Blue Collar Scientist

Hot on the heels of an outbreak of measles in Tucson, there are reports of an outbreak of measles in Salzburg, Austria. About 180 people are infected, and most of them are children who attend the same private school.

Hubert Hrabcik, director general of public health in Austria’s Health Ministry, said the vaccination rate for measles, mumps and rubella, which are administered together, may have been “almost nil” at the school.

This would not be surprising, since if you aren’t immunized, you’ll very likely get the highly communicable disease. And as I mentioned before, if you get it, you are exposed to a significant risk of developing corneal ulcers and scarring, and blindness. There’s also a risk of encephalitis leading to brain damage. I don’t know whether this situation is a result of anti-vaccination activists (update: it is), but it nevertheless illustrates that their vision for the world has consequences: rampant disabling disease.

In an effort to curb the number of infections, Salzburg schools now will require students to prove they have been inoculated or that they previously had the disease. If students refuse to be vaccinated, they could be barred from classes, Hrabcik said.

Health Minister Andrea Kdolsky said in a statement there was “no need to panic,” but she and Salzburg Gov. Gabi Burgstaller urged people under the age of 40 who have not had measles to be vaccinated.

Keeping children away from the schools, and forcing others to bear the expense of immunization is necessary to deal with the outbreak, obviously, but it isn’t a particularly good thing. Yet that is the direction we’ll likely go if the anti-immunity crowd have their way.

Hi everyone! My name is Karen, and I’m a veterinarian. I’ve joined this blog to provide a roughly once-weekly column on medicine and related topics. I’m writing under the byline Iatros Iatra Polygenos¹, which in ancient Greek means - as far as we can tell - something like Doctor of Many Species.

A few years ago, I treated a young dog for something - I can’t even remember what now, but I do remember it was a painful condition. While the animal was in the hospital, we gave him carprofen - known commercially as Rimadyl - as well as lots of love. When it was time for the puppy to go home, we sent some carprofen with him, along with the usual instructions about dose. It looked like the puppy was on track for a successful recovery.

Later that night, the unfortunate puppy’s owners decided that the animal was in pain, and that the carprofen wasn’t working. So, without telling me or anyone else at the clinic, they gave the puppy a “natural remedy” - willow bark. Within a couple hours, the puppy was dead.

What happened here?

The post-mortem showed that the poor puppy had extensive internal bleeding and kidney and liver damage. These results strongly suggested the dog died of an overdose of NSAIDs. Carprofen is an NSAID, so I was initially worried that I had made a mistake on the dosage and inadvertently killed the dog through my own error. But when I met with the dog’s owners and had a look at the prescription bottle, the dosage was right. And the owners insisted they had complied with instructions and given the proper dose. A count of the remaining pills showed they were right.

That’s when they mentioned the willow bark they’d given the dog, and it all became clear.

NSAIDs are a class of drugs that reduce pain, inflammation, and fever. They are quite safe, as long as you use an appropriate dosage. But when an overdose occurs, bad things can happen very quickly. If the overdose is minor, the effects can include nausea, vomiting, and ringing of the ears - fairly innocuous. But if the overdose is severe, you can end up with bleeding in the stomach and upper part of the small intestine, dangerously high fever, uncontrollable hyperventilation which leads to a dangerous rise in the pH of the blood, disruption of kidney function, and a loss of the body’s ability to regulate potassium, which leads to loss of muscle control, the stopping of the heart, and eventually death. You can also get cerebral edema - a buildup of fluid in and around the brain - coma, hallucinations, and other not very nice symptoms. It’s important to note that these are the side effects of an aspirin overdose, or a willow bark overdose - they’re both the same type of chemical.

