It expresses my own belief that “when the time comes” I’d like as little treatment as possible.  However, the reality, at least from the stories of my friends today, shows that end of life decision to be very complex.

My first friend is Deb.  She’s the daughter of a good friend of mine that died of cancer over 5 years ago.  I helped in the last few months with her mother, and to everyone’s horror, Deb was diagnosed with lung cancer.  You can imagine, the mother, dying of breast cancer, knowing her daughter had lung cancer.

Deb has never smoked, and only worked in hospital environments as a nurse. Lung cancer is even more difficult for people like Deb, as people assume she smoked.  We all like to take a small comfort in the thought “Well I never smoked so won’t get lung cancer”.

Link: Lung Cancer Incidence Rates High Among Women who Have Never Smoked

Up to 1 in 5 women with lung cancer have never smoked or lived with a smoker.   Deb though refuses to waste time explaining to people “No I never smoked”.  To her, cancer is the great equalizer, those suffering and battling it, all deserve compassion.  It doesn’t matter if you smoked or not, lung cancer is a horrible thing to face.  No one “deserves” it  because of a habit.

Deb decided to go on chemotherapy and experimental treatments.  She’s been through them all, or so it seems.  Pills, shots, infusions.  Some make her sick, some she barely notices.  Treating lung cancer long term means switching treatments, keeping with one until the cancer stops responding and then going on to the next.  Deb will never, ever, stop chemotherapy of some sort.  It’s taken a toll.  But her quality of life remains very good.  She works 2 jobs.  She joined weight watchers (with her doctor’s permission) and looks fabulous with her new thinner figure.  (Chemo doesn’t always make you lose weight).  She travels to Hawaii and to visit family.  Best of all she has 2 new grandchildren she never had before she was diagnosed.  They are the delight of her life.  Deciding to go the aggressive treatment route has worked out well for her.  She’ll never be cancer free, but each year she gains is another victory for science.

My other friend I ran into by accident at the food store.  I hadn’t seen Joan for many months.  I asked about her husband, and she began to tear up.  She said her husband had died, and then immediately added “We should have listened to him”.  She then went on about how her husband when diagnosed with cancer had said “I don’t want any treatment” and said he was “ready to die”.  She said her children and doctor had all convinced him to get treatment. She was almost in tears (in the dairy aisle) as she said “It was wrong of us to do that”.  Her husband suffered horribly and in the end she said it was “just one thing after another”.  I knew this was something she felt strongly about, because usual dairy aisle conversation is “oh hey, how’s it going?”

The difference perhaps between my friend Deb and my other friend’s husband is that for one science offered results and the other science offered pain and misery.  Deb’s lung cancer results are not typical.  But her taking a chance gave her years that have perhaps been the richest she has ever had.  My friend’s husband was older.  He had lived his full life.  The difference between cancer diagnosis in your early 40′s and in your late 70′s, both with poor results from chemotherapy, is that in your early 40′s you aren’t even thinking about death.  In your late 70′s you’ve at least thought about it some.

Deb made her choice by herself.  Her family had input but from the start she was ready to fight the cancer.  My friend’s husband had to be talked into it.  He was fine with just pain killers and quiet time with family before he died.  I know a lot of older friends that would choose full throttle chemotherapy, and some younger ones that might not want the endless regimen of chemotherapy Deb goes through.

No matter what, fighting cancer is very difficult for both the cancer patient and the family and friends.   Life, and death, doesn’t always give us clear choices.

I think in the end, how one chooses to battle an illness needs to be a personal choice.  My hope is that those choices are respected and supported.

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This post, A Tale of Two Treatments, originally appeared on She Thought on January 13, 2012.
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A Rinderpest epidemic in the 1900ies (image FAO).

In the last few weeks and in the general indifference of media everywhere, the FAO has been celebrating an event of rather tremendous import:  Rinderpest was officially declared eradicated, joining smallpox in the all too short list of such eradicated diseases. This announcement was by no mean unexpected, due to the very nature of disease eradication, a process itself deeply dependant of the nature of the pathogen…

Rinderpest, originally a German word meaning “cattle plague”, is a paramyxovirus, a large family of small, enveloped, single stranded RNA virus. Interestingly enough; it is most closely related to the human measle virus. This similarity is most likely not coincidental as evidence have recently emerged that the human pathogen actually originated from a zoonotic virus that took the opportunity brought to it by the domestication of cattle and jumped from the cattle to the human about ten to eleven centuries ago.

Also not coincidentally, rinderpest shares several characteristics with the other eradicated pathogen, smallpox. Like it, it is a virus, an ‘obligate intracellular pathogen’, a biological entity that requires to infect a host in order to reproduce and one with a relatively narrow range of susceptible hosts. This make them ideal candidates for eradication as an effective vaccine program, such as the rinderpest vaccine developed by Plowright and Fisher in 1962, will prevent infections and allow to break the transmission cycle. Without a susceptible host a virus, especially an enveloped one such as rinderpest and smallpox will not “survive” very long in the environment (as an side, viral envelopes are themselves a pretty cool bit of virology: They are mostly composed of bit of the host’ cell membranes that the virus rip off on its way out to wrap itself in. As it is part of the host’ self, it allows the virus to hide itself from the host immune system, but, on the other hand, tend to be more fragile than a virus’ naked capsid).

The strategy for eradication therefore, consists in the systematic immunization of susceptible hosts, especially around areas of known outbreak, to create the epidemiological equivalent of a firebreak and cut off the virus’ transmission. And, because the virus can not be carried outside of an epidemy; the absence of such signifies that no viruses are present or active. This is why the announcement was not a surprised, the last known outbreak of rinderpest dates back from 2001. The delay in the announcement was mostly due to the possibility of the disease still roaming around unreported, as it is likely that it did for some time in West Africa after the Kenyan outbreak.
In this regard, the announcement was mostly a matter of ratifying officially a state that had been considered a truism for some time.

