 2%; gp120, 2%).” Confirmed by: http://elcid.demon.nl/1995_Western_blot_35pc_of_donors_have_1_band_at_least.png Antibodies to Human Immunodeficiency Virus (HIV-1) in Autoimmune Diseases. ” 126 blood donors as a control group…At least one band was shown on immunoblotting in 26% of patients with autoimmune diseases and 35% of controls. ” 

So HIV tests are basically tools to fool perfectly healthy individuals into believing they’re carriers of a deadly virus and put them on deadly drugs. A self-fulfilled prophecy.

Oh, really? When PR is confronted with questions about PCR and viral cultures being used to confirm antibody tests, he gets really defensive and claims that one is personally attacking him.

PR is also into Holocaust denial, as I stated before:

“Recall that the Holocaust is an unfalsifiable theory, ie, it is impossible to refute because it is expressly prohibited by law in many European countries. Therefore, the Jewish Holocaust is not a historical fact but a legend that it takes an act of faith to believe.”

(Thanks to Pedro [not her real name] for the translation.)

So why am I writing about PR?

I’m writing about PR because he is exactly the kind of person that needs to be countered at all possible opportunities. In your private life (e.g. at work, in your family) and in your public life (e.g. out with friends) you must counter the ramblings of people who deny historical facts and scientific evidence. I’d advice you to be gentle and respectful, but you know me better than that by now.

To the AIDS denier, you must explain to anyone within earshot of that AIDS denier that we know that HIV causes AIDS because the grand majority of people who are infected with HIV go on to develop AIDS if they are not treated. They also go on to die. We know that the grand majority of people with AIDS have HIV infection. We know that the virus multiplies inside of immune cells, thus killing the immune system and allowing for opportunistic infections. Plenty of us have held the hand of a dying AIDS patient. Are there infected people who do not develop AIDS? Yes. Are there people who develop AIDS but were not infected with HIV? Yes. AIDS is a collection of diseases and conditions, a syndrome. But we see it in people with HIV infection for the most part (almost 100%).

The AIDS denier will try to use rare occurrences as clear evidence of their point. Don’t let them.

Likewise, the Holocaust denier will say that there were no extermination camps in Germany during the Nazi regime. This is true. The extermination camps were outside the country of Germany and in Nazi-occupied Europe. Here’s a map. They will also tell you that Hitler never signed an order to exterminate 6 million Jews and another 6 million “undesirables”. For that, read this.

In other words, stand up to the bigots, the denialists. Tell them and anyone around them why, how, when, and where they are wrong. Be ready to present the evidence, like radioactive decay to young Earth creationists, the physics of water vapor to those who believe that airplanes are dropping chemicals in contrails, or simple epidemiology to those who believe vaccines cause autism. It is important that we do this because they can do a lot of damage with their ideas.

A lot of damage.

**** UPDATE ****

The troll decided to show up in the comments section. Let me make this clear to you, Mr. PR, this is not your blog. This is not your platform to spread more antisemitism, misogyny  and AIDS denialism. Your comments are not accepted, and they will be deleted. (What’s that about misogyny  Mr. PR has told a group of female scientists that women naturally lack initiative and need father figures to guide them and tell them what to do next.)

Advertisements

Movies You Should Watch: "My Own Country"

“My Own Country” (1998) is a movie based on the book by the same name by Dr. Abraham Verghese. It tells the story of Dr. Verghese’s experiences in the South in the beginning days of the HIV/AIDS epidemic. The movie, like the book, is not for people who are still, to this day, close-minded about the origins of the epidemic. They should read the book and watch the movie, yes, but it is presented in such brutal honesty that it will only make them revolt against it even more. People who see this movie and are inspired to see human beings as the frail and fallible beings that we are will also come to see people as capable of unconditional love… Something reserved in literature and history only to the deity of the highest order.


Dr. Verghese was an outsider in the town of Johnson City, Tennessee. Ethiopian by birth and Indian by heritage, the movie makes it clear that he was accepted in the town only because of his education. But race is not the issue with this town, not the way the movie is framed. The issue is this new epidemic that has arrived in the form of young, gay men with AIDS. Men who were otherwise healthy and full of life begin to lose weight at a phenomenal rate, become too weak to go on in life, and eventually succumb to the disease.