Willow bark was probably the first NSAID. It was first mentioned in the historical record back in the days of Hippocrates. The bark would be mushed up into wine to make a tincture. This potion would cause severe gastrointestinal discomfort, but it would kill pain. The active ingredient in willow bark is salicin, which looks like this:

The molecule is actually very close to that of another NSAID, Aspirin. The resemblance might be more obvious if you mentally rotate the diagram below about 120 degrees clockwise:

Both of these compounds - salicin and aspirin - are metabolized in the body to salicylic acid. Salicylic acid is toxic if there is enough of it around, so if you simultaneously take a safe dosage of aspirin, and a safe dosage of the active ingredient of willow bark, you are going to get more salicylic acid production in the body than the people who wrote the dosage instructions ever intended you to have.

Carprofen is a bit more complex and looks considerably different from aspirin and salicin, but if you look carefully, you can see that one end of the molecule is pretty similar to aspirin:

And indeed, carprofen is also a salicylate drug, just like willow bark and aspirin.

The fascination with natural remedies is causing a lot of problems in people and animals alike. Those who take natural remedies do not always disclose this to their doctor, let alone consult them in advance. This leads to interactions and overdoses that can be fatal. Just because something is “natural” does not mean it is safe!

Another problem is that the FDA does not regulate the manufacturing of natural remedies. Commercially manufactured medication is strictly regulated. The information on a drug’s label - including the amount of active ingredient, and the purity of the preparation - has to be accurate. If it isn’t, it can be recalled, resulting in a sharp financial loss to the manufacturer. In extreme cases, people can go to jail. But with “natural remedies,” the amount of active ingredient is not required to match the manufacturer’s claims, nor are there standards for purity. Depending on the “remedy,” you might be ingesting nothing but fillers from this week’s bottle, and getting more than is safe from the next batch.

Back when I was treating that unfortunate puppy, a lot of resources discussed the hazards of willow bark in terms of potential overdose and interaction with other NSAIDs. Now, there is more research to draw on, and the new information suggests salicin is less toxic and has a smaller chance of leading to upset stomach than aspirin. And it looks like the effects of salicin last longer than aspirin. But there’s bad news - willow bark is not pure salicin; it is also full of tannins, which are toxic and can damage the gastrointestinal tract. White willow bark preparations are between 8% to 20% tannins, but if you are going to get enough salicin for pain relief, tannins are unsafe at around 10%. At most of the measured concentrations, tannins lead to toxicity before a therapeutic dosage of salicin can reached. Tannins can also cause liver and kidney damage, so when they are coupled with drugs that are metabolized by these organs, the result can be deadly.

Based on this new information, I’m no longer so confident that my patient the puppy died of an NSAID overdose, caused by the double-whammy of two different drugs. It could have been a result of kidney damage from tannin toxicity, which made the puppy unable to metabolize the carprofen. Either way, the lesson is clear - NSAIDs, whether natural or medical, need to be treated with respect.

Oh, and one parting thought. I shudder to think about anyone giving an NSAID to a cat. Cats aren’t able to metabolize most NSAIDs, and giving them one could easily kill them, or lead to kidney and liver damage - or at best, just make them extremely sick.

1. I’m aware Iatros is masculine - if a real Greek scholar can help out, I’m all ears. [↩]

Of particular interest to me because of the years I spent living in nearby Sierra Vista, Arizona, reports say that Tucson is experiencing an outbreak of measles.

Arizona health officials are concerned a measles outbreak in the Tucson area could spread across the state. There have been nine reported cases of measles in the Tucson area, the Pima County Health Department said Monday in a news release.

Public health officials are concerned because measles is extremely contagious. If you are exposed, and haven’t been vaccinated, the chances are 90% that you’ll get it. It is spread through the air.

Once you catch it, you are contagious for four to twelve days before you start showing symptoms. so you can be spreading it around for better than a week before you ever realize you’ve been infected.

Once you are symptomatic, if you get good health care, your chances of dying of the disease are only 0.1%. If you live in the developing world, your chances of dying are 10%.

So you shouldn’t worry too much about getting killed by measles. You should be concerned about going blind - for measles causes corneal ulcers and scarring. You can also get encephalitis, leading to brain damage. These are serious risks for a small child, the sort of thing that can lead to a lifetime of problems and suffering.

