Friday, 26 August 2016

Bad journalism

I'm not a writer.  I dabble a bit here and there and I've even gotten paid for it a few times (Thanks, Daily Beast!), but I don't really pretend to be a writer.  That said, I'm certainly not a journalist.  I don't pretend to be one of them either, so I can't really say I understand the ethics of journalism per se.  I do understand ethics in general, however, so I believe I can definitively say that journalists should report the truth.

That doesn't always happen.

Take the coverage on little Israel Stinson, for example.  In case you haven't been following this very sad case, Israel was a 2-year old boy in California who had an asthma attack nearly five months ago at the beginning of April.  He was initially taken to a hospital and stabilised, then he was moved to the paediatric intensive care at another hospital where he unfortunately suffered cardiac arrest.  After extensive testing he was pronounced brain dead, but he was still moved to yet another hospital for further evaluation.  Two more doctors at the third hospital performed brain death evaluations and again pronounced him brain dead.  Plans were made to remove him from life support.

Ah ah ah, not so fast.

Israel's parents refused to accept the diagnosis, and after much legal wrangling and online fundraising they were able to airlift him to Guatemala where he had feeding and breathing tubes placed.  According to Israel's parents, a paediatric neurologist in Guatemala saw "some brain activity" on an EEG (I have seen no corroborating evidence from any doctor or any report), which supposedly showed that he was not brain dead.  Then about two weeks ago he was transferred back to California, this time to Children's Hospital Los Angeles, with hopes that his parents, Jonee Fonseca and Nate Stinson, could eventually care for him at home.  They got a restraining order preventing the hospital from doing any more brain death studies, presumably because they were afraid of the results - that he was still brain dead.

And as has always been the case in brain death in the entirety of human history, Israel's brain death was not reversible.  A California judge lifted the restraining order yesterday, and as soon as Israel was taken off somatic support, he stopped breathing.  Exactly as would be expected in a brain dead patient.

As a parent (and as a doctor) it upsets me viscerally me that this little boy was kept in limbo for so long because his parents (like those of Jahi McMath) refused to accept that their son was gone, but what exasperates me even more is the way the press has covered it:

You get the idea.  The verbiage is strikingly similar, and it is similarly misleading.  No, Israel did NOT die after being removed from life support.  Israel died nearly five months ago when his heart stopped and his brain was deprived of oxygen for 40 minutes.  But it is much more sensational to report that a toddler died after being removed from life support, because it implies the hospital was doing something wrong.

The headlines are misleading enough, but the articles are infuriating - the implications turn into downright accusations.

The most egregious was from Fox 40, a news station based in Sacramento (where, probably not coincidentally, Israel was first declared brain dead at UC Davis).  I can not even sum up the stupidity here, so I will let their own words damn them as the article opens:
A Vacaville 2-year-old is dead, not because of the severe respiratory illness that stole his vibrancy along with his breath last April, but because of the heartless action by a hospital in the midst of an appeal, according to his loved ones and his lawyers.
I can't even.  I want to even, but I can't.  This is how this ridiculous article starts, but if you can believe it, it gets even worse.

"This is a sad, sad state because this is an execution of an innocent 2-year-old in this country. This child was alive and this child was not brain dead," said Attorney Kevin Snider. 
An execution, Snider says, carried out by Children's Hospital of Los Angeles on his client Baby Israel Stinson. 
"Unfortunately the courts and the medical community wanted to rush in and pull the plug on him to be crass," he said. 
Are these people fucking serious?  Sure some doctors (surgeons, mainly) seem to enjoy being crass, but do they really think that doctors are in the business of killing toddlers?  Even putting aside the ridiculous bullshit from the lawyer, is there any such thing as journalistic integrity with these writers?  If there is, I completely missed it.  How could they possibly include that insane quote?  An execution?  Really??

Despite this, Fox 40 made absolutely no effort to show the other side of the issue - that three different doctors at two separate hospitals had all performed independent brain death studies, and all had found the same thing - that he was brain dead.  There was no mention that the EEG is not a definitive study for brain death and that there had been no confirmation of the supposed "brain activity".  There was no comment whatsoever that Israel had been completely unresponsive and had not opened his eyes since his cardiac arrest.  Nothing.  Zero.  Nil.  And of course because of privacy laws in the United States, the hospital was unable to comment on the entire affair and defend their entirely defensible actions.

KCRA, another news station from Sacramento (surprise, surprise) included the insane "execution" quote from Kevin Snider but took it even further:
"This was an execution of an innocent 2-year-old by the authority of California,” Snider said. “Had this child been a murderer or a terrorist, he would have had far more appellate rights by our courts than he was given.”
Wha . . . what . . . WHAT?  Are you . . . WHAT??  This child was given nearly five months to get better.  He didn't.  He was declared dead by three different doctors, and this clown calls this an execution?  Hyperbole does not even begin to describe this putrid cesspool of flapdoodle.  But KCRA doubles down with more Snider claptrap at the end of the article:
"Though society has produced medical geniuses, it also has not produced with people with a high moral IQ in the medical field sadly," Snider said.
I don't believe any more needs to be said about that.  I nearly screamed when I read it, and I was tempted to throw my computer across the room when I typed it.  It just speaks for itself.

And to put a little cherry on top, Israel's parents are reportedly planning on suing Children's Hospital LA, because of course.

Sigh . . .

My final thoughts on Israel's saga is that he is finally at rest.  Finally.  I hope Jonee Fonseca and Nate Stinson will eventually feel some sense of closure.  Israel had been gone for a long time, and his continued presence in a hospital bed was only causing his family undue grief.

I honestly and truly wish them peace.