The people around these young men are scared to death of what is going on. If you are too young to remember those days — and I’m not — you will see how people truly reacted to HIV and AIDS. They would not touch a person who was infected. They would not hug, kiss, or want to be around an infected person. Even Dr. Verghese’s wife asks him once when he gets home, “Did you wash your hands?” The stigmas and stereotyping are all there, and they are presented without judgment, more as the natural response of society to something that is scaring them to death — sometimes literally.

But it’s not just homosexuals that are seen to be affected in the movie. A heterosexual couple become infected when the husband has sex with men. He is dragged to the hospital by his wife and children and sheepishly admits to having sex with men and women. “I like sex,” he admits. Later, when the wife is told that both she and her sister are also infected, both from the husband, she is seen contemplating suicide. That is what I meant by being scared to death.

Dr. Verghese continues musing about homosexuality and what he is seeing all around him. It is touching because he seems to be trying to rationalize what is going on around him. We all do this. We see such horrors and unspeakable things through the news or in person and we try to tell ourselves that we, humans, are not really that evil. We can’t be. If we were, we would have never progressed as much as we have in this world.

In a post-HIPAA society, it is shocking to see how news of peoples’ diagnoses spreads through town. People are said to stand up in church and “out” their relatives with AIDS. Employees of the hospital are rumored to be spreading diagnoses to people in the community. When you realize that people who were diagnosed with HIV infection, or AIDS, were fired from their jobs, shunned by their families, or worse, you come to understand why it became necessary to have stronger privacy laws.

Somewhat humorous is a scene where a young man we meet earlier in the film has passed away. His sister comes to make sure that his body looks presentable for the funeral. The mortician is asked to put on socks on the body and returns with a silly-looking pair of rubber gloves that are more fitting for an electrician working with a high-tension wire. The sister remarks that the body is “pickled” and that there “is no bug in the world that’s going to survive that”.

We also see something that is still going on to this day: A family overriding the wishes of their dying relative while the relative’s helpless partner looks on. “We have legal authority,” they claim while the partner is brought to tears at the prospect of extending his beloved’s suffering. Without preaching, just by presenting the facts, we see how this is not the best thing for the patient, only for the family.

Threaded throughout the movie are scenes where the audience gets to see that unconditional love I wrote above about. When a gay man embraces his partner, both crying over the diagnosis, a nurse states that she wishes a man loved her like that. That embrace is powerful because people with AIDS at that time were shunned to the point that people did not want to be in the same room with them at times. Handshakes were questioned, and hugs were forbidden. Ignorance and fear, the most virulent contagions, guided people’s responses. Science and reason, the antidotes to these things, were set aside back then as they continue to be ignored today.

Yet there is hope, there is always hope. We see the hope in this young infectious disease doctor who is doing his best to inform the public on what HIV and AIDS are and what they are not. We see the hope in his staff who work with him and start to understand what is going on and what the best course of action is. And we see hope in the family members of those who are stricken with the disease and come to accept their relatives, love them, take care of them until their dying day, and become advocates in the community for those who are shunned and too weak to defend themselves.

If you are an advocate for public health, for social justice, for equality, then this is a great movie for you to see. The book goes into even more detail, of course, but the movie is powerful enough. When you see that the issues of those days are still here today, you can’t help but to want to rise up and fight it, do something about it. And we must.

We must.

Correlation And Causation With Some Plausibility For Good Measure

One of the biggest problems in the battle against diseases is figuring out exactly what thing or things cause a disease. In the late 70’s and early 80’s, men and women – a lot of them being gay – started to come down with opportunistic infections at an accelerated rate. The cause was not known, but epidemiologists did come to realize that those who developed the syndrome – later to be called AIDS – were more likely to be exposed to certain behaviors and sexual preferences. That is, the personal attributes and the disease correlated, but it would be unscientific and wrong to say that one would get AIDS for the sole fact of being gay.

That sure didn’t stop the “moral majority” and others from stigmatizing an entire segment of the population. It wasn’t until HIV was isolated and discovered as the causative agent – and some heterosexual celebrities acquiring the infection – that the term GRID (Gay-Related Immune Deficiency) beam AIDS.

