I trail off into a slightly awkward silence that the mechanic cheerfully fills. I realise that what I’ve done is akin to what my patients frequently do; I’ve come into the car emergency department (well, my local garage) with a preconceived idea of what’s wrong because I’ve “spoken to Dave.” I could equally have “googled it” or “had a friend who had the same problem.” I feel a building empathy for the chap in front of me who has almost certainly stripped down more wheel bearings than I’ve inserted cannulas, yet who manages to indulge my ramblings. He does so because it’s part of his job not to offend the customer, just as much as it is to actually work out why my car is making more noise than an angry swarm of wasps in a bass drum.
As I sit there waiting to find out if Dave was right (he wasn’t), watching anxious customer follow anxious customer, I begin to see frequent parallels between the mechanic’s job and my own. He listens to symptoms (“She’s knockin’ when I go over a bump” or “She’s pulling to the left when I brake”) and he clarifies detail: “Did you hit the curb parking?” I can see him making a differential diagnosis in his mind as he walks off into the workshop to begin the initial investigations. The customer waits nervously, wondering how serious it is (how many columns will be on the final invoice.) The mechanic checks the car for dangerous faults (“…of COURSE your 24-year-old weight-lifter’s pleuritic chest pain is probably musculoskeletal, but you wouldn’t want to miss a P.E. Where’s that link to the Wells score again?”) and then has a look at the more likely stuff. He also humours me by checking out the wheel bearings, not because he thinks they’re the likely source of my noisy ride but because he knows I won’t be happy until he’s allayed my concerns.
Finally he comes to a diagnosis (“the tracking’s out and your rear wheels are wearing unevenly”) and proposes a treatment plan (“New tires and a quick go on the machine that makes sure all 4 wheels are pointing in the same direction, at least until you hit that curb again…”) In my case it’s easy; no complicated jargon, no debate about the cause of my problem, a relatively cheap solution and a high chance of success. But what about the unfortunate chap after me? He had an intermittently illuminating ABS light.
The mechanic patiently explained that unless the light came on whilst he was in the garage, investigating the multitude of possible causes would be drawn out, expensive and potentially fruitless. I couldn’t help but think back to the 24-year-old weight-lifter again. More specifically, I was remembering the inner monologue that occurred whilst I wrote my notes; that wonderful breathing space in any emergency physician’s day where you actually get a chance to think. “Of course it’s ALMOST certainly musculoskeletal, but he IS describing sudden onset pleuritic chest pain… What’s his Wells score? Good, low risk… Oh, bugger, his D-dimer’s up. I KNEW it would be, he said he had a snotty nose. Oh, thank goodness, I can PERC him… Excellent, PERC negative, I can discharge. Wait, what about pneumothorax? Better get a chest x-ray, just in case…” In medicine, and particularly in the emergency department, we’re comfortable balancing probability and risk. However, it took me longer to learn how to explain this to the anxious young lady with the non-specific abdominal pain, the normal observations and the soft belly than I care to admit. I know perfectly well that her pain will almost certainly dissipate as inexplicably as it arrived and if it doesn’t then we’ll have plenty of time to act on her worsening symptoms before anything untoward happens. However, convincing her of this fact at 3am is always a task requiring rapport, finesse and careful safety netting advice.
As I hear my mechanic put yet another anxious patient at ease (“It’s probably just smoking because it’s a diesel. They always run a bit dirty and if it’s your head gasket that’s going then you’ll get plenty of warning. Just keep an eye on the oil and make sure it doesn’t turn milky.”) I wonder where he developed the consultation skills that I’ve worked on my whole career. I’m relatively sure that nowhere in his training was there a session labeled “Simulated Customer Encounter” or “Breaking Bad News”, yet he manages it like a seasoned, kindly, greying physician who appears to have all the time in the world in the middle of a busy medical ward round.
Perhaps if we’d spent less time ensconced amongst the pillars of books with our noses buried in the latest journal and just a little more time chatting to Dave we wouldn’t need lectures to remind us how to talk to people.
Now, if only I knew my camshaft from my timing belt then I might even be ready for a career change.
The post On Camshafts and Communication appeared first on LITFL.
I trail off into a slightly awkward silence that the mechanic cheerfully fills. I realise that what I’ve done is akin to what my patients frequently do; I’ve come into the car emergency department (well, my local garage) with a preconceived idea of what’s wrong because I’ve “spoken to Dave.” I could equally have “googled it” or “had a friend who had the same problem.” I feel a building empathy for the chap in front of me who has almost certainly stripped down more wheel bearings than I’ve inserted cannulas, yet who manages to indulge my ramblings. He does so because it’s part of his job not to offend the customer, just as much as it is to actually work out why my car is making more noise than an angry swarm of wasps in a bass drum.
As I sit there waiting to find out if Dave was right (he wasn’t), watching anxious customer follow anxious customer, I begin to see frequent parallels between the mechanic’s job and my own. He listens to symptoms (“She’s knockin’ when I go over a bump” or “She’s pulling to the left when I brake”) and he clarifies detail: “Did you hit the curb parking?” I can see him making a differential diagnosis in his mind as he walks off into the workshop to begin the initial investigations. The customer waits nervously, wondering how serious it is (how many columns will be on the final invoice.) The mechanic checks the car for dangerous faults (“…of COURSE your 24 year old weight-lifter’s pleuritic chest pain is probably musculoskeletal, but you wouldn’t want to miss a P.E. Where’s that link to the Wells score again?”) and then has a look at the more likely stuff. He also humours me by checking out the wheel bearings, not because he thinks they’re the likely source of my noisy ride but because he knows I won’t be happy until he’s allayed my concerns.
Finally he comes to a diagnosis (“the tracking’s out and your rear wheels are wearing unevenly”) and proposes a treatment plan (“New tires and a quick go on the machine that makes sure all 4 wheels are pointing in the same direction, at least until you hit that curb again…”) In my case it’s easy; no complicated jargon, no debate about the cause of my problem, a relatively cheap solution and a high chance of success. But what about the unfortunate chap after me? He had an intermittently illuminating ABS light.
The mechanic patiently explained that unless the light came on whilst he was in the garage, investigating the multitude of possible causes would be drawn out, expensive and potentially fruitless. I couldn’t help but think back to the 24 year old weight-lifter again. More specifically, I was remembering the inner monologue that occurred whilst I wrote my notes; that wonderful breathing space in any emergency physician’s day where you actually get a chance to think. “Of course it’s ALMOST certainly musculoskeletal, but he IS describing sudden onset pleuritic chest pain… What’s his Wells score? Good, low risk… Oh, bugger, his D-dimer’s up. I KNEW it would be, he said he had a snotty nose. Oh, thank goodness, I can PERC him… Excellent, PERC negative, I can discharge. Wait, what about pneumothorax? Better get a chest x-ray, just in case…” In medicine, and particularly in the emergency department, we’re comfortable balancing probability and risk. However, it took me longer to learn how to explain this to the anxious young lady with the non-specific abdominal pain, the normal observations and the soft belly than I care to admit. I know perfectly well that her pain will almost certainly dissipate as inexplicably as it arrived and if it doesn’t then we’ll have plenty of time to act on her worsening symptoms before anything untoward happens. However, convincing her of this fact at 3am is always a task requiring rapport, finesse and careful safety netting advice.
As I hear my mechanic put yet another anxious patient at ease (“It’s probably just smoking because it’s a diesel. They always run a bit dirty and if it’s your head gasket that’s going then you’ll get plenty of warning. Just keep an eye on the oil and make sure it doesn’t turn milky.”) I wonder where he developed the consultation skills that I’ve worked on my whole career. I’m relatively sure that nowhere in his training was there a session labeled “Simulated Customer Encounter” or “Breaking Bad News”, yet he manages it like a seasoned, kindly, greying physician who appears to have all the time in the world in the middle of a busy medical ward round.
Perhaps if we’d spent less time ensconced amongst the pillars of books with our noses buried in the latest journal and just a little more time chatting to Dave we wouldn’t need lectures to remind us how to talk to people.
Now, if only I knew my camshaft from my timing belt then I might even be ready for a career change.
The post On Camshafts and Communication appeared first on LITFL.
