The essence of bigotry is making assumptions about an individual or treating them based upon a group to which they belong. This is not limited to race and ethnicity, and can also include profession. There is a difference in that people are not born into their profession; there is a sorting process (both self-selection and societal), and so statistical observations about those who enter a profession are legitimate. Never-the-less, simple-minded statements to the effect that all lawyers are crooks, all doctors are arrogant, and all priests are pedophiles, is bigotry plain and simple.

It seems that people are most sensitive to bigotry aimed at groups of which they are members, and so when people try to tell me how doctors are (sometimes not knowing at the time that I am a doctor) I admit that gets my attention more than if they chose to insult oceanographers as a group.

Doctors are a popular target of bigotry these days for various reasons, some earned but mostly unfair. Historically physicians enjoyed a place of privilege in society. A generation or two ago nurses would stand when a doctor entered the nursing station, and no one questioned the paternalistic style that was typical of the doctor-patient relationship. Believe me – those days are long gone, but culture has inertia and that quaint image of the physician persists to some degree, although only in the negative sense it seems. Because doctors are seen as privileged many people think that they are a fair target for unfair criticism – that bigotry against doctors is OK.

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Yesterday was my daughter’s birthday and today is my birthday. If my wife had not had such a quick labor we might have shared a birthday, but Julia, my daughter, now nine, has declared that she is happy to have her own birthday that she doesn’t have to share with anyone else. I am bothering to tell you this as an explanation for the short and light entry today. Birthdays take precedence over blogging.

Chakras

Our present to Julia was a weekend at a water park resort, and as an added treat she had the full manicure/pedicure at the kid’s spa – complete with a cup of ice cream while they worked on her. While waiting in line to pay (her sister and cousin joined her in the spa as well) my brother and fellow SGU host Bob and I noticed a sign advertising their chakra-aligning massage. Chakras are part of Eastern mysticism – centers of life energy in the body that control different aspects of life, such as consciousness or digestion. It’s pure, pre-scientific, magical thinking woo – but to Westeners has the exotic feel of another culture. It is otherwise no different than the belief that there is a small elf or goblin living in your stomach.

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Last year I wrote an entry summarizing the evidence concerning the association of cell phone use and brain tumors. The bottom line of my discussion was that the plausibility of the claim that cell phones may cause brain tumors was low but not very low; there is currently no reliable evidence for a correlation but neither has one been definitively ruled out, for cell phone use of less than 10 years the data is basically negative, and for cell phone use greater than 10 years there is also no definitive evidence for a correlation with brain tumors but the data has a slightly positive trend, ruling out any clear or strong effect but not a small effect. There is a theoretical concern that if there is a small effect the children may be more susceptible.

I have also discussed this data in a Youtube video, and recently Orac has summarized the evidence as well.

Fears of cell phone use and cancer have resurfaced in the public consciousness due to a memorandum written by Dr. Ronald Herberman, The director of the University of Pittsburgh Cancer Institute and UPMC Cancer Centers. He issued an advisory to the 3000 faculty and staff of his institution stating:

“Recently I have become aware of the growing body of literature linking long-term cell phone use to possible adverse health effects including cancer. Although the evidence is still controversial, I am convinced that there are sufficient data to warrant issuing an advisory to share some precautionary advice on cell phone use.”

He also cites preliminary and unpublished data to support his concerns. I do not want to discuss again the data itself, and will simply refer back to my previous blog post as well as Orac’s for a summary of the existing research on this question. I do want to discuss the appropriateness of Dr. Herberman’s actions – or the balancing act of giving fair and early warning about potential risks or threats without becoming an alarmist or causing more harm than good.

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All interventions have their risks. No medical treatment that actually does something is completely without risk. That is why the standard method for evaluating a treatment is to assess the risk vs benefit ratio, as applied in an individual clinical situation. Risks are therefore justified if they are outweighed by the benefit. It is therefore not reasonable to cite instances of bad outcomes in order to impugn a treatment or a profession, without putting such outcomes into the proper context of the benefit of such treatments.

Of course – if there is no benefit to the treatment because it is based upon abject pseudoscience, then any risk is unacceptable. Here are two recent tales of risk without benefit – otherwise known as malpractice and incompetence, euphemistically referred to these days as complementary and alternative medicine.

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This week Michael Savage questioned the legitimacy of most diagnoses of autism because they are based only on symptoms – not on any objective tests. I have also been engaged in a blog discussion with Dr. Jon Poling about the exact nature of his daughter’s diagnosis – does it represent autism or something else. Both questions are ultimately about the very nature of a neurological diagnosis (or medical diagnosis in general). So I thought I would dig deeper on this question for background.

As a clinician I often discuss with patients what I think about their diagnosis. In my experience most people begin with many misconceptions about how diagnoses are typically made. I also train student doctors and they too typically come to me needing a far more complete and complex understanding of how diagnoses are made and what they mean. So even outside of the context of autism controversies this is a very useful topic to cover.