You might ask yourself why, since measles has a vaccine, that an outbreak has occurred in Tucson? It is because of anti-vaccination radicals:

Dr. Karen Lewis, a medical director with the Arizona Department of Health Services, said health officials are concerned that some parents aren’t vaccinating their children because of concerns about links to autism. “People have started to forget how bad of a disease it is and have started listening to people saying vaccines aren’t good,” Lewis told The Arizona Republic.

Fifteen of these peoples’ kids are now at risk for blindness and other lifelong complications of the disease. But worse than that, they have the potential to infect babies who haven’t reached vaccination age.

The health department recommends an accelerated schedule for vaccinating children, with one dose between the ages of 6 and 12 months of age and two more doses starting on the child’s first birthday.

So…. One way of looking at this is that thirty selfish parents who believe in a whacky conspiracy theory that claims vaccines cause autism which just enriches a medical industry that wants it to happen (so they can make more money) have now imposed upon thousands of babies the need to take vaccines earlier and more often. Which carries a small risk, as well as a small expense.

This should be illegal, folks.

I’ve been meaning to post for a while about Airborne, the vitamin supplement widely believed to be able to prevent sickness - widely believed, it seems, thanks to misleading advertising. Airborne, who pulled down $150 million in 2006 and presumably similar amounts in other years, have agreed to return a piddly 23.3 million bucks to consumers who can prove they bought Airborne, to settle claims of false advertising. I first heard of the matter from Orac and yesterday Steve Novella covers the issue again at Science-Based Medicine.

Originally, I just wanted to post to point the settlement out to a particular reader of mine who actually bought some Airborne some months back. (If this is you, go get your claim form and get your money back.) But Novella brings to light two things I hadn’t previously noticed, and both are worth covering.

Airborne used to carry claims of a clinical study showing efficacy on its packaging. These claims were removed. Most think it had to do with an expose by ABC News that reported, among other things:

GNG [where the clinical study was supposedly conducted] is actually a two-man operation started up just to do the Airborne study. There was no clinic, no scientists and no doctors. The man who ran things said he had lots of clinical trial experience. He added that he had a degree from Indiana University, but the school says he never graduated.

But Airborne CEO Elise Donahue says that embarassment over this investigative reporting is not the reason the claims were removed. The real reason, she says, is:

We found that it confused consumers. Consumers are really not scientifically minded enough to be able to understand a clinical study.

Well, this blog is devoted to the notion that anyone, whether “scientifically minded” or not, is capable of understanding scientific principles and conclusions. So I blow a big raspberry at such a condescending remark, and point out that Airborne’s management has a surprisingly contemptuous attitude toward its consumers.

In a separate issue, Novella reports:

Airborne contains too much vitamin A. Two pills contains 10,000 IU, which is the maximum safe limit, but the instructions say to take three pills per day. So taken as directed Airborne contains more than the safe limit of vitamin A. This would also have to be added to vitamin A consumed in food, and of course many consumers may also be taking a multivitamin without realizing that Airborne is essentially just another vitamin pill itself.

An overdose of vitamin A, which your doctor will know as Hypervitaminosis A, can result in nausea, jaundice, irritability, anorexia, vomiting, blurry vision, headaches, muscle and abdominal pain and weakness, drowsiness, emotional and cognitive changes. The Wikipedia article cites references if you want to go pursue more information.

Now hypervitaminosis A doesn’t normally occur until tens or hundreds of thousands of IU of vitamin A are consumed. But frighteningly, the toxicity is enhanced by alcohol consumption, and in people with compromised kidneys, just 4,000 IU can be fatal. Remember, one pill of Airborne contains 10,000 5,000 IU, and they recommend you take three every day. What a way to discover you are renal compromised, eh?

The Capital Times reports:

An 11-year-old girl died after her parents prayed for healing rather than seek medical help for a treatable form of diabetes, police said Tuesday.

…

[Everest Metro Police Chief Dan] Vergin said an autopsy determined the girl died from diabetic ketoacidosis, an ailment that left her with too little insulin in her body, and she had probably been ill for about 30 days, suffering symptoms like nausea, vomiting, excessive thirst, loss of appetite and weakness.

