Monthly Archives: November 2011

“Believers are stupid.”

Notoriously smart Christian, Francis Collins

Sadly this sentiment comes up pretty often in atheist circles.  Some non-believers can be downright vituperative about religious people.  Sometimes I think it’s just extreme frustration with silly arguments or hateful attitudes associated with certain religious groups.  But a lot of the time, it seems to be meant very literally.

The mistake people are making is in confusing a selective, compartmentalized suspension of rationality with stupidity. It is abundantly clear that manymany intelligent, otherwise reasonable people turn off their critical thinking when it comes to religion. Believing something without evidence and reason is pretty much the definition of “faith,” after all.  In my experience, people who believe in something supernatural didn’t come to that belief through rational review, but more due to tradition, personal revelation, or plain old gut feeling.

Intelligence and rationality are often treated as synonyms in our culture, so it’s understandable that people conflate them.  But you can be really smart, and you can systematically review most claims with evidence and reason in mind, and still cordon off an area for beliefs that don’t get that treatment.  I think for people who try to subject every single claim to rigorous critical thinking, this approach is very puzzling and frustrating.  Sometimes it’s hard to get beyond that gut reaction of bafflement to the empirical truth that lots of intelligent people are religious.

As a thought experiment, imagine some belief you consider total, obvious codswallop – whose roots and causes are clear to you as mistakes of observation or well-known foibles of human perception. Perhaps alien abduction stories, the healing power of crystals, astrology, or bigfoot sightings. Now, don’t you just have a visceral reaction along the lines of, “How could anyone believe THAT? How could someone be so blind as to what is actually going on?” If you know a believer in this stuff who is otherwise bright and sane, don’t you boggle at how they can carry both of these personality aspects in the same brain? That mystified disbelief is just how non-believers tend to feel about smart believers.  Hell, I don’t understand how I could have believed the things I did when I was Catholic – there’s not a lot of hope of me really grokking the religious beliefs of other people!

But really I think we should examine this meme in our community and dispose of it.  Of course some individuals or some particular arguments may be stupid, and there’s no need to obscure that fact.  But if we could forge ahead with the idea that we all have more in common than religious labels would imply, I think we would do more for acceptance of atheists and for bettering our society in general.  We also need to remind ourselves that we’re not 100% rational either, because emotions are necessary for reasoning.  I guess it all boils down to a simple idea.  While I do think any equal rights movement needs a few firebrands, for the vast majority of us, Phil Plait’s famous advice is the best way to make cultural and interpersonal headway: “Don’t be a dick.

So for my part, I don’t think believers are stupid.  I have lots of friends of different beliefs, and generally it doesn’t even come up.  We all have a lot more to talk about, like work, kids, budgets, good books, favorite movies, relationships, health issues, family issues, jokes, housekeeping, procrastinating housekeeping, and on and on and on.  As long as you’re not spewing hatred or trying to use government force to indoctrinate my kids, your beliefs are no skin off my nose.  I wish more believers and more non-believers would get on board with that.

Kills germs on surfaces – so we should definitely drink it!

“If it’s not accepted as medicine, it will cure you!”

This seems to be the mentality of many folk who extol the virtues of bizarre home remedies.  These people are the most confusing to me.  I can kind of understand where you’re coming from if you want to avoid pharmaceuticals, pesticides, toxic cleansers, and so on.  Many people are trying to live a “natural” life, and while that may be a  fantasy in some ways, it does make sense to eat whole foods, avoid unnecessary drugs, limit exposure to pesticides, plasticizers, and other chemicals that may cause problems for our bodies or our environment, and even to use home-grown herbs to treat the symptoms of mild, self-limiting diseases.  Hell, I can even understand the use of homeopathy to an extent – it’s billed as a mild, side-effect-free to make sure the body is working at its best.  It was specifically formulated as an alternative to toxic and dangerous treatments used in the 18th century.  People like to think that there’s something more natural, that won’t cause bad side effects, that they can use to cure themselves.  That’s understandable.

But then there’s this subset of people who seem to latch on to a particular cure which isn’t herbal or natural in any way.  It may be the product of standard industrial processes or pharmaceutical research.  But the key to this woo is that the substance not be used as intended by mainstream science.

