You keep hearing it where?

I recently received a question from a friend. They asked if there was any truth to Benadryl causing dementia. They linked to this online video:


#duet with @beachgem10 As an allergist, I co-sign this message. I have been encouraging people for a while to move on from this medication. #allergy #medicine #sideeffects #sleep #change

♬ original sound – Beachgem10

“I keep seeing this come up,” he wrote. Come up where? In peer-reviewed literature? In well-done, controlled studies? Or just on social media? Because social media algorithms are designed to keep you engaged. So, if you have an interest in dementia, the algorithm is going to learn this over time and direct just about every wild theory at you. In this case, the “association” between diphenhydramine (the active ingredient in Benadryl in the United States) and dementia comes from observational studies looking at long-term anticholinergic use.

Long-term, in case you missed it when I wrote it just now.

What did the study do? The researchers took 3,434 participants over the age of 65 without dementia and followed them for 2 to 18 years. They then looked at the prescribed medications (anticholinergics) and how long they took them, then compared the cumulative exposure to the outcome of dementia. Here’s the deal, though… It wasn’t just diphenhydramine. The papers states: “The most common anticholinergic classes used were tricyclic antidepressants, first-generation antihistamines, and bladder antimuscarinics.” Furthermore, they were dealing with a population already at higher risk for dementia, those 65 and older. And, as the discussion section states:

“We should note a few potential limitations of our study. Several methods exist for estimating anticholinergic burden, with no single criterion standard. We focused on high-potency anticholinergics based on pharmacologic properties, and our list is in alignment with what is endorsed by the American Geriatrics Society. Misclassification of exposure is possible because several first-generation antihistamines are available as over-the-counter medications. However, GH members often purchase over-the-counter medications at health care plan pharmacies, and these purchases are recorded in the computerized pharmacy database, improving data capture. As in any observational study, unmeasured or residual confounding could introduce bias in our estimates. However, we controlled for a number of factors not typically found in studies restricted to administrative data (eg, self-rated health, depressive symptoms). Our exposure measure relied on prescription fills and did not guarantee that the medication was consumed. Finally, the generalizability is unknown, and our findings will need replication in other samples with greater numbers of minority participants.”

Gray SL, Anderson ML, Dublin S, et al. Cumulative Use of Strong Anticholinergics and Incident Dementia: A Prospective Cohort Study. JAMA Intern Med. 2015;175(3):401–407. doi:10.1001/jamainternmed.2014.7663

Did you catch it? Here: “We focused on high-potency anticholinergics based on pharmacologic properties, and our list is in alignment with what is endorsed by the American Geriatrics Society.” I’m no pharmacist, but Benadryl for seasonal allergies once in a while during allergy season is probably not high-potency long-term, right? Maybe?

In case you missed it, I also wrote that diphenhydramine is the active ingredient in Benadryl in the United States. This is because the brand name has different antihistamines in different parts of the world: “Benadryl may contain different antihistamines. In Vancouver, it is diphenhydramine; in London, United Kingdom, it is cetirizine; in Cophenhagen, Denmark, it is acrivastine.”

My biggest concern here is the statement of “I keep seeing this come up.” I asked my friend where he had been seeing this, and he told me it was on his social media, just like I expected. Their algorithm is probably now feeding him one thing after another about health and healthcare, and the algorithm is probably also missing the mark… As algorithms tend to do.

When we try to learn and grow, one of the hardest things to do is to let go of our preconceived notions and find points of view that are different from our own. This is tricky with science because an “opposing” or “different” point of view may very well be a point of view that is anti-scientific and just plain wrong. Still, we need to seek out those alternative reasons for the things we are seeing. We don’t want to be deceived by the things we think are true when they are not true. Us epidemiologists use biostatistics for this, making sure that the math checks out on our observations and that what we have seen has nothing to do with chance and everything to do with a true association.

My friend doesn’t seem to be interested in listening to alternative reasons behind the observation that the active ingredient in American Benadryl is associated with dementia. When I pointed out to him these other points of view, he lashed out and said that he was convinced the medication was causing him to lose his mental acuity. It could not possibly be because he is getting older and has smoked weed regularly for going on 20 years now. Nope, it must be the seasonal allergy medicine.

This is how life is in this new era of technology, when people will trust random people on the internet more than they’ll trust friends with fancy letters like “MPH” after their names or “biostatistician” in their job titles. After all, what do we know? We just work all the time to defend Big Bad Voodoo Pharma after all, right?


So I friended some anti-vaccine people on Facebook…

…And, Jesus H. Christ, are they nutty.

Apparently, there are “thousands and thousands” of children being “injured” daily by “toxic chemicals” in vaccines. Of course.

First, we have Christina England, who wants vaccines to be 100% safe and 100% effective. Only then will she stop misinforming people about them:

Screen Shot 2015-06-19 at 6.50.35 PMThen we have Tristan Wells, who is a germ theory denialist and thinks that vaccines didn’t save us:

Screen Shot 2015-06-19 at 6.50.56 PMAlso, I’m an unhealthy and uneducated person:

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They also don’t understand the Nirvana Fallacy:

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Then they call in the clown car:Screen Shot 2015-06-19 at 7.15.17 PM

Then a person hiding behind a computer screen writes this:

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And, of course, they deny they’re anti-vaccine:

Screen Shot 2015-06-19 at 7.14.48 PM

Then there was this conversation with “Thinking Moms Revolution” blogger Zoey O’Toole:

Me:To be honest, I want to know if anti-vaccine people like you really do believe that required vaccination policies are like the Jewish Holocaust that almost killed my great grandparents.