One topic that keeps recurring and obligating me to write about it consists of critically analyzing stories of children with cancer whose parents, either on their own or at the behest of their child, stop or refuse chemotherapy or other treatment. It is, sadly, a topic that I’ve been discussing for nearly a decade now, starting first on my not-so-super-secret other blog and continuing both there and here. Indeed, the first time I wrote about this problem was in November 2005, a fact that depressed me when I went back through the archives to find the first post I had ever done on this topic because so little has changed in that time.
I was painfully reminded of this last week when stories started circulating in the media about the death of Makayla Sault, an Ojibwe girl and member of the New Credit First Nation in Ontario:
The entire community of New Credit is in mourning today, following the news of the passing of 11 year old Makayla Sault.
The child suffered a stroke on Sunday morning and was unable to recover. Friends and family from across the province travelled to New Credit First Nation today to offer condolences, share tears and pay their respects.
Makayla, as you might recall, was an 11 year old aboriginal girl from Canada with lymphoblastic leukemia. She was one of two 11-year-old aboriginal girls last year who refused chemotherapy and have medical stories that are eerily similar. The other girl’s name is unknown (at least to me and most of the public), because of privacy concerns in her legal case, but she is referred to in court documents as “JJ” and is a Haudenosaunee girl from Six Nations of the Grand River First Nation, also in Ontario. I discussed her case extensively back in November and will be discussing her more here, but the short version is that, like Makayla, JJ, too, developed lymphoblastic leukemia, underwent a short course of chemotherapy, stopped the chemotherapy, and discovered a cancer quack by the name of Brian Clement, who promised JJ’s mother that he could cure her cancer. As a result, as is often the case in such situations, there was a legal battle, and Ontario Court Justice Gethin Edward ruled that the parents can let their daughter die. Of course, he didn’t put it in those words. Rather, the Justice Edward ruled that “traditional healing” is such an integral part of aboriginal rights that the parents’ “right” to treat their children with “traditional healing” trumps the right of the aboriginal child to live. I know, I know, I’m letting my bias show, but functionally and for all practical purposes, that’s what his ruling means.
When I come across a story like this, in which a child is being medically neglected and allowed to die, as Makayla Sault was and JJ is, I come at it from one unwavering viewpoint: The right of the child to receive proper medical care and thus to live trumps pretty much everything else. Religion doesn’t much matter to me. Nor does race, nationality, or culture, even that of the Amish or indigenous peoples. I am completely unapologetic about this stance, no matter how “intolerant” I’ve been called regarding this case and about other cases in which religion was the motivating factor behind the parents’ refusal to seek science-based treatment for their child. Competent adults with deadly diseases are free to choose to be treated, not to be treated, or to undergo quack treatment, but a child is not competent to make such a decision. Because of that, a child depends upon her parents to choose what is in her best interests.
None of this is to say that wide latitude shouldn’t be given to parents to choose their children’s health care. The state should never step in lightly. There are many gray areas, after all. However, when parental choice so mind-numbingly obviously conflicts with the best interests of the child and will inevitably lead to that child’s unpleasant death, as Makayla’s case so harshly demonstrated and JJ’s case will almost certainly demonstrate by the end of this year, then parental “rights” should cease to matter as well. Again, I make no apologies for this viewpoint, any more than I did when I lamented how a young Amish girl named Sarah Hershberger is similarly being allowed to die of a treatable cancer.
Now, another child who with proper medical treatment had a much better chance of surviving than dying has died because she and her parents chose quackery over effective treatment, and another is heading that way.
It seems a long time ago, but it was only a couple of months ago when I first discussed the case of Makayla Sault in the context of the story of JJ, a First Nations girl with cancer, whose fate was almost certainly sealed by Justice Edward’s ruling. Rather, instead, as did Sault’s parents, JJ’s parents took her to Brian Clement, a Florida quack who isn’t even a physician but somehow has been treating patients with cancer at Hippocrates Health Institute in West Palm Beach for many years now with his “Life Transformation Program” that includes a veritable cornucopia of quackery. Indeed, former staff of his are suing him for operating “a scam under Florida law” and practising medicine without a licence. Interestingly, approximately a third of Clement’s business appears to come from Canada. Why his quackery is particularly popular among Canadians is a mystery, but it is.
Clement seems to have a thing for treating everything with wheatgrass enemas. Wheatgrass, according to Clement, can increase red blood cell count, decrease blood pressure, cleanse the blood, organs and GI tract of “debris,” stimulate the thyroid gland, “restore alkalinity” to the blood, “detoxify” the blood, fight tumors and neutralize toxins, and many of the usual other things quacks like Clement claim. He even offers the infamous “detox footbath,” plus intravenous vitamin therapy, cranial electrotherapy stimulation, combination infrared waves plus oxygen, acupuncture, colon hydrotherapy (apparently with or without wheatgrass) and lymphatic drainage. There’s even a bit of quackery hilariously called colorpuncture, in which various colors are applied to acupuncture points.
You get the idea.
Brian Clement’s clinic has nothing to do with Ongwehowe Onongwatri:yo (indigenous medicines) and everything to do with good, old-fashioned European-American quackery focused mainly on wheatgrass, raw vegan diet, and “detoxification.”
Makayla Sault, as you might recall, preceded JJ in seeking treatment from Brian Clement. She was diagnosed with acute lymphoblastic leukemia last year and began a course of induction chemotherapy. After eleven weeks, alarmed at the side effects, she refused further chemotherapy. Her reasons for stopping were explicitly religious, complete with a video in which she explained her reasons for stopping:
Then she reads her jarring words. “I am writing this letter to tell you that this chemo that I am on is killing my body and I cannot take it anymore.”
“I have asked my mom and dad to take me off the treatment because I don’t want to go this way anymore,” she said, describing how chemotherapy left her unable to walk and nauseous, with terrible sores and organ damage.
“I know that what I have can kill me but I don’t want to die in a hospital on chemo, weak and sick,” she said. “I wish that the doctors would listen to me because I live in this body and they don’t.”
And then a vision of Jesus:
In the video, she explains that she is at peace because of her faith. She said Jesus appeared to her in her hospital room, telling her not to be afraid.
He was wearing a robe and prayer shawl, with long straight hair, and was “beautiful,” she said. He showed his hands, with the stigmata marks. Two angels were beside him.
“I asked him ‘Can you heal me?’ and he said ‘You are already healed,’” she said. “He told me ‘Do not be afraid. You are my child.’”
In October, she filmed another video from a boat, saying, “I just want everybody to know that I’m alive and well and that I’m healed.”
The first video is here:
The video of Makayla on a boat is here:
It’s hard not to be moved seeing this video, knowing what happened to Makayla just a week ago. Like all children (and many adults), she is laboring under the delusion that death by cancer is better than suffering through chemotherapy. It’s not.
Both of Makayla’s parents are pastors at an evangelical church; so it is not surprising that she shared their Christian faith. They supported her decision, although the decision was initially challenged by the Brant Children’s Aid Society (CAS), the CAS backed off and closed the case file because “we have to recognize the traditions and the community of First Nations people,” according to director Andy Koster, speaking last May Koster also said:
“The more we looked at it we realized that this is a warm, loving family,” said Andy Koster, executive director of the Children’s Aid Society of Brant. “We don’t believe that bringing her into care, taking her away from that family — which is her support — and forcing chemotherapy, is going to be in any way emotionally sound for her, or psychologically or even spiritually.”
Nice job there, Mr. Koster. Letting such a child die of untreated leukemia isn’t emotionally sound for her, either, but that’s what the Brant CAS decided to do. No one said that forcing chemotherapy is a good thing; rather, it’s the lesser of two evils. Another child who very well might have been saved and lived to a ripe old age is dead, her whole life ahead of her having been thrown away pointlessly, because her family relied on quackery instead of effective medicine. Once more, a cancer quack has claimed a very salvageable life.
The saddest thing about this is that this outcome didn’t have to be. All reports indicate that Makayla’s tumor was a treatable variety. In fact, it was the same kind of cancer the First Nations girl whose case I discussed has, lymphoblastic leukemia, although it wasn’t as favorable a variety as JJ’s. Pediatric oncologists estimated that Makayla had a 70%-75% chance of surviving five years, because the cancer had the Philadelphia chromosome. Since recurrences after 5 years are almost nonexistent, that’s essentially a cure. So, yes, it’s quite possible that Makayla could have been treated with the very best drugs modern medicine has to throw at lymphoblastic leukemia and died anyway, roughly a one in three to one in four chance. However, by abandoning chemotherapy and choosing Clement’s quackery instead of Makayla’s best shot at a cure, Makayla and her family reduced her chances of survival from a very good shot to zero shot. To be honest, after the descriptions of how her condition was deteriorating in November when I originally wrote my post about JJ, I’m a little surprised that she lasted two whole months more. From the news reports, she sounded as though she was in bad shape in November. But last she did.
