In the US we have semi-compulsory vaccination. Keeping up to date on the vaccine schedule is required in order to attend public school. However, families always have the option of attending private schools, which can determine their own vaccination policy, or they can home-school. Also, each state can determine its own exemption policy. Medical exemptions are uncontroversial – if you medically cannot get a vaccine, that is up to your doctor, not the state. However, some states have religious or personal (philosophical) exemptions. These have been under increasing scrutiny recently.

Other countries have different systems. In the UK, for example, there is no compulsory vaccination to attend school.

These policies are all being reexamined in the wake of the burgeoning anti-vaccine movement and the resulting return of previously controlled vaccine-preventable illnesses. Let’s take measles, for example. As you can see by the chart, measles cases have increased by greater than 20 fold from 2010 to 2019 in the US. But if we pull back even further, in 1980 measles caused 2.6 million deaths worldwide, with cases in the US alone measured in the hundreds of thousands. By 2000 routine use of the MMR vaccine had prevented an estimated 80 million cases of measles.

Also by 2000 measles had been eliminated in the US – that means there was no circulating virus in the wild. All cases came from outside the country. Outbreaks were also very limited, because there was no fertile ground for the virus to spread. The antivaccine movement has changed that.

The rate of children getting MMR has not changed much in the US due to compulsory vaccines, ranging from 90-93% over the last two decades. It has dipped to around 91.1% recently, but the overall number remains high. However, this statistic hides what is really going on. Vaccine refusal clusters, by neighborhood and by school. If a private school does not require compulsory vaccination, then anti-vaxxers will cluster there. These pockets of very low vaccination rates then serve as potential locations for outbreaks, and that is exactly what happens. In recent years these outbreaks have been large enough to spread into the general population.

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Many outlets are covering the story of Mari Lopez, a YouTuber who claimed, along with her niece, Liz Johnson, that a raw vegan diet cured her breast cancer. Johnson recently updated the videos with a notice that Mari Lopez died of cancer in December 2017. She has refused, however, to take down the videos.

The story, unfortunately, is a common one. When people are diagnosed with cancer it is understandably a psychological shock. They face not only the grim possibility of their death, but also the prospect of surgery, chemotherapy, and/or radiation therapy – none of which are pleasant. It is a life-altering event. It also makes people vulnerable – in that situation, who wouldn’t want an escape hatch, a way to get back to their normal life? That is what cancer quackery offers – forget surgery and chemotherapy, just engage in this mild intervention, like a diet change, and your cancer will be gone.

Those who get lured in by this siren song experience one of several possibilities. First, many may still undergo some initial treatment, such as surgery, to treat the cancer, but then refuse adjunctive therapy like chemotherapy or radiation. Some of those patients may, in fact, be cured by the surgery. Often the purpose of the chemotherapy is to reduce the risk of recurrence. Others may forgo any science-based treatment.

Following the initial diagnosis, with or without some intervention, there is what we call the honeymoon period. In this phase the cancer may be relatively asymptomatic. This is especially true if it was discovered because of some screening test, like an X-ray or blood test, and not because it had already become symptomatic. This period can last for months and even years, depending on the stage and type of cancer. This is the phase where those who pursued some form of cancer quackery convince themselves that they are cured. They will also tend to credit the alternative treatment with their cure, even if they received surgery or some other standard treatment.

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Some cultures routinely have a siesta after lunch. Is napping in the middle of the day good for you or bad? The short answer is – it depends. However a new study adds further evidence for a possible benefit to the mid-day nap, at least for elementary school children.

Let’s start with the concerns about napping, which has to do with “sleep hygiene.” Sleep hygiene refers to behaviors that optimize sleep quality, such as avoiding bright light late at night, going to bed with an empty stomach and bladder, and keeping a consistent schedule. One item on the good sleep hygiene list has been to avoid napping during the day. The problem with napping is that it makes it more difficult to fall asleep at night, which can result in a net loss of total sleep and sleep quality.

