Thoughts of the day

I’ve created a separate blog (with the creative title “Michael Hawkins Maine”) where I’ve gathered the random ‘Thought of the day’ posts I’ve made here and elsewhere. The topics range from science to politics to hiking to my hatred of spicy food. It’s more a collection for me since I like to go back to some of my writings to get thinking about a topic that may have been out of my mind for a little awhile, but I hope it’s at least mildly interesting to other people.

Check it out.

Circumcision: The evidence still isn’t vanishing

Increasingly, circumcision is becoming a health policy in places where it is needed most. WHO, UNAIDS, and especially The Bill and Melinda Gates Foundation are some of the groups are the forefront of this fight against deadly diseases and infections. More recently we’ve seen American groups such as the American Academy of Pediatrics come out in favor of circumcision. This is in large part due to three extremely strong studies that came out in 2006, but those were really just the final straw. Evidence has been building for the effectiveness of circumcision in fighting disease and infection since the late 70’s, and more specifically it has been building against fighting HIV since the late 80’s. The evidence is in: Circumcision helps protect against infections, penile cancer, and STD’s, including HIV. It’s an extremely important tool that should be promoted around the world. And so, as the debate quickly pivots from whether or not circumcision is effective to figuring out why it is so damn effective, more organizations are coming out in favor of it in ever stronger terms:

U.S. health officials on Tuesday released a draft of long-awaited federal guidelines on circumcision, saying medical evidence supports the procedure and health insurers should pay for it.

The Centers for Disease Control and Prevention guidelines stop short of telling parents to have their newborn sons circumcised. That is a personal decision that may involve religious or cultural preferences, said the CDC’s Dr. Jonathan Mermin.

But “the scientific evidence is clear that the benefits outweigh the risks,” added Mermin, who oversees the agency’s programs on HIV and other sexually transmitted diseases.

I went into the circumcision debate many years ago without a dog in the fight. I was neither passionately against the practice nor fervently in favor of it; my general indifference parted greatly with what any Google search will show. However, as I began to hear more and more about the topic, and as I began to study global health issues more and more (especially during the time I was studying and volunteering my time in Haiti), I found my position slowly shifting. But it was indeed a very slow shift. With degrees in both biology and philosophy it was easy to be torn. The evidence had clearly tilted – at the least – in favor of circumcision, but what about the ethical arguments against it? I would need to resolve those concerns before I would support circumcision as a health policy. And that I did. The sole argument the anti-circumcision crowd has against circumcision is that it violates bodily autonomy. But so do other things which many in that crowd clearly support. Namely, vaccines can and do permanently change a person’s body for life without their consent. Looking at circumcision and vaccines, then, under the isolation of the argument from bodily autonomy, what’s the difference? They both change the body forever and neither is done with consent when done to infants/toddlers. The only responses I ever get to this is that vaccines are more effective or that the changes aren’t visible. Pshaw. They aren’t always more effective, and even where they are, so what? The argument from bodily autonomy doesn’t get to be put on the shelf when it’s convenient to ignore. The effectiveness of a procedure is irrelevant; all that matters is the necessity of the procedure. Vaccines and circumcision are both necessary to a healthier world, but neither is an absolute necessity to survival. Yes, more people will die without either, but that’s immaterial. And as for the changes being internal, I guess I wasn’t aware how aesthetics-focused the anti-circumcision crowd was.

I went on a bit of a rant there, but I hope it was effective. The ethical argument – singular, not plural – is weak. Yet the biological argument is strong. And as I learned more, it became quite clear that it was stronger than I initially thought. I freely admit that by the time I became involved in this debate (likely 2009, and as early as 2010 on NBS) I should have done all the proper research; I could have easily found myself where I am right now rather than going through a slow shift.