Now Makayla’s parents have suffered the worst loss a parent can suffer. They are, no doubt, suffering intensely, as is Makayla’s entire family and tribe, over the loss of their beloved. I do not blame either Makayla or them, at least not nearly as much as I blame Brian Clement for having duped them. Unfortunately, as is often the situation in these cases, the Sault family does not accept that the cancer killed Makayla. As is so frequently the case when a patient who dies while treating her cancer with alternative medicine, they’re blaming the chemotherapy. In a statement, they said:
Makayla was on her way to wellness, bravely fighting toward holistic well-being after the harsh side effects that 12 weeks of chemotherapy inflicted on her body.
Chemotherapy did irreversible damage to her heart and major organs. This was the cause of the stroke.
We continue to support Makayla’s choice to leave chemotherapy. At this time we request privacy from the media while we mourn this tragic loss.”
Yes, as happens so often in these cases, it’s not the quack’s fault that the child died. It’s the fault of those evil “Western” doctors and their poisonous chemotherapy. Always and forever. Unfortunately, a stroke is a known complication of leukemias due to either cancer-related coagulopathy or complications of treatment. It’s one way that patients with end stage leukemia die. Given that Makayla hadn’t been treated in months, her stroke was almost certainly due to her cancer, not to damage from chemotherapy. True, one chemotherapy drug that might well have been used in the initial induction chemotherapy that Sault had can cause stroke, but not a delayed stroke several months after the therapy had been discontinued.
As I pointed out in the comments of a story about Makayla’s death on Doubtful News and an oncologist has pointed out in an interview, intracranial hemorrhage due to leukemia is a not uncommon terminal event when the bone marrow is taken over by the cancer and can’t make enough platelets and other blood products. Similarly, an ischemic stroke can occur due to (1) leukostasis, with high white blood cell counts (as can be caused by acute lymphocytic leukemia) causing sludging in the blood vessels of the brain or, less commonly; (2) direct infiltration of the brain with leukemia; or, less commonly, particularly in children, (3) a red blood cell count so low that it causes lack of oxygen to the brain. It’s thus far more likely that Makayla died of end stage leukemia and that her stroke was the immediate terminal event than it is that chemotherapy-related complications from many months ago resulted in a stroke. I have no doubt that Makayla’s family and people believe that the chemotherapy caused her stroke, but the likelihood that it did compared to the likelihood that progressive leukemia caused her stroke is infinitesimally small. From a medical and oncologic standpoint, it’s just not a convincing story, as much as they believe it.
In a way, I can’t blame the Saults for believing that it was the chemotherapy that killed their daughter. I really can’t. It’s completely understandable. If they stopped believing that, then they would have no choice but to accept that it was the choice to abandon chemotherapy that doomed their daughter. That’s just not something that any parent is likely to be able to admit. In any case, once again, the “rights” of the parent trumped the right of the child to effective medical care.
Makayla is now dead and buried. It is too late for her. Her family and community must deal with their horrible loss as best as they can. However, it might not be too late for JJ and other children elsewhere who are suffering from cancer but not receiving effective treatment. Fortunately, according to a press release from her family, she appears to be currently cancer-free. Not surprisingly, due to the usual misunderstanding that families who abandon chemotherapy for quackery for hematologic malignancies nearly always have, her family believes she is doing well because her latest tests have failed to find residual cancer:
The 11-year-old at the centre of a controversial ruling on aboriginal medicine tested negative for signs of cancer, her family says, months after she was pulled out of chemotherapy early in favour of natural therapies.
According to a published statement, the family credits the alternative treatment for the remission. But oncologists say it may be the result of the two weeks of chemotherapy the girl underwent at McMaster Children’s Hospital in August before her mother pulled her out.
Another story from Two Row Times reports:
Once we had the court ruling that upheld our right to use our traditional healthcare we sought out a oncologist who would work with our unique situation. I felt it necessary to have her closely monitored as we navigated through uncharted territory. Toronto Sick Kids agreed to fulfill that role. Of course we needed to hear the oncologist’s spiel about no child ever known to survive leukemia without chemo and they expect her to begin dying in mid January. I booked a biopsy for mid January. Its now 6 months following the diagnosis with only our choice of treatment. We received the biopsy results yesterday – NO VISIBLE CANCER!!!
An announcement was also posted on Facebook by Hippocrates graduate Jane Schweitzer describing the news.
Of course, JJ’s remission is far more likely to be the result of the chemotherapy that the girl underwent in August than it is to be due to Brian Clement’s quackery or whatever traditional healing methods they’ve also been using. I’ve explained this concept several times of late. For hematologic malignancies like this, there are several phases of chemotherapy, starting with the induction phase. The induction phase is designed to put the patient rapidly into remission. However, as pediatric oncologists (not to mention adult oncologists who treat hematologic malignancies) learned the hard way decades ago, it requires sustained courses of chemotherapy to prevent leukemias from rapidly recurring. Basically, it’s often easy to get a patient into remission, but keeping the patient in remission is much harder.
One good thing about this article is that the reporter interviewed some actual oncologists who explained this concept rather well:
“From my perspective, there’s lots that traditional healing can offer in terms of symptom management and support, but based on my scientific training I think it’s exceptionally unlikely that traditional medicine has cured her of her disease,” said pediatric hematologist and oncologist Dr. David Dix, a clinical professor at the University of British Columbia.
“It is quite possible that she went into remission after the first two weeks of chemotherapy,” he said. Dix said the likelihood of the cancer returning is “100 per cent” and that any return of the cancer will be more difficult to treat.
And, later in the article:
The typical course of treatment for lymphoblastic leukemia involves four weeks of intensive chemotherapy which puts “99.9 per cent” of people into remission, Dix said. That is normally followed by about six months of heavy chemotherapy, then about two years of maintenance chemotherapy.
“Achieving remission, even with a short duration of chemotherapy, is expected,” said Dr. Kirk Schultz, professor of pediatrics at the University of British Columbia. “The whole focus of chemotherapy in children with acute lymphoblastic leukemia is to get a curative outcome, that they cure the disease and it never comes back.”
And the conclusion of the article:
“Any pediatric oncologist would tell you that the likelihood of her disease recurring or relapsing is 100 per cent, that she’s at very high risk of recurrence for her disease,” said Dix. “When she does relapse it becomes more difficult then to get her back into remission. It’s very much better to get her back into chemotherapy as soon as possible.”
So what we have in JJ is, medically at least, a very similar story to that of Makayla Sault, just delayed. Her cancer will eventually recur, probably within the next year, and at that point it will be much more difficult to eradicate than it would have been if the girl had only undergone standard-of-care chemotherapy and completed the full course during her first pass. She didn’t.
It’s been noted that there are significant differences between these cases. For instance, Makayla was much more bright and assertive than JJ apparently is, so much so that some believed her capable of making decisions about her own health care. Given her visions of Jesus as a rationale for stopping treatment, I’m a bit—shall we say?—skeptical that that was true. In contrast, Justice Edward found that JJ “lacked capacity to make such a life-and-death decision,” even as he ruled that the traditional medicine was so integral to aboriginal rights that JJ’s parents had the right to refuse chemotherapy for her.
It’s not entirely clear exactly what treatments JJ is undergoing. For instance, this Two Row Times article states that since August she has “followed a strict protocol utilizing indigenous medicines, ceremonial healing and nutritional therapies – including consuming a 100% raw and sugar free vegan diet” and that she “has also pursued other nutritional and supplemental therapies under the wisdom and guidance of indigenous healers and advisors across North America.” Her mother in her statement wrote:
I believe our deep rooted faith in our medicine and ceremonial medicines, diet and exercise have been the reason for the biopsy results. I thank my Creator and all He set out on earth. I acknowledge our medicines. That they still fulfill their duties as our helpers, our healers. I acknowledge the spirit helpers that manifest themselves and their assistance in ways unknown to us still existing in the physical plane. I acknowledge my individual responsibility to look to Creation for what we need in all aspects of my family life. I acknowledge the individuals who still carry the ancient Haudenosaunee medicine knowledge. They choose to devote their lives from very early on to be a servant to the nation.I am eternally grateful to so many for the strength and support that, today has resulted in [my daughter’s] good health.