Zoey: You can’t expect people to think you are seriously interested in their thoughts when you use a term like “anti-vaccine people” at the outset, especially when you are using it to refer to people who mostly vaccinated their children just as they were told. In addition, there is no quality or belief that everyone in the group of people you are referring to shares but a desire to improve children’s health. No one can or should speak for everyone else, including me. I’m going to overlook these things, however, and I’m going to answer your question seriously because promoting understanding is important to me and there is the tiniest possibility that by answering your question seriously understanding can result.
I’m not Jewish, but I grew up in two heavily Jewish communities, spent four years with an Israeli that I nearly married, and live in a house owned by Hasidic Jews who consider me, a very “modern” single mother of two children, to be the best tenant they could ever have imagined. In addition, as an empathic person, I have always felt drawn to the huge physical and psychic wound of the Holocaust. I’ve read a number of biographies of people who lived to tell the tale (and I know that only a small percentage did), watched Shoah in its entirety with tears streaming down my face, and even played Anne Frank on stage. As the very Jewish director said at the time, “You’re too old, too tall, and too blonde (I dyed my hair to do the part), but I want you to do it anyway.”
I understand why people feel the way they do about the Holocaust. It was a tremendous injustice perpetrated on innocent people, and it’s one that we should remember and make absolutely certain never happens again. If I had lived in Europe at the time, there is no doubt whatsoever in my mind that I would have been part of the Resistance because injustice demands resistance.
Now . . . imagine you have a child, a beautiful, healthy baby. You are told that to keep that beautiful, healthy baby safe you must repeatedly inject a slew of toxic chemicals into that child’s body. You do as you are told because, of course, you want to protect that innocent child whose life depends upon your making smart decisions. Only, instead of being “safe,” your child spikes a fever, screams in an unearthly way that you have never heard before, has grand mal seizures and loses all his/her previously acquired skills right before your eyes. Your child comes down with a host of related physical conditions that make life difficult and possibly dangerous for all concerned, resulting in repeated ER visits, stress on the order of combat veterans, and the complete devastation of your finances. Then you find out that the same exact thing has happened to thousands and thousands of other babies.
Can you understand why people might feel very strongly about something they were told would HELP their children but, instead, ended up harming their innocent babies beyond anything they could possibly have imagined? Can you imagine what it’s like when the world doesn’t listen and not only does not acknowledge their losses, but actively DENIES them as well? Denies them to the point of ADDING unnecessary mandates that are going to reap more and more victims on a global scale? I know you don’t believe this is the case, but just IMAGINE for a moment what it would be like for YOU if it WERE the case. (Because it IS the case for many, many people.) FEEL the despair. Feel the anger.
The people who compare what happened to their children to the Holocaust are NOT trying to diminish what happened to people like your great-grandparents in World War II; they are trying to get you to understand the depth and intensity of their feelings about what happened to their own children when they did as they were told. They’re trying to get you to see that “doing as you are told” can get you hurt or killed now, just as it could get you killed as a Jew in Germany in the 1930s. And that’s just not right.
Injustice is injustice, and allowing it to continue hurts us all.

Me: Thank you for your lengthy response. Let me begin by defining what I mean by “anti-vaccine.” When I call someone anti-vaccine, I am not denying that they at one time or another vaccinated their children. I am not denying that they themselves may have been vaccinated at one time. However, they are now exaggerating the risks of vaccination while minimizing the benefits. They claim, as you do, that there are “thousands and thousands” of children hurt by vaccines when all the evidence is that there are not.
Now, in your mind, instances of things like autism, cerebral palsy, allergies, and so on are the result of vaccination. Why? Perhaps because those conditions were only recognized after an exposure to a vaccine in utero or once born. Or perhaps because the lies and misinformation posted widely on blogs and websites has convinced them of this. However, people who have been trained extensively on teasing out coincidence from associations have found that the observed associations in “thousands and thousands” of children with different diseases fade away when confounders and effect modifiers are taken into consideration.
But that won’t convince you or your friends because we are paid shills. The men and women, parents themselves, who have worked to make vaccines as safe and effective as possible with the technology we have and in the imperfect world that we live in are called things like “devils,” “pharma shills,” or worse. To people like you, we are not experts even with our myriad of degrees, our work in the field treating and preventing vaccine-preventable diseases, or the papers that we have published in peer-reviewed journals. We are not experts especially if we are not parents, as if I could go have sex right now and be branded an expert in about 40 weeks. Or, if we do have children, we are not experts because our children are neurotypical or otherwise healthy. Or, if we do have children with autism or any other of the conditions you attribute to vaccines, then we are not experts because we do not see the world as warped as you think that it is.
Not only do I disagree with you that you are not anti-vaccine, I disagree with you that anyone in any circumstance is justified in comparing the Holocaust to anything but the Holocaust. The Holocaust was a systematic program to exterminate an entire people. At last count, it killed 12 million (half of whom were Jews). The vaccine program in this country and around the world is not designed to make a people disappear. It is not aimed at putting anyone in slavery so that one day they be killed in cold blood.
And that’s another big error in the narrative of the anti-vaccine groups in California and everywhere. Diseases and conditions like autism, cerebral palsy, allergies, etc. are not death sentences. The children are still there, still alive. They were not stolen. They were not taken. They were not killed in a systematic way in hopes of purifying humanity. To put it simply, there is no Holocaust caused by vaccines, and there is no justification in comparing the perceived association between a child’s health and vaccines to the Holocaust.
Speaking of Freedom and Justice. Freedom goes hand-in-hand with Justice. While we are free to be vaccinated or not, it is unjust for us to not spread out the risks and the benefits of vaccination among all of us. It is unjust for any of us to sit in our position of privilege, with access to some of the best healthcare in the world, and spread ideas that convince people who do not have said access to skip or outright refuse a public health intervention.
I don’t deny that vaccines have caused unfortunate severe reactions in children, but they have done so at a rate orders of magnitude smaller than what or would like us to believe. Likewise, they have saved lives in orders of magnitude larger than what TMR or Lowell Hubbs wants us to believe. Anyone who says that vaccines are 100% safe and/or 100% effective are no better than anti-vaccine people, and I will be among the first to call them out. But you know what I haven’t seen any “pro-vax” person do? I haven’t seen them protest with such vitriol and such hatred as I’ve seen some of your friends do. I haven’t seen a pro-vax person tell an anti-vaccine person that they’re going to hell, or, as has done, engage in anti-semitism such as the blood libel of their “Thanksgiving Dinner” photoshop fiasco.
So we are on opposite poles, Zoey. I’m sitting here in Seoul looking at an enormous outbreak of something very deadly, praying to God that we can control it and come up with a vaccine soon. I bring with me the tools of epidemiology, the knowledge collected by generations of people who saw associations and decided to explain them with science not rhetoric. And I will never, ever stop.
You and I will be long gone form this earth, Zoey, and children the world over will still be vaccinated, diseases will be forgotten. And that right there is worth debating you and your like-minded colleagues… That right there is worth not using caps lock.