Still; it is a remarkable achievement: the culmination of many decades of dedication  (the Global Rinderpest Eradication Program was founded in 1994 but was preceded by a host of more local efforts stretching back all the way to the 1900ies).

It is also a reminder to us of the amazing potential of a well conducted vaccination program. At a time when measles are making a come-back in the U.S and in Europe, a tragic situation due to the most part to insufficiencies in vaccine coverage, it is always a good lesson to keep in mind. It is vaccination that got us rid for good of daddy paramyxovirus; and vaccination is also going to be the way to got to tackle the virus’ prodigal son…

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This post, Good-bye Rinderpest!, originally appeared on She Thought on June 19, 2011.
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Because few people are actual infectious disease experts or experts in immunology, vaccinating children requires reliance on the authority of the scientific consensus, which is that vaccines are very safe and effective.

There are a couple of barriers to analyzing the medical literature. The details of scientific primary sources require subscription or fee-based access. Even when access is available, most members of the lay public are simply not trained to accurately interpret the data. I rely on secondary sources, primarily Science Based Medicine, for an accessible and credible overview of the literature. It’s straightforward and matter-of-fact, which is exactly how I like to consume scientific information. Unfortunately, SBM is not as seductive or emotive as purveyors of medical misinformation such as Mothering Magazine.

Mothering is a gorgeous publication that features delicious recipes, lovely family activity ideas, eco-friendly lifestyle advice, and other harmless-yet-interesting fluff that resonates withe me. Unfortunately, readers also encounter a great deal of medical misinformation. The format taps into fears of inadequate mothering and offers counter-culture solutions that will finally make one a “good” mother. It’s very seductive, especially when it elevates even mundane parenting choices to self-righteous political positions. Of course Mothering is strongly against vaccination, and provides all kinds of science-y sounding language and anecdata to support this position. It’s very hard to sort out credible information about vaccines, and I have a lot of sympathy for parents who choose not to vaccinate. It’s even more difficult when anti-vaccination confers social status.

I have long thought that alpha moms jockeying for position within parent groups contributed to decreasing rates of vaccination. More recently, I’ve been thinking about the larger societal pressures that influence anti-vaccination.

I was inspired by a discussion in the comment section of an SBM article by Dr. David Gorski about Mothering Magazine’s deadly medical advice, including a plethora of vaccine misinformation and HIV denial.  The entire comment thread is worth reading because there are a number of very bright people who contribute a great deal of interesting insight. Below is an excerpt of my small bit.

Commenter Windriven asks:

“So what drives Mothering’s readers? Why are so many people willing to ignore science and medicine in favor of anecdote? Clearly these are engaged parents; why else would they subscribe to a parenting magazine? One presumes that they have been exposed to the pro-vaccination argument. One presumes that they are aware of the thorough discrediting of the MMR link to autism.

Are there any studies examining this?”

I responded:

“@ Windriven: I’ve actually thought quite a bit about this, and I have some ideas about what I think might be going on. This is based on my anecdotal observations, not on any rigorous study.

Many women who can afford to stay home gave up careers to do so. Larger society undervalues stay-home moms (as well as teachers and other child care workers). So bright, educated women find themselves in clusters, isolated from prestige, and they bring the work ethic and focus that advanced them in careers to parenting. They must seek status and validation from other members of the stay-home community, and this requires separating themselves from the unwashed masses. (My friend calls this “competitive parenting.”)
This subculture fosters increasing intensity and extremism, and practices that might have begun as reasonable choices are pushed to extremes. Once everyone in the group is breastfeeding infants, for example, the higher-status women are the ones who breastfeed kindergartners.
This trajectory translates to increasingly harmful cultural norms. Once everyone treats vaccination as an ala carte menu, the higher-status women are the ones who are rejecting vaccines, or rejecting prenatal care, or obstetrical care, or whatever. Statistics are such that the individual mothers and children are likely to be unharmed by these decisions, and this leads to strong confirmation bias.

Mothering is one more source of validation and status. It feeds right into the paradigm I attempted to describe. The pressure to conform is intense, and I’ve actually heard mothers defensively/apologetically rationalize to other mothers things like weaning early, or allowing a doc to prescribe antibiotics for something potentially serious. [...]”

Windriven:

“@Anthropologist
Yours is a fascinating conjecture. It certainly explains the herd mentality. But why woo instead of science? Why don’t these mothers end up as uber-vaccinators?”

Me:

“@ Windriven:
‘Why don’t these mothers become uber-vaccinators?’

My personal biases tends to lead me (correctly or not…) to conjectures involving status and power. My read is that challenging the authority of conventional medicine and MDs is one way of artificially ascribing status to oneself. [...]”

The contemporary anti-vaccine movement should by all rights be a small fringe movement. Its tenants have been roundly and repeatedly discredited, and yet it persists. It’s going strong both on the pages of Mothering and other parenting sites, and in real-life parent subcultures. I think that there is a good deal of observational evidence favoring my off-the-cuff theory of a convergence of in-group status and societal marginalization of stay-home parents. This, coupled with misinformation that appears credible published on mainstream sources, fuels the unfortunate rise in potentially deadly preventable diseases.

Whether or not my assessment about the anti-vaccine movement is correct, treating parents, teachers, and childcare workers like respectable, contributing members of society would benefit everyone.

Vaccine image from the CDC public domain image gallery.

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This post, Social Status and Immunization, originally appeared on She Thought on May 25, 2011.
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According to their website:

“From March 9th 2011 – April 17th 2011 our community will be one of many cities joining together for the largest and longest coordinated pro-life mobilization in history.”