Yet, in an article published by CBC News, reporter Connie Walker describes an interview with JJ’s mother and a visit to the Hippocrates Health Institute by dryly noting:
There were two teas — one given to her by a healer in their community and another sent by someone she met on Facebook who says he is a medicine man from Saskatchewan.
The tea was likely the only indigenous medicine at Hippocrates.
As a First Nations person myself, I’m confident I can say that none of my ancestors abided by a strict raw vegan diet, or took high doses of vitamins intravenously or underwent cold laser technology. Regardless, her mother said Hippocrates was in line with her belief in natural medicine.
The entire story comes across to me as very consistent with Brian Clement being a particularly slick-talking con man and quack who didn’t like being questioned. Walker noted having viewed many of Clement’s videos in which he extolls the benefits of wheatgrass and attacks vaccines and “Western medicine” in general. One that stands out to me is this video of Clement being interviewed by Joe Mercola:
It’s chock full of pseudoscientific nonsense.
Walker reported further:
She [JJ's mother] spoke about the director, Brian Clement, with glowing adoration. “What struck me most,” she said, “was he was not afraid of cancer. Cancer didn’t shake him like it shook me.”
It was his words that convinced her to leave chemo. She said she called him from the waiting room at McMaster and he assured her that leukemia was “not difficult for them to deal with.”
It’s a claim he denied when we confronted him about it in Florida. He denied other allegations, too.
No, he was not practising medicine without a licence as some former employees of his alleged. Nor was he treating people battling cancer and other serious illnesses, he said. He was teaching them to heal themselves.
Can he give me the names of anyone he’s helped? I asked. “Get off my property!” he shouted.
Ah, yes. A classic 60 MINUTES-like moment, the kind reporters love, when the target of their investigation gets ticked off and kicks them out of their office or off their property.
Sadly, the hard part will come when this girl’s leukemia, as is almost inevitable now, recurs. What will the parents do? Will they admit that the combination of “traditional” medicine and Brian Clement’s quackery didn’t work and finally let their daughter be treated with state-of-the-art chemotherapy? At this point, that is probably the best outcome that can be expected for JJ, because her mother is clearly never going to bring her back to have her leukemia treated correctly as long as the girl appears to be tumor-free, even though that would be the course of action that would maximize her daughter’s odds of survival. The problem, of course, is that this honeymoon period probably won’t last very long. The clock is ticking or the sands of the hourglass are running out. Pick your metaphor.
Unfortunately, I fear that when this girl’s cancer does recur, the parents will not change course. After all, this is what the girl’s mother has said:
In an interview with CBC News, her mother said, “This was not a frivolous decision I made. Before I took her off chemo, I made sure that I had a comprehensive health-care plan that I was very confident that was going to achieve ridding cancer of her body before I left the hospital. This is not something I think may work, this is something I know will work.”
Unfortunately for this woman’s daughter, it is doubtful that she will be able to admit that this “something” didn’t work, even after the leukemia recurs. Then we’ll have a second Makayla Sault, another dead aboriginal girl.
How can such things happen? How can governments so routinely allow children to die due to medical neglect because that is what the parents choose, often based on religion, personal belief, or culture? If you want to know how bad it is, just consider the case of Herbert and Catherine Schaible, discussed by both Harriet Hall and myself. In 2009 the Schaibles chose prayer over antibiotics for pneumonia for their first child. The child died. The Schaibles received ten years’ probation and had to promise, in essence, that their other children, who were not removed from their care would receive modern medical care. In 2013, a second child, who was 8 months old at the time, developed pneumonia and died the same way. It took the second death of a child before the state actually took their children away and put them in jail. As Steve Novella has pointed out, if parents only use medical opinions as a justification for choosing quackery or denying care, the state will usually intervene, as Ottawa is doing in the case of Marco Pedersen, whose son Aiden also has acute lymphoblastic leukemia, which Pedersen wants to treat with hemp oil. If, on the other hand, religion or culture is used as justification for choosing quackery over effective treatment, courts seem to be much less willing to step in and see that the child receive effective treatment.
This dynamic has definitely been at play in the two cases of the aboriginal girls. With Makayla Sault, both religion and her aboriginal culture led to the reluctance of authorities to intervene. With JJ, it’s primarily her culture. Indeed, her community and tribal elders fully supported the parents, as did Makayla Sault’s. Indeed, when CAS was looking into Makayla’s case, New Credit Chief Bryan LaForme warned that hundreds of community members in the “Makayla Defence Force” would spring to action should the CAS attempt an apprehension. Emotion also ran high for JJ, as demonstrated by a Facebook post I cited in my previous post. I cited the whole thing before, but for this post I will simply cite a particularly relevant part, so that you don’t have to go back. Accusing McMasters Children’s Hospital of trying to “undermine our way of life”:
The court affirmed that our use of traditional medicines was integral to our cultures, historically and today. The court recognized that our right to use our medicines is not subject to the approval of western medical practitioners.
And:
Forcing a First Nations child to undergo unwanted, mainstream, medical treatment is an affront to the dignity and autonomy of that child, our cultures, and our nations. Had our children been forced into treatment, it would have had a disastrous effect on their emotional, psychological, and spiritual well-being. Instead of being proud of their own traditions, they would learn that the laws, governance, teachings, and medicines of the Haudenosaunee and Anishinabe cultures were wrong and even dangerous. This is simply not true.
No, but Makayla Sault’s family learned that they were ineffective the hard way. Or they would have, if they had actually used traditional medicine instead of a the quackery of a white man from Florida. Unfortunately, this view led JJ’s community hold fundraisers and provide JJ’s family with enough money to fly to Florida and pay the $18,000 Clement charges.
Believe it or not, I understand, at least as much as a middle-aged citizen of an oppressor nation can, that aboriginal peoples have been treated horribly by the Canadian government, just as those in the US have been treated horribly by the US government. I know about, for instance, the Canadian residential schools, in which aboriginal children were forced to attend boarding schools away from their families and communities in order to assimilate them into the dominant Canadian culture. There, aboriginal children often suffered physical and sexual abuse. It’s not surprising that there still exists in Canadian aboriginal communities a great deal of distrust of the government and the medical system that facilitated such cultural imperialism, the same as the native peoples in my country very much distrust the government that drove them off their lands and into reservations.
As simply as I view things, in which the life of the child is paramount, on the ground, sadly, things often are not that simple (although, I would add, they should be). In the case of religion, because of the deference given religious beliefs governments are often very reluctant to intervene to stop religion-based medical neglect, as was the case with the Schaibles. Because of Canada’s abominable history with its native tribes, Canada’s aboriginal peoples understandably tend to view even attempts to help two of their children through the lens of the residential schools and past oppression. Toxic attitudes common to many cultures, that of the US included, that ascribe absolute rights to parents over their children fuse with past grievances that led to current distrust and turn what should be a case of child welfare into a chance to assert aboriginal rights through the proxy of JJ’s case. Unfortunately, among the tribes, few seem willing to speak up for these two girls’ right to the best shot at life medicine can give them. Thus, tribal authorities have done a grave disservice to aboriginal children in allowing their mistrust to lead to their using two innocent children as a weapon in their fight to obtain more autonomy. Meanwhile, Canadian authorities, aware of all these things, bend over backwards not to appear to be “undermining” the culture of the native peoples, even though they know it will cost the life of a child. In all of this, the rights of children as autonomous beings rather than the property of their parents or extensions of their parents’ cultural identity, are lost, possibly irretrievably.
How do we overcome this? Putting the child first, rather than religion, race, nationality, or culture, would be a way to start. If everyone involved could do that, just for a moment, for JJ there might be a chance to save her. Or maybe I’m just too naïve, and JJ is doomed after all.
It was summer 2006, the days long and the nights warm, and I was an intern, living by the beach and working a rotation in emergency. My memories of this time are like those of childhood holidays, a jumble of sensation and moments, rounded out and glossed by time and nostalgia, but I can say with certainty that it was a golden period.