One of the things which always kept me tilted towards being pro-circumcision was the dogmatic attitude of the anti-circumcision crowd. It didn’t matter what evidence was presented to them, their ethical stance trumped everything. That would be fine, of course, since it would be a valid basis for opposition (even if I or anyone else disagrees with it). Unfortunately, this crowd has a habit of attacking perfectly valid science. PZ Myers did this back in 2011 when he said the following:

The health benefits. Total bullshit. As one of the speakers in the movie explains, there have been progressive excuses: from it prevents masturbation to it prevents cancer to it prevents AIDS. The benefits all vanish with further studies and are all promoted by pro-circumcision organizations. It doesn’t even make sense: let’s not pretend people have been hacking at penises for millennia because there was a clinical study. Hey, let’s chop off our pinkie toes and then go looking for medical correlations!

Emphasis mine. Clearly, whereas the organizations promoting circumcision as a health policy or recommendation have had a history of different positions on the matter, it’s ridiculous to say they’re inherently pro-circumcision. Moreover, the irony meter here is off the charts. The anti-circumcision crowd is incredibly vocal, despite being a scientific minority. Indeed, whereas the pro-circumcision groups came to their conclusions only after being presented with evidence, the anti-circumcision groups are composed entirely of people who oppose the practice on ethics first; they cherry-pick the science after the fact.

But that isn’t the important point here. As the title of this post says, the evidence of the benefits is not vanishing. It’s not vanishing with further studies. It’s not vanishing with time. It’s not vanishing at all. All we’ve been seeing is 1) more and more groups coming out in favor of the practice and 2) research focused on why it’s so effective. (Of course, all this criticism is coming from a guy who once had a debate with Jerry Coyne where he said that no evidence could ever convince him of the existence of God. While I share his lack of theistic belief, I don’t share his position here. I can’t imagine a more anti-scientific thing to say than that there is no possible evidence that could convince me of something. I could be convinced unicorns exist. I greatly doubt that will happen, but it’s possible; denying these possibilities when speaking in abstract terms is doltish.)

Anyway.

[The new guidelines] are likely to draw intense opposition from anti-circumcision advocacy groups, said Dr. Douglas Diekema, a Seattle physician who worked on a circumcision policy statement issued by the American Academy of Pediatrics in 2012.

“This is a passionate issue for them and they feel strongly that circumcision is wrong,” said Diekema, a professor of pediatrics at the University of Washington.

Indeed, the head of one group did argue against the CDC’s conclusions on Tuesday, saying they minimize potential complications from the procedure.

The guidelines “are part of a long historical American cultural and medical bias to attempt to defend this traumatic genital surgery,” said, Ronald Goldman, executive director of the Circumcision Resource Center.

Notice the name of the anti-circumcision group in that quote: Circumcision Resource Center. Hmm, what other group of people try desperately to sound legitimate despite everything they hold dear? Perhaps it’s the people who run sites and groups like Evolution News and the Discovery Institute and the Geoscience Research Institute – creationist groups. Honestly, I’m not sure who should be insulted more by this association.

Some times the quackery makes me laugh

There’s a lot that distresses me about naturopaths and other quacks. They are a genuine danger to the health of all those who encounter them. This may be in the form of an active danger – cases abound of them prescribing contra-indicated drugs – or it may be in the form of a more passive danger, such as when someone with an easily treatable but potentially deadly disease is misdiagnosed by one of these poorly trained charlatans – but they are a danger any way one wishes to look at it. That said, that doesn’t mean the ineffective methods of these quacks can’t be hilarious. Take this interview with Portland quack Sarah Kotzur:

To determine the best course of treatment, including an appropriate homeopathic remedy, Dr. Kotzur spends two hours with a new patient. “I’m trying to know you as a whole person,” she says. “I’m going to ask about what kind of dreams you have, what kind of food you crave. What is your body temperature? Do you sweat? Are you thirsty?”