Monday, 22 August 2016


Getting advice seems to be a problem from the moment we are born.  Well, not so much getting advice, but listening to it.  Parents warn their children not to run with scissors, put on a jacket, wash their hands, and STOP HITTING YOUR BROTHER.  As children get older, the advice gets more serious: look both ways crossing the street, drive slower, STOP HITTING YOUR BROTHER (that one never seems to change).  This advice seems pretty self-explanatory, though children always seem to argue about it.  But other things we tell children need to be explained: why it's stupid to smoke, why it's necessary to put on your seat belt, why you should STOP HITTING YOUR BROTHER.  And then there is some advice that just shouldn't need to be given.  It is so easy to understand and so damned obvious that it shouldn't even need to be mentioned.

Like "Don't put things in your butt."

Since I just mentioned it, it clearly needed to be mentioned.  To Jack (not his real name™) in particular.

Now before I continue, yes this is another rectal foreign object story, and yes I just posted one a couple of weeks ago.  But this one is just Too. Damned. Good.  So here it is for your reading pleasure and distinct anal discomfort.

My RFO patients have thus far all been men, and Jack was no exception.  What makes him slightly different is his age.  All of the other men in whose rectums I've spelunked have been in their late 30s or early 40s.  In other words, old enough to know better than stick something (Coke bottle, butt plug, dildo, etc) in their asses.  Jack, on the other hand, was in his late 60s.  So WAAAAAY old enough to know better than to stick something in his ass.

Jack came in around midnight complaining of, you guessed it, a pain in his ass.  Apparently he wasn't satisfied with the variety of toys available at his local sex shop, so he decided to make his own.  Now a quick perusal of Google will reveal a wide variety of do-it-yourself sex toy kits.  Yes, I checked.  For science, really.  These evidently were also not good enough for Jack and his, uh, needs.  No, instead of some commercially available silicone toy kit, he decided wax would be better.

Vanilla-scented wax, to be precise.

I walked into Jack's room to see an elderly-looking man in Standard RFO Position - somewhat on his side with a grimace on his face.  I decided not to beat around the bush.

Me: OK, what did you put in there?
Jack: *grunt* It's a candle.
Me: . . .
Jack: *grunt*
Me: And why did you . . . Ugh, never mind.  How long has it been in there?
Jack: *grunt* Two . . .
Me: Oh, just two hours?
Jack: . . . days.

Yes indeed, Jack had melted down a vanilla-scented candle, molded it into an apparently pleasing shape, and inserted it into his rectum.  Two fucking days ago.  He had been trying in vain (obviously) to remove it manually.  He had tried an enema.  He had tried stool softeners.  But last I checked, none of those things can melt wax.

The object was easily palpable in his rectum, but it felt fucking huge.  There was nothing for me to grasp, no way for me to remove it easily.  So off to the operating theatre we went.

Once he was asleep I could do a more thorough exam.  Unfortunately the exam was exactly the same.  It still would not come out.  Most foreign objects can be grasped with some special graspers and will slide back out the way it went in.  But not this goddamned thing.  There was no lip, no flap, no anything on which to gain any purchase.

So I did the next best thing: I crushed it.  That is not hyperbole or exaggeration - I literally put the grasper in his rectum and closed the jaws around the thing, crushing whatever part of it I could into bits.  I then removed those bits and went at it again.

The next 20 minutes of my life consisted of breaking off another small piece and removing it (along with some of the plastic wrapper which he had not bothered to remove), all the while taking care not to grab any portion of his rectum (that would be considered bad, as you can imagine).  Finally it was small enough to remove the remainder, and everyone in the room breathed a large sigh of relief.  I think I even audibly grunted in Jack's place when it came out.

The next morning Jack felt much better.  I gave him his discharge instructions, as well as what he could expect over the next several days.  And predictably I also gave him a bit of advice that should never actually need to be spoken aloud:

1) Don't EVER stick anything into your rectum ever again.
2) If you decide to ignore #1, don't wait two days to seek help when you can't get it out.

Tuesday, 16 August 2016


I love to learn.  When I was a child I had to read books or *gasp* listen to my teachers.  But nowadays the entirety of human knowledge is contained on a tiny device I keep in my pocket, and any information I could possibly want is simply a finger tap away (Hmm, why did Nicolas Cage change his name from Nicolas Coppola?).  My mantra in life is "Any day you learn something new is not a wasted day."

Well, that's only partly true.  My real mantra is "Don't be fucking stupid", but that doesn't look quite as nice on a picture:

Actually I take that back.  I think it looks pretty damned spiffy.

Anyway, learning is one of the few true joys in life.  There are so many things to learn about, so many topics, so many funny cat videos on YouTube.  One of the best things about medicine (and surgery in particular) is that there are always new things to learn.  New drugs are discovered, new surgical techniques are perfected, new diseases are described, and new treatments are devised to conquer it.

And people discover new ways to act fucking stupid.

When I was a child I thought Russian Roulette was a "game" played only in movies like The Deer Hunter.  But no, it turns out that there are some people stupid enough to have played (and lost) in real life.  And I found out recently that despite the horrendous stupidity that must by definition be inherent in the game, there are still people fucking stupid enough to play it.

Like Tracy (not her real name™).

This should not be a difficult concept to grasp for anyone with more than two brain cells to rub together, but pulling the trigger of a loaded revolver may result in a projectile coming out of the business end very fast.  Even if the gun only has one bullet in it, there is still at 16.67% chance that dangerous things will happen.  That's a phenomenon that is generally regarded as bad, especially when the gun is being pointed at something important, like, for example, a person's head.  Apparently Tracy and her friends weren't aware of the concept, because they all decided to play while "partying". 

Nevertheless, somehow nobody lost.  Perhaps the gun wasn't actually loaded, or perhaps they all got very lucky.  Regardless, the game ended, and no one ended up with a bullet-sized hole in his or her cranium.  But the luck would run out a short while later when the game changed from Russian Roulette to Russian Poker.

