But trying to figure out why it is bad is pretty difficult. Part of the problem is, some people experience stress differently than others. Some people seem to slide right through life’s issues and come out the other side as if nothing happened. Other people, it seems, can have a major crisis if they so much as get a hangnail that week. To further complicate things, the difference in how people experience stress seems to also play a role in disease and, as they say, stress leads to disease.

The problem is, that’s not entirely true. You see, the medical community has been playing badminton with this issue for quite some time. They have found a lot of correlational studies, like the link between cardiovascular disease and stress and the link between obesity and depression. There’s also a correlation between diabetes and obesity and one between diabetes and depression. These are correlations, but correlation, as they say, is not causation. BUT that doesn’t mean that correlation is not important. Correlation is very important. It just isn’t a cause.

This means that stress probably doesn’t cause disease, but it is possibly related to the progression of some diseases.

What we know:

Stress can decrease some immune system functions while increasing others. Because of how medical science is reported in the media, people’s understanding of the immune system is limited. Thus, when it was announced that some researchers had seen changes in the immune systems of people under stress, the media interpreted it as a kind of universal reaction.

Instead, stress-response by the body is pretty complicated. What we’ve found is that stress does change our immune system, but that, alone, doesn’t lead to disease. In fact, some types of immune response during stress are improved while other types of immune response may leave part of your body vulnerable and what happens during your stress-response depends on the type of stressor and the duration of stress. Thus, stresses like exercise are an overall benefit to the immune system. That doesn’t necessarily mean you won’t be a little more sickly during an exam.

But, the immune system doesn’t protect against all types of disease. Many diseases are not germ-based and some of those diseases are also correlated with stress. When you look at studies on heart disease and stress, you’ll find an endless list and much of the information is confusing. Because medical science is still trying to work out the details, what you find may seem inconsistent. Again, what we do learn is context-specific. Marital stress seems to make heart disease more dangerous for women.

That advertisement just got a million times creepier.

While medical science is still trying to tease out how stress relates to heart disease, in most respects, there’s significant evidence that if risk is there, stress can trigger heart attacks. The sad side of this information is that it comes from natural ways to find a direct correlation: tragedy. Of course, triggering the worst consequence of a disease is not, itself, causing the disease. Individual heart attacks are caused by a blockage in an artery that prevents blood from flowing to the heart. We already know that stress does lead to an increase in blood pressure and an increased heart rate. Thus, with the pre-existing condition of plaque-filled arteries, loose plaque or blood clots, we can easily see how a little stress can trigger a heart attack, while the cause of the heart attack was a blood clot and clogged arteries.

Cancer is also correlated with stress, but we don’t know exactly why or how. In fact, we know so little about stress’ correlation to cancer, I hesitate to even expound, because I don’t want to say something without more confidence in the data.

But, even with cancer, there seems to be confusion by the public that cancer is caused by stress, but that’s not what the evidence seems to say. Instead (see the above link) most studies on cancer and stress show cancer growth increasing when the individual is under stress. This doesn’t mean cancer starts with stress, it just means cancer is likely more harmful in those who are stressed, already.

But, even this article isn’t so simple as it seems. Remember where I mentioned that exercise seems to benefit the immune system (with some sort of implication that exercise decreases stress)? Well, as it turns out, even that is a conditional thing. While there are health benefits to exercise, including it possibly reducing your stress levels overall, if you’re stressed before your exercise, those effects may not be quite as beneficial, since your risk of heart attack seems to increase.

So, going for a run on a normal day might not be a big deal, but running from this:

Don't worry, I think that's his burping face.

That could be the added stress needed before a run to end your life early from a heart attack. If it happens daily and you don’t end up meeting the bear for lunch, I mean.

Of course, this completely ignores our problem over most correlation health studies. Does the stress come before the illness or does the illness come before the stress? Most of the time, we can see links between things, but there are too many variables to pin one thing down as being a cause. Sure, stress may lead to a person doing this:

But that is not an immediate risk. We also know that obesity correlates with depression in such a way that the more obese a person is, the more likely they are to suffer from depression and the more weight a person loses, the less depressed they seem to become. So, where stress and depression are linked, we can’t really say that stress is the causation of various risks associated with obesity, including heart disease, diabetes or cancer.

So, you may wonder, why is this important? It is important because people make decisions about their health based on information they get from the general media. The media seems to advocate this idea that stress causes disease and that idea feeds into various types of bad science.

Some examples:

Herbs to reduce stress, making odd claims about toxins, stress attacking you and even an apparent misunderstanding of evolution.

Accupuncture to treat stress, with dangerous symptoms that might require immediate medical care.

Even a recognizable network like TLC has information worth questioning when they make claims about stress-caused illness and then suggest aroma therapy.