Zoey: Right off the bat your definition of my friends and I is completely off. We do not “exaggerate the risks of vaccines while minimizing the benefits.” We tell the truth. There is plenty of evidence that there are thousands and thousands of children who have been badly harmed by vaccines, and many, many others who have been less badly harmed, but you are not willing to see it. We have no motivation to tell anything other than the truth because we are concerned with the safety and health of children, all children, first and foremost. There are some people who do exaggerate surely, but then there are some people on every side, including yours, of every issue who exaggerate.
The only way for you to believe what you’re saying is to discount the evidence of thousands of smart, caring, attentive parents and their doctors, many of them my very good friends. Not just the evidence of what happened to them in the first place, but the evidence on what happens to them when they are treated for the damage that was done. Shockingly enough, many of them get well. Some of them completely. Being a smart, caring, attentive parent myself, I cannot discount that testimony so easily.
NO ONE is an “expert” in MY health or my children, but me. So, no you are not an expert in what has happened to me or my children, nor are you an expert in my friends or their children. And, no, those parents are not going to believe your “expert testimony” over what they saw with their own eyes and what the lab tests told them. When they DID listen to “people like you” (and sorry, but that “people like you” is offensive because you clearly know nothing about me) their children got sick, very sick. There are those who can “tease out” etiologies of issues, but they are rarely considered the “experts” by the mainstream. The “experts” merely shrug their shoulders, throw up their hands and say, “I’m sorry, you’re just unlucky.” Or “It’s genetic.” Only when the parents stopped listening to the so-called “experts,” did they figure out how to get their children well. Which do you think is more motivating to a parent? The road where you arrive at a very sick, supposedly “incurable, genetic” condition? Or the road where that child gets well? Is it any wonder those parents aren’t listening to you? You may not be a parent, but I hope to God that, if and when you ARE, you choose the road with the well child.
I never said “anyone in any circumstance is justified in comparing the Holocaust” to anything. I tried to get you to understand, just for a minute, why someone would do it. I agree that the Holocaust was about systematic extermination. While genocide is not unique in human history, the scale and cold efficiency of the Third Reich was indeed unique, and I hope it stays that way. I do not believe that the vaccine program is INTENDED to harm children. I think that there are a great many people of integrity working within the system trying to do their best to serve humanity. However, the vaccine program as it is currently constructed IS harming children on a large scale (mainstream study determined up to 54% of American children today are living with chronic health conditions when you include obesity. Clearly all that vaccinating is making us the healthiest population on the planet — oh, wait. No, it’s not) and the people in charge of the program either truly don’t believe it (largely because they don’t want to, there is PLENTY of evidence), or because they simply don’t care because the situation as it is feeds their egos, their desire for power, and/or lines their pockets. THAT is not in any way unique in human history, unfortunately.
So . . . you’re not a parent, right? I suspect you don’t have any idea how offensive the parents you’re talking about would find your paragraph about “diseases and conditions like autism, etc.” not being death sentences. Just as they may not understand why you find the Holocaust comparison so offensive. Would it really be “okay” with you if your beautiful, healthy child were rendered permanently ill by something you were told was “perfectly safe” and would “protect” your child? Would you really console yourself with the fact that your (previously healthy) child, who has multiple seizures daily, can’t talk, is still in diapers and beats you frequently because he is in so much pain, is “still there”? “Still alive”? Would you really say to Karen Kain, whose daughter Lorrin spent her short life on many seizure medications, with a breathing tube and a wheelchair, you “didn’t lose her”? And when your child’s sensory processing is so over-the-top that ordinary moments cause the child to “bolt” with no warning from safe places with no awareness of safety, to the point that no less than five children with autism ‘wandered” to their death in the last few weeks, would you say, “Well, hey, that’s fine with me, at least he won’t get measles”?
I happen to be the parent of a child who died, and you know what? I’d take my chances with measles any day, and I’m not alone because existence is not all anyone wants for his or her children. And it’s not all they should want for their children. We are not guaranteed existence. Children are killed by car accidents, drowning accidents, freak illnesses, etc. every day, and that is tragic, yes, but it is simply impossible to escape all risk of death. And if you spend your life trying to avoid death rather than living it to the fullest, you render it meaningless.
You haven’t been paying attention to your “pro-vax” friends if you’re not seeing vitriol. EVERY SINGLE one of us has been told MANY times that we’re “child killers,” “cunts,” and that people hope that our children die of vaccine-preventable diseases. Someone even made a website with a “Jenny McCarthy body count” because Jenny McCarthy DARED to TELL THE TRUTH about what happened to her child. Believe me, you”re getting off easy with “devil.” I have no idea what you’re talking about with the Age of Autism Thanksgiving Dinner photoshop stuff.
*sigh* “Generations of people who saw associations and decided to explain them with science not rhetoric.” You know what I find most ironic here? Your use of the name Edward Jenner. You want to know why? Edward Jenner listened to “anecdotes.” He heard that milkmaids didn’t get smallpox. He thought about what that might mean. Maybe it meant that people who got cowpox were then immune to smallpox. Did he have any scientific data to support that hypothesis? Hell, no! Just a bunch of “anecdotes.” The whole field you’re talking about was BUILT on anecdotes, but now, somehow, “anecdote” is a dirty word. As if by ignoring them, we can pretend they have no bearing on reality. Any scientist with a truly curious mind who wishes to solve problems, one worth their salt in other words, knows that in those “anecdotes” lies scientific gold, clues to questions worth answering, some of which haven’t even been imagined yet. It’s piles of data just begging to be quantified, and yet no one has. So much for “seeing associations” and “explaining them with science.” You may not know this because it is probably of no interest to you, but virtually every scientific study that has any value to the autism community is merely confirming things that those “crazy, anti-vaccine” people knew a long, long time ago and that “experts” — “people like you” told them was categorically untrue. A truly scientific mind would find it curious that these people could be right about everything else, and yet be so “wrong” about something so basic as vaccines.
In addition to not discounting the testimony of thousands of literally thousands of parents, I cannot discount the science I had read that makes it very clear that what is injected can indeed affect the brain, especially if it is injected before the blood/brain barrier is closed. I gather you are an epidemiologist. I don’t know how much you know about immunology, but if you really wanted to “explain associations with science” you would be interested in the fascinating science being done on how autoimmunity can be induced with hypodermic needles and aluminum adjuvants. I suggest you hunt it down, otherwise you will be completely taken by surprise when people actually stop vaccinating — at least wide-scale vaccinating — because they recognize that it has caused a host of unintended consequences that is slowly crippling the population, well maybe not that slowly anymore.
I’m sorry if my use of caps lock annoys you, but in addition to a degree in Physics, I have a background in acting. In my head I emphasize certain words, and I like to convey the sense as I think it. Facebook does not give me the option of italics, so caps lock it is.