I had never heard of Russian Poker before, but apparently instead of pointing the gun at your own head, you point it at someone else.  In other words, stupid goes to stupider.

If you can't hear that foreboding foreshadowing music, then you aren't paying close enough attention.

Tracy was clearly sick when she rolled through the trauma bay doors just before noon.  Not sick like *cough cough* but sick as in I'm About To Die, Please Help Me.  

"Hey there Doc, this here is Tracy.  She's 16, shot once in the lower abdomen.  I can't see any other wounds.  Her heart rate is around 120, blood pressure is about 90."

My Inner Pessimist started yelling at me, "Move faster, dummy!"  I already was moving fast, goddammit.  My Inner Pessimist can be a bit of a dick sometimes.

She was sweaty and had that glazed Don't let me die look in her eyes.  We stripped her clothes off quickly, and the medics were right - a single gunshot wound to the left lower abdomen near the pelvis.  We turned her on her side to examine her back, which superficially looked normal.  I then parted her buttocks (while the medics gaped) and found the other gunshot wound on the left butt cheek.  (Note to all future trauma surgeons out there - ALWAYS LOOK BETWEEN THE BUTT CHEEKS.)

My Inner Pessimist started yelling louder.

Take two fingers and put one on your left lower abdomen beside and below your hip bone and one on your left butt cheek.  Don't worry, go ahead - no one is watching.  Good.  Now imagine a line between those two fingers.  There are a lot of very important structures there - small intestine, colon, iliac artery, iliac vein, ureter, possibly even the bladder.  A hole in any of them could be bad, but an injury to the iliac artery can easily cause fatal bleeding.

She needed to be in the operating theatre - NOW.

Ten minutes later we had her in the theatre where we first put in a bladder catheter, and her urine was clear yellow - good, the chance of a ureter or bladder injury was fairly low (though still not zero).  Five minutes after that I had my hands inside her abdomen.  There was a fair amount of blood, but no catastrophic bleeding.  Inner Pessimist quieted down somewhat as I breathed a brief sigh of relief and quickly examined her colon and found it to be normal (another happy surprise).  My Inner Pessimist finally stopped yelling as I ran her small bowel and found one small bullet hole, which I stitched closed.  I found the entry and exit wounds in the left lower abdomen/pelvis, and the bullet had missed the iliac vessels by less than 1 cm.  It had also missed the sigmoid colon by 1 cm, the bladder by 2 cm, and the ureter by 1 cm.

Now that is lucky.

A few days later as she was recovering she told me the story of how she got shot, including the game of Russian Poker that she had evidently lost.  "I didn't even know they had guns when I went to the party," she told me.  Yet that apparently didn't stop her from participating.  Any reasonable person would, oh I don't know, LEAVE.  

But fortunately being a surgeon means constantly learning, and if there is one thing this episode taught me, it was to update my mantra:

Thursday, 11 August 2016



People talk too much.  I've often said that a closed mouth gathers no feet, but no one seems to listen, probably because they're too busy flapping their gums.  Despite the fact that everyone on the planet seemingly talks nonstop (my children included, unfortunately), some truly great notable quotes have managed to avoid getting buried by the mundane and banal:
I have a dream. - Dr. Martin Luther King, Jr
To find yourself, think for yourself. - Socrates
That's one small step for man . . . - Neil Armstrong
I will not let anyone walk through my mind with their dirty feet. - Mahatma Gandhi 
This above all else: to thine own self be true. - William Shakespeare 
As you can see there have been some pretty goddamned great quotes over the course of human history.  But as with everything, there are two sides of the story.  As great as those quotes are, some others have said some really fucking stupid things:

Yes . . . they actually wrote that.  Fucking imbeciles.  To be fair, if you were to put a microphone on Trump at any time of day, you'd probably get many more quotes that would fit quite nicely on any Stupidest Quotes list.

Anyway, sadly none of the really good quotes have been either A) said by me or B) directed to me.  And since this egotistical little blog is all about me, I thought I'd share probably the greatest thing anyone has ever said to me. 

Brace yourselves. 

Anyone who knows anything about this stupid little blog knows that my favourite thing in the world is the RFO.  In case you aren't clear on what an RFO is, you can read more about them here, here, or here.  I may make it seem like RFOs are very common, but sadly they are not.

Hmm . . . reading back that last paragraph, I make rectal foreign objects sound incredibly creepy, even creepier than they actually are.  Let me explain so I don't sound quite so creepy.  The reason I like removing them so much is because it is usually a very simple procedure, and it is a remarkably satisfying experience.  

Hmmmm . . . that explanation didn't really seem to help things at all.  Damn.

Ok fine, you want the truth?  You really want the truth?  You think you can handle the truth?  FINE!  Yes, I enjoy taking things out of people's asses.  There, I said it!  Are you happy now?  I enjoy it, and if that makes me a disgusting human being, then so be it.  But before you turn away to vomit, consider this: It takes only a few minutes, patients feel better immediately, they often require little-to-no anaesthesia, and they usually are able to go right back home.  How many other surgical procedures are able to make that claim?  Very few.

Did that help at all?  Still no?  Well damn.

Anyway, back to the story.  

The call from the emergency physician came in just before midnight (of course), and it was the same as all the others:

Doctor Emergency (not her real name™): Hey Doc, I have a guy here with something stuck.
Me {suddenly fully awake}: Something?  What is it?
DE: I don't know, and he won't tell me.  I can feel it, but I can't get it.

I may have sounded a tad too excited, because when I arrived a few minutes later, Doctor Emergency looked startled, like she was about to call a psychiatrist on me.  Apparently I need to learn to tone down my excitement a bit.