The parents explained that the reason their child did not get better as a result of prayer is that they did not have sufficient faith.

The mother believes the girl could still be resurrected, the police chief said.

The parents told investigators their daughter last saw a doctor when she was 3 to get some shots, Vergin said. The girl had attended public school during the first semester but didn’t return for the second semester.

If you didn’t catch it up there, the girl was 11 years old when she died. She hasn’t seen a doctor since she was three. She went more than two-thirds of her lifetime without medical care.

The girl has three siblings, ranging in age from 13 to 16, the police chief said.

“They are still in the home,” he said. “There is no reason to remove them. There is no abuse or signs of abuse that we can see.”

Social service agencies and the social work profession will continue to have difficulty establishing credibility amongst common-sense people as long as they continue to consider this sort of thing normal. It should be viewed as a form of neglect that necessitates professional intervention.

Will the parents be charged? I don’t know, but I doubt it. A Wisconsin state law was helpfully posted in the story comments:

State statute 948.03(6): A person is not guilty of an offense under this section solely because he or she provides a child with treatment by spiritual means through prayer alone for healing in accordance with the religious method of healing … in lieu of medical or surgical treatment.

The comments predictably have a bunch of religious extremists defending the parents’ actions as an efficacious response to sickness, even though every controlled study ever done has shown that prayer is ineffective at curing or even helping someone who is sick. Personally, I think it is fine to pray for your child to be healed, as long as you also get them some competent medical help. A sane, fit parent does anything and everything they can to save the life of their child.

Sometimes the issue when not seeking out health care is lack of insurance or inability to pay for an expensive treatment. The parents operate a small business, operating a coffee shop in a suburb of Wausau, according to the story. Diabetic ketoacidosis is both easily, and fairly inexpensively, treated - at least if you don’t let the condition progress to an acute, dangerous form. People who get it and seek medical attention do not die of it. But it is still possible that the parents didn’t have the money for the treatment, right? It could be they were praying not because they thought that was the best thing to do, but because they had no alternative - right?

Wrong.

Wisconsin has a health insurance program for children called BadgerCare Plus. You can sign up for it here, and it provides comprehensive services to any child under 19, whether they already have insurance or not. Services do require a co-pay. The co-pay ranges from fifty cents to three dollars.

I’m thinking that someone selling lattes for a living can afford a fifty-cent co-pay if it means saving the life of their child.

Several people sent this to me, but I saw it on Pharyngula first.

Jack Klugman has made two television ads for First Freedom First.

Hat tip to Bay of Fundie.

I want to take a slightly different look at the Catholic Church’s new “mortal sins” than the perspectives I’ve seen in the blogosphere over the last few days.

Imagine for a moment that you have a job in a laboratory. You have a very long polymer in your test tube, and your job is to add a chemical to that test tube that cuts the molecule in half and snips a little segment out of the newly-formed ends. Then you add a new chemical that rebuilds the recently-destroyed ends with new sequence, then stitches them back together. When this process¹ is completed, you inject the polymer into a bilayer lipid membrane, go home, and enjoy hearty meal and a good night’s sleep.

If you do this, the Catholic Church warns that you are going to Hell. The long polymer in my example is a piece of human DNA.

Let’s say you have exactly the same job, fiddling with these molecules in test tubes, but your work eventually leads to the ability to grow human transplant organs in pigs. Hundreds of thousands of people’s lives are saved by this capability, who otherwise would have died on a transplant waiting list, or as a consequence of organ rejection.

Well, guess what? If you heal all these people, you are going to Hell.

You would go to hell even if you removed the duplicate 21^st chromosome from a single-celled trisomy-21 embryo (trisomy 21 is the cause of Downs syndrome), thus relieving a human life of considerable suffering and difficulty learning and communicating - to say nothing of helping the baby’s parents. Genetic manipulation is genetic manipulation, and healing people is no excuse according to the church. Split some DNA, and you will meet Satan the instant you die, for the Catechism of the Catholic Church says:

Immediately after death the souls of those who die in a state of mortal sin descend into Hell.