Of course, AIDS is not the only example.


I told you just the other day how nationalities and ethnicities are associated with certain conditions. Lou Dobbs wrongfully claimed that immigrants brought more cases of Hansen’s Disease (Leprosy) to this country than naturally occur. A discussion on recent cases of measles in Milwaukee undoubtedly turned into an immigrant bashing that would have made the most liberal KKK members blush. And God help you if you’re from Africa and trying to donate blood.

All of these examples above are instances of correlation between a disease and a person’s (or people’s) origin. Biologically speaking, it doesn’t matter where you come from. You’re still game to be infected.

But there are other examples were people have wrongly associated two things and then deduced that one caused the other – or vice-versa. For example, two non-scientists writing for an anti-vaccine blog recently published a seven-part story associating arsenic in pesticides with polio. They eyeballed data from the last 120 years and decided that arsenate in pesticides must trigger polio outbreaks because more polio outbreaks have been detected since the use of those pesticides started.

Sounds plausible, don’t it? Well, actually…

We all had a chuckle when a skeptical writer recently said that cases of autism have been on the rise since microwaveable popcorn went into the mass market. If you plot the incidence of autism and the sales of microwaveable popcorn, the lines almost overlap. Again, that’s just “eyeballing” the data without much of a scientific investigation. And that’s where a lot of assumptions about causation go badly.

Even if a study is well-designed and carried out by reputable institutions, there can be mistakes. For example, some time ago, a study was performed to look at the association between coffee and pancreatic cancer. The study concluded – with really good statistical data – that people with pancreatic cancer were more likely to be coffee drinkers. The researchers left it at that and walked away from their study, letting the public decide on whether or not to drink coffee.

Well, astute epidemiologists the world over noticed a funny thing. They noticed that the data never took into account the coffee drinkers’ smoking habits. Once the smokers and non-smokers were placed into different categories, people with pancreatic cancer were more likely to be smokers AND coffee drinkers. People without pancreatic cancer were more likely to be coffee drinkers BUT NOT smokers. Yes, it was the smoking, stupid – or the smoking stupid. The coffee industry took a while to make a comeback after that.

This brings me to biological plausibility of the whole damn thing. In the example of the coffee and cancer, there was no known biological process by which coffee could trigger pancreatic cancer. On the other hand, there was a process by which smoking could trigger pancreatic – and other forms of – cancer. In the example with arsenate in pesticides, there is no known process by which pesticides somehow make the polio virus more virulent – capable of infection – or more pathogenic – capable of causing disease. And, in the case of HIV/AIDS, one could see where certain sexual behaviors could lead to a better transmission of the virus, but there is no evidence whatsoever that one’s sexual predilections – who we’d like to shag – would make any difference to the virus. It will still infect all who are susceptible, meaning the whole of humanity if we’re not careful in how we use contaminated sharps, how we have sex with each other, and how we test blood donors (regardless of their national origin or sexual orientation).

Does the scientific data change and certain once-implausible events become plausible? Absolutely. But they’re far and few in between, and the scientists who once held them to be implausible will correct themselves and admit that there is now evidence of plausibility. And, for God’s sake, don’t just “eyeball” the data. Run through something, anything… Even MS Excel will do in a pinch!

In the case of vaccines and autism, that kind of evidence still has not come forth, despite all sorts of attempts at finding it. In fact, we have been trying to close the book on the vaccine-autism “debate”, but the anti-vaccine people won’t let it go. Once they do, we will be able to move on and help autistic people not only know why they are autistic but how to better treat them so they may live fuller lives.

I ended by talking about anti-vaccine advocates for a reason, by the way. I was asked recently if I thought anti-vaccine advocates presented an existential threat to the world or even just the country. It’s a question that will be asked of the protagonist in “The Poxes” twice. He will be asked about it on “Vaccination Day” and then again in “Five Years Since”. His answer will be much like my own five years ago and then again a few days ago. So look for that.

How Many Was That Again?

Have you ever noticed that reports of case counts from public health sources usually have the word “reported” included in them? You have, haven’t you? Well, have you ever wondered why that is so?