I want to be clear about something. It isn’t that we shouldn’t try to reduce our stress levels. Seeing a correlation between stress and health should be something that makes us pro-active and even somewhat concerned about our stress levels. At the same time, the outright claims made about stress causing certain health problems (when they confuse correlation with causation) can lead to people ignoring the very real causes that we are aware of. It can also lead to people making poor decisions about their health. The benefits of abstaining from a greasy burger is not the same set of benefits that someone might gain from an hour of meditation or dropping out of an especially challenging project or class. When it comes to changing something like eating habits or exercise, we at least have more solid data on how that benefits us than we do over how to deal with stress.

Of course, since stress really can be a trigger for life-threatening conditions, it is reasonable to reduce stress if you are at risk for a heart attack. At the same time, be aware of what is actually causing that, so that you can change other parts of your lifestyle as well. Stress doesn’t appear to be the cause of disease. Rather, stress seems to trigger disease-related problems and can increase your predisposition for certain health problems and diseases because of how it affects your immune system, cardiovascular system and even your cellular chemistry. Since enabling a disease is not causing the disease, take care of yourself in ways that are practical, first.

After that:

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This post, Stress and the Confusion Over if it Causes Disease, originally appeared on She Thought on May 3, 2012.
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Lately, I’ve been doing a lot of researching on mummies for a project that I’m working on. This researching has branched off in several directions and

King Tut: An Invasion of Privacy?

resulted in me learning some fascinating things. My research on mummies has a lot to do with hygienic and medical histories of the remains of ancient cultures and, totally coincidentally, io9 recently published this article: Do we have the right to violate King Tut’s privacy?

The article argues that even though mummies come from a time so far removed from our own that current ethical concerns about remains don’t apply, that because we might be looking at medical histories of the long-dead, including King Tut’s, for attention and because we don’t want our own remains treated the way we treat mummies, then we should respect their medical histories as we do modern patients.

This isn’t the first time I’ve seen concerns like this expressed. Various groups have raised similar concerns and it is a tough set of questions to address. First, I want to mention a few things about why we study the medical history of mummies and other remains from ancient cultures.

Who Owns History?

Essentially, history is painted for us by the victors of the past, sometimes, and sometimes it is painted for us by what little we find that is left behind. Our history tells us a lot about human behavior and so by looking into the past, we gain knowledge about ourselves. If we ignored history or hid from it, we run the risk of viewing ourselves through a lens that is so distorted, we might repeat past mistakes or ignore the needs that we currently have.

Imagine, for a moment, that we forgot how we think the Black Plague was spread through Europe. We think, currently, that it was spread through the fleas which lived on the rats which were common amongst the people at the time. What would happen if we weren’t aware of not only that, but other cases of how disease has spread in history? How would that affect how we view disease today?

Who Owns Medical History?

Essentially, we gain by knowing about the medical histories of those who died in the past. While we may create headlines by announcing that King Tut had an STD, it is also the case that knowing he had an STD might tell us something about STDs in his time, especially if we learn about other mummies who had them. I know you’re probably aware that we have current medical studies that we also rely on in order to benefit ourselves, but conditions now and conditions in history are different and even the illnesses that we are concerned with now are not always the same as they were in the past; neither are the environmental and social conditions. That doesn’t mean that we have left those elements behind, completely, though, or that we gain nothing by examining events that happened in those different contexts.

In order to approach this matter practically, and to consider it rationally, it may be important to look to the ways that related issues have been addressed in the more recent past. Let me take a detour for a moment and talk a little about the Native American Graves and Repatriation Act.

The Native American Graves and Repatriation Act

Back when the Americas were first being colonized, there were already people here. The colonists, though, didn’t see the people here as being the same as them and they often treated them horribly, denied them rights, stole their land and even made them slaves. Alongside this, the remains of the people who lived in the Americas were also often disturbed. The colonists sometimes saw the remains as novelties, searched them for valuables and even used whatever they found for trade. In order to address the ethical questions surrounding older remains, like those of King Tut, I will compare them to some reasons that NAGPRA was created.

Probably the most important reason for NAGPRA is for the protection of Native American rights equal to the protection of the rights of the other cultures and social groups in the United States. From the onset of colonization until only a few decades ago, the Native American population’s rights that seemed so basic to the invading cultures were not respected. Property rights and inheritance concerns were primary battles for Native Americans who witnessed the graves of their relatives being dug up and looted. NAGPRA was supposed to help change all that by criminalizing the looting of the graves of Native Americans and taking Native remains. This didn’t necessarily put Native Americans under the same legal umbrella as the rest of the country, but it attempted to give them equal footing within cultural settings, history and social situations that were unlike their own.

