I am very happy to announce that I’ve joined Science-Based Medicine (http://www.sciencebasedmedicine.org/). My first post appears today and it’s about … homebirth.

The new CDC report on infant mortality, Behind International Rankings of Infant Mortality: How the United States Compares with Europe, is an object example of how to deceive with statistics. It purports to be a detailed investigation of infant mortality, but it inexplicably fails to investigate the most important detail.

According to today’s article in the NYTimes:

High rates of premature birth are the main reason the United States has higher infant mortality than do many other rich countries, government researchers reported Tuesday in their first detailed analysis of a longstanding problem.

In Sweden, for instance, 6.3 percent of births were premature, compared with 12.4 percent in the United States in 2005, the latest year for which international rankings are available. Infant mortality also differed markedly: for every 1,000 births in the United States, 6.9 infants died before they turned 1, compared with 2.4 in Sweden. Twenty-nine other countries also had lower rates.

If the United States could match Sweden’s prematurity rate, the new report said, “nearly 8,000 infant deaths would be averted each year, and the U.S. infant mortality rate would be one-third lower.”

The use of this example highlights to disingenuousness of the authors. In their supposedly “detailed” report on infant mortality, they fail to analyze the most important detail: race. Unfortunately, African descent is a major risk factor for prematurity, and prematurity is a major cause of infant mortality. Therefore, it is hardly surprising that the US has a higher infant mortality rate than Sweden. The US has the highest proportion of women of African descent of any first world country. Sweden, of course, has virtually none.

The authors, however, seem more interested in jeering the US for its supposedly low standing in international comparisons than they seem in actually getting to the source of the problem. The report is filled with grim looking graphs that show how “poorly” the US fares when compared to other first world countries.

The first graph highlights the fact that the US is ranked 30th in the world for infant mortality. But the authors acknowledge that the US has a more comprehensive definition of infant mortality than other first world countries, many of which exclude the deaths of very premature infants even when they are born alive. The authors present a second graph adjusting for this discrepancy. In that more accurate graph, the US ranks 18th.

The authors mention the impact of race on prematurity, but they never adjust for it. The CDC Wonder website gives us access to the same database that MacDorman used in the study. Therefore, we can adjust for race. Doing so, would put the US 14th in the rankings.

The authors also mention assisted reproductive technology, but they don’t adjust for that either. The rates of twins, triplets and higher is greater in the US than in many European countries because of differing rates of assisted reproductive technologies and the difference in techniques.

The authors acknowledge that on an age specific basis, the US actually does better than almost all European countries. In other words, we are better at saving premature babies. Our relatively low ranking is the result of a higher rate of prematurity.

So our higher rate of infant mortality does not reflect poor medical care. It reflects factors beyond the control of doctors. Race is an uncontrollable factor; obstetricians and pediatricians have no control over assisted reproductive techniques. In fact, the data actually show obstetricians and pediatricians do a remarkable job of ensuring infant health.

Dr. MacDorman’s bias is most evident is her gratuitous swipe at obstetricians. According to the Times article:

Another factor in the United States, she said, is the increasing use of Caesarean sections and labor-inducing drugs to deliver babies early. The American College of Obstetricians and Gynecologists has guidelines stating that babies should not be delivered before 39 weeks without a medical reason, but doctors may be declaring a medical need more quickly than they did in the past.

“I don’t think there are doctors doing preterm Caesarean sections or inductions without some indications,” Dr. MacDorman said, “but there sort of has been this shift in the culture. Fifteen or 20 years ago, if a woman had high blood pressure or diabetes, she would be put in the hospital, and they would try to wait it out. It was called expectant management.

“Now I think there’s more of a tendency to take the baby out early if there’s any question at all.”

Dr. MacDorman neglects to mention that there is no evidence that such births are contributing in any way to the infant mortality rate. Indeed, the existing evidence suggests that these births actually save lives. During the time period when early deliveries increased, the rate of stillbirth dropped by 29%.