The most extreme case I can think of is bleach.  Bleach is a very mainstream product.  It’s manufactured by big companies.  It’s corrosive.  It’s a substance often avoided by crunchy people due to its potential to harm humans and the environment.  Bleach has been shown to be very effective at killing microbes on surfaces however.  It’s recommended for cleaning in the home for HIV patients because it kills bugs so well.  Bleach disinfection is even promoted as a stopgap method of killing HIV in heroin syringes if no clean needles can be obtained.

Somehow people have extrapolated all that microbe-killing power to a notion that ingesting bleach can cure diseases in the body.  “If bleach kills HIV in a syringe, it will kill HIV in my bloodstream” is how the thinking goes.  It almost makes sense, if you ignore the fact that drinking bleach will cause major burns in your esophagus, stomach, and intestines, and will kill you long before it would provide any theoretical benefit.

Similarly, silver can be used as an antiseptic and is used in topical application to prevent infection.  Some cranks have made the “if it’s good topically, it must be great ingested” leap and advocate ingestion of colloidal silver to cure, well, everything.  However, there’s no evidence showing ingestion of colloidal silver treats any disease or condition.  It’s probably not as bad as drinking bleach as far as immediate injury, but colloidal silver can cause kidney damage and seizures.  Far more entertaining is its celebrated, non-toxic side effect, argyria.  It turns your skin and mucous membranes gray-blue.  So if you want to get no benefits whatsoever, risk major organ damage, and wind up looking like a sick smurf, colloidal silver is for you!

Here’s a quick list of other products of good old toxin-laden, money-driven, factory-produced technology, that are hailed as cures for things that science doesn’t use them for:

Dichloroacetate, allegedly a cure-all for cancer, in reality a substance that might fight cancer, but may be too toxic for use in the body.

Laetrile, another cancer “cure.”

F***ing Magnets, how do they work?  They don’t.

Vicks on your feet to stop a cough.

Tagamet for warts.

Aspirin dissolved on a sore tooth, rather than ingested.

Milk of Magnesia for acne.

Listerine for everything.

I won’t pretend to understand all the psychology underlying this behavior of off-label use as alternative medicine.  But it seems to me that a large part is just desperation – when the doctor only has difficult, complex, or slow-working answers, these remedies can make people feel like they’re fixing the problem.  And certainly the idea of getting one over on The Man is appealing.  The medical-industrial complex may want to charge you a lot of money for a treatment that might or might not work, but you can show them up by just rubbing Listerine on [body part] and fixing yourself!  That sense of control is really appealing.

And ultimately, I think Mark Crislip has a large part of the answer:

As I have discussed before, users of alternative therapies are not comfortable with nuance and subtlety, and,  I think, prefer black and white binary approaches.  Mercury in one form is toxic, so all forms of mercury are toxic.  Some forms of silver are beneficial, so all forms of silver of benefit, including colloidal silver. The inability to deal with shades of gray is a hallmark of many forms of alternative therapy.

The Cynical O.B.

I was really excited to see a blog called “The Skeptical O.B.”  Having read The Thinking Woman’s Guide to a Better Birth, I knew that standard O.B. practices are often more about intuition and tradition than evidence-based medicine.  I thought it would be so cool to see an actual O.B. looking at the risk/benefit analysis on interventions like induction, epidural, and c-section.

Whoops!  Boy is my face red.  The blog could better be named, “The Hidebound Ideologue Against Natural Birth.”  Now, I am interested in skepticism of natural birth practices as well as hospital practices.  You don’t automatically get a pass from me because you’re doing something crunchy.  But god damn, Amy Tuteur is so vituperative, condescending, and obnoxious in her approach, and so obviously devoted to propping up standard hospital practices, that I can’t read her blog even if it might offer some interesting info on homebirth safety or midwifery guilds run amok.

Amy typically storms into each post with a haughty and self-assured stance, declaring her position to be self-evidently correct and everyone else to be feeble-minded.  Most recently, she announced “The largest, most comprehensive study ever done of homebirth has released its results and there’s nothing left to argue about: homebirth increases the risk of perinatal death.”  The study she’s citing though, states almost the opposite take-home message in its Conclusions:

The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.

