Yes, You Agreed To This

I waded into an argument last week after seeing what Ren wrote about fluoridation. A Doctor of Dental Surgery (DDS), who shall go unnamed because he’s a bit of a douche about stuff, decided to go on and on about how fluoridation of drinking water is an experiment on unwilling participants. Those participants, he claims, are the public, and the public never agreed to this according to him.

Number one, fluoride in drinking water is nowhere near a toxic level. It’s not even close. And there is little evidence that fluoride bioaccumualtes in humans. The human body is set up to deal with these things quite well. Unless your kidneys are completely in shambles, you’re going to be okay.

Number two, the people/public did agree to fluoridation of the water supply, even if they didn’t have a vote on it. In the United States, we elect people to make these decisions for us. Frankly, we would get nothing done if we had to hold an election every time some public health intervention needed to be made.

Essentially, we assented to have our elected leaders use the best available evidence and intervene on our behalf when a public health problem is identified. If we don’t like it, or if they do the wrong thing, then we vote them out… Or have a revolution or something.

Sorry, George.

This batshit insane rambling that vaccines or fluoride or vitamin K for newborns are all experimental is, well, insane. We took a vote, people. You lost. Live with it and go vote at the next election. Until then, drink up!

How to convince the world that vaccines are the ultimate evil. Step one: Buy yourself a Congressman

What do you do if you’re in desperate need of some sort of validation about your misguided, uninformed, fraud-driven beliefs about vaccines? Do you fund more research into vaccine technology and how to make it “safer”? Do you use your money to fund autism programs that look to make the lives of autistics better at all levels? Or do you find a Congressman who will believe your drivel and give you some sort of credibility and pour money into his coffer?

If you’re a reasonable person, and you have a lot of money, and you’re worried about autistics, you would be inclined to fund organizations and programs that look to advocate for autistics (and other people with developmental disabilities). You might contact your representatives in Congress, maybe even the President, but you would know better than to give them any money directly. After all, you’re always going to have an elected representative. There is always going to be someone to answer the phone when you call Congress. So why give money to them? Let them get their own money.

Ah, but if you’re not a reasonable person, you believe in all sorts of conspiracies, and people are making fun of you over your delusions about vaccines and autism, well, then you need to buy yourself a Congressman. How do you do that? By paying between $500 and $1,500 just to meet and greet the person who is most likely to give you a sympathetic ear in congress. Lately, that person has been Representative Bill Posey from the Florida 8th Congressional District.

Allow me to step back for a moment. Look at the situation. If you want to meet and greet the person who owes you his current job in Congress, you have to pay a minimum of $500. Don’t kid yourself into thinking that you can call up their office and get an appointment. Regular folks don’t get that usually. Maybe if you’re from a relatively small district. Maybe if you know people who know people. Most of the time you’ll end up just talking to staffers, because money.

Now, let’s go back to the anti-vaccination activists who are trying to buy themselves a Congressman. How much do you think they’ve “invested” in buying Rep. Bill Posey? One thousand? Two thousand? Three thousand dollars? According to the Federal Elections Commission, the following people have given money to him:

Jennifer Larson, who sits on the board of the “Autism Recovery Foundation” and is a big anti-vaccine activist who seemingly loves to defend Andrew Jeremy Wakefield, gave $1,000 to Bill Posey. I could be wrong, but Ms. Larson doesn’t live in Florida’s 8th. So you do the math on why she’s giving him what to a family with a special needs child would be a windfall.

Mark Blaxill, who is not a scientist and not a journalist, also donated $1,000 to Representative Bill Posey. Why if not to win favor with Representative Bill Posey?

J. B. Handley also gave $1,000. Mr. Handley is a very wealthy man who seems to be convinced that vaccines and nothing but vaccines caused autism in his child. He is so convinced that he is happy to see public health in the United States on the decline.

And then there is Barry Segal, who also gave $1,000. He sits on the board of Focus Autism, the organization which funded the hilariously inept “study” (more like back-of-the-napkin miscalculations of numbers) by BS Hooker, who also sits on that board.

Wait a goddamned minute! Did two board members of an anti-vaccine organization look at each other and decided to fund and conduct a study on vaccines and autism and come out with findings that vaccines cause autism? I’m shocked!