The First Amendment was also a central point to the creation of NAGPRA. Death itself is viewed, across cultures, as having religious significance. How we deal with the dead within that context varies from one religion to the other and great pains are taken in order to respect the religious wishes of the dead and their remaining relatives. Because of the religious significance of deaths and burials, NAGPRA is considered a protection of Native American religious rights that reinforce the First Amendment, the same law that grants people the right to perform religious ceremonies in prison and to publicly protest.

Human Rights — For the Dead?

NAGPRA was developed in the interest of human rights that were bestowed upon the United States by our adherence to the constitution. While mummies are not privileged enough to have the rights granted by the constitution, it is worth noting that the ethical concerns that grant those protections should be considered when regarding the remains of other cultures. Certainly, due to the laws regarding lineage in NAGPRA, should any of the remains we receive from other countries be remains that can be traced to living family and the family does not grant permission for scientists to examine those remains, the most ethical action to take would be to return the remains. This is because the part of NAGPRA which is concerned with lineage is based on basic principals supported by many bioethicists. In fact, that is where we should look next in order to consider the fate of remains like those of King Tut:

1) Bioethics

Bioethics, naturally, is a complex field of study. Any place where ethical concerns have vast gray areas, where each side has a valid complaint, is going to be a difficult field for someone to not only learn, but to navigate. That being said, bioethics experts have still managed to come up with some basic things to consider whenever they are addressing an issue in the medical or scientific world. In case you want to enrich your knowledge about these matters, I highly encourage you to look up the Belmont Report the following comments are based on it.

2) Justice

While the brief discussion on NAGPRA already touches on this concept, it is a vital concept when it comes to bioethical concerns. Justice is an ambiguous term whose definition swings wildly within each society. In one society, cutting off the hand of a thief may be considered ‘justice,’ while, in another, justice may be only the containment of those who might do harm to others. But justice is not just about punishment, it can also be about the distribution of resources or the way we acquire authoritative positions within a group. So, the question that has to be asked, and that is being asked in the above linked article is, has the treatment of King Tut’s remains and those of other ancient people caused them an injustice?

3) Autonomy

Autonomy, in this case, is the allowance of an individual to make decisions for themselves. If you or I are autonomous individuals, then we are people who are considered capable of making our own decisions. Not everyone considered capable of this task, though, and it is frequently the case that some parts of the population are disallowed to make decisions for themselves. For example, children, the mentally insane and, oftentimes, the dead.

In the case of King Tut, he clearly isn’t capable, in his incapacitated state, to make his own decisions. In his lifetime, the possibility that people would be attempting to examine his medical history a few thousand years into the future, was not really something anyone considered. As such, the King was not even capable of granting his permission or stating his wishes in case something like this were to occur. King Tut was, then, and is, now, incapable of making a decision for himself. When someone in our own time is incapable of making decisions for themselves, those decisions fall to their immediate family. If the family is unavailable, it is then a decision that is turned over to the closest reliable people who are the most informed. This means that the scientists dealing with Tut have to make his decision for him.

This seems like it shouldn’t be such a big deal. We make decisions for the dead all the time. We decide if they should be buried or cremated or if they should be tossed into the ocean or turned into fertilizer. So, what’s so different about King Tut? Well, King Tut is King Tut. The reason we raise concern about King Tut and not the many other corpses that we make decisions for is because King Tut was once someone very important and now he is a gateway of information that lets us look far into the past. But the issues surrounding Tut are not just about decisions regarding his grave. Instead, they’re issues surrounding privacy, to which the same applies. We do very little to respect the privacy of our dead. Instead, the privacy of our dead is one of the first things we violate once they die. We sell their stuff, we investigate their financial and medical issues and, if they’re someone important, we broadcast it across the world, just in case anyone else wanted to know about it.

Autonomy only seems to exist for the dead if the deceased planned far enough ahead.

4) Dignity

The idea that each individual deserves a certain level of respect and ethical treatment is another concept that comes rolling through the debate on how to treat ancient remains. In the case of King Tut and other remains that we allow scientists to evaluate, it seems like their preservation and the effort put into learning their stories is the absolute highest amount of respect that we could possibly give them. Ensuring that they are not smashed about and ground up into some sort of silly compound by some health quack and not leaving them out in the elements to be swallowed back up by the Earth is also, very likely, the best we can do to ensure that the remains are treated in an ethically sound manner.

5) Beneficence and Non-Maleficence

Sometimes, it is important to do something for the good of the individual and sometimes it is important to do no harm. The problem is, sometimes doing no harm means not doing what is best for someone and sometimes doing something for the good of the individual is extremely harmful. The King Tut dilemma seems to boil down to this point. What we gain, overall, from the study and sharing of information of King Tut and other ancient remains stands to benefit our society as a whole. The overall benefit far outweighs the tiny cost that a man that died so long ago may not have liked what we’re doing to his corpse.