I was beginning to find my feet within the world of medicine, finally feeling like a real doctor. We were still in the old department in those days, poorly designed and hopelessly undersized for our growing patient load, yet warm and friendly, the glass walled doctor station affectionately known as “the fishbowl” a hive of social activity. My wins were simple things; a growing success rate in IV cannulation, mastering the art of plastering and suturing, independently managing common emergency presentations such as pneumonia and Colles’ fractures, my first shoulder joint reduction (a modified Kocher’s technique with traction).
Hours outside work felt like one long holiday. The junior doctor ED roster, weekend and evening heavy, can be a lonely one when everyone else is at work in the depths of a southern state winter. Over summer, however, a 4pm shift start feels like a day off, and a 5.30pm finish leaves hours of daylight. The small unit I shared with two friends was walking distance from both the beach and the pub, ensuring a constant stream of Melbourne guests and an ongoing vibe of festivity.
And then there was surfing, always surfing. Anyone can surf on a Queensland holiday, but there is a distinct joy in punctuating a satisfying day’s work with a splash in the ocean. Surfing alone or with friends, a quick sunrise dip on a still morning before work, or east coast odysseys on runs of days off. Storing my board in the residents’ quarters on hot days to stop the wax melting in the car, leaving nightshift and heading straight to the beach, followed by eggs and a cold beer at a favourite cafe before heading home to sleep. Surely this was a magnificent life.
More summers came and went, and friends moved on. I have no recollection of making a formal decision to stay in both emergency medicine and my home by the beach, it simply became evident I wouldn’t leave. Then a romance led to the intertwining of two lives and blossomed into a family. We all moved into an old house on a large block with glimpses of the ocean from the neglected backyard, and slowly set about making it ours. I am now part of my family unit first, myself second. I drive the same highway to work that I did as an intern, detouring along the coast on my way home to check the surf, but these days I don’t stop. Family, work, study, the house and garden, so many forces keeping me land bound, so many good reasons not to plunge in. Yet it often feels that a little piece of me is missing.
It’s not just the relinquishing of personal freedom I struggle with, but the recurrent little deaths of youthful possibility. Raising a family and completing a formal training program are noble and rewarding pursuits, but they are also ruthless dream slayers. We cannot live all potential lives, and will do ourselves an injustice if we try. I have never lived in Paris for six months and become fluent in french, nor toured the Californian longboard circuit. We all have these, I dare say, the dreams we have let go by yet carry around with us, packed tidily into a secret little backpack.
Nine years have passed and I am working a busy shift on a hot, sticky day, when it feels like the whole state is holidaying in our town. I am well on my way to becoming a competent emergency physician and still love the never ending challenge. My small wins are a smoothly executed intubation, wrestling a rampaging department into submission overnight, pulling off a novel procedure or tactfully solving a disposition issue. We have been in the new department for years now. It was the right move, but at times I still miss the cramped coziness of the old place.
I hear the loudspeaker call of a resus patient, and walk in to see a young man, clad only in boardshorts, sand clinging to his legs, face contorted in pain, gingerly supporting the weight of his left arm. What happened, I ask. He was paddling for a wave and his shoulder just popped out. I enquire as to which break, and it is one of my favourites, a rolling point situated on a scenic bluff, far enough out of town to keep the crowds down. It would be offshore today. For a moment I forget his pain and I am there, on that wave, the sharp sting of spray in my face, weight of water between my fingers, gliding down the face and springing to my feet, my longing so strong I can taste it, like an unexpected mouthful of salty water. How I want to go back to a time when I would arrive at work with grains of sand in my hair, euphoric with surfing and emergency, the two somehow forever wedded for me that first year. The moment passes and I drag myself back to the present, where I belong. I do shoulders differently now. Some nitrous and gentle external rotation with a flexed elbow, and with a sudden clunk the rounded humeral head is also back where it belongs, the procedure familiar and satisfying in my hands.
The next day we take our children to the beach, low tide with a forgiving swell. We rarely battle with a board on family visits any more, the finite resource of adult upper limbs already allocated to towels, buckets, other miscellaneous beach paraphernalia and a rather sturdy toddler whose preferred mode of transport is balanced on my hip, like a chubby-cheeked, divine smelling bag of lead. But today I grab a board from my teenage nephew, and suddenly I am paddling, gliding, standing, trimming, waving enthusiastically to my daughter playing on the shore. I am not that intern girl anymore, nor would I want to be, but for the duration of that wave I capture something of the sense of freedom and possibility of my glorious first summer by the beach, and realise that perhaps it is play that is the missing element in my crowded life these days. And as I drive down the highway to work this evening, window down, breathing in the warm summer night, I will be thinking of that wave, all that came before, and the many more still to come.
The post Warm summer nights appeared first on LITFL.
Registration for NECSS, the North-East Conference on Science and Skepticism, is now open. Included in the program will be a day of Science-Based Medicine.
Speakers will be Harriet Hall, Jann Bellamy, David Gorski, Steve Novella and Mark Crislip.
NECSS will be held April 9th–12th, 2015, in New York City at the Fashion Institute of Technology. The SfSBM part of the program will be Friday, April 10 and you can attend one or more of the days. $95 for one day or $195 for the entire conference.
A preliminary program, subject to change
| Time | Speaker | Topic |
| 10:00 | Steve and David | Introductions and Welcome. |
| 10:10 | Steve | TBA |
| 10:40 | Harriet | Chiropractic |
| 11:10 | David | Integrative Oncology |
| 11:40 | Mark | Acupuncture |
| 12:10 | A buffer because | we will run over |
| 12:30 | Lunch | |
| 1:00 | Lunch | |
| 2:00 | Jann | Legislative alchemy |
| 2:30 | Panel | Topic pending |
| 3:15 | Question and answer | Questions from the twitter and audience |
| 4:15 | Break | |
| 4:00 | Crislip MC, Jann, David, | Jeopardy |
| Steve and Harriet Compete | ||
| 5:00 | Wrap up | |
| 5:15 | SfSBM business meeting | |
| 5:45 | End |
For more information and to register, go to NECSS or this registration page.
The Society for Science-Based Medicine is a co-sponsor of NECSS and paid SfSBM members can get a 15% discount using the code SFSBM2015.
This would be a good time to consider joining or renewing a membership in the Society for Science-Based Medicine.
A self-aggrandizing moment.
You may not know this, but for a year I blogged on my own on the topic of infectious diseases.
I had self-published those early essays in a volume and readers gave it good reviews: 4.5 Stars on Amazon and a 3.89 on Goodreads, but they complained about the lack of copy editing. Go figure.
No longer. Bitingduck press is my publisher and has collected, edited, and organized the first year’s Rubor, Dolor, Calor, Tumor blog entries, now available on Kindle for a mere $5.99. Other versions, including a paperback, to follow in about 10 days. It should be 99% typo free.
Puswhisperer: A year in the life of an Infectious Disease Doctor .
The perfect gift for the pus lover in your life.
Although Botox® has become a household name and is now the most common medical procedure performed world-wide, it is not the only FDA approved botulinum toxin. There are actually 3 currently approved by the FDA that have the same actions—Botox, Dysport® and Xeomin®.
What are the uses for these materials? The most common is to improve the appearance of the frown line (the 11’s) on the forehead, but also uses in the face include improving forehead lines, crow’s feet, lip line-s, lines under the eyes and can produce a lift of the face (so called Nefertiti lift).
It is also used to decrease the fine wrinkles over the face and the décolleté. Additionally, these injections can decrease the pain from migraine headaches and decrease the problem of sweating under the arms and on the palms and soles.
The injections are not painful, have very few side-effects (most common is bruising especially around the eyes), and it must be remembered that there is a delay in its action since it is actually treating the underlying cause of the wrinkles, i.e. the muscles. Most commonly it begins to work in about 3 days, reaches its peak in 7-10 days and will last anywhere from 3-8 months depending on the area injected and the skill of the injector.
The post Botox injections in Nashville, an Update – By Dr. Melvin Elson appeared first on Dr. Melvin Elson - Official Website.
It was summer 2006, the days long and the nights warm, and I was an intern, living by the beach and working a rotation in emergency. My memories of this time are like those of childhood holidays, a jumble of sensation and moments, rounded out and glossed by time and nostalgia, but I can say with certainty that it was a golden period.