In my experience of her work, this is representative.  She is the opposite of a skeptic – she decides on her position, and then twists and cherry-picks evidence to support it.  It also doesn’t help matters that she is absolutely vile and superior to any commenter who dares to question her pronouncements and offer counter-evidence.  In other circumstances, I’d be very interested in her information about the Midwives Alliance of North America keeping their statistics on births secret, and appearing to require almost a loyalty oath before giving someone access to it.  But a.) I don’t trust her to give me all the information, and b.) I don’t want to don a bile-proof jumpsuit to wade through her excoriating commenters who offer other perspectives.

This was such a wasted opportunity.  In my opinion, all birth practices need a good review based on the most recent evidence available.  Honestly, I probably agree with Dr. Amy on a lot of things.  I think unassisted childbirth is a terrifying new trend that exposes mothers and babies to too much risk.  But I think that it’s useful to look at the hospital practices and insurance structure that drive women to birth without any attendant whatsoever, and try to reform our institutions so mothers can feel safe and secure in a hospital, or have access to a well-trained, licensed midwife.  Dr. Amy thinks the answer is to sneer and call these mothers fools.

Vaccine Avoidance and The Trolley Problem

Mention the vaccine debate to a skeptic, and their blood pressure will rise precipitously.  Vaccine opponents like Jenny McCarthy leap to mind – people who are loud and aggressively irrational, who cling to discredited theories and practitioners and invoke tinfoil-hat level conspiracy theories to explain why the evidence is against them.  It’s no wonder that vaccine supporters distrust and even revile anyone labeled as “anti-vax.”

But it’s not just a belief in Wakefield and his faked data about autism that motivates vaccine-cautious parents.  Between those who adhere to the CDC schedule and those who hyperventilate about Congress forcibly turning children into “mercury-laced vaccinated guinea pigs”  there are a lot of parents who are just worried about their kids’ health.

To be honest, I think a lot of their motivation originates in emotion rather than reason, but that doesn’t make them fringe loonies.  They hear that a doctor wants to stick needles in their tiny, vulnerable baby and inject, well, stuff.  Not only are they being injected with dead viruses and such, but there is some mystery about what else is floating in that syringe.  Moms who scrupulously avoid pesticides, preservatives, dyes, and even sugar are told that the doc is going to deliver an industrially-produced cocktail of substances directly into their infants’ muscles.  You have to admit, that’s kind of scary.  And most people don’t emulate Mr. Spock and dispassionately weigh the relative risks of each decision.  They are guided by their gut reactions.  And in this case, their gut says, “that seems bad.”  Humans aren’t really built to look at statistics and risk in a logical way – we react, then interpret evidence in light of that initial emotional reaction.

Humans are also really, really prone to the post hoc ergo propter hoc fallacy.  Even if someone intellectually knows that one event closely following another doesn’t imply causation, the emotional impact of watching a child have a serious health problem shortly after a vaccination can’t be underestimated.  And of course, some children really do have serious reactions that are related to vaccines.  It’s quite natural and prudent for parents to withhold future vaccines from such children if there is an elevated risk of further reactions.

Generally, the reluctance about vaccinating on schedule  is not due to parental neglect, but quite the opposite: parents who avoid vaccines tend to be extremely cautious about their children’s health.  As alluded to above, many of the alternatively- or non-vaxing parents I know are exceedingly careful about birth interventions, breastfeeding, sleeping safety, car seat safety, nutrition, and every variable they can control in the slightest to maximize their children’s well-being.