A quick glance at the patient's X-ray told me two things: 1) There was no evidence of perforation (good), and 2) whatever "it" was was not metallic (also good - that usually makes it easier to grab).

I walked into the room and introduced myself to Antonio (not his real name™), who seemed entirely plussed.  That was fairly extraordinary - I was expecting him to be at least a little nonplussed.  Regardless, I decided not to beat around the bush and got straight to the point:

Me: Hi there, I'm Doctor Bastard.  So what is it?
Antonio: It's an anatomically correct dildo.  Well, actually I guess technically it's a dong.

Uh . . . well that was unexpected.  I felt somewhat stupid because I had no idea that there was a difference, so I asked him.

"You see doctor, a dildo is just a phallic object, but a dong is shaped like a penis and has balls."

Oh.  Well ok then.

After absorbing that information (and silently wondering if I will ever have occasion to use it again), I asked him how long it had been stuck.  Six hours, was his answer.  SIX FUCKING HOURS.  He had apparently been trying (and failing) to remove it for quite some time before giving up and resigning himself to the fact that he would need to seek professional help.

And that's where I stepped in.

A rectal exam gave me all the information I needed.  I could feel it just a few centimeters above his anal verge, but as is usual in these situations I couldn't grasp it.  Fortunately I had thought ahead and had stopped by the operating theatre front desk for a few supplies, including some heavy duty grasping clamps.  \

After a bit of light sedation, Antonio lay down on his side.  I inserted the clamp into his rectum along my finger, felt for the flange, and grabbed it (making sure not to catch any rectal tissue).

"Ok Antonio, are you ready?  One . . . two . . . three . . . PUSH!"

After about 10 seconds of grunting, pushing, pulling, screaming, and prayer, out popped this:
Most of the time all that grunting and pushing results in a baby.  No such luck for Antonio.

Though I figured I knew the answer to my obvious question already, I decided to ask it anyway.  Do want your dong?  And that's when Antonio hit me with the greatest thing anyone has ever said to me:

"Um, no.  I don't think my wife wants it back."

In my entire medical career I've rarely had to suppress a laugh as much as I did at that precise moment.  But suppress it I did.  At least for a few minutes until I got back to my car.

And then the hilarity of imagining Antonio giving his wife her dong back, trying to explain where he had been, and where it had been, fell over me.

I'm sure she would have said something notable.

Thursday, 4 August 2016

Gish gallop part 3

I am publishing this a bit early since I'll be on a well-earned vacation next week.  I may do some writing while I'm shooshing down a ski slope or basking in the sun under a palm tree with a fruity beverage or hiking through the mountains or relaxing lakeside, but no promises, folks.

With that said . . .

Welcome to part 3 of my 95874-part (apparently) series on anti-vaccine Gish gallops.  {EDIT: This is part 3 of 3.  I can't do it anymore.}  I congratulate you on making it this far.  If you haven't read Part 1 and Part 2, you haven't missed much except for the usual antivax cherry picking, intentional misdirection, hand waving, half-truths, lies, damned lies, and outright fucking lies.  If you'd really like to subject yourself to such balderdash, either A) go back and ready them, B) bash your head against the wall, or C) just head over to Natural News or  (all three would probably hurt equally as much).  Bullshit is all Natural News and publish.  Seriously, I haven't seen one single article on either site that I would call reputable.  It really and truly is all bullshit.

So having smashed several brand new computers while writing my last update and with another brand new computer in hand, I'll now continue slogging through the Gish gallop that is Kelly's Marvelous List of anti-vaccine resources.

When we left off at the end of page 4 (that's right, only 12 more pages to go, folks), Kelly was introducing an article about the Cantalago virus, a mild, self-limiting disease of Brazilian cows and their handlers that lasts about 3 weeks.  In it, the authors describe how the virus may have been derived from a smallpox vaccine strain that escaped into nature.  I hadn't heard of the Cantalago virus, so I was intrigued, and I actually learned quite a bit here (see antivaxxers?  That's called having an open mind.  You should try it sometime).  A bit more antivax-style research (read: a Google search) led me to a fascinating study of  the new virus' history and its genome.  It seems a strain of vaccinia from a smallpox vaccine sent to Brazil from France in 1887 was able to escape and then use cows as a natural reservoir.  The argument that Kelly is making here is, "Look!  A vaccine caused a new disease!  It's bad!"  But I would pose this question: which is worse, a mild and self-limiting disease that lasts for 3 weeks, or FUCKING SMALLPOX, a horrid scourge on humankind that killed 500,000,000 people in the 20th century alone?  What the hell is wrong with these people's brains that makes them completely unable to understand the concept of a risk:benefit ratio?

Moving on.

Starting on page 5, we have Graham Ewing's cesspool article cesspool that antivax activists love to tout.  In fact, it appears as #108 on Ginger Taylor's list of 124 articles that don't in any way prove vaccines cause autism.  I didn't go into detail about this particular piece of shit before, but I will here because what the fuck, I seem to enjoy torturing myself (and, by association, you people).  Ewing quite definitively concludes that "sensory dysfunction and systemic failure, manifested as autism, is the inevitable consequence arising from subtle DNA alteration and consequently from the overuse of vaccines".  Inevitable consequence?  Wow, strong words!  And what evidence does Ewing use to support such a definitive conclusion?  None.  NONE.  He provides no evidence in support of the conclusion, and he consistently proves that he doesn't understand the articles he cites.  Nor does he offer any new actual evidence himself; instead he simply spreads typical antivax lies throughout.  Think what I'm saying is just hyperbole?  Oh ye of little faith.  Allow me to quote from Ewing himself: "Vaccines are not subject to double blind clinical trials despite the evidence of vaccine-drug interactions and perhaps also of vaccine-vaccine interactions."  However, a simple 0.851-second Pubmed search for "vaccine double blind" would have shown Mr. Ewing that there are 2938 hits of double-blind placebo-controlled trials of vaccines and cured him of this particularly mendacious bit of stupidity.