Click to enlarge

The reason for that is because of the inherent nature of epidemiological surveillance and the barriers to getting an exact case count for every single disease or condition out there. Some of these issues with surveillance make for an overestimation of the number of cases. Other issues make for an underestimation of the number of cases. In all cases, it is highly unlikely that you are seeing the true number of cases in any report from public health.

Does that make these reports not useful or even – as some will claim – “manipulated” in any way? Not necessarily, and let me tell you why…

CASE DEFINITIONS
The first thing you need to understand in analyzing descriptive data presented to you from public health sources is the case definition being used in counting cases. A case definition is usually presented in terms of person, place, and time. For example, a case of Salmonella food poisoning may be defined as “anyone with a stool culture positive for Salmonella who ate avocados in Pittsburgh in the week of December 8 to 15″. That’s pretty specific, right?

Case definitions can also be very broad, like saying that a case of Salmonella food poisoning is “anyone with gastrointestinal disease with an onset of December 10 to 17”. This definition would surely bring up many more cases than the cases from the previous, more stringent case definition. So you can see why you need to know exactly what defines a case.

DIAGNOSTIC TOOLS
Likewise, you need to know what diagnostic tools are being used to define a case. In our example above, we used a stool culture to define the specific case definition and a clinical description of “gastrointestinal disease” to define the second. When being presented with data, make sure that you know what diagnostic tool – or tools – was (were) used. It makes a big difference.

For example, in the late 1970’s and early 1980’s, we had very little with regards to technology to isolate the Human Immunodeficiency Virus (HIV). So an HIV infection had to progress to Acquired Immune Deficiency Syndrome (AIDS) – a collection of signs and symptoms of the deterioration of the immune system – in order to define a case of HIV infection. AIDS itself was very broad at first, and the definition then was refined. As more and more diagnostic tools have been made available, the case definition of HIV and AIDS has changed. Where the presence of an opportunistic infection was once enough to diagnose a person with AIDS, there are now lab tests to look at the white blood cell counts and diagnose earlier in order to intervene and treat earlier.

AUTISM
The example with HIV/AIDS above is true of autism as well. It used to be that there was no uniform diagnosis for autism – or any of the conditions that fall within the autism spectrum. Children were either “hyper”, or “retarded”, or “slow”, or had some other condition. As medical science began to understand what it meant to be on the autism spectrum, the definition of someone with autism changed, leading to better recognition of cases and a subsequent rise in the prevalence – the underlying rate of disease in a population – that we see now.

Incidentally, the case definition for autism became more sensitive and specific – and thus more accurate – around the same time that vaccines began to be more abundant and more recommended. This lead to the misperception that vaccines raised the rates of autism and not the better diagnostic tools. But that is for a whole other discussion.

BETTER SURVEILLANCE
It goes without saying that an improvement in surveillance methods also leads to a change in the number of cases observed and counted. For example, infant mortality reporting has gotten better as more and more health care providers in the United States are able to report infant deaths electronically. Health departments at all levels of government are more active in their surveillance of cases by surveying hospitals, clinics, and even midwives on the survival numbers of infants. So you can see how this extra effort to count the deaths that were previously not reported has led to the belief that the infant mortality rate in the country has increased.

Other countries don’t have the same systems as we do in the United States. As a result, their infant mortality rates are different – even lower –  than those observed here. Is it true, then, that the US is failing in controlling infant mortality compared to countries with less resources? Nope. It’s all in how we’ve been counting the numbers. Apples to apples, the rates are much better in the United States, where expectant mothers have better access to prenatal care and children are – for the most part – born in medical facilities capable of caring for them if they are in trouble.

CONCLUSION
So here is what you do when you compare two rates of a single disease either across time, across location, or even across populations of people. You need to make sure that the case definitions of both datasets are comparable and as close to matching as possible. Otherwise, you really are comparing apples to oranges. You also need to look at the diagnostic methods used for each dataset. There is no use in comparing one dataset whose cases were diagnosed based on symptoms – a subjective way of diagnosing – and another dataset whose cases were diagnosed by a lab – an objective way of diagnosing. Finally, you need to look at the surveillance system that collected these data and make sure that the systems for both sets of data are – yet again – comparable. If one relied on providers reporting cases while the other went out and looked for cases, then – yet again – you will find yourself comparing apples to oranges.