Now, to some extent this caution may be misplaced.  Parents may think that the risk of not vaccinating is lower than the risk of vaccinating.  If vaccine inserts had a well-founded comparison chart that laid out the relative risk, maybe some of these parents would feel more comfortable vaccinating.  The vaccine information statement I just got for the flu vax just states, “The risk of a vaccine causing serious harm, or death, is extremely small.”  Well, the risk of my kid getting serious harm or dying of the flu is “extremely small” too, right?    The statement goes on to warn that the vaccine could very rarely cause life-threatening allergic reactions.  But veryvery cautious parents are going to read that and have serious harm . . . death . . . life-threatening jump out and stick in their memory, then compare that to the time they had the flu and felt a bit unwell for a week, and they will conclude that there is no way the risk is worth it.  If the information statement had a table showing “Risk of death from vaccine = .000001” and “Risk of death from the flu = .000005” maybe people would have the data to make better decisions.  (I totally and completely made up those numbers, just to demonstrate what I’m saying, by the way. I also realize that some may look at the research and conclude that the risk of death from a vaccine is actually higher than the risk from the disease.  Personally I’d like some expert statisticians to analyze the data for parents.)

I also think that the vaccination decision is related to the ethical reasoning displayed in The Trolley Problem and its related hypothesis, The Fat Man.  In those hypotheses, people are pretty willing to divert a train from a track that has five potential victims tied to it, even if that will accidentally cause the death of a single person.  But people are generally reluctant to agree that they would push a fat man off an overpass to derail the train as it is about to hit five people.  In both cases, the number of people saved compared to the number sacrificed is the same.  But people are not willing to take deliberate action to harm someone, even in situations where they are willing to take an action they know will probably cause the same harm as an unintended consequence.

I think that parents who don’t vaccinate on the CDC schedule are functioning according to this pattern.  They will risk their children happening to encounter a serious vaccine-preventable disease and being harmed.  But they can’t accept the possibility that they might choose to inject shit right into their kid’s bodies and thereby cause them harm.  That might not be a logical reaction.  It might be frustrating to vaccine proponents and public health officials.  But it is a profoundly human reaction.

Nipple Yeast, Part 2 – Alternative Treatments and What’s in Them

OK, this is what you’ve been waiting for – “natural” and alternative remedies for candidiasis! (Part 1 is background and doctor-style remedies.)

First up, gentian violet.  This is renowned for its quick-acting slaughter of all things fungal, and it’s often recommended in crunchy circles.  Whereas most yeast treatments take at least two weeks, this takes about three days.  The one big drawback is that this stuff is seriously PURPLE and stains everything it touches. (That’s my daughter with a purple mouth, purple thumb, and slightly purple pajamas thanks to GV.)

Want to guess where gentian violet comes from?  Nope, it’s not extracted from organically grown violets.  Nor from gentian flowers.  It’s an extract of coal tar.  It was first used as a dye, but then users noticed when they used it for gram staining microscope slides, it killed all the wee beasties they were trying to look at.  (And yes, I find it a bit hilarious that there are people who decry mineral oil use on the skin, but who happily slather the insides of their infants’ mouths with extract of coal tar.)

The other potential risks of gentian violet are mouth ulcers and a possible increased risk of cancer.  But that’s based on a study of ingestion of large amounts by mice.  Honestly, if I had it to do again, I would still use gentian violet for nipple yeast.

Next big natural cure: grapefruit seed extract (GSE).  Again, this seems to be a pretty powerful antimicrobial agent.  There is research showing that its efficacy is comparable to that of bleach in killing microorganisms.  And because it’s derived from grapefruit, a lot of moms feel more comfortable using it on their nipples and in their infants’ mouths.  But that’s where we need to back up the truck – the reason this stuff is so powerful is that it is either contaminated with or nearly chemically identical to well-known antimicrobial chemicals Triclosan, benzethonium chloride, and benzalkonium chloride.  The latter are often referred to simply as BAC.  One study found some commercial GSE preparations contained Triclosan.  The others typically find the spectrometry is pinging for BAC.

The main manufacturer of GSE, Nutriteam, Inc., maintains that their product is not contaminated with BAC.  They say their GSE is just similar to BAC, so it confuses the spectrometer.  And well, I kind of believe them.  My conclusion is that their product isn’t contaminated.  It’s just that it is for all intents and purposes BAC.  I don’t know how BAC is typically manufactured, but I suspect you can make it using grapefruit as a raw material.  And Nutriteam themselves call GSE a “quaternary compound” (just like BAC is), and describe a manufacturing process that sounds pretty industrial and non-crunchy.  It sounds like they’re doing pretty typical chemical synthesis to me.  And they wind up with a substance that tests and works just like BAC, only they call it a dietary supplement so they don’t really have to comply with any regulations, and they slap a label on it that makes it sound like something natural, not a “chemical” or gods forbid, a “toxin.”