I didn’t respond after this. It’s just not worth it. She’s not going to understand that we live in a world where there are easy scientific tools to look into the spurious associations that her and her friends see. We don’t live in the times of Jenner or Pasteur. We don’t need to take coincidences as “scientific gold,” and we don’t need to be parents to understand the science of vaccines.

The only silver lining in all this is something that a friend wrote on his blog: Many years from now, the anti-vaccine people will be remembered en masse for the whacky things they said and wrote. The rest of us will be remembered for standing up to the lies and for promoting a public health intervention that has saved millions of lives.

Another Fellow of the American Academy of Pediatrics who should know better

With the current outbreak of measles centered around Disneyland, we’ve been paying a lot of attention to what 2014’s Douchebag of the Year, Dr. Robert “Bob” Sears had to say about vaccines. As it turns out, it’s nothing but a bunch of whining and finger-pointing at us “stupid” people. We’ve also been watching “pediatrician to the stars” Dr. Jay Gordon, MD, FAAAAAAAAAAAAP. (Too many A’s?) He’s been more reserved in what he’s had to say about measles, but there are strong hints that he may or may not have believed BS Hooker’s horrible attempt at epidemiology.

Today we got a tip that there is another pediatrician out there. By “out there,” we mean out there in outer space when it comes about medicine. This is yet another pediatrician who should know better, but doesn’t seem to. It’s another person who committed themselves to the healing arts and then just apparently threw reality out the window and went with the quackery. What follows is from his “about” page, and it contains plenty that should make you shudder at the thought of him having a say in anyone’s healthcare:

“Dr. Palevsky is a renowned board certified pediatrician, sought-after lecturer, and published author, who utilizes a holistic approach to children’s wellness and illness. In his current practice, Dr. Palevsky provides patients and their families with personalized, comprehensive consultations to address their children’s wellness, and acute and chronic illnesses.”

The key word in that paragraph is “holistic.” While it is a good idea to treat the whole person and not just the one symptom when dealing with a patient, the word “holistic” has taken on a different meaning as of yet. It’s kind of like the word “gluten.” It used to mean something that certain people could not eat because of an allergy. Now it means absolute poison. (Spoiler alert: Corn is “gluten free” because it’s corn, not because it ever had gluten in it.) Lately, “holistic health” has come to be synonymous with a wide array of Supplements, Complimentary, and Alternative Medicine (or S.C.A.M., for short). But let’s keep reading:

“He offers consultations and educational programs to families and practitioners in the areas of preventive and holistic health; childhood development; lifestyle changes; nutrition for adults, infants and children; safe, alternative treatments for common and difficult to treat acute and chronic pediatric and adult conditions; vaccination controversies; mindful parenting; and rethinking the medical paradigm.”

Did you catch it? “Vaccination controversies.” I wonder what that is all about? Here’s what Dr. Palevsky had to say to fellow quack Dr. Joseph Mercola:

“When I went through medical school, I was taught that vaccines were completely safe and completely effective, and I had noThey’re (sic) reason to believe otherwise. All the information that I was taught was pretty standard in all the medical schools and the teachings and scientific literature throughout the country. I had no reason to disbelieve it.

Over the years, I kept practicing medicine and using vaccines and thinking that my approach to vaccines was completely onboard with everything else I was taught.

But more and more, I kept seeing that my experience of the world, my experience in using and reading about vaccines, and hearing what parents were saying about vaccines were very different from what I was taught in medical school and my residency training.

… and it became clearer to me as I read the research, listened to more and more parents, and found other practitioners who also shared the same concern that vaccines had not been completely proven safe or even completely effective, based on the literature that we have today.

… It didn’t appear that the scientific studies that we were given were actually appropriately designed to prove and test the safety and efficacy.

It also came to my attention that there were ingredients in there that were not properly tested, that the comparison groups were not appropriately set up, and that conclusions made about vaccine safety and efficacy just did not fit the scientific standards that I was trained to uphold in my medical school training.”

Yes, ladies and gentlemen, Dr. Palevsky appears to have abandoned what he was taught in an accredited institution of higher learning, what was based on verifiable evidence and gone through the rigors of scientific discovery, and exchanged it with anecdotes and hearsay from like-minded people. Evidence be damned. If the people around you say something that jives with your way of seeing the world, that must be correct and not what we know from centuries of scientific knowledge. If something “appears” to be wrong, then don’t learn why it’s wrong, just write it off altogether. If something is not “completely” safe and “completely” effective then it is worthless.

Alright, so we know he’s anti-vaccine. What else does he say about himself on his about page?

“In using his “whole child” wellness philosophy, Dr. Palevsky recommends and incorporates the teachings and therapies of nutritional science, acupuncture and Chinese Medicine, chiropractic, osteopathy, cranial-sacral therapy, environmental medicine, homeopathy, and essential oils, along with natural healing modalities such as aromatherapy, yoga, Reiki, meditation, reflexology, and mindfulness.”

We’re going to just go ahead and stop right there. We don’t need to read any further to know that Dr. Palevsky has abandoned everything that made him a pediatrician and seems to now be embracing the magical arts. After all, that is what homeopathy, Reiki, and reflexology are… They’re magic. It’s pure and unadulterated magic that has failed time after time to stand up to scientific scrutiny. Seriously, there hasn’t been any evidence that any of it works beyond the placebo effect.