Infant mortality and prematurity are real and serious problems, and they won’t be solved by pretending they are simply medical problems. Infant mortality in general, and prematurity in particular, is the result of racial, social and economic disparities that must be investigated and addressed. MacDorman’s report risks obscuring this critical point in favor of castigating medical practitioners. Doctors are not responsible for the US ranking in infant mortality statistics, and therefore, they cannot fix it. If our goal is to prevent infant deaths, we must be honest about the real causes.

It sounds like a horror story made up by an anti-abortion group, but it is not. Neocutis, a Swiss “cosmeceutical,” is being marketed as a “Bio-restorative Skin Cream with PSP™” for “sensitive, stressed and irritated skin.” PSP are processed skin-cell proteins and the manufacturer, Neocutis SA, is honest about where they came from:

Inspired by fetal skin’s unique properties, Neocutis’ proprietary technology uses cultured fetal skin cells to obtain an optimal, naturally balanced mixture of skin nutrients including cytokines, growth factors and antioxidants.

Neocutis SA, cognizant of the ethical objections, declares:

Since the 1930s, the international medical community has used donated fetal tissue to better understand cell biology and as an essential tool in the development of vaccines, which are credited with saving millions of lives worldwide. The 1954 Nobel Prize for medicine was awarded to researchers who utilized fetal kidney cells to develop the polio vaccine… Our view—which is shared by most medical professionals and patients—is that the limited, prudent and responsible use of donated fetal skin tissue can continue to ease suffering, speed healing, save lives, and improve the well-being of many patients around the globe.

In other words, Neocutis SA believes that this is yet another benefit of stem cell research. But is this what proponents have in mind when urging the funding of stem cell research? Does support for stem cell research to cure fatal diseases extend to support for stem cells in cosmetics?

Dr. Summer Johnson of Bioethics.net asks:

… [W]hat moral complicity exists for those who choose to put fetal skin protein creams on their faces?

She acknowledges that consumers are likely to have one of two responses:

Yet for some, this will have no moral implication at all. For them, fetal proteins in a face cream aren’t any different from animal or plant protein because for them the moral status of the aborted fetus doesn’t have the moral status to give one concern if consent to both abortion and research took place.

But for many, it would be unthinkable to fetal ANYTHING into their deepening wrinkles to make them become less so. In fact, many would rather have crow’s feet deeper than the Grand Canyon than have a fetal tissue cell touch their face as a result of their moral conviction…

I must admit that this issue has never occurred to me. When I think of stem cell research, I think of life saving technologies, not cosmetics. Does it matter, though, what the stem cells will be used for once you’ve decided they can be used? Is there any moral difference between using the tissue of aborted fetuses to cure cancer and using it to cure wrinkles? And if it does matter, what does this tell us about the status of fetal tissue? Are fetal cells no different from the animal and plant cells often used in the manufacture of cosmetics?

At a minimum, people deserve to know when products are manufactured using the tissue of aborted fetuses so they can decide for themselves whether to buy and use them. The real question is whether we should go further. Instead of leaving the moral decision to individuals, should we restrict the use of fetal tissue to life saving products, or even to no products at all?

The message boards at Mothering.com contain one of the largest repositories of homebirth death stories that can be found anywhere. It’s rather ironic that Mothering continues to promote homebirth as completely safe when they have more evidence than most that it leads to unnecessary deaths.

Consider the following stories gathered over the past few months:

I want to start by telling you that homebirth is a wonderful thing and I think it can be done by first time moms with breech babies. I also want you to know that I am NOT trying to scare you. But – I am a first time mom, with fantastic, educated midwives and I had my first baby at home in June. He was breech, which we were pretty sure about beforehand, his head got trapped, he suffered a lack of oxygen and was declared brain dead. He lived 4 days on a ventilator in the NICU.