Now, BAC isn’t actually evil, necessarily.  It’s used as a preservative in cosmetics and in anti-bacterial wipes.  Hell, if you’ve ever given a urine sample, you have probably smeared BAC all over your naughty bits.  And since many people have used GSE without ill effects (beyond a bitter taste and the possibility of dry, peely skin), I wouldn’t be averse to using it myself if I ever got nipple yeast again.  I really don’t like that the manufacturers are getting away with fooling people, but look at my previous yeast post – it feels like rubbing your nipples with broken glass.  For me, I’d hold my nose and use GSE since it makes that go away – quickly, for both me and my nursling, without having to get a prescription and explain to the doctor why Nystatin doesn’t work and how much Fluconazole you really need to prescribe, and so on.  But I do think moms deserve to know the real story before they decide whether to use it.

So there you go, two wildly popular crunchy alternative yeast treatments, that aren’t really that crunchy.  But I’d still use them!

Skeptical Quickies

I had important things to do today like physical therapy, and shopping, and going out to lunch.  I just got to sit down in front of the computer, and my kid has to get ready for a sleepover, so here are some links of interest.  Monday we’ll do alternative yeast therapies, I promise!

Self-help guru gets 6 years in sweat lodge deaths – a newage self-help guru basically roasted a bunch of people alive, in the name of enlightenment.

FDA revokes Avastin’s approval for breast cancer treatment – but you can still get it prescribed off-label.

Science fights fluoridation – do modern opponents have some real science on their side?

American Pain Foundation creates informational website for CAM – it does talk about some of the risks of CAM treatments, but not comprehensively (aortic dissection isn’t mentioned in regards to spinal manipulation, for instance), and seems quite dewy-eyed and trusting when it comes to efficacy.

Canadian Medical Association Journal: natural health products should be subject to the same regulations as pharmaceutical drugs – “it is a near-universal truth that any substance that exerts a beneficial effect on a biological system will also have the potential for adverse effects.”

Nipple Yeast – Part 1 of 2

As you read the post title, some of you are saying, “what the heck is that?” while some of you are groaning in remembered agony.  For the uninitiated – you know yeast infections?  Well, you can get one in your nipples when you’re breastfeeding.  And they hurt like hell.

A “yeast infection” is caused by candida albicans, a fungus. Yeast used in making alcohol and bread is saccharomyces cerevisiae, which is in the same taxonomic family as candida, but is a different genus and species.  It has no role in yeast infections.

Candida is normally present on our skin, it’s just when it grows out of control that it becomes a yeast infection.  That also means that it’s difficult to diagnose – a culture isn’t going to reveal whether it’s just “some” yeast or “too much.”  So diagnosis is usually done by looking at the mom’s symptoms and history. Predisposing Factors include recent use of antibiotics, hormonal changes during pregnancy, and nipple trauma.

For the mother, the most noticeable symptom of nipple yeast is pain.  Pain that makes you writhe, makes you dread nursing.  Mothers with bad cases describe it as having their nipples rubbed with broken glass.  It’s often accompanied by itching or burning, and it stays the same or gets worse as a nursing session goes on.  If it hurts when the baby latches on, but gets better once he’s on there, it’s not likely to be yeast.

Other symptoms can include dry, peeling, flaking, red or shiny skin, blebs, recurrent mastitis, or yeast infection in another part of the body.

In the baby, symptoms of candidiasis include white patches in mouth, a pearly look to saliva and insides of lips, excess gas,  fussiness, refusal to nurse, and clicking during nursing.   The baby may have a raised red diaper rash with outlying red bumps.  Most importantly, the baby may have no symptoms.  This is something many doctors seem ignorant of.  A mom says she suspects yeast, the doctor looks in the baby’s mouth and doesn’t see white patches, and says it’s not yeast.  A lot of the time, the only evidence of a yeast infection is the mother’s pain, and some doctors won’t take that seriously. Another mistake many doctors make is treating only one half of the nursing dyad.  The standard of care is to treat mother and baby whenever one shows symptoms of candidiasis.  Otherwise, one is constantly passing a new load of yeast to the other, despite treatment.