As Dr. Mark Crislip has stated, adding apple pie to cow dung doesn’t make the apple pie taste better. Likewise, adding a thin veil of medicine through the letters after his name doesn’t make Dr. Palevsky’s quackery any more legitimate. It makes his claims of being a man of medicine worthless.

To seal our indictment of Dr. Palevsky (and we’re using “doctor” very loosely at this point), here’s an excellent piece-by-piece rebuttal of his statements by “Sullivan” at Left Brain Right Brain. In that rebuttal and in this page on Dr. Palevsky’s website, you’ll notice that Dr. Palevsky seems to have abandoned Germ Theory:

“Acute symptoms, such as fever, vomiting, diarrhea, rash, cough, runny nose, mucus production and wheezing, are all important ways in which children discharge stored accumulations of wastes or toxins from their bodies. These toxins enter and are stored in their bodies from repeated exposures to in utero, air, food, water, skin, nervous system stress, and injected materials, that for whatever reason, don’t easily exit their bodies through the normal means of detoxification. These toxins are too irritating to children’s bodies and must be removed. Eventually, a critical level of the toxins is reached, and children get sick with symptoms to purge them. Children, therefore, must be allowed to be sick, in order for them to get well.”

Really? Then why does Dr. Palevsky recommend the following in a different page?

“If your child is less than 3 months old and has a fever, please go to the nearest emergency room.

If your child has a fever and a rash of little dots under the skin, please go to the nearest emergency room.

If your child has a fever, neck pain and the light is bothering him/her, please go to the nearest emergency room.

If your child has a fever, along with urinary complaints, swollen joints, inability to walk, or other complaints that concern you, please seek immediate medical attention.

If along with your child’s cough, your child is having difficulty breathing, is breathing rapidly, is wheezing, has a mental status change (see Pediatric Checklist), or is an infant below 4 months of age with a cough, please seek immediate medical attention.”

Why, Dr. Palevsky? Why go to the nearest emergency room if these are all just things that the child’s wonderful self-cleaning, self-healing body will take care of? I think he wrote this as a cover-your-ass set of recommendations because the bullshit he spills previously can get him in hot water if a child ends up having meningitis or measles and the parents go with “cranial-sacral therapy,” whatever the hell that is.

The most telling part of his website is the following statement found all the way at the bottom of most pages:

“Disclaimer: All material on this web site is provided for educational purposes only. Consult with your health care provider regarding the advisability of any opinions or recommendations with respect to your individual situation.”

In other words, “I’m not saying what I’m saying, I’m just saying.”

We at The Poxes believe that it is about time that the American Academy of Pediatrics take a really long, hard look at some of its members (the physicians with the “FAAP” after their name) who have abandoned science and embraced magic and attempt to use that magic to convince people that scientifically proven preventative and therapeutic measures like vaccines and antibiotics are not necessary. Because, with “fellows” like these, the AAP doesn’t need any enemies.

Who will be 2014’s “Douchebag of the Year”?

A few years ago, a fan of this blog got into a lot of trouble at work because he dared call a misogynist anti-vaccine loon who was being more than creepy to women on social media a “douchebag.” The douchebag launched a series of emails to our friend’s employers. He also made an appearance in blogs talking about the issue, threatening to sue people who dared talk bad about him. Needless to say, the guy eventually backed off and went back to doing whatever people like him do when they’re not harassing people who call them on their crap.

It was because of that incident that I adopted some rules for this blog. I didn’t want what happened to our fan to happen to me, hence all the secrecy about who I (or we, at times) really are. Yeah, yeah, I’ve broken some of the rules some of the time. No one is perfect.

So we’re going to break the rules one more time before the year’s end. All of us, you included.

We’re going to name the anti-vaccine, anti-science “Douchebag of the Year.”

Feel free to nominate someone in the comments section. Nominations will be accepted until December 28. We’ll then have two days of voting before the “Douchebag of the Year” is named on New Year’s Eve in the final post for this blog for the year. A donation to a pro-vaccine organization will be given in the Douchebag’s name.

Here are my nominations:

  • Andrew Jeremy Wakefield for his race-baiting propaganda about a so-called “CDC Whistleblower” who looks more like a confused old man than someone who actually has “dirt” on the CDC. Not only that, but he also tried to scare a science blogger by threatening a lawsuit against her for calling him on his bullshit, and continues to try and sue the British Medical Journal from the comfort of his palace in Texas.
  • Anne Daschel, aka “Daschelbot,” for her almost non-stop commenting on any vaccine-related news site or blog. If you’ve read one comment, you’ve read all of her comments.
  • Cynthia Parker, aka “CIA Parker,” who, like the Daschelbot, comments and comments and comments and comments, and none of her comments really have any kind of sense. To her, everything is caused by vaccines, and her self-diagnosing is truly amazing.
  • Robert F. Kennedy, Jr., for his book on thimerosal, in which he fully joins the cult of anti-vax.
  • Ginger Taylor, for making this video and trying to sound knowledgeable when she is, in our opinions, not knowledgeable at all.
  • John Stone, the Age of Autism British weirdo, for trying to figure out who I am and where I work, as if that will stop any of us from doing what we do.
  • Peter Doshi, PhD, for being resurrected in anti-vaccine websites and talking points and not doing anything to correct the record on his apparent AIDS denialism, even when given a chance to do so.

Who do you nominate?

Why is HIV/AIDS so deadly?

FYI… This is the fifth of ten posts that have nothing to do with vaccines.

Once in a while, a new loon is pointed out to me, and I read their insanity. This is the story of such an occasion:

Why is HIV/AIDS so deadly? According to the World Health Organization, AIDS kills about 1.6 million people per year. We know what causes AIDS. We know that HIV infection can be prevented through safe sex, no sex, proper screening of the blood supply, administering drugs to HIV-positive people to lower their virus counts. We have very good screening tests to administer to people and make sure they get the care that they need. And we can explain all this to millions at a time through the use of all sorts of media.

So what gives?

The answer can be a little complicated. There are some political interests involved that misuse (or don’t use) the resources given to them to combat HIV/AIDS. There are also people in very high positions of authority who believe that the disease is a proper and just punishment for all sorts of “immoral” ways of being, e.g. homosexuality.