40 Days for Life is a focused pro-life effort that consists of 40 days of prayer and fasting, 40 days of peaceful vigil, 40 days of community outreach. We are praying that, with God’s help, this groundbreaking effort will mark the beginning of the end of abortion in our city — and throughout the UK.

At first it seems like a harmless protest, they’re entitled to speak out about their beliefs, right? Besides, they’re not being viscious and abusive as the pro-life movement in the US is known to often be. However, as March 9th draws closer I have a cold and terrible concern that has been growing in the back of my mind. The very fact that these people are going to be on the streets with their peaceful protest brings me more fear than the idea of the violent protesters being out there in their place.

It’s all because of a conversation I had with the leader of the London branch of ’40 Days for Life’ last year. I got in touch with him after the Daily Mail ran an article about them entitled: The new abortion war; Doctors murdered… clinics firebombed. Could Britain follow in the steps of the militant U.S ‘pro-lifers’?

At the time I hadn’t known they were in the UK and it surprised me that pro-lifers were so active in this country. The title of the article had shocked me as I knew the extent of the violent ‘pro-life’ protests in the US and I couldn’t imagine such a thing coming to the UK.

The Daily Mail article reported that the British organiser of ’40 days for life’ (which is widespread in the US already) is Robert Colquhoun who is 28 and trained for the priesthood but now works in finance in the City. The Daily Mail said:

Robert paid about £280 for a ‘starter protest kit’ that he bought on the internet from 40 Days’ head office in America.

‘It’s a brilliant idea,’ he says. ‘They give you the best training I’ve ever had. It’s all online and really clever. And then they send the basic resources — the big banner and the signs — and you adapt them to the local campaign. It’s the best thing I’ve ever done in my life. We need to get the message across here.’

In return, he’s provided regular updates to the 40 Days HQ in Texas. ‘They’re very interested in how it all works in the UK and how the ­campaign’s been going in London, so we’ve been feeding all our findings back to them and they seem really pleased. The group’s grown exponentially in America, so we’re hoping it will take off here.

‘We’re hoping for at least 1,500 local volunteers by Lent. This is just the beginning — we have so much to learn from America.’

The last part of that quote scared me very much indeed as he didn’t elaborate on what he meant by ‘so much to learn from America’. Would that be how to firebomb clinics and kill people? How best to use placards with dead babies on them to shock people arriving at abortion clinics? How much did the London branch of 40 days want to learn from pro-lifers in America?

Being the proud skeptically minded person that I am, there was no way I could simply take the Daily Mail’s word as fact so I did what anyone should do, and I contacted Robert directly who very kindly answered most of the questions I had about their campaign, their aims and their beliefs.

As I have said above, I was aware of the ‘pro-life’ movement and protests in the US, but it was always something I only knew a bit about as it had never been something I had to deal with on a local level. London isn’t local for me, but it’s a bit closer than America (if that makes sense).

My knowledge of the way in which pro-lifers justify their actions wasn’t top notch and so for me, this was a great way to really understand the people behind the scary Daily Mail headline that suggested that Pro-lifer activists could already be in the UK.

What follows is my conversation with the leader of the London branch of ’40 days for life’:

Hayley: Thank you for sparing me some of your time, I appreciate you are busy with your campaign. In the Daily Mail article there is a link between breast cancer and abortion mentioned that suggests abortion can increase the risk of cancer. I was wondering where the link with breast cancer comes into play as I saw that many cancer charities deny such a link.#

I was also wondering how exactly abortion was a sin? I saw in the article “We don’t love sin, we love the sinner” but I don’t understand how abortion is a seven sin. Also, do you not feel that making abortion illegal or less accessible, girls and women will still abort in “back street abortion clinics” which can seriously harm them?

Robert: Abortion is a sin because it is the deliberate ending of the life of an unborn child. This is contrary to the will of God. Since abortion has been legalised, it has grown exponentially and has been encouraged throughout.

We encourage people of faith and conscience to pray and fast for an end to abortion. So far six women have changed their minds about having an abortion as a result of our initiative and we have helped to build a growing consciousness about the humanity of the unborn child.

Hayley: You say “Abortion is a sin because it is the deliberate ending of the life of an unborn child. This is contrary to the will of God” but does God not order people in the bible to kill children – and does he not, himself, kill children?

Whoever strikes his father or mother shall be put to death. (Exodus 21:15 NAB)

From there Elisha went up to Bethel.  While he was on his way, some small boys came out of the city and jeered at him.  “Go up baldhead,” they shouted, “go up baldhead!”  The prophet turned and saw them, and he cursed them in the name of the Lord.  Then two shebears came out of the woods and tore forty two of the children to pieces. (2 Kings 2:23-24 NAB)*

Please tell me why your God feels it is okay to murder children, but it is not okay to “murder” unborn children?

Robert: The Old Testament passages you have used are out of context from their true meaning.** The most important passage is from the Old Testament 10 commandments: You shall not kill. Abortion in fact violates all the ten commandments:

If you’ve had an abortion yourself- there is wonderful hope and healing available from this ministry that I highly recommend as truly excellent. <a link was provided via email>

Hayley: You say that six women changed their minds about having an abortion. Were they Christian? If not, do your campaigners have any right to tell other people how to live their lives? Isn’t it a bit arrogant of anyone to presume they can dictate wrong and right to another human?

Robert: Those who changed their minds were from a variety of different backgrounds. Many of them did not know that there were people who were willing to help them with many practical needs which were the primary reasons that they were having abortions. They all felt as if they had no choice but have an abortion.  We do not impose, merely propose an offer of unconditional help to those in need.

In terms of dictating right or wrong to other humans: that is what the law does by giving a list of laws by which society is governed. No laws would equal anarchy. In the case where the law in an injustice, a further difficulty arises.