Emphasis mine, hilarity Kotzur’s. One wonders how she decides to interpret this arbitrary information when ‘treating’ one of her ‘patients’. If the person has dreams where they can’t run fast, does that mean she prescribes a dose of treadmill time? Tough to tell, but I’d venture a guess that most of her ‘treatments’ come down to garlic, some sort of berry, and/or what is basically water.

The rest of the article goes into attempting to legitimize the practice by noting how it works with insurance and licensing:

Naturopathy has come a long way since the 1980s. There are currently six accredited schools of naturopathic medicine in the United States and 16 states now offer practice licenses. Maine has been licensing naturopathic doctors since 1996.

What the article failed to mention, and what naturopaths don’t want people to know, is that naturopathy is specifically banned in South Carolina and Tennessee. It isn’t medicine, it isn’t related to science, and every single one of its practitioners is a quack.

Anti-science quacks find success in Maine in their fight against health and vaccines

Vaccine rates for young people entering school has been declining in recent years:

The rate of unvaccinated kindergartners in Maine continues to climb and is now the fifth highest in the nation, according to a U.S. Centers for Disease Control and Prevention report released Friday.

The percentage of Maine parents voluntarily opting out of vaccines for their children is alarming state public health officials who have been working to bolster immunization.

Nearly 800 public school kindergartners in Maine started the 2013-14 school year without receiving the required vaccinations for diseases such as whooping cough and measles because their parents opted not to immunize. That represents 5.2 percent of all kindergartners in the state, up from 3.9 percent the previous year.

This is in large part due to the anti-vax movement that has been steadily gaining ground since the 90’s. Indeed, although disgraced British doctor Andrew Wakefield had his 1998 study linking vaccines and autism debunked – no one ever reproduced his results, and it was no wonder since he outright made them up – he remains a hero of the anti-vax crowd.

One of the more favored canards of anti-vax quacks is to call herd immunity a myth. Do a quick search and one is liable to find any given quack claiming that herd immunity makes no difference to the health of a state. I recall reading some random anti-vax nobody argue that because vaccines are between 60-80% effective, even with 100% compliance, we could still see an epidemic. Of course, while he spoke of vaccines at-large in an intentionally general sense, he actually linked to CDC statistics on the flu vaccine. I guess it was a coincidence that he found it inconvenient to tell his readers that he was talking about one specific vaccine, huh? So is the high bar set by quacks.

At any rate, for herd immunity to be effective, there needs to be about a 95% vaccination rate. Of course, 100% would be the ideal because we’re talking about saving human lives, but with all the anti-government and anti-science kooks out there, 95% is actually a very achievable number that allows for some bumper space. Unfortunately, sometimes we see areas that fall well below that bumper space. For instance, when vaccine rates for whooping cough fell to 91% in California, communities there saw an outbreak in the disease. Thousands got sick and at least 10 infants died. What makes this all the more heart-breaking is that these infants were too young to be vaccinated, meaning they relied upon the herd immunity around them to remain safe. Anti-vax parents and the quacks they trust are at fault for these deaths. Frighteningly, Maine is on a similar path.

The value of repetition

One of the most important things I heard while in college came from one of my favorite biology professors. It happened in an early intro class half-filled with bio majors, half-filled with people looking for a course with a lab. He was covering the basics of science itself, speaking to the value of repetition:

Science is all about reproducibility. If you can’t reproduce your data, it’s all a load of horseshit.

That isn’t to say a person can automatically discredit some new piece of research simply because it’s new and has therefore not yet been reproduced. What it means is that when scientists do attempt to reproduce previously found results, they need to be successful in order for the results to be accepted. An unfortunate side effect of human nature means that we don’t see negative results published as often as we should – unless, of course, they disprove what someone else has already published – but these results do still happen every single day. That’s just science.

This all brings me to a recent piece of news:

Scientists have managed to repeat one of the biggest medical breakthroughs of the last few years.