But there is also a group of people who believe that HIV doesn’t cause AIDS, though they should know better. One of these people is Kelly Brogan, MD. According to her website, she received her medical degree from Cornell University and two science degrees from MIT. She did her residence in psychiatry and is board certified in it. With all that education, all those hours, days, weeks, and months invested in learning how to heal people, Dr. Kelly Brogan has some interesting thoughts on HIV and AIDS.

For example, women with HIV should not take drugs to reduce the chances of passing the virus on to their babies. Why? Because:

“This was the case with a now infamous, but little-publicized perinatal trial of the drug nevirapine for the prevention of transmission of HIV from mother to baby. An NIH-funded trial staged in Uganda, HIVNET 012, was hailed as demonstrating a 50% decrease in transmission, and set the stage for world-wide drug dissemination and coercion of women like Joyce Ann Hafford, to their death.”

UPDATE (9/25/14): It looks like Dr. Kelly Brogan has taken down her article. But here is Google cache to the rescue:

Dr. Kelly Brogan quotes a Harper’s Magazine author who seems to claim that there was no control (or placebo) group in that study. But there was a control group…

The HIVNET 012 trial was conducted in 1998 in Thailand, with some startling results:

“In February 1998, a randomized, double-blind, placebo-controlled trial sponsored by the U.S. Centers for Disease Control and Prevention in Thailand of 393 mother/infant pairs showed that a short course of oral ZDV could reduce HIV-1 transmission by about 50% over a placebo—to an overall rate of 10%—in a non-breastfeeding population (CDC, UNAIDS, NIH, and NRS, 1998; Shaffer et al., 1999). 1 As a result, HIVNET 012 researchers formally dropped the placebo arms in a letter of amendment (known as Amendment I) to the protocol, and stopped enrollment on February 18, 1998.”

The study didn’t stop there, though:

“HIVNET 012 was redesigned and reopened on April 6, 1998—with approval of the Ugandan and U.S. institutional review boards—as a randomized, open-label, Phase IIB clinical trial.2 In this newly approved protocol, the target enrollment was 400 to 600 mother/infant pairs randomized in a 1:1 ratio. Women in the NVP arm of the trial would receive a single, oral 200-milligram dose of NVP at the onset of labor. Their infants would receive a single, oral 2-milligram-per-kilogram-of-body-weight dose of NVP suspension within 72 hours of birth. Women in the ZDV arm would receive 600 milligrams of oral ZDV at the onset of labor, followed by 300-milligram doses every 3 hours during labor. Their infants would receive oral 4-milligram-per-kilogram-of-body-weight doses of ZDV twice daily for the first 7 days of life. Boehringer Ingelheim Pharmaceuticals and GlaxoWellcome, respectively, donated the study drugs.

The HIVNET 012 protocol specified follow-up of mothers for adverse events for 6 weeks after delivery. Infants were followed for adverse events until 6 weeks of age, and for serious adverse events until 18 months of age. Researchers graded such events based on toxicity tables from the National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) for neonates, children, and adults, ranging from grade 1 (mild) to grade 4 (life-threatening). The 1997 Study Specific Procedures manual included the DAIDS toxicity tables, as well as a special grading system for adverse experiences related to skin rashes and dermatitis and hemoglobin in mothers (Jackson et al., 1997). As the medications were given for a week or less, the study did not modify drug doses for toxicity.”

It wasn’t all without some issues, though, and the trial was adjusted again:

“Researchers amended the study protocol in February 2000 (Amendment II) in response to findings in other studies that some women could develop viral resistance to NVP, and that some children treated with various antiretroviral drugs in utero or perinatally could possibly experience mitochondrial toxicity. The modification entailed extending follow-up of women in the NVP arm and all children in the 18-month study to 5 years, with yearly evaluations for NVP resistance in women who had received NVP (HIVNET 012 Investigators, 2000).”

And what were the final results?

“The 1999 Lancet paper also analyzed adverse events and toxic effects based on the first 556 mother/infant pairs assigned to treatment with ZDV (279 pairs) and NVP (277 pairs). The authors reported that “the rates of maternal serious adverse events were similar in the two groups (4.4% in the ZDV group and 4.7% in the NVP group),” and that “the occurrence of clinical or laboratory abnormalities in mothers was similar in the two groups.” The authors also reported that for infants, “the rate of occurrence of serious adverse events in the two groups was similar up to the 18-month visit (19.8% in the ZDV group and 20.5% in the NVP group).” The “frequency and severity of laboratory-detected toxic effects … were similar in the two groups.”

The second Lancet paper (Jackson et al., 2003), reported that infants assigned to the NVP arm continued to have a significantly lower rate of HIV-1 infection and a significantly greater likelihood of HIV-1-free survival through 18 months of age (Table 2.2). Specifically, the efficacy of NVP compared with ZDV was 41%.”

The Institute of Medicine, and others, back the study’s findings. That Harper’s Magazine article? It was widely chided for its inaccuracies regarding the relationship between HIV and AIDS.

So why does Dr. Kelly Brogan see this study as a bad thing? And who is Joyce Ann Hafford?

Joyce Ann Hafford was a 33 year-old woman who died from liver failure from the medications she was being given as she participated in a drug research study. She was HIV-positive, and she enrolled in the research study in an attempt to keep her unborn child from being born with HIV. The whole thing was an enormous mess. Ms. Hafford started showing signs of toxicity from one of the drugs, but her healthcare providers apparently put the blame on her condition and not on the drugs. The National Institutes of Health eventually confirmed that it was most likely the drug.

These things happen. I won’t deny that medications, even the life-saving ones, all have risks. At a population level, antiretrovirals are saving lives, but everyone needs to be monitored for side-effects. At the individual level, there are those who need to be treated for side-effects. Not treating HIV will inevitably lead to AIDS in 99.999999999% of people who are infected. Treating it will cause side-effects in a very, very small percentage of people being treated. It’s about weighing the risks.