Hayley: I was worried because I read in the Daily Mail article that somebody involved with 40 days in London feels that the methods used in America to campaign and target people attending abortion clinics need to be used in England too. What was meant by that? Some of the campaigning in the US is dangerous and violent and has led to murder.

Robert: The Daily Mail article was extremely misleading because only peaceful and prayerful means are used in our campaigns.

Hayley: What do your protest entail? For example, do you use graphic images on placards like in the US?

Robert: we have a prayer vigil for 12 hours a day: we have signs saying ‘pray to end abortion’ but no pictures of aborted babies as we don’t think that it is effective of pastorally effective to do that in that context.***

Hayley: Do the protesters really have the right to condemn women to a lifetime of raising a child they didn’t want? I know they may grow to love the child and that is great! However, you don’t know what led them to that clinic, what their backgrounds are, why they chose to abort the baby due to their backgrounds, positions, lifestyles. How can you be sure that you aren’t condeming a child to a terrible life?

Do you follow up with those women to ensure they are okay? Or do you just send them on their way?

Robert: We have a prayer vigil, not a protest. We don’t condemn or judge anyone, merely pray and offer help to those in need.

We offer counselling and help so they are not just sent on their way, so many have been helped thanks to our presence. To learn more about what abortion really is, visit: <link provided to me is available on request due to the graphic nature>

Hayley: But will the banning of abortion not result in women just seeking abortions elsewhere? We’ve seen that happen in the past. Backstreet abortions are dangerous and potentially fatal. Is that okay with you? That you could be condemming women to dance with death in order to live their life how they wish to live it?

Robert: We are not mainly interested in changing the law, but praying for an end to abortion.

Hayley: Do you not think that by protesting abortion you are actually infringing the human rights of the very women being labelled as ‘murderers’? I know people believe they are protecting the human rights of the unborn child and there is a lot of debate regarding the stage at which abortion becomes ‘murder’ but when is it ever okay to disregard one persons human rights for anothers? I don’t think it ever is. #

This is where the conversation ends.

The claim that six women had their minds changed by the campaigners is what worries me the most about the peaceful protests that are kicking off on March 8th. The ’40 days for life’ campaigners have no right to tell a woman what to do with her body, and they have no right to try and change a womans mind. I would also question whether they have the training or qualifications to deal with people who may be in a fragile state of mind.

I accept that the claim made by Robert is that the women in question were made aware of the fact that there were alternatives and that there was support they could get.

However, this happens anyway when you speak to your doctor about being referred for an abortion and when you visit a private abortion clinic.

A doctor is more likely to be able to give somebody access to suitable resources and the correct advice for their situation than a religious stranger on the street.

Peaceful protests or not, pushing your own beliefs onto others at a very difficult time in their lives in fundamentally wrong. Not only that though, threatening them with damnation from your god is simply cruel.

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This post, Conversations with a British Pro-life protester, originally appeared on She Thought on March 4, 2011.
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It is difficult to convey to those on the outside of an abusive relationship how very difficult it is to escape. One major reason why it is difficult to escape is because of all the decisions that have to be made to get a person from their precarious situation into a safe environment, where they can be safe. An abuse victim, just reaching freedom,  often has to build their life all over again. While they may have every reason to aspire for that dream, they may have difficulty navigating every step they have to take to get to their new life.

When helping victims of abuse, the task which counselors, advocates and the other professionals involved take upon themselves is assisting the victim in re-obtaining a healthy, normal life for themselves. In the case of domestic abuse victims, they have left a norm that was unhealthy for them, so they often have to build an entirely new understanding of what they want to consider as normal and healthy for them.

Speaking directly to possible victims, now.

When you make your decisions about your future, understand that you are not looking for a perfect answer. Instead, the answer you are seeking is the best available option that will help you get your needs met, be safe and will help you get closer to adapting to a sustainable life you can be happy in.

The decisions you make are likely to all be made in your head, but they should be structured decisions, based on good reasoning and with every consideration for your future. The process described below is an approach to decisions relating specifically to leaving abusive situations.

Step 1. Make a list of the most urgent decisions you have to attend to. Understand your related goals. If you need help, ask your counselor or a trustworthy friend to help you. In order to decide which decisions are the most urgent, consider factors such as how they relate to immediate and long-term safety, if there is a time frame that you have to act in or if it is important to you for some other reason. Remember that this is your life, your new beginning that you are planning.

Step 2.  Describe your options to yourself as best you can. If you are in a place where it is safe to write them down, do so, so that you have something to look at and edit if you need to. Write down how each option may or may not get you closer to your goals of safety and meeting your needs.

Step 3.  Make your decision based on what you know. Don’t rely on instincts or emotional cycles to pull you in one direction or another. Our instincts and emotions with regard to abuse are often misleading to us. They tend to be the reason why many victims stay in unhealthy situations. It is OK to disregard your feelings for long enough to make a decision and then set aside time later, after the decision has been made and acted on, to deal with the emotional aspect.

Step 4. Once you’ve made your decision, don’t procrastinate or try to talk your way out of it. Act on your decision! Following through with your decision can be the best thing that you’ve ever done for yourself.  Changing course in your decisions that are made in order to make you safe, either before or in the process of acting on it, can compromise your safety or have other long-term consequences.

Step 5. Once you’ve acted on your decision and done what you need to do to realize your goal, reward yourself. Do something just for you, even if it is small. Read a book you love, watch a movie, eat some chocolate, whatever it is that will help you tell yourself that you did a good job. Don’t take this as cheesy, back-patting. Helping to reinforce a feeling of satisfaction after making a decision will help you stay on track and increase your chances of successfully building a life for yourself.

Step 6. Re-evaluate. Once you have taken action, re-evaluate your situation and decide what other decisions need to be made to ensure your safety and well-being.

Wash. Rinse. Repeat.