I can’t possibly give a completely objective answer to all the questions surrounding human remains and their treatment by science, since there are so many hazy areas to roam through, but I do hope that the added information helps people make some conclusions of their own. My own stance, I think, is a fairly pragmatic one, involving a basic concept of what I think is for the greater good. But first, let me address the main conclusion of the original article that inspired this trail of thoughts.

The author of the io9 article suggests that we use what we know of how we want our remains to be treated in order to make decisions for King Tut. The problem is, there is tremendous variation, even today, in how people want their remains to be treated. Contributions to science does happen to be one of those options. Sure, as living creatures that rely so much on our social links to survive and who have been taught to be embarrassed about things such as STDs (and we happened to have one), we would be horrified if we found out that once we died, billions of people would have access to our medical records. When we’re dead, though, we would hardly have a reason to worry about it.

Doing the Greater Good

It is often said, when someone dies, that the funeral is not for the dead, it is for the sake of the living. It is the living who can measure what they have lost; it is the living who need answers and who seek closure. It seems to me that no matter how long someone has been dead, the most ethical decision to make regarding their corpse is to be as attentive as possible to the needs of the living – to do the greater good. That’s why we have funerals and why NAGPRA exists and why we learn about King Tut and share his story with the world.

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This post, The Bane of Human Remains, originally appeared on She Thought on March 22, 2012.
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This is analogous to how I listen to the Puscast podcast, a bimonthly review (in English) of the infectious disease medical literature. I speak Medical Literature about as well as I speak Spanish. Fortunately, I do know how to use Google for clarification.

Puscast host Mark Crislip is an infectious disease doctor practising in Oregon. He is a writer and editor for the Science Based Medicine blog, and heads up his own multimedia empire, where he houses archives and links to his several podcasts, blogs, and book.

The target Puscast audience is physicians. I may be out of my depth for parts of it, but I’m curious and interested in the subject. I try to just listen without worrying too much about, say, the details of how different antibiotics target various bacterial cell receptors. I can always look that up later.

The discussion is surprisingly diverse. Dr. Crislip brings snarky humor to bear on all manner of medical pseudoscience and on mistakes and misguided studies published in established journals as well. What I find especially interesting are Dr. Crislip’s thoughts about how the studies translate to real-world situations and clinical practice. I enjoy learning about how the new data gets applied in medicine. It’s reassuring to note that, for the most part, science-based medicine increases in efficacy over time.

Puscast includes this Black Box Warning:

The following podcasts may include sarcastic comments, snide asides, and rants off the topic of infectious diseases and may cover political, societal, and popular culture concerns. I think it is part of the charm of the podcasts, but if you do not like smartass, then these podcasts may not be your cup of tea and you should go elsewhere. But you can’t say you were not warned.

Some broad thematic trends that I’ve noted include:

1. Antibiotic overuse is very, very bad. This comes up frequently in discussions about newly resistant diseases.
2. Tropical diseases like dengue fever and disease vectors like rabid vampire bats appear to be moving north with global climate change.
3. Previously rare vaccine-preventable diseases are becoming more common in correlation with declining vaccination rates.
4. Dr. Crislip doesn’t like tattoos.
5. HIV therapies are amazing. I’m embarrassed to admit that two recent Puscast episodes have exposed my own myopia. One study looked at serodiscordant couples where one partner is HIV+. I live in such a bubble of ignorance that it didn’t occur to me that such couples exist. I assumed that everyone is either + or – or that the relationships dissolved once one of the partners was diagnosed. I had to pause and wrap my mind around this new-to-me but obvious paradigm.

Crislip discussed a couple of interesting HIV studies:

This first study looked at drug therapies which can prevent the spread of HIV to the non-infected partner. Which is awesome, but the regimen is not without risks. If the positive partner’s HIV is suppressed, then maybe the risks outweigh the benefits. Take home: use a condom. Which is generally a good idea anyway regardless of HIV status.

The second study looked at couples where both partners are HIV+. Doctors generally still recommend condom use to prevent the spread of other diseases and also because the partners may have different variations of the HIV virus. In this case, I had assumed that condoms were moot. I had no idea there are various types of HIV, and the other diseases in addition to HIV simply weren’t on my radar.

Again, in hindsight this should have been obvious to me. I like to think I’m so tolerant and enlightened, but clearly I need to bring more humility and humanity to how I think about HIV and its victims.

Dr. Crislip’s Puscast is endlessly interesting and entertaining. It’s challenging in a good way and fairly accessible to most audiences. It’s especially enlightening when it spotlights uncomfortable truths about myself.

Images from wikimedia commons

An earlier version of this article appeared at Does This Make Sense.

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This post, Puscast Podcast: A Non-Expert Review, originally appeared on She Thought on February 20, 2012.
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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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