And don’t waste your time trying to say that Focus Autism is not anti-vaccine. Their own “vaccine” page is filled with anti-vaccine tropes.

This is just the donations that we know of from “autism advocates.” There could be more, but the federal election donation laws are so murky that it is impossible to tell how much people gave to what congressperson or political action committee. At the very least, they gave $4,000 to a man who already has received over a million dollars in donations and has plenty of cash on hand to spend. That is $4,000 that could have gone toward something meaningful for autistics. Instead, it goes to a wealthy congressman from Florida who is in no way threatened to lose his seat.

But those are the priorities of people who think that there are monsters under the bed, who saw that their children are autistic and deemed those children to be lost, stolen, or worse.

Politics and science again

I won’t give you the details, but lets suppose that there is a disease X that is caused by agent Y and that agent Y is found in Z. Further, Z is found everywhere in the world. So, if you catch X, odds are you were exposed to Y from Z here, there, and everywhere.

Epidemiologists will tell you that it’s useless to test for the presence of Y in Z based on one case of X because finding Y will not tell you that the person caught it from that location of Z. Of course, this is of little relief to the friends and relatives of a person with X because they want answers. We put a man on the Moon, so why can’t we do a simple test and determine how the person got sick, or where they were exposed before they got sick.

However, if a group of people come down with X and all were in location A where there is plenty of Z, then Z will get tested to see if our suspicions are confirmed. Location A will also get tested if one person spent all of their time, 24/7, in that location an nowhere else. Again, these tests are done to confirm the outbreak, not to diagnose a single case of X.

It seems simple, right? There are rules based on evidence and science on when and where to test for Y in Z. Unfortunately, these rules, like many others, are subject to the whims of the people in power.

The people in power tend to want to stay in power. In the United States, most of the political power is subject to the demands of the electorate in an election year. (I think they could care less the rest of the year.) So, if someone related to a case of X knows someone in power, that someone in power will demand that those of us in public health, who work at the whims of those in power (because they sign our paychecks), go against the scientific rules and epidemiological guidelines.

This is exactly the situation an epidemiologist friend of this blog is going through. He is being asked, bullied, and strong-armed into testing for Y in location A because of one case of X. Testing will achieve nothing. It will not confirm the diagnosis, which has been made using advanced lab methods on the patient’s specimens. It will not cure the patient. It won’t even keep other people from getting sick because, as I told you, Y is everywhere where there is Z. People are just unlucky enough to get the right dose at the right time. (And smoking, cancer, lung disease, and old age don’t help, either.)

I advised our friend to swallow hard and endure, take it. They’ll hate him for it, but that’s the point of being an Epi, he can be the outcast. He can make the choice that no one else can make, the right choice.

Or he can just do the goddamn test and get it over with before the weekend.

Science by legislation to pin all evils on vaccines

I should have never gone over to check the online “newspaper” of the “autism epidemic” this morning. I was met with this post:

“Please click on the Take Action Link above to send a message to your member of the House of Representatives asking him or her to co-sponsor House Resolution H.R.1757, The Vaccine Safety Study Act. This bill directs the National Institutes of Health to conduct a retrospective study of health outcomes, including autism, of vaccinated versus unvaccinated children. The NIH adamantly refuses to do any study that compares health outcomes in these two groups. You have to wonder why.”

No, you don’t have to wonder why. The reason that kind of study is not done is because it would be unethical to do a randomized clinical trial, which is what these people want. Other studies, such as case-control studies, have already been done, and all show no association between vaccines and autism. But these people like to beat dead horses.

You can’t go wrong with the evidence

As I think of moving on to the next thing in my career as an epidemiologist and into public health policy, I have been thinking of what kinds of challenges I’ll face when I make the leap. If you know me, you know that I absolutely cannot stand politics and politicians. I hate that they are willing to say — or do — anything and everything so long as they stay in power. They’ll lie, cheat, and steal, and then deny that they did even in the face of convincing evidence against them.

See, in their silly little minds, they think that they are being “Mavericks” or “Win-at-all-costs Winner” by systematically doing things that are very “questionable” in order to retain their elected position. And it’s not just the elected politicians, either. I’ve met plenty of non-elected people in power who will also go to great lengths to stay in power. They will go along with a horrible plan, even one that they know is horrible, and then not criticize that plan once it is agreed that it was horrible.