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This post, Making Choices to Save Your Life, originally appeared on She Thought on February 25, 2011.
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One of the latest band-wagons they’ve jumped on is that various diseases didn’t disappear, they’ve just been renamed.  So polio became acute flaccid paralysis, which is actually a symptom caused by many different diseases and not a disease itself.  They also practice a classic switch, arguing that vaccines are failures because they don’t stop diseases they aren’t designed to stop.  Therefore meningococcal vaccine is a failure because it doesn’t stop earaches (I’m serious, who cares about that pesky meningitis and septicaemia) and HiB is a failure because it hasn’t stopped all meningitis.

HiB is the convenient name for Haemophilis influenzae b, which is actually a bacterium and nothing to do with flu.  It was originally thought to be the cause of flu until the virus was discovered and now the name is stuck.  Even though it is innocent there, it does cause a range of other diseases.  It is part of your normal microbiota, but when other factors such as a viral infection makes you more susceptible it can cause bacteremia, pneumonia and acute meningitis.  It is also known to occasionally cause cellulitis, osteomyelitis, epiglottitis, infectious arthritis, otitis media, conjuctivitis and sinusitis.  That’s quite a list, and some of them are deadly.

It’s a lovely case-study when talking to anti-vaxxers because the vaccine was only approved in the 90s.  This means we have reliable before and after incidence rates and can demonstrate the nose dive in disease when the vaccine was introduced.  And not even anti-vaxxers have tried to argue that there was a great leap forward in hygiene or nutrition in 1993.  Isn’t this a pretty graph:

So their only recourse has been to argue that it’s a failure because meningitis hasn’t disappeared.  Meningitis is an infection of the meninges around the brain and can be caused by many bacteria, viruses and even amoebae.  The HiB vaccine was never intended to stop all meningitis, it couldn’t.  It was designed to decrease the incidence of HiB and therefore save lives.

And then this graph appeared on VINE (it’s since disappeared for some strange reason):

It is quite obviously a fake:

• The “Total meningitis rate” started lower than HiB meningitis hospitalisations.
• It has spelling errors.
• The source doesn’t exist.
• It’s pretty bloody amateurish.
• Look who has the copyright – ‘Fictuscorp,’ fictus of course meaning false.

But VINE welcomed it with open arms.  When these simple errors were pointed out, both on the VINE facebook page and on blogs, it prompted this lovely, and revealing, comment from Erwin Alber, the creator of VINE (since deleted):

“People have different takes on reality, and sometimes some of them approximate, or even match, actual reality. To me the graph is real, to you it is a fake. To each his own”.

Translation:

“I do not care about facts, I do not care about evidence except when it matches and confirms the conclusions I have already made up.  You have to respect my right to my own little world.”

Update: In another conversation Erwin has just stated that not having references or sources is a good thing because it is using your brain to think independently.

But he did start to worry a bit because he messaged Marge England, the person who originally posted the graph, in her words:

I got a facebook friend thingy from this guy about the mockup.

Erwin Alber:
“Hi Marge,
thankyou for your interesting graph! Any chance of providing a link? The trolls are baying for my blood because there is no source mentioned!”
Yeah, well they should be baying you bloody nitwit. There was no link because I just made it. How on earth could you think it was real? It was just sooooo amateurish even as a fake.

…

My first comment disappeared. It says five comments but I can only see four?
It could just be my incompetence. Luckily it was still in my clipboard jiggy thing. Is it ok to out[sic] in again?

I have been away and just realised the uproar I caused.

I don’t do facebook much, or really at all. Just stumbled across this site of pseudo science from a friend at work.

I posted the graph above as an obvious joke on the one about polio I saw down a bit on the page.

I cannot believe people thought it was real! It took me maybe 5 minutes to do in mtpaint[sic]. I purposely made it such that is[sic] was an obvious mock up. Hell I called it fictuscorp for crying out loud.

You would seriously have to be deranged to think it was real. I don’t know if anyone here remembers the fake UFO shot that got published decades ago. The shot was made with several easy to spot mistakes that made the photo easily identifiable as a fraud. It was some sort of psychology experiment or something.

Yet UFO nuts still went ape over it.

I think I just performed the same experiment here by accident.

While it’s nice to have a chuckle and ease the frustration of dealing with people who are merrily misinforming and propadandising on their way, there are quite a few lessons from this.

The obvious one first: here’s perfect evidence that confirmation bias runs rampant in anti-vaxx arguments, such that they don’t care what or where or how good it is so long as it supports them.  In fact it’s bigger than confirmation bias: they don’t care about evidence. They may use it to whack other people over the head with, but it doesn’t touch ‘their reality’ at all.  This is particularly hard for skeptics to deal with, because to us the evidence should be the most important thing.  But it’s lovely if you’re talking to someone undecided – if they aren’t able to pick what’s wrong with this graph, how good can the rest of their arguments possibly be?

If they don’t care about evidence, vaccine education is pointless.  For those who have already made up their minds I mean, it is still useful for others.  So if undecided people are being bombarded with this in social media such as facebook, they need access to good information earlier.  Hygiene is a major health topic, why aren’t vaccinations taught about in schools?  Especially with HPV and various boosters being given to teenagers, that’s what’s called a teaching moment.

General critical thinking needs to be taught.  Reading that graph is a highschool maths skill.  I’ve taught that class, but we were concentrating on graphs used in advertising and how they can be misleading.  I can promise right now that I will use that exact graph whenever I teach it in the future.  Knowing that they should question it is critical thinking, something that should be taught in every single class our children take, and that we need to do with them every day.

And finally, amusing as this has been, please don’t play with the anti-vaxxers.  It might be a whole lot less amusing when we spend the next 5 years seeing that same graph over and over.  At least you won’t have to spend much time looking for a source to debunk it.