But wait, there's more.

Ewing also states that vaccines aren't 100% effective.  No one actually claims this, though antivaxxers like to say that vaccine advocates claim this (except that we don't).  But to make his point he uses an article from 1977 about the risks of the pertussis vaccine despite vast changes in the vaccine (not all of them good, admittedly) since then.  He also uses the typical antivax argument that 60% of victims in measles outbreaks have been vaccinated.  What he (and all antivaxxers, it seems) continue to fail to understand is simple statistics.  For example, in a typically vaccinated school with 100 students, 90 of them would be vaccinated (approximately).  Say 8 students become infected, 6 vaccinated and 2 unvaccinated.  That means 3-times as many vaccinated are infected, right!  THAT'S SO TERRIBLE!  VACCINES DON'T WORK!  Wait wait wait, no that is not what it means.  It means that 6/90 vaccinated students (6.67%) were infected but 2/10 unvaccinated students (20%) were infected.  See the difference?  Antivaxxers don't.  Plus, the disease tends to be much milder in those who have been vaccinated.  Antivaxxers don't mention that little nugget either.

Ewing also makes wild statements like "In general, vaccines may be influenced by antibiotics" with no support whatsoever other than an article from 1994 about vaccine-related polio in Romania, which has nothing to do with antibiotics whatsoever.  Seriously, that is his reference for that claim.  I have no idea what Ewing was smoking when he wrote this bullshit, but now that I've read it, I want to keep it as far from me as possible.  I also have no idea why antivaxxers include it among their most favourite sources that supposedly prove why vaccines are so horrible.  Actually, yes I do: because they haven't read it.  Or if they have, they don't have the processing capability to realise what utter bullshit it is.

Now I'm going to take a happy little break from this shit while I fix the crack in my desk where my head just hit it 178 times.  I also need to exchange computers.  Again.

. . .

Ok, I'm back.  Still with me?  No?  I can't say I'm surprised.  I'm barely still with me, and I live here.  Be glad you aren't inside my brain with me right now.  Though if you were you'd probably learn some fun new curse words.

Next up is not an article, but a letter to the editor about the purported relationship between the hepatitis B vaccine and diabetes.  Not evidence, just a letter.  Skipped with alacrity.  But don't worry, Kelly gets back to this topic later.  Stay tuned.

Next is an article demonstrating that injecting certain adjuvants can induce lupus-related antibodies.  In mice.  The authors go on to say "Whether this is relevant in human vaccination is a difficult issue due to the complex effects of vaccines and the fact that immunotoxicological effects vary depending on species, route, dose, and duration of administration."  Does Kelly mention this?  Of course not.

I told you she would get back to it.  The next article on Kelly's list isn't an article at all.  Again.  It's another letter to the editor of the BMJ refuting the conclusion of another article.  The original article states "It is unlikely that H influenzae type b vaccination or its timing cause type 1 diabetes in children."  Did you get all that?  Let me explain.  No, there is too much, let me sum up.  Basically the authors of the actual research article in question found no statistically significant increase in the incidence of type-1 diabetes in children after getting the HiB vaccine.  The author of the letter that Kelly cited basically is saying "But yes it does!"  And who is the author of the letter?  That would be Dr. J. Bart Classen, CEO of Classen Immunotherapies which touts that it researches "finding safer ways of using commercially available products including chemicals, drugs and devices" on its website.  Dr. Classen believes the HiB vaccine is causing an increase in diabetes in children despite multiple studies, meta-analyses, and Cochrane reviews which refute him.

NEXT.  I'm getting more and more frustrated with Kelly and her list.  I think I'm on my 9th computer so far today.

Next article we have a group of scientists that induced anti-phosopholipid syndrome (an autoimmune disease) in mice using tetanus vaccine.  Kelly doesn't comment on it, presumably because she doesn't understand a word of the abstract, which is filled with complex sciencey terms like "molecular mimicry and polyclonal B-cell activation" and "monoclonal antibody (MoAb) T-26 specific for TTd and anti-β(2)-glycoprotein I".  Another word she didn't understand was "hyperimmunization".  That's right, the scientists purposefully used a higher than normal dose of tetanus toxoid in order to induce a hyperactive immune response.  Did Kelly mention this?  Of course not, since it completely invalidates the point she tried (and failed) to make.

We have Tomljenovic and Shaw next.  I've discussed them before (see paper #115) and will not do it again except to say that they are rabidly anti-vaccine and this paper is a series of hypotheses which have all been disproved.

A curious paper detailing an increased risk in multiple sclerosis after Hepatitis B vaccine is next.  "Fatally flawed" doesn't begin to describe this mess.  First, they describe the trial as prospective, which it most certainly is not.  When authors don't understand the research terminology they use, that's strike one and two.  Strike three is when they identify 438 eligible cases but only include 163 of them, but then do the main statistical analysis on 11 of them.  ELEVEN.  Strike 4 is the refutation of this study by the author of a study which found the exact opposite.

Another study trying to link the hepatitis B vaccine to MS comes up next, though the author states (and Kelly quotes), "Hepatitis B vaccination does not generally increase the risk of CNS inflammatory demyelination in childhood.  However, the Engerix B vaccine appears to increase this risk, particularly for confirmed multiple sclerosis, in the longer term.  Our results require confirmation in future studies."  Confirmation, however, has not been found.

More hypotheses are next.  "Hepatitis B vaccine might be followed by various rheumatic conditions and might trigger the onset of underlying inflammatory or autoimmune rheumatic diseases. However, a causal relationship between hepatitis B vaccination and the observed rheumatic manifestations cannot be easily established."  That's it.