So one of my weaknesses in going into public health policy will be my willingness to admit when I’ve made a mistake and the sense of urgency I feel in correcting it. Now, some of you may think that I’m just blowing my own horn by saying that I am self-aware enough to admit my own mistakes — the kind of attribute reserved for historical figures. But I really am not. If anything, admitting my own mistakes has gotten me in trouble when I’ve uncovered mistakes made by me when others would have never found them.

The one big thing I hate to carry around is guilt. I really don’t like it. Ask Pedro. She can detect the slightest hint of guilt on me and make me confess to anything that I’ve done. So it’s going to be hard to be in politics when I am prone to admitting my own mistake. Although, to be honest, I have no interest in being a politician. I’ll just be working with them. But some of them are going to be my bosses, and anything I say or do will be interpreted in light of the day’s politics. This is going to lead to conflict and frustration.

Then again, you can’t go wrong if you have all the science and all the evidence on your side. Even if you make a huge mistake, as long as you did what you did with all the available information and evidence on your side, you really should be in the clear. I’m no mind reader, no fortuneteller. So, if I base the things I will do in public health policy on stuff that has been proven to work, then I should be okay.

Still, I’m sure I’ll find a way to get in trouble.

Books You Should Read: "When Germs Travel" by Howard Markel

Anyone who knows me knows that one of the big things I detest about Public Health as it is set up today is the interference of people who don’t know better into the things that we – the peons working the daily outbreaks and looking for cases of stuff – need to do without restrictions. Of course, I’m talking about politicians. The one issue that has painfully brought this to the forefront in my professional life is immigration. Time after time, I’ve seen politicians at all three levels of government call for the denial of basic health services to immigrants and their children. They reason that it is a waste of resources that could go to Americans.

It’s as if they think that viruses and bacteria know the difference between Pablo, the young apple picker from Oaxaca, and Paul, the corporate up-and-comer from Omaha with the dashing good looks. Pathogens don’t give a crap about who they’re infecting. To them, we’re all just sacs of growth media. The sooner we come to understand this, the sooner we can let go of the stigma that we cause to people based on their ethnicity and/or nationality and move on with what needs to be done.

The book “When Germs Travel” does a great job at telling us all about what happens when germs cross international boundaries and come to a new population – or society – and the kind of craziness that they cause. It covers six epidemics that were triggered by immigrants (or returning travelers) and the stupidity that ensued. For example, an outbreak of bubonic plague in Chinatown causes the authorities to cordon-off the area and not permit people who look Asian from interacting with the other ethnicities. Any epidemiologists worth his weight in salt will tell you that such an intervention by itself is useless.

You can’t quarantine or impose social distancing on just one group of people. You need to do it with all who are susceptible, regardless of race, ethnicity, gender, sexual orientation, disability, etc.

The book also covers the mistreatment of Jewish immigrants as they arrived in New York Harbor from Eastern Europe. They were screened for Chlamydia trachomatis, the causative agent of trachoma, which is an infection of the eyes. In that time, the infection was not treatable with antibiotics, for there were none. People were screened and told to go back to their country if they were found to be infected. On the other hand, if they had the right amount of money or the right connections in New York City, they were allowed to go on through.

A lot of help that screening did.

Not only that, but the screeners – medical doctors –  did not practice good hygiene. A high-ranking government official inspecting the intake points noticed this. That official? The President of the United States. Bo-yah!

I won’t spoil the rest of the book for you, but you know where this is going. You know of the treatment of Hatian immigrants because of HIV/AIDS. You know of the treatment of other immigrants because of Tuberculosis. Oh, you don’t know?

Everyone should.

One thing that resonates throughout the book is the hypocrisy of the decisions taken by politicians and the public health officials influenced by them. That’s right, not all public health workers are infallible and incorruptible. Many of them can be bought or intimidated into taking the wrong course of action when they need to protect the public’s health. And that’s one main reason why I will never, ever become a politician or play the politicians’ games.

I never want someone to write a book about how wrong I was in letting the next big epidemic or a small outbreak of diarrhea associated with a diner get out of control. That’s just plain embarrassing.