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In response to my blog post on Monday, David Kirby wrote a response in the Huffington Post and Dr. Jon Poling (father of Hannah Poling) wrote an open letter to me, placed in the comment section and posted at Age of Autism. It seems only polite that I respond to their kind attention.

The primary focus of my original post (which I further developed yesterday) was that the media is focusing too much attention on what celebrities and politicians are saying about the controversy surrounding the discredited notion that vaccines are a significant cause of autism. Over the past year Jenny McCarthy (now joined by her boyfriend Jim Carrey) has become the major spokesperson for a movement that, at its core, is anti-vaccine and is dedicated to the scientific opinion that vaccines are toxic and cause autism. Recently actress Amanda Peet joined the fray, professing her belief that vaccines are safe, are not associated with autism, and that parents who do not vaccinate their children are “parasites” for depending on other parents who do. (She later apologized for that remark, calling it “divisive”.)

While I appreciate Amanda Peet’s support, I feel strongly that scientific questions should be handled by the scientific community. Celebrities are great when they support causes – but when they second guess the scientific community and decide to advocate for their own scientific conclusions, they are more likely to cause harm than good. Continue Reading »

Yesterday I wrote about the fact that Amanda Peet had come out in support of vaccine safety, adding her voice to those who wish to counter the now discredited notion that vaccines are linked to autism. While I admire her for essentially reading the situation correctly, I lamented the fact that celebrities (like Jenny McCarthy) are getting too much attention for their opinions on scientific questions. Today, while bouncing around the blogosphere, I see that McCarthy and Peet were only the tip of the iceberg.

Britney Spears

Orac reported yesterday that Jenny McCarthy held a fundraiser for her antivaccination group (mischaracterized as an autism charity) Generation Rescue. Her boyfriend, Jim Carrey, was there, of course. But also making an appearance was Britney Spears. Orac nailed it when he wrote: “Because no one knows parenting and science like Britney Spears, I guess.”

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I have bemoaned in the past the celebrity culture in which we grant more weight to the opinions of celebrities than they deserve. It seems to be part of human nature to idolize and hero-worship. It can be benign, even healthy. Young athletes idolizing the talent and hard work of sports stars may be spurred on to greater achievement themselves. I also think that intellectual heroes, like Carl Sagan and Stephen J. Gould, can have an enormously positive influence on culture and society.

TV and movie stars, however, are famous because their profession involves public performance in a medium that potentially reaches millions. This is fine as far as it goes – I have no problem admiring stars for their entertainment value, their charisma, and their artistic talent and skills. It is reasonable to admire artists for their art.

The problem comes, in my opinion, when actors and actresses feel that their political opinions or ideology are somehow more valuable than anyone else’s because of their fame. I don’t necessarily blame them – they have a right to express their opinions and their fame gives them an outlet. I do think that if they are going to trade on their fame then they have a responsibility for what they promote, but I am not questioning their right to promote whatever they choose. Rather I maintain that the public should largely not care what celebrities think about issues that have nothing to do with their art and profession.

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Writing for the Huffington Post (an online news outlet that regularly hosts pseudoscience and anti-vaccinationist ravings), Deepak Chopra seeks to inform us: Why the Paranormal is Normal. What he actually demonstrates is his ability to twist and abuse language in an attempt to distract and confuse his reader. At this verbal deception Chopra is truly the master.

Language is important- words matter. Anyone who has studied a technical field should appreciate the need to use precise and unambiguous terminology. Good writers will also carefully choose words to illuminate, rather than obfuscate, what they wish to convey. It is also true that humans generally think in words. Language is closely tied to conscious thought. We therefore need clear language in order to think clearly. Words are also handle-bars with which we can grab hold of concepts – therefore by expanding our vocabulary we can expand our intellectual horizons.

Those who wish to push a claim or point of view that is illogical, at odds with reality, or simply does not make sense will often use language to force-fit their ideas to reality. They will use ambiguous terms, or will shift the definition of terms as needed, for example. This is exactly what Chopra does in order to make his dubious point.

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A new study just published in the New England Journal of Medicine followed three diets for two years: a low-fat diet, a low-carb diet, and a so-called Mediterranean diet which is moderately low fat and replaces red meat with poultry, fish, and nuts. The result are being touted in the media as vindication for the Atkins style low-carb diet, but a careful look at the study tells a more complex story.

Weight loss

There are different ways to assess the healthfulness of a diet. Most Americans are primarily interested in weight loss, but there is also heart-health, reduction in risk for DM, and overall nutrition to consider as well. But let’s start with weight loss.

The low-carbohydrate (sugars and starches) diet is promoted primarily as a weight loss strategy.  Proponents sometimes claim or infer that you can lose weight with a low-carb diet without reducing total calories – or, at any level of caloric intake, you will lose more weight. This has never been established and this new study does not establish it either. The real (and more plausible) question is whether or not a low-carb diet or a low-fat diet helps dieters achieve and maintain lower caloric intake to aid in weight loss.

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