I was beginning to find my feet within the world of medicine, finally feeling like a real doctor. We were still in the old department in those days, poorly designed and hopelessly undersized for our growing patient load, yet warm and friendly, the glass walled doctor station affectionately known as “the fishbowl” a hive of social activity. My wins were simple things; a growing success rate in IV cannulation, mastering the art of plastering and suturing, independently managing common emergency presentations such as pneumonia and Colles’ fractures, my first shoulder joint reduction (a modified Kocher’s technique with traction).
Hours outside work felt like one long holiday. The junior doctor ED roster, weekend and evening heavy, can be a lonely one when everyone else is at work in the depths of a southern state winter. Over summer, however, a 4pm shift start feels like a day off, and a 5.30pm finish leaves hours of daylight. The small unit I shared with two friends was walking distance from both the beach and the pub, ensuring a constant stream of Melbourne guests and an ongoing vibe of festivity.
And then there was surfing, always surfing. Anyone can surf on a Queensland holiday, but there is a distinct joy in punctuating a satisfying day’s work with a splash in the ocean. Surfing alone or with friends, a quick sunrise dip on a still morning before work, or east coast odysseys on runs of days off. Storing my board in the residents’ quarters on hot days to stop the wax melting in the car, leaving nightshift and heading straight to the beach, followed by eggs and a cold beer at a favourite cafe before heading home to sleep. Surely this was a magnificent life.
More summers came and went, and friends moved on. I have no recollection of making a formal decision to stay in both emergency medicine and my home by the beach, it simply became evident I wouldn’t leave. Then a romance led to the intertwining of two lives and blossomed into a family. We all moved into an old house on a large block with glimpses of the ocean from the neglected backyard, and slowly set about making it ours. I am now part of my family unit first, myself second. I drive the same highway to work that I did as an intern, detouring along the coast on my way home to check the surf, but these days I don’t stop. Family, work, study, the house and garden, so many forces keeping me land bound, so many good reasons not to plunge in. Yet it often feels that a little piece of me is missing.
It’s not just the relinquishing of personal freedom I struggle with, but the recurrent little deaths of youthful possibility. Raising a family and completing a formal training program are noble and rewarding pursuits, but they are also ruthless dream slayers. We cannot live all potential lives, and will do ourselves an injustice if we try. I have never lived in Paris for six months and become fluent in french, nor toured the Californian longboard circuit. We all have these, I dare say, the dreams we have let go by yet carry around with us, packed tidily into a secret little backpack.
Nine years have passed and I am working a busy shift on a hot, sticky day, when it feels like the whole state is holidaying in our town. I am well on my way to becoming a competent emergency physician and still love the never ending challenge. My small wins are a smoothly executed intubation, wrestling a rampaging department into submission overnight, pulling off a novel procedure or tactfully solving a disposition issue. We have been in the new department for years now. It was the right move, but at times I still miss the cramped coziness of the old place.
I hear the loudspeaker call of a resus patient, and walk in to see a young man, clad only in boardshorts, sand clinging to his legs, face contorted in pain, gingerly supporting the weight of his left arm. What happened, I ask. He was paddling for a wave and his shoulder just popped out. I enquire as to which break, and it is one of my favourites, a rolling point situated on a scenic bluff, far enough out of town to keep the crowds down. It would be offshore today. For a moment I forget his pain and I am there, on that wave, the sharp sting of spray in my face, weight of water between my fingers, gliding down the face and springing to my feet, my longing so strong I can taste it, like an unexpected mouthful of salty water. How I want to go back to a time when I would arrive at work with grains of sand in my hair, euphoric with surfing and emergency, the two somehow forever wedded for me that first year. The moment passes and I drag myself back to the present, where I belong. I do shoulders differently now. Some nitrous and gentle external rotation with a flexed elbow, and with a sudden clunk the rounded humeral head is also back where it belongs, the procedure familiar and satisfying in my hands.
The next day we take our children to the beach, low tide with a forgiving swell. We rarely battle with a board on family visits any more, the finite resource of adult upper limbs already allocated to towels, buckets, other miscellaneous beach paraphernalia and a rather sturdy toddler whose preferred mode of transport is balanced on my hip, like a chubby-cheeked, divine smelling bag of lead. But today I grab a board from my teenage nephew, and suddenly I am paddling, gliding, standing, trimming, waving enthusiastically to my daughter playing on the shore. I am not that intern girl anymore, nor would I want to be, but for the duration of that wave I capture something of the sense of freedom and possibility of my glorious first summer by the beach, and realise that perhaps it is play that is the missing element in my crowded life these days. And as I drive down the highway to work this evening, window down, breathing in the warm summer night, I will be thinking of that wave, all that came before, and the many more still to come.
The post Warm summer nights appeared first on LITFL.
Last week, I wrote about a rather impressive measles outbreak at the “happiest place on earth,” a.k.a. Disneyland. At the time I wrote that post, the outbreak, which had reached several states, had spread to 17 people. As I sat down to write this, I wasn’t actually sure that this topic needed another post, but then I saw this:
As the number of measles cases continues to rise in Southern California following an outbreak at Disneyland last month, about two dozen unvaccinated students at one Orange County high school have been forced to stay home after a classmate contracted the disease.
In a message to students and parents at Huntington Beach High School on Thursday, Pamela Kahn, health and wellness coordinator at the Orange County Department of Education, said that students “who do not have any documented [measles, mumps and rubella] immunizations will be excluded from attending school until January 29.”
Also, the number of confirmed measles cases has climbed to 52, 46 of them in southern California. In Orange County itself, there were 16 cases as of Friday, ten of them linked to Disneyland, the rest not, a finding that’s led health officials to conclude that “measles has become more widespread throughout the county.” Meanwhile, health officials in Californian are warning that the number is likely to go higher still.
Meanwhile:
A South Pasadena woman’s younger sister came down with the measles. Now, federal health officials want her locked down under quarantine, but she is resisting.
Ylsa Tellez is a 26-year-old grad student whose younger sister, 24-year-old Maura Tellez, was one of the confirmed cases of measles caught recently at Disneyland.
And:
“(They were) saying I need to get vaccinated and I need to be quarantined, otherwise I’m going to go to jail or something, or I’m going to get a misdemeanor,” said Ylsa.
Ylsa says she refuses to be a prisoner in her own home despite the possible quarantine order. Ylsa’s mother is also defending her daughter.
“It’s not nice when my daughter is threatened like this because she’s not even sick,” said Myrna Tellez.
No, but she’s been exposed. The reason to quarantine someone who has been exposed is because that person can be infectious before symptoms appear. That’s very reason for quarantines, and always has been, to keep people who have been exposed isolated until health officials can be sure that they aren’t contagious. One comment I saw about this issue (several comments, actually) questioned why we quarantine someone like Tellez but not Ebola patients. When I see a question like this, I want to respond: How is this thing not like the other? Measles is incredibly contagious through respiratory contact. In contrast, Ebola is not. It requires close personal contact with infected bodily fluids. Quarantine can stop the spread of a disease like measles; for Ebola it’s a lot more dicy.
As I discussed last week, the majority of the measles cases thus far have occurred in the unvaccinated. More importantly, the association of this outbreak with Disneyland gives this story legs. It’s drawn international attention of a very negative kind on how the antivaccine movement has spread misinformation and frightened parents, thus contributing to declines in vaccine uptake, which in turn have led to pockets of vaccine uptake sufficiently low as to permit, facilitate even, outbreaks of vaccine-preventable diseases. The heat has come down particularly hard on certain antivaccine-friendly pediatricians in the area, such as our old friend Dr. Jay Gordon in Santa Monica and, of course, Dr. Bob Sears in Capistrano Beach, right in Orange County itself. I took him to task last time for having downplayed previous measles outbreaks, treating the parents of his patients condescendingly by basically waving them away and telling them to get the damned shot if they’re worried but stop bugging him.
I exaggerate, but not by much.
What really make up my mind to follow up on this outbreak is that, over the last week, I’ve noticed that the antivaccine movement is pushing back. Stung by the publicity and criticism, they’re pulling out all the stops—or should I say tropes?—to deflect attention. Even “Dr. Bob” has gotten into the act, dropping all pretense of not being antivaccine, as he pulls out an old chestnut, much beloved of antivaccinationists since time immemorial (or at least for the last couple of decades). I like to call it the argumentum ad Brady Bunchium. Sometimes I call it the the “appeal to the Brady Bunch” or, more generally, the “appeal to classic television” vaccine fallacy. What do I mean by that?