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This post, Anti-Vaxx, Anti-Critical Thinking, originally appeared on She Thought on February 16, 2011.
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Essentially, SD has rewritten a clarification that was to be added to their law regarding justifiable homicide so that if someone killed another human being in defense of a pregnant woman’s fetus, it would be a legal act. Just a little thought can take us through scenarios in which we can see how the law might benefit or harm people, overall. For example, say we encounter a situation similar to the events leading up to the famous Scott Peterson case. If Scott Peterson was killed in the process of defending Laci to protect her unborn child, should the killer of Scott Peterson be let free? Well, SD’s law already accounts for that, in that situation, with their laws regarding homicide in defense of other people. But what if Laci Peterson, Scott Peterson’s wife and murder victim, were not at risk of death, but her fetus was? Would the killing of Scott fall under the same laws?

The answer is, currently, no. The reason for this is because of legal wording that has been an undertone of debates about reproductive rights for a long time. In order for it to be legal for a Scott Peterson type to be killed to protect Laci’s unborn, the unborn would have to be considered a person because the law specifically addresses the defending another person defense as applying if the individual is protecting another person. In light of this, it is not completely irrational to protect a fetus through the law with an addition to laws regarding justifiable homicide, assuming that what is protected is a wanted entity.

The reason why I use the Scott Peterson case as an example is not because it is a fantabulous example for this particular issue. Instead, it is because the Scott Peterson case has a comparable issue. In the Scott Peterson trial, it became an issue of major debate as to if Laci’s unborn child could be considered a second count of homicide against Scott or not. If it could, people feared, would this mean that an unborn fetus could be defended by law as a victim of homicide if it is aborted? The debate was pretty heated for quite some time and experts who examined the body were under pressure to decide if Laci had given birth to the infant or if it had somehow left her corpse after her death.

Since the fetus was killed as a result of Laci’s death, the debate over if Scott should be charged with the death of the fetus as a second count of homicide grew. This debate is what ultimately led to the Unborn Victims of Violence Act. Which, as it turns out, does for federal law what Rep. Phil Jensen claims to be doing with his provisions. The Unborn Victims of Violence Act includes provisions to protect those who perform abortions or obtain abortions. So, what does Jensen’s law really say?

Fortunately, it is easy to find a copy:

FOR AN ACT ENTITLED, An Act to expand the definition of justifiable homicide to provide for the protection of certain unborn children.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF SOUTH DAKOTA:
Section 1. That § 22-16-34 be amended to read as follows:
22-16-34. Homicide is justifiable if committed by any person while resisting any attempt to murder such person, or to harm the unborn child of such person in a manner and to a degree likely to result in the death of the unborn child, or to commit any felony upon him or her, or upon or in any dwelling house in which such person is.
Section 2. That § 22-16-35 be amended to read as follows:
22-16-35. Homicide is justifiable if committed by any person in the lawful defense of such person, or of his or her husband, wife, parent, child, master, mistress, or servant, or the unborn child of any such enumerated person, if there is reasonable ground to apprehend a design to commit a felony, or to do some great personal injury, and imminent danger of such design being
accomplished.

The emphasis is mine. That one word does what the provisions added to the Unborn Victims of Violence Act does to protect abortion providers and recipients. This law, while it feels scary, isn’t going to make it legal to kill abortion doctors and provides no more incentive to do so than the federal law that is already in existence.

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This post, South Dakota’s Under-handed Trick?, originally appeared on She Thought on February 16, 2011.
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Apparently the document has now been released. For those unfamiliar with the case, a few summaries via news articles exist online:

Penelope Dingle was 45 years old when she died of colorectal cancer on the 25th of August, 2005. In the weeks and months that followed, her four sisters Christine Hearn, Annemarie, Natalie and Toni Brown were at a loss over what to do about her passing.

They were concerned that Pen, who had chosen alternative therapies to treat her illness rather than conventional medicine, had died needlessly and her death needed to be investigated.

… During the opening address, Counsel Assisting the Coroner Dr Celia Kemp said the purpose of the inquiry was to determine if there needs to be tighter controls on the homeopathic industry.

…A long time supporter of alternative therapies, she began to see homeopath Francine Scrayen for fertility assistance.

Dr Kemp told the inquest that in 2001, Pen complained to Ms Scrayen there was blood in her faeces. She was prescribed homeopathic remedies.

The inquest was later told it would be two years before Pen was diagnosed with rectal cancer.

At that point, according to cancer surgeon Dr Cameron Platell, she had a good chance of survival had she been treated with conventional medicine. But Pen decided to seek alternative treatments and refused chemotherapy and surgery to remove the cancer. — ‘Homeopathic remedies under the spotlight’ – by Claire Krol, Jun 16th, 2010, ABC News.

Although it was a local case, it got some attention internationally – such as featuring in this Darryl Cunningham cartoon, part of a forthcoming book, which is critical of homeopathy – as an example of ‘Stories of people abandoning real medicine in favour of quack cures are not hard to find.’

(There’s also an earlier cartoon about the MMR vaccines by Cunningham that is worth checking out too.)

During that year, I investigated a few other links as to the case, and discovered that the family members (particularly Mr Dingle) were active in terms of commenting on blogs (something I hesitated to engage with, since I knew there was an ongoing court case). Around this time, there were a variety of other stories being printed and I essentially thought I’d wait until the findings were released.

The journey from 2005 to 2010 has finally concluded. It features on the www.safetyandquality.health.wa.gov.au website [PDF] – Coronial Inquest Into The Death Of Penelope Dingle (nee Brown) – Alastair Hope, State Coroner of Western Australia.

As Andy D writes on his blog, ‘The report is detailed, depressing and damning‘.

It consists of a 100+ page overview of the history of Ms Dingle’s health, the various stakeholders as to her situation in terms of advice and the eventual findings as to who contributed to the situation.