So what are doctors going to prescribe for this treatment? Basically, there’s Nystatin, azole creams, fluconazole, and All Purpose Nipple Ointment.

Nystatin is the traditional treatment for babies with candida overgrown in their mouths.  Unfortunately, it now has relatively poor effectiveness, due to the evolution of resistant candida.  According to the experts, “Use should be limited to never-treated cases of thrush.” (Riordan & Wambach, Breastfeeding and Human Lactation, 4th Ed.)  Possible side effects include skin irritation, diarrhea, nausea or vomiting,and  stomach pain.Azole creams miconazole and clotrimazole can be found labeled as athlete’s foot and jock itch remedies at the drug store (there are other drugs used for athletes foot and jock itch that aren’t necessarily safe for nursing – it’s important to read labels!).  They can also be used on a mother’s nipples, and according to Jack Newman, M.D., they don’t have to be washed or wiped off before nursing as long as they’re applied sparingly after a feeding.  Possible side effects are burning, redness, skin rash, blistering or other skin irritation.

Fluconazole is a systemic drug, taken orally. Newman recommends 400mg loading dose, followed by 100 mg twice daily until mother is pain-free for a full week, and this regimen can be really effective, especially when other treatments haven’t worked.  This can be used along with topical treatments, and has been used in newborns and premature infants in the hospital, though I’m not sure if pediatricians will prescribe it generally.  It has little transfer into mother’s milk.  Possible side effects include acid or sour stomach, belching, change in taste or bad, unusual, or unpleasant (after) taste, heartburn, indigestion, stomach discomfort or upset.

All Purpose Nipple Ointment is an invention of Jack Newman’s.  It combines antifungal, antibiotic, and corticosteroid drugs into one cream, to kill yeast and opportunistic bacteria while reducing inflammation (and thus pain).  It needs to be prepared by a compounding pharmacy, and it can’t be used in a baby’s mouth, but it can be well worth the effort for a suffering mom.  The formula is Mupirocin 2% ointment (15 grams) + Betamethasone 0.1% ointment (15 grams) + Miconazole powder to make final concentration 2%.  There have been no clinical trials for efficacy or toxicity, and under some circumstances, corticosteroid element may favor yeast growth.

Next time: Alternative treatments for candidiasis

This is why we get angry

A self-styled “holistic healer” injures several and nearly kills one with arsenic-loaded remedies.  (To be fair, the remedies were indeed all-natural.)

A homeopath and his wife allow their infant to die a slow and tortuous death of infection due to severe eczema, because they believe homeopathy will cure her, despite repeated warnings from doctors.

A woman eschews medical treatment for her breast cancer, opting for The Secret and a quack’s ideas about acidity causing disease.  She dies.

Lots of people believe that alternative treatments will extend their lives or even eliminate their cancer, and some of them give up entirely on conventional medicine.  It’s one thing to decide that the cost of chemo is too high and make an informed choice to live as well as possible.  It’s quite another to rely on alternative treatment to save you, then die anyway.

People go to a chiropractor to get pain relief, but may wind up with a fatal stroke,

Or the chiropractor might tell the person to stop taking her medication for epileptic seizures, resulting in her death.

People take “dietary supplements,” which are practically unregulated by the FDA, and wind up dying, or if they’re lucky, just going into liver failure.

This isn’t to say that conventional medicine is risk-free.  But typically there is a good chance a remedy will actually do something beneficial that will balance out the risk.  With alternative remedies, usually the most you get is placebo effect.  Sure, regular medical practice is not always actually evidence-based, but at least that is the goal.  With alternative practices, there are no standards whatsoever, and perhaps more importantly, there is no mechanism for improvement.  There can’t be when proponents take a “heads I win, tails you lose” approach that rationalizes every failure and lauds every apparent success.

For more examples of the dangers of woo belief, see