One antivaccine trope is a claim that the measles just isn’t that serious a disease, followed by the question or implication: Why are we worrying about it so much? Examples of this fallacy include this video, Measles, Back In The Days Before The Marketing Of The Vaccine:
The video above includes clips from The Donna Reed Show (specifically this episode), The Flintstones, and The Brady Bunch about the measles. It’s a theme repeated by, for example, the antivaccine crank blog Age of Autism (AoA) in posts like this one entitled Before Fear Sold Vaccines, Children Got Sick… On TV Even and Measles and Chicken Pox: Entertainment or Epidemic? You get the idea. Back in the days before vaccines for measles and various other childhood diseases, almost everybody got these diseases as a child. For most children, they were usually self-limited diseases and no big whoop, right? Just another childhood disease that most children had to endure, right? After all, Hollywood included bits about measles in sitcoms and cartoons, such that Donna Reed didn’t think it was a big deal, and the Brady Bunch didn’t think the measles were a big deal. In fact, all the kids were happy not to have to go to school and sat around smiling and playing Monopoly! About the only thing that the writers get right is that the measles is contagious as hell, but that only provided more grist for the comedy mill to make jokes about all the kids coming down with measles, and then Mike and Alice too. Only Carol escaped because, as we learn in the last scene, she had had the measles “years ago.” In fact, for completion’s sake, here’s the entire episode, in case you’re interested:
Of course, I can’t help but see that episode of The Brady Bunch and wonder why Mike and Carol hadn’t gotten at least some of their kids vaccinated. After all, the vaccine was licensed in 1963, and that show first aired in 1969. Not surprisingly, given how effective the measles vaccine has been, by 1969 the incidence of measles had already plummeted dramatically:
Not that one would expect comedy writers to be familiar with vaccine recommendations at the time, but based on past recommended vaccination schedules, it might have been unsurprising that the older kids were unvaccinated, but one would think that the younger children would have been. Also, by 1969, measles incidence had become so much less common, particularly in children under 10, that one can’t help but think some fuzzy-headed and nostalgic writers were a bit behind the times. After all, The Brady Bunch wasn’t exactly a font of scientific knowledge. For instance, I remember an infamous three-part “very special episode” of the show (parts 1, 2, 3) where the family vacationed in Hawaii and Bobby found a tiki statue claimed to cause bad luck. Once the tiki statue was in Bobby’s possession, all sorts of bad things started happening to the family, including a surfing accident and Peter nearly being bitten by a tarantula. In the story, there was a curse that couldn’t be lifted until the tiki was returned to an ancient burial ground. I suppose antivaccinationists would use a that The Brady Bunch story as an example of how people understood back in 1972 that there actually do exist tiki statues in Hawaii that confer extreme bad luck on the ones who possess them. That’s the quality of argument here: Silly, vacuous, and a non sequitur.
In any case, the essence of the argumentum ad Brady Bunchium fallacy with respect to vaccines is that measles was no big deal before the vaccine and that pharmaceutical companies and health officials are stoking unneeded fear of measles in order to sell the vaccine, through a combination of desire for profits and ideology. In fact, if you peruse the more stinky cesspits of antivaccine nonsense (such as the comments in AoA), you’ll see commenters, particularly older ones who were children before the measles vaccine was available in the early 1960s and/or who had had the measles themselves sometime during the 1940s-1960s frequently referencing the above YouTube video to argue that measles is nothing, that it’s something “we” all had and did just fine. It’s very much of a piece with curmudgeons of a certain age (which, unfortunately, includes my age) complaining about today’s youth and pointing out how they used to walk to school in the snow and uphill both ways or the occasional equally cranky rants by surgeons trained before work hour limitations (like me) about how they loved being on call every second or third night and spending 100+ hours a week in the hospital, the only problem with every other night call being that you miss half the cases. It’s basically an assertion of superiority and toughness by the older generation over the younger, the sort of thing that’s been going on hundreds of years.
Indeed, if you really want to see this sort of approach taken to an extreme, just check out VaxTruth.org the website of Marcella Piper-Terry, a woman who is known for her extreme antivaccine views to the point where she has likened vaccination to rape and has recently been ranting about the “civil rights violations” of quarantine for measles. In a series of posts, Piper-Terry has argued, echoing the argumentum ad Brady Bunchium, that measles is not harmful and that measles is even good for you, citing a rather interesting experiment in which massive doses of the measles vaccine has been used experimentally to treat cancer based on case reports of spontaneous regression of Hodgkin’s lymphoma in children after measles infection.
Piper-Terry even cites an abstract from a fundamentalist Catholic scientist named Theresa Deisher, who through her Sound Choice Pharmaceutical Institute (SCPI), has been trying to prove that DNA from “aborted fetuses” in vaccines is responsible for autism through its ability to recombine with the infant’s DNA. It’s very much of a piece with the same sort of nonsense peddled by Helen Ratajczak in a truly awful “review” article published four years ago that keeps being resurrected, Michael Myers-like, every so often. The sad thing is, Dr. Teisher is a real molecular biologist and really should know better, but apparently does not, at least not any more since she became an “adamant right-to-lifer.” Like the case of Peter Duesberg and his HIV/AIDS denialism, Dr. Teicher has become full-on antivaccine based on the use of cell lines derived from a fetus decades ago to manufacture some vaccines. In some of her posts, she even invokes the intellectually dishonest gambit beloved of antivaccinationists I dubbed “vaccines didn’t save us.”
Particularly despicable in Piper-Terry’s post is how she zeroes in on 450 people dying each year of the measles in the US in the years before the vaccine was licensed dividing by the entire US population of 189 million at the time, and concluding that only 0.000237% of the US population died of the measles each year. In fact, in the post referenced by Piper-Terry entitled Putting Measles Into Perspective, her friend Dawn Babcock Papple even asks rhetorically about the number of people dying of the measles world-wide, “When over 150,000 people die each day total, is 540 people dying of measles each day really that outrageous?”
The entire attitude is that the 450 deaths from measles each year in the US before the licensing of the vaccine and the 197,000 people dying worldwide of measles now are inconsequential. I kid you not. See why I call this attitude so despicable? I suppose to these two antivaccine warriors, the last major measles outbreak in the US before the current one. This is what Dr. Paul Offit spoke about in his talk at TAM last year, and his description of watching children die of the measles was incredibly depressing. In this outbreak, 55,000 cases and more than 120 measles-related deaths were reported, is no big deal either. What’s a few hundred dead children, after all, compared to freedom from the evils of vaccines?
Sadly, “Dr. Bob” has traveled far down the same sort of path as Piper-Terry, at least in terms of echoing her sentiment, and that of many antivaccine activists, that measles is “no big deal.” True, he isn’t as crass or callous about it, expressing sympathy for people outside the US who die of measles, but his arguments, at their core, are very much the same as those of Piper-Terry and Papple, although he at least is not foolish enough to use the “vaccines didn’t save us” gambit. Last week, Dr. Bob posted this update on the Disneyland measles outbreak on his Facebook page entitled JUST HOW DEADLY IS MEASLES? In it, Dr. Bob strives mightily to convince his readers that the measles is no big whoop. I’m reprinting the complete text, in case Dr. Bob has second thoughts and sends his Facebook post below down the old memory hole, not to mention for the benefit of those of you who don’t have Facebook accounts:
The full text of Dr. Bob’s little rant follows:
What makes measles so scary? What is it about measles that spreads fear and dread through our population? Three things, in my opinion, set it apart from most infectious diseases that make us afraid: 1. It’s untreatable, and it has a high rate of complications, so we are at it’s mercy, 2. It’s been virtually eliminated from the U.S., so we aren’t used to it anymore, and 3. It’s potentially fatal.
Now, let’s play two truths and a lie. Two of these statements are true, and one is not. Well, the one that is not is technically true, but it’s not true in all practical terms.