Of particular interest is the part where private health insurance groups are called to order about how they contribute to such cases:

While I do not agree with the proposition that such alternative medical regimes should be outlawed, unless and until their supporters can provide appropriate and sufficient science base, any apparent legitimisation of these regimes could provide mixed messages for vulnerable and often desperate cancer suffers.

Evidence at the inquest revealed that homeopathic remedies are sold in pharmacies in Western Australia and homeopathic practitioners, such as Mrs Scrayen, have affiliation with private health insurance companies. In a context where health costs are increasing at an alarming rate and private health insurance companies struggle to meet the full costs of procedures, medications and hospital beds, it is a matter of concern that funds which which could be allocated to such fundamental health needs are being allocated to non-science based alternative medicine practitioners. –  Coronial Inquest Into The Death Of Penelope Dingle (nee Brown) – Alastair Hope, State Coroner of Western Australia, page 99.

The Coroner’s concluding recommendations are as follows:

Recommendation No. 1

I recommend that the Commonwealth and State Departments of Health review the legislative framework relating to complimentary and alternative medicine practitioners and practices with a view to ensuring that there are no mixed messages provided to vulnerable patients and that science based medicine and alternative medicine are treated differently.

In this case the choice for the deceased should have been a simple one between accepting the surgical option offered by Professor Platell or facing a painful death. That choice was made more difficult because the deceased was offered other “alternatives”.

Recommendation No.2

I recommend that the Medical Board of Western Australia finalise its document ‘Complementary alternative and unconventional medicine’ if it has not already done so and take steps to ensure that the document is promulgated to the profession and complied with.

This news item will most likely be covered in national and local news tomorrow – how much of it will have an impact upon this proposed document, I’m not too sure. There are many deaths that have not have had as much media attention as this one.

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This post, The Sad Saga Of Penelope Dingle Concludes – The ‘Vulnerable’ Prey Of Complementary And Alternative Medicine, originally appeared on She Thought on February 12, 2011.
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All of a sudden Gardasil is big news.  And by ‘all of a sudden’ I mean ‘since the flurry over Wakefield.’  Don’t get me wrong, they’ve always hated Gardasil with a passion.  It’s been a good indicator that at Age of Autism it’s all about the vaccines, because they froth about it even though it has no possible link to autism.  But with the confirmation that Wakefield is a money-grubbing fraud pushing autism to the edge of the table, if not entirely off, they need a new way to scare parents and preferably a new market who might not realise how the anti-vax machine works.

Enter Gardasil, aimed at teenage girls and now being pushed to show that even without autism vaccines are still the font of all evil.  The parents of the current crop of teenagers either vaccinated their little ones before 1998 so they are new to anti-vax tactics, or even better they caught the beginning of the saga but haven’t heard all the rebuttals over the years, leaving them perfectly primed to be scared now.

My local group of anti-vax nutters, the Australian Vaccination Network, have had a busy week.  They’re trying to bury an unfortunate comment their leader made saying that vaccination is ‘rape of a child with full penetration‘ (but she didn’t mean it in a sexual sense, you’re just too illiterate to know the real meaning of the word rape).  And among the usual misunderstood medical articles and Natural News rants they link to have been several on Gardasil, including the newspaper reports “Mom Blames Teen’s Illness on HPV Vaccine,” and “Woman Warns Against Gardasil Vaccination,” a set of videos from Truth About Gardasil, allegations of false advertising of Gardasil, begging for donations to fund a documentary against Gardasil and a satirical advertisement for Protectasil.  There have been plenty of other links, but this is an unusual amount on Gardasil.  Plus Age of Autism have got into the act claiming that Abortion Stillbirth Events From Gardasil Far Exceed All Other Vaccines.

If Gardasil becomes the next battleground it indicates tactical thinking, if some of them are rational enough to be backing away from Wakefield.  Which indicates that it really isn’t about saving children, but about winning or advancing some other agenda.  They’re the ones who keep telling us to follow the money.  Unfortunately they’re also getting support from the religious right on this one, because donncha know that a vaccine against sexually transmitted infections will cause promiscuity.

So it looks like it’s time for us all to brush up on our Gardasil knowledge.  There have been three fairly standard complaints so far – it kills people, it makes people sick and now it causes miscarriages.  Science-Based Medicine has already looked at Gardasil in some detail with The HPV Vaccine (Gardasil) Safety Revisited and Mercola, Gardasil, and Toyota? among others.  The Skeptical Ob has also covered the miscarriage angle – put simply, if you have two groups of a hundred people, one composed of women only between 9 – 26 and the other balanced evenly between male and female and across all ages, weighted towards children and teens, which group is going to have more pregnancies?  Yep, according to anti-vaxxers the reason there are more miscarriages after Gardasil couldn’t possibly be because it’s targetted at the group likely to become pregnant.

If anyone has been in doubt, this possible shift demonstrates that it is not the anti-vaxxers we need to be talking to because they have long made up their minds.  But there is a whole new group of parents out there we need to be telling that correlation does not equal causation and demonstrating basic statistics.  If we have learnt any lessons from the past 12 years, now is the time to be applying them.

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This post, On Gardasil and Goalposts, originally appeared on She Thought on January 31, 2011.
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When you research a subject like this in depth, you find that certain studies keep popping up as offering especially strong evidence. These studies are widely cited and referenced in both popular and scholarly discussions of the subject.

One of the most famous studies of the effects of mass media on girls involved teens on the island of Fiji, and what happened to them after television was introduced to the island in 1995. It is considered especially important and insightful because it allowed a very rare glimpse into a culture that had not been previously exposed to television. (Before anyone nitpicks, the headline above is merely simplified shorthand for what the study found, it did not actually claim that TV causes anorexia, but that girls exposed to TV scored higher on a test for disordered eating, as noted below.)