Almost exactly one year ago, Johns Hopkins researchers made national headlines when they announced that they’ve vanquished the AIDS-causing virus from a child born to an HIV-positive mother in Mississippi. They began antiretroival treatment before the baby was 30 hours old. She’s now 3.5 years old and still virus-free, even without treatment in the last two years. Researchers have puzzled over how it happened, and many remain skeptical. The child was only the second person ever to be “cured” of HIV; the first was an adult through a stem-cell transplant. Since it’s difficult to prove that the body has been completely cleared of HIV, Nature explains, being “functionally cured” means the virus is effectively controlled and the immune system stays healthy without treatment.

Just yesterday, doctors announced that they have cleared the virus from a second baby infected with HIV. This girl was born in Los Angeles last April to a mother with advanced AIDS who had not been taking her medication. With aggressive treatment beginning just four hours after her birth, the virus was undetectable within 11 days, the New York Times reports.

A sample size of 2 does not scientific fact make (though there are upwards of 8 other unconfirmed cases around the world), but it cannot be understated how much this bolsters the legitimacy of attacking HIV in infants this way. It could turn out that the virus is still living somewhere in the bodies of these children – adults who have been functionally cured have had the virus return shortly after certain surgeries such as bone marrow transplants – so this remains a game of wait-and-see. However, if this proves to be an effect method for curing HIV, then not only will there be immediate benefits to HIV-positive newborns, but some insight may be spread into how we can better detect the hidden HIV in adults patients who are functionally cured.

The Second Law of Thermodynamics

To the right is one picture out of a series that was taken after the Bill Nye-Ken Ham debate the other night. Creationist question Creationists were asked to write questions that they would like to ask of Nye. (I’d link the whole series, but it came from BuzzFeed. I already feel dirty enough having clicked the link myself.)

To answer the man’s question, the second law of thermodynamics does not disprove evolution. The second law states that the entropy of an isolated system never decreases. That is, things because less orderly and more chaotic over time without an input of energy from an outside source. Since the Universe is an isolated system as near as we can tell, all the organization we see will eventually dissipate – no more stars or planets or black holes or anything else that uses energy. Eventually even all atoms will cease to move.

Creationists believe this fact of the Universe applies to evolution because they view evolution as greater and greater organization over time, and that requires an input of energy. They’re right so far. Where they fail is in their belief that greater and greater organization is not possible over time. As best as any rational person can tell, creationists appear to believe Earth is a closed system and that with enough time it should all fall away. Except it isn’t closed. That big yellow ball in the sky has a tendency to provide us with more energy than we know what to do with. (Not that we’ve been the best at harnessing it.)

Of course, we don’t need to even go as far as the Sun – at least so long as we aren’t talking about plants or photosynthesizing bacteria. We take in energy all the time. It ultimately comes from the Sun and, to an extent, Earth’s core and magnetic field, but on a day-to-day level, we don’t exist in a closed system at all. A dinosaur that killed another dinosaur had a source of energy to take in: the dead dino. An early hunter-gatherer would find energy by hunting and gathering. And right now I’m about to go find some energy in a hot chai tea.

Avoid these sources for your science

This is a very brief and very far from exhaustive list of sources one ought to avoid when looking for any sort of scientific information. After each person and/or organization is a list of the area in which they most commonly spread lies:

Deepak Chopra – Quantum physics, alternative medicine

NaturalNews.com/Mike Adams – Alternative medicine, vaccines

EvolutionNews.org – Evolution, intelligent design

Dr. Oz – Alternative medicine, apple juice

Andreas Moritz (though he is now deceased) – Cancer, HIV/AIDS, Diabetes, all around quack

WattsUpWithThat/Anthony Watts – Global warming

Dr. Keith Ablow – Psychiatry, youth psychology, gender issues

Stanislaw Burzynski/Burzynski Clinic – Cancer, quack treatments

Marc Stephens – Mostly law, but he lied about being a lawyer in order to try and protect the Burzynski Clinic