I know this is completely terrifying. I also know that statistically we should have been fine. I have researched this TO. DEATH. and the three big risk factors for vaginal breech birth are 1) preemie – my son was 40w5d; 2) large babies – my son was 6lb 12oz; and 3) first time moms with “unproven” pelvis. We cannot point to any one definitive thing that led to this issue. [My son’s] head was actually pretty small and my pelvis is just fine. I know that we did the best we could for our son, and that there are no guarantees in a hospital either. The risks of epidural and c-section are about equal to a vaginal birth. I just want you to know that it can be done, but it can also end in tragedy. I know that hospital births sometimes end in tragedy too so I refuse to allow myself to think about what would have happened to me or [my son} in a hospital.

I find it particularly sad that this woman who supposedly research the topic “to death” did not know that C-section is safer than vaginal breech delivery.

At the following homebirth, the baby was born with a serious undiagnosed congenital anomaly. It is not clear if the baby would have survived the necessary surgical repair, but the baby was certainly doomed by being born at home:

My peaceful homebirth turned into a full-out trauma complete with dozens of officers coming in to take pictures of the “crime scene” before I could even get covered or stitched or anything. They kept telling me that there will be nothing doctors can do- he was born wrong and you caused this- it was absolutely my worst nightmare come true. I kept passing out on my way out of the house and there were officers and firemen just standing there watching me- not offering to help at all. It was absolutely horrendous.

Now, I still support homebirth and know that it was not the cause of my son’s death- my midwife is very competent and did what she could- his condition was undiagnosed or else we would have delivered at a hospital. However, I suspect that many people (this being their first/only experience with home birth) think that the home birth is the cause, or at least contributed to, his death. My DH is still passing over the born at home part when he tells the story and I feel like it all has to be some dirty little secret or something. My relatives were whispering about it at the graveside service.

I guess I just wish in a way that I hadn’t had a home birth- because losing my son is hard enough without dealing with these aspects of the trauma… I will never have the home birth experience I was hoping for. I guess I’m mourning that loss as well as the loss of all the experiences I expected to have with my son.

Another mother replied with the story of her loss:

… I too had fire and police arrive and turn what was also a beautiful HB (until that nightmarish moment when my son was born dead) into a seriously traumatic event. They treated it like a crime scene, wanting to take the placenta and videotape as evidence … [A]fter a battery of tests, placenta pathology and a full autopsy they found no proof of an abruption and nothing wrong with my son which several doctors have come to the only conclusion, that is was a cord-compression.

I too felt my midwives were very capable and I have been told babies die in hospitals too. I don’t want to add insult to injury here but babies die in hospitals for different reasons… most stillbirth occurs [before] arriving at the hospital … whereas intrapartum loss is rare at hospitals. I feel if I had been on consistent monitoring they would have been able to track the HR decels better and probably done a c-section (my worst fear) but he would have LIVED (most probably)!

There is not a day that goes by that I don’t feel the pain of being guilty for killing my son. I have been told over and over again it was not my fault which I have come to accept [as] different than the HB being at fault …

The decision to HB is not something someone enters into lightly, it is usually well researched and considered and a decision made out of a deep intense love for what we believe to be best for our babies … and I unlike you was very vocal about our decision to HB for this proudful reason shooting my mouth off like we were better than all my friends who I thought were radical but chickened out and have to have their epidurals, etc. and now I feel like I am eating crow, BIG TIME! …

The mother of the baby who died of a congenital anomaly sums it up most poignantly:

It is so hard. We both chose homebirth because we believed in making the best choice for our babies – and we thought this was it. To have that belief snatched from us, along with our babies, is so very, very hard.

We are currently in the midst of an epidemic. No, not the H1N1 epidemic, though that’s the most immediate threat. What threatens the long-term health of our nation, particularly our nation’s children, is an accelerating epidemic of ignorance. Vaccine rejectionism, the flat-earth theory of the 21st Century, previously the domain of the crazies, has gone mainstream.

Doctors are frustrated. As Dr. Nancy Snyderman angrily declared on her NBC show, we are just a “stone’s throw” from witnessing a return of polio to the US. Measles and pertussis (whooping cough) are already making a comeback. Although the absolute number of cases is still in the hundreds, the effects of vaccine rejection on medical practice extend beyond the number of children who are sick.