I can barely even comment on the next one without smashing yet another keyboard, but I'll try.  Sigh.  Here goes.  It's Tomljenovic and Shaw again, and this time it's 2 case studies of teenage girls who died unexpectedly after getting the HPV vaccine.  Sounds pretty damning, right?  Well, no.  The 19-year old girl died 6 months afterwards.  Her autopsy was negative, but the authors curiously say it "allegedly revealed no evidence of neuronal loss or neuroinflammatory changes", which sounds strangely accusatory.  The 14-year old was found dead in the bathtub, and the autopsy again showed no underlying brain inflammation, but it did show ischemic encephalopathy (damage due to lack of oxygen), exactly what one would expect in someone who drowned.  But but but but the authors re-examined brain specimens and found evidence of anti-HPV antibodies in the girls' brains, indicative of vaccine-induced cerebral vasculitis, inflammation of the blood vessels.


But perhaps you've heard of Johns Hopkins?  Duke University?  Vanderbilt University?  Columbia University?  Researchers from those institutions reviewed this article and found, well, I'll let them explain: "On review, the CDC-CISA working group identified scientific concerns with the article, primarily, interpretation of histopathology and immunopathology methods.  These concerns negate the authors’ conclusions and significantly limit any interpretation of the results shown in the paper."  Basically their methodology was shit, their interpretation was shit, and their conclusions were based on said shit.

And now, good grief, is an article by, oh my, Burton Waisbren, who has published several articles on, ugh, chronic Lyme disease, and, *sigh*, how MMR causes autism.  I can't even.  I won't even.

We're making progress here, folks.  We're on page 6 now!  Only 10 more . . . to . . . go.

Next is an article from the Medical Hypotheses journal.  Yes, it's just a hypothesis.  Skipped.

I have no idea what Kelly thinks the next article proves, except that self-limiting diseases are self limiting.  Kikuchi-Fujimoto disease causes enlarged lymph nodes and fevers, it has an unknown cause, and it goes away by itself.  This is a case report of a girl who was diagnosed with KFD after getting two vaccines.  It went away.  That's really it.

I think my favourite example of cherry picking and not understanding the science is next.  This is an animal study with baboons, which were immunised with either the whole cell pertussis vaccine or the acellular vaccine, which is known not to be as good as the whole cell version (it does not last as long or protect as well).  Animals which got the acellular vaccine did NOT get the severe disease, but they still were colonised with the bacteria and were able to transmit the infection to other animals.  The baboons that got the whole cell vaccine were also protected but cleared it faster.  Where the abstract says "Baboons vaccinated with aP (pertussis vaccine) were protected from severe pertussis-associated symptoms", Kelly annotates "(NOT TRUE)".  Really?  Is she calling the authors liars?

Anyway, the point Kelly is making here is that animals (and by extrapolation, people) who get the acellular vaccine (which is everybody these days) can spread the infection to others.  OH  NO!  TERRIBLE!  And I agree, that is rather terrible.  But do you know who else can spread it?  UNVACCINATED PEOPLE.  The difference is that the ones who get the acellular vaccine won't get the severe life-threatening disease, unlike unvaccinated people.  Kelly and her ilk try to make it out that only people who get the acellular vaccine can spread the disease.  BZZZZZZZZZT wrong, Kelly.  They essentially become asymptomatic carriers.  The unvaccinated become symptomatic carriers.

I've only gotten through 7 pages, and I'm going to stop.  I skipped down a bit and found a bunch of case reports, "aborted fetal cells" scaremongering, SV40 scaremongering, vaccine shedding scaremongering, XMRV stupidity (it's a lab contaminant and cannot infect humans), and half a page of links.

But then a quote on page 13 caught my eye, and I thought I'd share it here:
Pure bloody evil - blatant conflicts of interest endangering the health, safety, health rights freedoms, rights to individual informed consent to treatment and individual rights to refuse treatment.
These corrupt bastards are nothing but vaccine industry whores and pimps and we the people won't stand by and let them forcibly inject us all. This will create a revolution of people demanding their full human and health rights freedoms not being told what to do by the corporate whores and pimps and the revolving doors to Governments and the web of deception and conflicts of interests/corruption all through it like sewer pipes.
And there you have it, folks.  This is what these people think.  We are "pure bloody evil" and "corrupt bastards" (well, they're half right) for pushing vaccines.  I don't think anything else really has to be said.  Kelly decided to put this in her "educational document".  This is supposed to be science?  Seriously?

I literally cannot say anything as damning as they say themselves.

And with that, I am done with Kelly and her list.  I apologise for putting you people through this bullshit.  If anyone needs spare computer parts, I think I have a few memory chips and various cards and boards that aren't completely smashed to bits.  There seem to be several "Q" and "BACKSPACE" keys scattered across my floor too.

Monday, 1 August 2016

Gish gallop Part 2

WARNING: This is Part 2 of a multi-part response to yet another anti-vaccine crackpot, so proceed at your own risk.  

When we left off at the end of Part 1, I had decided to skip down a bit on page 1 of Kelly's already-ridiculous 16 page "document" a bit.  It had taken me hours to slog through just the first half of the first page that was supposed to educate and awaken me on the dangers of vaccines.  By the end of part 1, I had learned a lot, but the vast majority was about the mindset of these antivaccine lunatics.

With that lovely and stimulating preface which is sure to make you want to read on, we're moving on.