Perhaps because Dr. Kelly Brogan is not an epidemiologist and most of her training appears to be in psychiatry, Dr. Kelly Brogan seems to believe that all antiretroviral drugs are the ultimate evil, which fits well with her statements about medical science:

“This medical-scientific-industrial marriage has brought us many a meme that we hold on to societally, as truths:

That depression is a chemical imbalance

That cholesterol causes heart disease

That exposure to bugs equals deadly infection, and vaccines protection

Cancer is a genetic time bomb

That HIV causes AIDS, the equivalent of certain death”

She links her last statement, the one about HIV and AIDS, to a known AIDS denialism group. I’m not even going to touch her statements and blog posts on vaccines. (She thinks that herd immunity is fiction, apparently. Something that made my head explode.)

And there you have it. People continue to die from HIV/AIDS in part because people who should know better continue to perpetuate the idea that HIV doesn’t cause AIDS, with variations to that theory. Some say that HIV is just a “passenger virus” and that it is an incidental finding with AIDS really being caused by the drugs used to treat HIV infection. Others say that HIV is a manufactured virus, aimed at homosexuals or at Africans, but still not a full-fledged cause for AIDS. And so on and so forth.

Without telling us her complete stance on the matter, Dr. Kelly Brogan certainly can seed some doubts in those who may not be initiated. But we are initiated, aren’t we, folks?

HIV leads to AIDS, plain and simple

FYI: This is the second of ten posts that will not be related with vaccines.

Back in the late 1970’s and early 1980’s, there was a lot of scientific confusion as to what the relationship was between Acquired Immunodeficiency Syndrome (AIDS) and a newly discovered retrovirus first known as HTLV-III and then renamed to HIV. Thirty-plus years and millions of dollars later, we have come to understand that HIV infection, if left untreated, progresses on to AIDS. We came to understand this because we observed people with HIV and people without it. Then we went one more step further and observed people infected with HIV who were treated and those who were not treated. We did these observations in real-world situations and also in controlled situations. We also did these observations in animal models.

All the evidence is there, and it is very clear that HIV causes AIDS.

Still, there are a group of people out there who honestly believe that HIV doesn’t cause AIDS, that AIDS is the result of things other than HIV, or that neither HIV nor AIDS actually exist. (There are wilder theories than those, if that is possible, but I don’t have time for them.)

A few years ago, I came upon the comments of a man who has some “interesting” views of the relationship between HIV and AIDS. Here is the comment:

“Whether ORAC knows anything about medicine or science is unclear, but he knows NOTHING about how to conduct an investigation.

Having conducted thousands of criminal, civil and military investigations since 1980, it was clear from the onset that Deer’s so-called investigation resembled more of a hit-piece than a real investigation. As such, it was the perfect pretext for the kangaroo court known as the medical board review.

ORAC’s outrage is also telling. Since truth is the best defense in such cases, Deer’s defense should be extremely easy – unless, of course, he lied to destroy Dr. Wakefield’s career.

Because I have been involved in more than 100 criminal, civil and military cases involving medical and scientific incompetence since 2009, I am not at all impressed that ORAC is funded by the DoD, NCI or any other US government agency. And having recently cleared a US Marine of criminal charges by impeaching a top military infectious disease expert, I’d say that ORAC’s outrage is likely based upon his fear that he will be eventually be discovered as a charlatan as well.

If ORAC is telling the truth, nothing would preclude the use of his real name. The fact that he blogs on this pharmaceutical marketing website is telling.

Clark Baker LAPD (ret)”

He did us all the favor of directing us to his website, the “Office of Medical and Scientific Justice”. It’s a pretty legit-sounding website that talks a lot about clearing people who are innocent from false accusations against them. Just read the “About” page:

“Having conducted thousands of criminal and civil investigations since 1980 with the LAPD and as a licensed investigator, Mr. Baker founded OMSJ in 2009 after witnessing the reluctance of government agencies and research centers to investigate allegations related to medical and scientific corruption (also known as JUNK SCIENCE).

Many of the agencies and companies that market junk science fund activist groups and local, state and national politicians who facilitate corruption that has cost taxpayers billions of dollars in wasted research dollars. Junk science is used to keep predators on the streets, convict the innocent and injure or kill 2-4 million Americans annually.”

Read in a vacuum, that all sounds great… Until you start reading into Mr. Baker’s ideas. (Tip o’ the hat to regular reader/commenter “Lilady” for the link.) It seems that Mr. Baker is an HIV/AIDS denialist. Among some of the claims on his website are the usual bits of anti-science strategy. First, deny the science and call it “junk science”, but never mind that 99.9% of scientists (that is, 100% of reputable scientists) know and understand that HIV does cause AIDS, that HIV is not a “passenger virus”, and that HIV without antiretroviral treatment is pretty much a death sentence. Second, to try and back up those anti-science claims, find something by a member of the 0.1% of whacky scientists and publish the hell out of it. Third, find instances of scientists misbehaving and then try and discredit their scientific work and that of their colleagues. Finally, cater to what the far right-wing groups and their members want to hear.

It really is quite humorous that Baker follows the same playbook of almost all other anti-science activists follow. Cherry pick and discredit. Cherry pick and discredit. Cherry pick and discredit and be mean about it. Cherry pick, discredit, be mean, and put yourself up on a pedestal as being more than you really are. Oh, and sue people. Don’t try and fight the science, just goddamn sue!

Unfortunately for humanity, Clark Baker is not the only AIDS denialist out there. There are plenty, and there are plenty with advanced degrees whose letters after their names give them some degree of credence. For one reason or another, people listen to them, and we all pay for it dearly.

Ideas are like a virus

Ideas are like a virus. They seem to come out of nowhere and spread like wildfire before something bring them under control, especially the bad ones. Take, for example, the idea that vaccines cause autism. We had heard before that vaccines could cause this or that, but it wasn’t until something sent the idea over the critical threshold and into the minds of anyone willing to accept the idea. Was it Andrew Jeremy Wakefield’s sham paper-not-a-study in 98? Was it Jenny McCarthy’s entrance into the vaccines-cause-autism debate? Who knows for sure, but I do know that the idea that vaccines caused autism acted very much like a virus and only a deep understanding of biology and virology/immunology (or just blind trust in the medical establishment) were necessary to counteract the effects.