But it turns out the real answer is more nuanced. Some studies, such as this Spanish study in favor of siestas, show that a 30 minute light nap in the early afternoon is actually a net benefit, including improved memory, performance, and a reduction in stress. In 1995 NASA conducted a study and found that 26 minutes was the optimal time for their pilots to nap in order to optimize performance.

The features of a beneficial nap, therefore, include a limit on time to around half an hour. They also include (and this is probably a linked feature) lightly napping only – not falling into a deep sleep. The deep sleep is more likely to interfere with sleep onset at night. Also, the nap needs to be early in the afternoon, at least four hours prior to when you want to sleep at night. It should also be part of your routine schedule.

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This study has a fairly narrow focus, but it does relate to an interesting topic. A new analysis finds that the betting market predicted the Brexit vote an hour before the financial market.

This says something about the efficiency of these respective markets in processing and reacting to information. The authors also conclude that if the financial markets were optimally efficient they should have predicted the result of the Brexit vote two hours before they did.

OK, this is more than a bit wonky, but what I really want to discuss is the more basic concept of predictive markets as it relates to crowdsourcing and big data. The idea is that a lot of people in the aggregate may be better at either making decisions or reflecting emerging trends than any individual or small group. This gets interesting when you compare crowdsourcing like this to individual experts.

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I don’t usually do lists, but I do find it interesting to look back over the past year and review major events and trends. It’s good for the memory, and the exercise always reminds me of how terrible memory is. I often realize that I forgot about major events, and also have a poor sense of how far in the past certain events occurred. (Was that this year or last year?)

So here are the pseudosciences from 2018 that I think deserve to be remembered. I am going to list them in no particular order, and just keep adding them until I run out of time.

Climate Change Denial

It does seem that 2018 may have been a bit of a turning point for the recognition that climate change is real, imminent, and deserving of far more attention and priority than we are giving it. There were multiple reports all agreeing that essentially the problem is worse than we thought, we have less time than we thought, and we better get cracking. The IPCC, for example, pointed out that even if we keep warming to 1.5C above pre-industrial levels, an ambitious and probably not achievable goal, bad things will still happen, just not as bad if warming goes beyond that point. A US government report echoes this, adding that further warming will be economically damaging and it is cost-effective to prevent it rather than deal with the consequences.

Several surveys also show that people are increasing concerned about climate change. Even some conservatives admit they were wrong on climate change. Even the writers of South Park admitted their prior error in an apology series of episodes to Al Gore.

Therefore, perhaps the worse pseudoscientists of 2018 is anyone still denying that climate change is a real problem that needs to be dealt with. The denialist strategies have not changed – no, the Earth is not warming, well if it is it’s not due to human causes, well even if we are causing it the results won’t be bad, well even if they will be bad there is nothing we can do about it anyway, and whatabout China? Like all pseudosciences they start with the desired conclusion – that we don’t need to do anything about it, just keep burning fossil fuels, and then they reverse engineer a justification for that conclusion.

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SGU Listener, Alex, recently sent me a question about the safety of irradiated food:

“Dr. Samuel Epstein, chair of the Cancer Prevention Coalition, is quoted as saying, “Every man, woman and child who takes a bite of irradiated food increases their chance of getting cancer. It is no exaggeration to say that our government has turned the American people into guinea pigs.”

Is there any science to this? Am I irradiating my body by eating bread? Do irradiated bananas give me a double dose of dangerous death rays?”

This is another example of the general rule – for every safe and life-saving technology out there, there is a group of people fearmongering about its risks.  Irradiating food is a completely safe and effective way to reduce the risk of food borne illness and contamination. It is an underutilized technology because of unwarranted fears.

Irradiated is not radioactive

Food treated with radiation is not radioactive itself. So you will not get any extra dose of radiation from consuming such food. Radiation has simply passed through it in order to kill bacteria and insects.

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Sleep is critical for optimum health and performance, but is often underappreciated by the general public. For example, I see many patients with chronic symptoms that are either caused by or greatly exacerbated by poor sleep, but didn’t make the connection to their chronic insomnia.