By Michael Hawkins Posted in Science

Get vaccinated

It never ceases to amaze me just how many anti-vax people there are out there. Every time I bring up the topic it isn’t the pro-vaccine people who come out in support. No, instead it’s almost exclusively the anti-vax quacks. I suppose the same thing happens with circumcision, 9/11, and a history of Obama’s life: the anti-circumcision crowd, truthers, and birthers are going to immediately overwhelm the discussion. But even with this massive selection bias, the sheer number of nuts out there is incredible. I suspect to see as much regarding this post, should it garner a response at all. However, as a decent human being with a little bit of knowledge, I feel duty-bound to present a few vaccine facts.

Vaccines are incredibly safe. This is true of all vaccines, but especially of the flu vaccine. The most likely side effects anyone is going to suffer are mild soreness or a low grade fever. A study from about 10 years ago did find that one version of the swine flu vaccine from the mid-70’s was associated with a tiny increase in Guillain-Barré syndrome, but correlation is not causation. No one knows why there was such an association, but for this reason those with a history of the syndrome are cautioned and should speak with their doctor to assess their exact situation. Also, those with severe egg allergies are cautioned, plus those who are currently sick with one thing or another should wait.

Vaccines change each year because of evolution. From time to time I’ll hear an objection to the fact that the flu vaccine is different each year. Why, the argument seems to go, scientists are just guessing. That’s not true. While they are making an educated guess, it’s more than just throwing up a prayer and hoping they get it right. Each year’s vaccine is based upon the most recent research and information available. This is necessary because of the speed of a virus’ evolution.

Everyone over 6 months old should get vaccinated. This, of course, takes into account the caveats I’ve already presented, but for the vast majority of people, vaccination is recommended. Vaccines save lives, and if that’s not important enough to you for some crazy reason, they also save money by cutting down on sick days.

The flu vaccine is effective. Exactly how effective the flu vaccine is will vary from year to year, as well as from age group to age group. A person’s overall health is also a factor. In general, though, the vaccine’s effectiveness ranges from 50-80%. The most common (and most annoying) ‘counter’ to this is to look at absolute risk reduction. A person who does this is usually either a quack or has gathered information from a quack. It isn’t that absolute risk reduction is invalid. It’s a perfectly good way to understand how wide-spread a disease or sickness is and how our health policies are dealing with it. For the flu vaccine, the actual reduction in risk is about 1.5%. That sounds miniscule, but we can make a lot of things sound miniscule. What’s happening here is we’re looking at the total population and calculating the number who would get the flu without any vaccine. That’s a very small percentage. Then we’re looking at how likely it is that of the percentage that actually gets vaccinated is going to not get the flu as a result. Again, this is useful. However, when presented in the context of this discussion, it isn’t useful. It would be as if someone argued that since the absolute risk of contracting HIV in Tanzania is very low over, say, intercourse with 5 different partners, the 97-99% effectiveness of condoms is moot. Why, who needs condoms? You probably won’t contract it anyway! Pshaw.

Vaccines, not sanitation, have eradicated or nearly eradicated disease. While it’s obviously true that increased bathing, hand washing, and better filtered water have made us healthier and less likely to contract various diseases, these alone cannot get rid of disease. Smallpox has been eradicated for over 30 years now because of vaccines, not because more people than ever are buying bars of Irish Spring soap. Polio is nearly eradicated because of vaccines; India was recently declared polio free – that isn’t a country exactly known for its impeccable sanitation practices. Yellow fever persists because so many people go unvaccinated (even though the vaccine is 99% effective), and no amount of sanitation is going to change how many people die from it each year since its primary vector is the mosquito.

There are far more thorough sources out there that have vaccine facts covered in much better detail than I have here, so this is far enough for me. I simply wanted to address some of the issues that bother me the most about the vaccine misinformation floating about. For nearly every single person, vaccination is the smart option. The caveats are small and specific, the side effects minor and manageable. Get vaccinated.