The utterly preposterous "Vaccines didn't save us" bit from the ironically titled "Child Health Safety blog" predictably shows up.  This has been roundly destroyed by Dr. David Gorski far better than I ever could, so I will leave that steaming pile of bullshit alone and refer you to Dr. Gorski for full details.  The TL;DR version: it's total bullshit.  There is then a link to a story about why Japan banned the MMR (due to increased reported side effects) and switched to separate vaccines.  That sure sounds damning, right?  What Kelly and her colleagues don't tell you (cherry picking, anyone?) is that even after Japan completely eliminated MMR in 1993, their rate of autism continued to rise just as fast as it was before.  The only thing that tells me is that MMR doesn't cause autism.  I wonder what Kelly and her friends think it means.  We don't know, because they gloss over this little nugget.

Skipping down a bit more, there is a link to the ridiculously named "National Vaccine Information Center", which is, according to their mission statement, "dedicated to the prevention of vaccine injuries and deaths through public education and to defending the informed consent ethic in medicine".  In reality, they are 100% antivaccine, and their president, Barbara Loe Fisher, is #131 in the Encyclopedia of American Loons.  There is no other information on the link, just the link.  So the reader is left to wonder the significance.

Next are multiple links to Age of Autism, followed by multiple links to Natural News (which incidentally has now become my go-to source for comedy).  Natural News is a hive of pseudoscience, conspiracy theories, and outright bullshit (but heck, they do have a store!)  I can therefore skip these with aplomb and panache without any reservation whatsoever.

One of the next sources is a link to the Sierra Leone Times.  Hm . . . curious.  Upon clicking it, it refers to a Natural News article (ugh, of course) about the varicella vaccine being ineffective in South Korea.  I had to search for the paper, and upon reading it I discovered that Kelly actually had a point - the 2014 study found that the chicken pox vaccine was only found to be 54% effective with a high breakthrough rate and little amelioration of disease.  The authors' conclusion, however, was not "THIS VACCINE SUCKS!", but rather "This vaccine sucks and we need a better one".  Indeed, looking at the statistics in other countries (for example in the US where a different and much more effective vaccine is used) reveals a startling difference:
But Kelly didn't list this site in her sources, now did she.  The fact is that vaccine wasn't great, but there are better ones available that are quite effective and very safe.  Kelly doesn't want you to know this, however.

After more sanevax and healthimpactnews links (more head-crushing antivax comedy masquerading as information), I skipped forward to the next page where I was dismayed to find a bunch of Facebook links.  Now last time I checked (and feel free to correct me if I'm wrong), Facebook is not exactly a bastion of peer-reviewed science.  In fact, I'm not aware of any peer-reviewed science having been published on Facebook.  I have no idea what Kelly thought Facebook posts were supposed to prove, so I skipped them without a second thought.  If there is any useful information in any of the links, I have to assume it will be contained in the rest of Kelly's expansive document.

There's also a link to a story about an outbreak of mumps where 8 university students were infected despite being fully vaccinated.  However, again what Kelly's friends don't tell you is that the mumps portion of MMR is 88% effective (less than both the rubella and measles portion), and the infection is typically milder among those vaccinated compared to the disease that unvaccinated people get.  And let's again remind ourselves of the protection rate of not being vaccinated: That's right, 0%.  And since most people are vaccinated, it is likely that a majority of the patients in any outbreak will be vaccinated.  That's just simple statistics, folks.

You'll now have to pardon me as I slogged through (read: skipped) more Facebook links, YouTube videos, Huffington Post posts, Natural News bullshit, Vaxtruth balderdash, Vaccine Impact poppycock, No Vaccine hooey, and Health Impact News codswallop.  Bullshit bullshit bullshit, more bullshit, and AAAH, here we go.  A Pubmed article.  Finally!  Now we have some literature.  Ok let's see . . . it's uh, wait, an article from 1950 about the similarity of the mousepox virus to the cowpox virus, and variola to vaccinia?  I don't, uh, yeah, um . . . hm.

There's also a horrible piece of hypothetical pseudoscience from Theresa Deisher who holds a PhD in Molecular Cellular Physiology and should be capable of some good science, but nay.  She purports that foetal DNA fragments in vaccines may combine with our DNA and do bad things.  My oh my.  I can't even begin to touch on this as well as Dr. Gorski did here.  This is nothing but fear mongering.  Know what else contains DNA?  MEAT AND  VEGETABLES.  Ever heard of mutant chicken-people laying eggs and pecking people's eyes out?  (Listen up, Hollywood - that's a great fucking idea for a movie.  Call me.)  The likelihood of tiny bits of foreign DNA recombining with ours is thiiiiiiiiiiiiiiiiiiiiiiiiiiiis close to 0, and the likelihood of that tiny bit of DNA being useful AND recombining with native DNA in a way that would be functional is approximately the likelihood of James Cameron making my Chicken People movie AND me winning the lottery every week for the next 1.93 million years.


As I scrolled down to page 3 (yes, after all that we're still only on page 3 out of 16), a very prominent name nearly popped off the page: Johns Hopkins.  And it's actually a link to a story the Hopkins website!  Huzzah!  Something credible!  But alas, it's a study about brain inflammation in autism, which is one of antivaxxers' latest obsessions, it seems.  The hypothesis seems to go a little like this: autistic brains have more inflammation, and vaccines induce the immune system, and yada yada yada AUTISM!  But Kelly and her friends missed one little detail: THE VERY FIRST LINE: "While many different combinations of genetic traits can cause autism . . . ".  But no, they ignore that little tidbit to make the giant leap to a false conclusion.  I have no problem with the hypothesis that microglial cells are activated in brains of autistic people, but there is no evidence that vaccines induce this.

Right after Hopkins was another name I recognised: CHOP (Children's Hospital Philadelphia).  The link goes to the aluminum information page.  Aluminum is another favourite target of antivaxxers because they don't understand it.  At least, that's the only reason I can think of.  Anyway, CHOP very clearly details how much aluminum is in each vaccine dose versus how much is ingested in the diet (about 26 times as much in the diet if a baby is fed soy-based formula), though I will acknowledge that proportionally more aluminum is taken up and enters the circulation when it is injected than when it is ingested.  No, it is NOT injected directly into the bloodstream.  Dr. Paul Offitt explains this very nicely in a video ON THAT PAGE.  This seems to be another self-destructive link for Kelly (though her ilk are not very big fans of Dr. Offitt).