1. Untreatable? Correct. There is no anti-viral medication that will help, so we just have to stand by as the disease runs its course. We are powerless, and that creates fear. We don’t want to take a risk with something which we have no way to mitigate or control. The only thing that may make measles less severe is high dose Vitamin A therapy (which is approved by the WHO). But that’s not an anti-viral med; it just helps us fight it off a little better.
Complications? Ear infection is the most likely complication – treatable. Pneumonia is next – also treatable. Ya, you don’t want those things to happen, but they are treatable. Encephalitis? That’s much worse. Fortunately it’s extremely rare in well-nourished people (see below).
So, the lie is that measles has a high rate of serious complications. It doesn’t. It CAN, but it rarely does.
2. Eliminated? Virtually. Over the past 20 years we’ve sometimes only had 50 cases a year. Sometimes 150. Nobody knows measles anymore, and when we are ignorant of something unfamiliar, we fear it until we understand it.
Ask any Grandma or Grandpa (well, older ones anyway), and they’ll say “Measles? So what? We all had it. It’s like Chicken pox.” Ask a twenty-five-year-old mom with two young kids, and she’ll scoop up her kids and run away from you for even mentioning the M word.
If you understand measles, you wouldn’t fear it. Respect it.
I do acknowledge that it’s a public health nightmare in that it takes a lot of effort and money to contain these outbreaks. And it causes a lot of people to get tested, quarantined, or treated with preventive immune globulin shots. It’s no joke. But, those efforts are largely because we are trying to contain it, not because it’s going to kill everybody. So, not fear – respect.
3. Potentially fatal? Technically true, but herein lies the lie. It’s been publicized as “the deadliest of all childhood fever/rash illness with a high rate of complications.” Deadly? Not in the U.S., or any other developed country with a well-nourished population. The risk of fatality here isn’t zero, but it’s as close to zero as you can get without actually being zero. It’s 1 in many thousands. Will someone pass away in the U.S. from measles one of these years? Tragically yes. That will likely happen to one person. It hasn’t happened here in at least ten years (or more – I don’t even know how many years we have to go back to find one). When that happens, it will be extremely tragic.
But will it spread through the U.S. and kill people left and right? No. Does measles do that in underdeveloped countries? Sadly, yes. It kills countless people worldwide every year. So, that’s how health officials can accurately say it’s so deadly. They don’t have to tell you the whole truth, just the part of the truth that they want you to believe.
Measles can also be serious for young infants, just as many diseases can. It can also be serious for immunocompromised people, just as all illnesses. It can also cause pregnancy complications, just like many infections can. Measles isn’t unique in these risks. But they are risks nonetheless.
So, fear measles? No. Not in the U.S.. Respect measles? Yes. Take appropriate precautions with it. But don’t let anyone tell you you should live in fear of it. Let’s handle it calmly and without fear or blame.
“Without blame”? As in, “Don’t blame me for the consequences of what I’ve been saying and doing for all these years”? Nice try, Dr. Bob. You’re not getting off that easily, nor will you be so easily allowed to shift the blame to the parents who listened to you rather than your own words and behavior.
Notice how Dr. Bob even invokes a variant of the “argumentum ad Brady Bunchium” fallacy when he mentions how “grandma and grandpa” poo-poo the measles as being “just like the chicken pox” and dismiss it with, “We all had it,” an attitude that he compares to that of a 25-year-old mother who’s never seen the measles before and therefore fears it because she doesn’t know it. It’s a rather clever inversion of the argument frequently used by pro-vaccine bloggers that points out that the reason parents don’t fear vaccine-preventable diseases anymore—the usual example used being polio—is because they’ve never personally witnessed the death and complications these diseases used to cause. In retrospect, I’m actually a bit surprised Dr. Bob didn’t mention the infamous “measles” episode of The Brady Bunch, actually. Come on, Dr. Bob. Let it out! You know you want to!
On that note, after having read Dr. Bob’s treatise above, I’d like you to go and read Marcella Piper-Terry’s initial response to the Disneyland measles outbreak from January 8 entitled Measles at Disneyland! Can you tell the difference? Other than Piper-Terry’s longer post, with calculations designed to make you think that measles was never a big deal, Dr. Bob is using exactly the same arguments without adding the calculations, in particular the key argument being that measles in developed countries is not a threat, only in those “other” people in Third World countries who aren’t as developed as we are because, you know, we’re superior. Measles doesn’t kill very many of us compared to those poor, blighted savages! (I exaggerate, but, I contend, only a little.) He dismisses complications of measles as being “treatable” and therefore of little consequence. In fact, he makes it sound as though a measles-associated ear infection is equivalent to measles-associated pneumonia, dismissing them both as “treatable” with a jaunty, “Ya, you don’t want those things to happen, but they are treatable.” Never mind that many, if not most, cases of measles-associated pneumonia require hospitalization. As Dr. Roy Benaroch sarcastically puts it in his post entitled Dr. Sears continues to salute our children with his middle finger, many parents would indeed consider an ICU stay “somewhat of an inconvenience.” (I like Dr. Benaroch’s style.)
Think of it this way. According to the CDC, before the vaccine, 48,000 people a year were hospitalized for the measles; 4,000 developed measles-associated encephalitis; and 400 to 500 people died. By any stretch of the imagination that was a significant public health problem, and the introduction of the measles vaccine in 1963, followed by the MMR in 1971, made it much less so. As Dr. John Snyder reminded us five years ago responding to Dr. Sears making the same arguments in his book, measles is not a benign disease, regardless of what popular culture thought of it 50 or 60 years ago.
Of course, even Dr. Bob has to concede that measles-associated encephalitis is a Very Bad Thing, but he dismisses the risk with an equally jaunty rejoinder that encephalitis is “extremely rare in well-nourished people” (i.e., his well-off patients at whom his Facebook post is aimed). As for death, Dr. Bob’s message is, “Don’t worry, be happy.” After all, according to him, the risk of fatality is “as close to zero as you can get without actually being zero,” or one in many thousands. Funny how Dr. Bob (and the antivaccine activists to whom he panders) dismiss a possibility of death of this magnitude as being of no consequence; yet, a one in a million chance of Guillan-Barre disease after the meningococcal vaccine (or a one in several hundred thousand risk of severe reactions to vaccines in general) is completely unacceptable. Indeed, if you accept at face value Dr. Bob’s grossly exaggerated estimate for a severe vaccine reaction of one in 100,000, by Dr. Bob’s own definition, the risk of severe reactions to any given vaccine is even lower than “as close to zero as you can get without actually being zero.” Even if you accept Dr. Bob’s even more ridiculously inflated estimate that the risk that “any one child will suffer a severe reaction over the entire, twelve-year vaccine schedule is about 1 in 2600,” I can’t help but note that we’re now in the range of the likelihood of a child with measles dying due to his disease in the United states. To Bob, the risk of these vaccine injuries is unacceptable, but a similar or much higher risk of death if a child catches the measles is just the cost of doing antivaccine business. According to Dr. Bob, yes, sooner or later a child is going to die of the measles—and won’t that be so tragic?—but it’ll likely only be one.
Hypocrisy, thy name is Bob Sears.
If Bob Sears weren’t such a worthless excuse for a pediatrician when it comes to promoting misinformation about vaccines, I’d almost feel sorry for him. Almost. He is, however, a perfect example of what the phrase “hoist with his own petard” means. Dr. Bob has for years made a profitable career for himself as the “reasonable” face of the vaccine-averse, painting himself as not like all those other loony antivaccinationists out there but rather as a reasonable pediatrician taking a “middle way” and “listening to parents.” Now the consequences of the ideas Dr. Bob has promoted are starting to become apparent, with measles outbreaks becoming increasingly common right on his home turf, leading the parents of his patients to ask him what to do now that low vaccine uptake encouraged by him are facilitating measles outbreaks like the most recent one in Disneyland. They are asking him for guidance, and he’s fobbing off the responsibility on them, telling them just to “get the vaccine” and if you “don’t want the vaccine, accept the risk.” Nice.
I’ve been fearing for a long time that the US was only several years behind the United Kingdom and Europe when it comes to suffering a major resurgence of the measles and that such a resurgence was coming. I hope I’m wrong, but I fear that 2015 might finally be the tipping point when measles really comes roaring back to levels not seen in a quarter century or even more. If that happens, Dr. Bob Sears will have to take his share of the blame for cashing in on fear and driving vaccination rates down. He’s not alone.