The study is often described as concluding that television had created anorexia-like behavior or body image disturbance. Here’s how one writer, Sylvia Lerigo, cast the story:

Compared to the past, when simply “being” was the priority, Fijian teens had become as obsessive about body image and weight as teenage girls in the West who were suffering with conditions like anorexia. Prior to this invasion of television, the Fijian female body was considered more attractive when fuller and naturally feminine, which Fijians considered ideal for childbearing and child rearing. Becker noticed that almost 74% of young women in Fiji considered themselves “too fat” and thinness was what most Fijian teens craved. Why Teenage Girls Want a Skinny Image: Teens Spend Large Amounts of Time Obsessing About Looks

Let’s take a closer look at this widely-cited study to examine what, exactly, it found.

In Dr. Anne Becker’s famous 2002 study (“Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian girls,” British Journal of Psychiatry, 180: 509-514) Becker and colleagues visited Fiji in 1995, a few weeks after television was introduced to the island, and returned in 1998, three years later.

Each time they asked school-age Fijian girls (average age 17) about how much TV they watched (and their attitudes about the programming), and questions about their binging and purging behaviors. High scores on an eating disorder scale [EAT-26] increased 12.7%, and induced vomiting to control weight increased 11.3% between 1995 and 1998. Becker concluded that “key indicators of disordered eating were significantly more prevalent following exposure to television.”

The Fiji studies are often cited as strong evidence that exposure to thin images in the mass media are linked to eating disorders, and have implications for American teen girls as well. There are several important caveats that should be kept in mind when considering the study’s validity that are rarely mentioned, and only become apparent upon a close reading of the research. For example:

1)      Becker’s study involving Fijian girls had a total of only 63 participants in 1995, and 65 in the 1998 follow-up. This is a very small sample size, and makes the study’s conclusions difficult to generalize. A sample size of at least a few hundreds subjects would provide much better evidence that the findings were valid. Fiji had a population of around 85,000 people in 1995, and it’s not at all clear that a sample of 64 teen girls represents the population as a whole.

It should be noted that only one-third (29.2%) of the 1998 sample, or 19 girls, scored high on the eating disorder behavior test. So Lerigo’s claim that “Fijian teens had become as obsessive about body image and weight as teenage girls in the West who were suffering with conditions like anorexia” seems misleading at best.

There’s also the puzzling fact that while Becker takes pains to state that eating disorders were essentially unheard of in Fiji prior to the introduction of television, she found 8 girls (out of 63) who scored high on the 1995 test, a mere two or three weeks after television was introduced to the island. This group is considered the “before TV exposure” group, yet 12.7% of the girls apparently scored high on the test with little or no television exposure. Yet after three years of exposure to the mass media’s constant thin images and unhealthy messages, only 12 additional girls scored high on the test. While an increase from 12.7% to 29.2% is statistically significant, is seems like a curiously small increase if the mass media is as powerful as often claimed.

2)      The girls, though claiming to diet and wanting to emulate the bodies of thin TV actresses, did not actually lose weight between the 1995 and 1998 surveys. Becker notes, “there were no significant differences between the samples in mean age or body weight” (p. 510) (in fact, if anything the girls got slightly fatter, as the average BMI went from a 24.5 to a 24.9). Thus the Fijian girls were a hair’s breadth away from being overweight (overweight is a BMI of 25) both before the introduction of TV and three years later, thus there’s no evidence that exposure to the TV images led to any weight loss or anorexia.

This puts Lerigo’s comment that “Becker noticed that almost 74% of young women in Fiji considered themselves ‘too fat’” in a whole different light. If you hadn’t read the study, it would seem to suggest that these thin or normal-weight girls had been brainwashed into believing they should be thin like Jennifer Aniston. Instead, the reason that 74% of Fijian girls considered themselves “too fat” is because they probably were too fat! This has nothing to do with thin models in mass media and everything to do with the high-fat typical Fijian diets.

3)      Fijians were incredibly naive about television. According to Becker, the girls they interviewed believed that TV shows like Seinfeld, E.R., Home Improvement, Beverly Hills 90210, and Friends were news stories and reality shows. They did not understand that the people they were seeing were actors. They could not understand the difference between a scripted sitcom and real life, yet they were being asked complex questions about their attitudes regarding the TV characters. On this important measure alone, American teen girls are polar opposites from the Fijian girls. Young women are very media savvy and certainly don’t mistake Grey’s Anatomy for a news report. This seriously undermines attempts to draw parallels between the Fiji study and the media’s influence in modern America (something most writers on the issue, including Lerigo, specifically do). Becker herself points this out: “Generalization about the impact of television upon Fijians to other populations requires caution” (p. 512).

4)      Becker did not determine whether or not the 65 girls in the 1998 follow-up study had disordered eating symptoms or attitudes before 1995. Because the same population of girls was not used (which would control for this variable), there is no way to know whether or not television caused the increase or not. Put another way, for all Becker knows, the girls she interviewed in 1998 might have scored high on the disordered eating test before they ever watched television, if Becker had tested them in 1995. Furthermore, even though television was only introduced to Fiji in 1995, mass media images of thin models and actresses were seen in Fiji many years earlier in the form of magazines, newspapers, films, and so on. So it was not, as often claimed, a culture that had little exposure to the “thin ideal.”

All this of course does not mean that the famous Fijian study is invalid, but it’s important to understand the limitations of the research, and what the study actually found. This widely-cited, highly-touted research is far less impressive when you take a closer look at the study—something writers and reporters rarely bother to do. The claim that exposure to TV and its mass media images increased eating disorders is one interpretation, but there are good reasons to be cautious about the validity and generalizability of the study.

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This post, A Closer Look at the Famous Fiji “TV Causes Anorexia” Study, originally appeared on She Thought on January 24, 2011.
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