A lot of the blogosphere’s coverage of this issue has been pretty laid back - just poo-pooing the Catholic Church’s ignorant railing against some obscure scientific discipline. Which is fine as far as it goes. But I want it to go farther:

The Catholic Church hasn’t condemned some vague activity called “genetic engineering.” They’ve condemned people, whose job it is to take some chemicals and use them to alter other chemicals. They’ve condemned some very nice, virtuous people who, by doing this stuff with chemicals, have, and will continue to, alleviate human suffering on a massive scale.

1. which I have simplified to excess. [↩]

Here is an excellent example of how the antiscience movement harms people and stands in the way of their happiness. This video is from the IEEE Spectrum Online, and it is about a prosthetic arm currently under development. A really amazing, very cool prosthetic arm, so please watch.

The best bit is toward the end:

Amputee: I’ve been able to do stuff with this that I haven’t, seriously, I haven’t been able to do in 26 years.

Interviewer: Like what?

Amputee: Pick up a banana. Peel a banana and eat it, without it squishing….

A few seconds after that, he mentions something else he could do with the prosthesis that he hasn’t done in 26 years….

What would have happened here if the engineers and amputees that are working on this prosthesis had taken an antiscience approach to their work? Simple: They wouldn’t even have tried to build this thing. There’s way too much mysterious technology at work here - footpad input systems, sensory feedback devices, multiple parallel processing, closed loop positioning systems¹…. It all comes from science, and you can’t hate science and have anything to do with developing something like this.

An antievolutionist, applying the logic of their worldview to this problem, would have said “we don’t know how to make an artificial arm like this, so it can’t be done.” And they might well have said “If someone loses an arm, God meant it to happen, for his own mysterious reasons.” Or perhaps they would blame the victim: “if only the amputee had enough faith they would be healed.” This isn’t wild, unfair conjecture on my part, Christians actually say stuff like this.

Such as Exhibit A:

This guy says that amputees would be healed if only Christians had enough faith, and if good spiritual leaders would arise. Amputations wouldn’t be a problem, see, if we just all agreed about god, and were all holy and spiritual. If that happened, then we wouldn’t need those pesky engineers who are working to give people their arms back right now. If only we were better Christians, amputees could have their arms back, you know, whenever we might get around to being good enough Christians and all that….

This next guy says that amputees do heal. What he means is that they don’t bleed to death; that the blood clots, scar tissue forms, the wound heals over, and they don’t die. Apparently not dying is considered just as good as “getting your limb back.”

He also says people who disagree with him are ignorant of science and are in “violation of the philosophy of science.” Whatever that means. Why should I even listen to it, or think about his point at all? There’s a really simple fact in place here. Engineers who embrace what science tells them about materials and energy have actually created a really outstanding artificial limb, and the kid broadcasting from his bedroom is nattering on and on about how the rest of us misunderstand science. Well, I think I’m going to go out on a limb here, and embrace my alleged stupidity, because I think the engineers are doing a good and creditable thing, whilst the antiscience folks are just bellyaching into webcams² from their bedroom.

If we leave it up to these antiscience people, the amputees will be sitting outside the city gates dressed in rags begging for coins while we all try to join the perfect church and raise up some kind of ideal spiritual leader who will make everything better. This has never worked before. These are terrible, terrible people, with a crass and uncaring attitude toward their neighbors.

Who do I like better? Duh. The person who looks around and says, “holy crap, that guy doesn’t have an arm, let’s figure out how to make him one,” and then goes to work building it. Those are the people who have chosen to join us in civilization, those are the people who have exhibited a grasp of and commitment to morality, and those are the people who are actually helping their fellow man. Let’s hope the antiscience people get a clue and join us in this endeavor.

1. Ok, that’s not mysterious at all - that’s part of my stock in trade. But much of the rest seems daunting. [↩]
2. The irony, that webcams come from science, is not lost on me [↩]