Not only is adequate quality sleep necessary, people have different daily (“circadian”) rhythms – some people are most alert in the morning, others mid-day, and still others in the evening. Further, this does not seem to be due entirely to habits, and therefore we cannot just tell night owls to go to bed earlier. They are not in control of their biological rhythm.

The sleep rhythm is affected by light levels and seasonal differences, so there is some room for tweaking the environment to improve sleep overall and adjust the daily cycle. Bright lights and close-up electronic devices are terrible for sleep in the late evening. If someone is having trouble getting to sleep, having 2 hours or so without electronic devices prior to bed time is a good idea.  But there are limits here as well – night owls will still be night owls.

A recent study looks at the effect of circadian rhythm on school performance. The hypothesis was that a mismatch between a student’s internal schedule and their forced school schedule would affect performance.

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Robert F. Kennedy Jr. talks with reporters in the lobby of Trump Tower in New York, Tuesday, Jan. 10, 2017, after meeting with President-elect Donald Trump. (AP Photo/Evan Vucci)[/caption]

Robert F. Kennedy Jr. considers himself an environmentalist. While advocating for the environment, he has become particularly concerned about the effects of mercury on human health. This in itself is reasonable, and there is broad scientific agreement that we should make efforts to minimize human exposure to mercury.

But Kennedy goes beyond reasonable recommendations based upon scientific consensus. He has become part of what we call, “The Mercury Militia” who have become unmoored from reality in their zeal to combat the perceived evils of mercury. The mercury militia further became tied to the anti-vaccine movement when it was claimed that the mercury in some vaccines was causing harm (it doesn’t). He has become a visible example of how someone can cocoon themselves in their own reality.

In a recent interview for Stat News Kennedy tells a number of falsehoods about vaccines. In essence he is lying, although it is possible he believes the lies he tells. Kennedy has apparently dedicated a large portion of his life to this issue, publicly advocates for his position, and certainly has resources at his disposal. And yet he gets basic facts about vaccines hopelessly wrong. How does that happen?

Paul Offit has written an excellent take down of Kennedy’s interview, explaining many of his falsehoods. For example, in the interview Kennedy claims: Continue Reading »

The extent of Arctic sea ice is an important marker for global climate change. In the last forty years it also has been unequivocally shrinking. NASA has been tracking Arctic sea ice extent at different times of the year, with the September minimum being an important point of comparison. Like any chaotic system there are going to be short term fluctuations, but the long term trend is crystal clear. Look at the graph and look at the video on the NASA site linked above – the shrinking is clear.

The first estimates for September 2017 are in and they are consistent with the overall trend. Arctic sea ice’s most recent maximum for the September minimum was in 1996 at 7.87 million square km. The minimum minimum was in 2012 at 3.62 million sq km – less than half. This year the minimum is estimated to be 4.7 million sq km, slightly more than 2016. All of the last 10 years are below the average for the previous 30 years.

This past year we had a warm winter, which led to the lowest amount of March Arctic sea ice on record, but a cool summer allowed the Arctic ice to rebound a bit.

All of this adds to the strong scientific consensus that the globe is warming and this trend is largely due to human factors (not natural cycles). But as you probably know, there is a well-financed campaign of denial, ideologically and financially motivated, to muddy the waters and create doubt and confusion about this scientific consensus. This is easy to do with complex scientific questions.

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As with most things, the answer is more complicated than it may at first seem.

Up to now the official answer was simple – always finish prescribed courses of antibiotics. Stopping early, it was argued, could increase the risk of antibiotic resistance. The idea is that bacteria which are a little resistant to the antibiotic will survive longer, and if they are not wiped out by completing the course, the partially resistant bugs will then reproduce, with random mutations leading to greater resistance. The antibiotics are essentially a selective pressure leading to resistance.

This makes sense, and is almost certainly true with certain chronic infections, such as tuberculosis.

A new review, however, suggests that we cannot apply this rule simplistically to all infections. It depends on the type of bacteria involved.

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