Towards the bottom of page 3 (YES, STILL ONLY PAGE 3) there is an article from the journal Vaccine (which also published the excellent Taylor meta-analysis) entitled "Annual influenza vaccination affects the development of heterosubtypic immunity".  Hm, good title, good article - this should be good!  It states that getting a flu vaccine (ie against the H3N2 subtype) may inhibit immunity against other subtypes of the flu virus (ie H5N1) and which "highlight(s) the importance of the development of vaccines that provide protection against influenza A viruses of all subtypes".  The underlying message of the article is that the flu vaccine is probably the least effective vaccine we have, so we need to a better one.  Kelly's annotation here says "(of course the answer is MORE and BETTER vaccines)"  Well no Kelly, not necessarily more, just better.  But isn't that what we should want?  Better vaccines?  It doesn't say it's unsafe, it doesn't say it has massive severe side effects, just that it isn't that protective.  So I don't remotely understand the controversy here.

Moving on to page 4.

The first article discusses how maternal antibodies from mothers vaccinated with MMR protect newborns from measles, mumps, and rubella for 3.3, 2.7, and 3.9 months respectively, and 3.4 months for varicella.  Babies of unvaccinated mothers had about 2 months additional protection.  However, MMR and varicella vaccines are not recommended until 12 months, meaning that ALL children are unprotected for at least 6 months, relying instead on herd immunity to protect them.  Even Kelly must admit that lower vaccination rates would lead to higher infection rates, especially in highly susceptible infants, and even Kelly must admit that's bad, right?  RIGHT?

The next citation is a review of the chicken pox vaccination program in the US, published in the Vaccine journal in 2013.  While they state the program is effective (with chicken pox reports dropping 72% from 1995 to 2000), it was not found to be cost effective due to increased morbidity.  The authors also state that the vaccine doesn't offer long-term protection.  This is no surprise to anyone who understands how these vaccines are supposed to work.  They certainly weren't a surprise to Marin et al who conducted a meta-analysis of varicella vaccine effectiveness (published in March 2016).  They found an overall effectiveness of one dose of the vaccine was 81% and a 98% effectiveness against moderate/severe varicella.  In other words, one dose of the vaccine is pretty damned good at preventing chicken pox, but REALLY DAMNED GOOD at preventing severe chicken pox (a booster has now been recommended).  Is it cost effective?  Perhaps not, but that shouldn't matter nearly as much.  It should be expected that preventing disease will not be free.

Next up we have an article from the CDC.  Now I'd just like to point out that to many antivaxxers, the CDC is a completely evil, vile, and thoroughly fraudulent organisation that must not be trusted for any reason.  Unless the CDC reports something potentially bad about vaccines, because then whatever the CDC says is gospel.  Anyway, this article details how the pertussis vaccine may select for Bordetella pertussis bacteria which carry a particularly nasty promoter which makes them more virulent.  Note that this article does not say the vaccine doesn't work (though the acellular version is well-known to be less effective than the whole cell version), nor does it say that the vaccine is dangerous.  Is this nasty strain of B. pertussis a good thing?  Of course not.  But using an article like this in an attempt to invalidate vaccination is ridiculous.  Articles like these are useful for researchers to learn about how these bugs work so they can stop them.

The next article is a bit of hand-waving and cherry picking about Haemophilus influenzae, a bacteria which can cause numerous infections, notably meningitis.  The vaccine protects against H flu type b, not a.  During the 1-year period after Hib vaccination started, Hib meningitis dropped by 69% (HUZZAH!) but H flu type a meningitis increased by a whopping 800%.  Now before you go all crazy let's look at the actual numbers.  The incidence of Hib meningitis was 2.62/100,000 person-years before vaccination and 0.81 after.  The incidence of H flu type a meningitis was 0.02/100,000 person years, or 131 times lower than Hib, and it went up to 0.16, which is still 5 times lower than the incidence of Hib after vaccination.  Want some proof of cherry picking?  Kelly uses these two quotes directly from the article's abstract: "Hib immunization contributed to an increased risk for H. influenzae type a meningitis through selection of circulating H. influenzae type a clones" and "the incidence for H. influenzae type A meningitis increased 8-fold".   But the VERY NEXT SENTENCE in the abstract is this: "The risk attributable to serotype replacement is small in comparison to the large reduction in Hib meningitis due to immunization."  In other words, the vaccine led to an increase in a very unusual subtype, but that increase was FAR less than the DECREASE in the more common type.

Cherry picked indeed.

And there was yet more cherry picking ahead.

Next up is an article showing that the rotavirus vaccine effectiveness in Nicaragua was only 58% due to vaccine-type virus genes recombining with wild-type viruses.  But not only did Kelly fail to mention the very first line of the abstract (where it happens to mention an effectiveness rate of 90% in developed countries), she also conveniently forgot about (or doesn't know about) a study from Finland entitled "No evidence for selection pressure by universal mass vaccination with RotaTeq® vaccine."   A similar study from Brazil found the same thing, and a systematic review from South Korea found it to be safe, effective, and cost-effective.

We're still not even 25% through Kelly's list, and I'm fucking exhausted.  I can't imagine how the three of you who got this far actually feel.

I think I'll pause there, because this long stupid article is too long, too stupid, and too something-else-I-can't-think-of-right-now.  There will be more in part 3, and I'll probably end it all there.

The article, that is.  Not me.  I'm not committing suicide over this bullshit.