Still, enough people have been infected with that idea to really cause us some problems. The Wakefields and McCarthys of the world are mere vectors for this contagion, as are others. Some are willing vectors who have been taken over by the idea to such a degree that they are willing to say or do anything to spread the pathogen to the four corners of this round planet. Others are ignorant and perhaps even unwilling participants in this plot to take over the world by the idea that vaccines are evil.

From my epidemiological analysis (on the back of a piece of paper while sitting under a shade and drinking a daiquiri), I’ve come to conclude that the idea that vaccines are evil seems to strike a certain group within the general population and that some people seem to be naturally immune to it. Then there are others who only get infected a little bit, and their disease seems to be sub-clinical. These are the people who are okay with some vaccines but not others, or who will vaccinate under protest, many times praying to their god(s) that nothing bad happens.

Yet all ideas are like viruses, and there are good ideas out there. It wasn’t until the idea that washing your hands hit its critical point that gastrointestinal diseases associated with handling food came under control. The spread of the idea that germs could be killed by heat correlates very, very well with the increase in overall survival of many populations around the world. And the idea that board-certified, licensed healthcare providers know just a little bit more than celebrities has probably prevented quite the number of deaths.

I’m hopeful about the idea that vaccines are safe becoming permanently predominant over the idea that vaccines are not safe. Certainly, premature babies and old folks would benefit greatly from the former and by the eradication of the latter. But I’m sure that there will always be some natural host for anti-vaccine ideas, someone out there in the wild that will come into contact with our collective consciousness from time to time and trigger epidemics of ideas that will, in turn, trigger epidemics of vaccine-preventable diseases.

So we must keep ourselves healthy and ready to repel such bad ideas with a strict diet of science and healthy skepticism. We must eat and drink plenty of knowledge and practice daily critical confirmation of the things we are taught by looking at all the evidence, especially the evidence coming from people and institutions that know what they’re doing, that have been accredited by reputable organisations to do what they do.

Lastly, when someone spills the bad virus all over you, wash it off with some facts and bathe it in reason. And wash your hands as well.

A different definition of “fiction”

I was talking to a friend who works in a psych unit the other day, and he asked how I was dealing with the anti-vaxxers and other denialists. I told him that it was a little frustrated at times that there are so many people willing to ignore reality for fiction. He told me about a psychological concept called “fiction”. This is not fiction in the traditional sense. This is fiction in that a person has created a sort of reality around them that is real to them, maybe even tangible, even if all the evidence points to the contrary. You have probably seen examples of this in women who go to deliver a child and had convinced themselves all the time that they were not pregnant, even going on public record and saying that they had no clue (never mind the belly, the lack of a menstrual period, and other indicators of what reality was). You also see it too often in men who cheat on their wives and have convinced themselves that what they are doing is not wrong, or that there will be no consequences.

My thoughts went to the “Weirdo” John Stone of Age of Autism. He is convinced that I am someone else, someone employed by “Big Pharma”, and that I am in cahoots with a whole bunch of other people who are pro-vaccine. I’ve offered to him to become my “friend” on Facebook and get to see pictures of myself and my family, where I am working, and even my telephone number, but he has not agreed. Why? Because he is convinced that I am “despicable”. That, or he doesn’t want the fiction that he has created about me to be torn down. After all, if I turn out to be just a random guy and not who he thinks I am, there is no more boogeyman, no monster under his bed.

The Weirdo is not the only one, of course. There are plenty of leaders and followers in the anti-vaccine camp that have created a fiction around their lives. To many, their children were not autistic until the minutes or hours following their childhood vaccines. Even when they are shown videos of their children exhibiting autistic behaviors before vaccination, their fiction will not allow them to accept this. Their fiction dictates that vaccines and only vaccines cause autism, not their genes, not anything else. (Although some would concede that maybe the environment had something to do with it.)

In many, and very heated, discussions about vaccines (and even about science in general), public health officials and workers (and anyone in any way associated with the pharmaceutical industry) get compared to the Nazi regime which ruled Germany in the 1930’s and 1940’s. To take in and understand why that analogy is flawed, you have to understand what happened during that time in Europe. I won’t bore you with the history class, but I will tell you that public health working to save the lives of children today is nothing at all like what happened under the Nazi regime. We are not arbitrarily picking children and killing them en masse. We are not tying anyone down and performing medical experiments on them. We don’t believe that one ethnic or religious group is to blame for all of society’s ailments.

To be a person of science, and someone who believes in science, we cannot have the luxury of creating fictions around our lives. Sure, we may create mini-fictions to understand why someone like the weirdo or the kid may hate us with such a passion, but we pretty much accept reality for what it is. Personally, I believe the weirdo just has a psychosexual obsession with me, but that’s just me, and I’m no psychologist. That’s a very minor personal fiction compared to what he fantasizes believes about me, maybe. And I’ve told you about his obsession with Dorit Reiss as well. On the contrary, we need to live and accept the evidence and do something about it. Even those among us who believe in a higher power, I’m yet to find a true person of science who falls to their knees and prays instead of taking evidence-based action.

So how do you deal with a person or a group who is/are cocooned in their own fiction? With some, it will be just a matter of breaking down that fiction with facts. With others, there will be absolutely nothing you will be able to do. What they see as reality looks, feels, and even tastes like reality, so there cannot be anything else. In the case of the weirdo, it will not matter how many times I explain to him that I am not who he thinks I am, and that I’m not at all interested in him in the way that he seems to think I am interested in him… Which sends shivers down my spine.

Some are just too far down the rabbit hole

I’ve told you before that the true anti-vaccine activists blame anything and everything wrong in their lives, or with the minds and bodies of their children, on vaccines. The same goes for anyone who believes in conspiracies, alternative medicine, ghosts… You name it. They will believe their bias before believing anything else, including clear and tangible evidence.

A friend of mine pointed me to this link from “GeoEngineering Watch”, a website dedicated to conspiracy theories having to do with “weather engineering”. If you look through the site, you’ll see the usual hodgepodge of unscientific theories about what is going on with the crazy weather we’re seeing around the world. Instead of going with the science of climate change because of increased carbon dioxide in the atmosphere (most of it from our pollution, and a lot of it from volcanoes), the authors of the website seem to go with contrails, radio wave transmissions, military experiments, etc. Continue reading