Pediatricians and family practice physicians are wasting extraordinary amounts of time counseling parents contemplating vaccine rejection. Counseling is, of course, part of any doctor’s job, and we routinely counsel against ignorance in other areas of medicine (HIV, sexually transmitted diseases, etc.). But in those cases we counsel against prejudice and lack of knowledge. What makes vaccine rejectionism extraordinary is that we are forced to counsel against the ignorance deliberately disseminated by professional vaccine rejectionists.

Within the medical community, doctors are beginning to debate the possibility of “firing” families who refuse to vaccinate their children for deadly illnesses like polio and pertussis. Dr. Gary Marshall speaking at a recent American Academy of Pediatrics conference explained that it is both legal and ethical to refuse care:

In the middle of treatment, you can’t just say, I’m done, …

But if it becomes obvious that you and the family will never see eye to eye on a specific issue, there’s no reason not to “fire” them, providing you follow the steps necessary to avoid charges of abandonment. Those include providing written notice that you will no longer treat their children and giving them a set time frame — at least 30 days — to find another physician.

Doctors are and have always been legally entitled to refuse to care for specific patients as long as they did not abandon them in the midst of an acute event. This drastic step is usually reserved for patients who are difficult, disruptive or openly disrespectful. It is an acknowledgment that every doctor is not right for every patient.

It is rarely used merely because patients disagree or are non-compliant. Patients have every right to disagree with recommendations or to ignore them. Non-compliance is a serious problem, but it is often a case of “the spirit is willing, but the flesh is weak.” Smokers know they need to quit and generally make good faith efforts to do so. Alcoholics are often more distressed about their conditions than their doctors, but they are addicted and have great difficulty doing what they know is right.

There is something fundamentally different about vaccine rejectionism because it is a rejection of the principles of science and medicine. It is illogical and “evidence resistant.” When the patient does not agree with the doctor on the absolute requirement that medicine should be based on science, there is no common ground. And since vaccine rejectionism depends on absurd conspiracy theories regarding the financial motives of doctors and vaccine manufacturers, it destroys the trust necessary in the doctor patient relationship.

While individual doctors are certainly free to legally “fire” families who reject vaccination, it is a poor way to address the problem. It places children at risk for being unable to obtain good medical care in a crisis. Those most likely to suffer, the children, are not the ones who made the foolish and uneducated decision. Moreover, at this point, the problem has grown too large to be solved by physicians acting individually.

This is a public health problem of the most basic kind, and should be solved with government based public health measures. The government should more strictly enforce vaccination policies. Technically children cannot go to school if they are not vaccinated, but it has become all too easy to obtain vaccination waivers on the grounds of religious or personal beliefs. The government should end the policy of allowing philosophical exemptions.

All children should be fully vaccinated against fatal childhood infectious diseases as a requirement for being allowed to attend school. It makes particular sense to apply a vaccination requirement to attending school because schools are where non-vaccinated children posed the greatest threat to other children.

In an effort to placate parents with religious and philosophical objections, the government has fueled the epidemic of ignorance. It is time to address that ignorance head on. If you want your child to go to school, your child must be vaccinated. Period.

The time for endless discussions about irrational, non-scientific claims is over. The rest of the population deserves to be protected from the effects of this ignorance. Individual doctors cannot, and should not be expected to, handle this serious problem alone. The government must step in and put an end to this nonsense.

We survived almost all of human history without it. Yet in the last 100 years people have allowed themselves to be hoodwinked by a huge corporate conspiracy into believing that we “need” their products. They cite studies and claim we don’t understand science; they ignore ancient folk wisdom and have no respect for our intuition. They peddle their products without regard to the dramatic increase in chronic diseases and weakened immune systems of recent decades. I’m speaking, of course, of “Big Floss.”

It’s time to take our mouths back from corporate domination. It’s time for alternative dentistry.

To hear the corporate “tools” of Big Floss tell it, we need to use their products not simply every day, but many times a day. They’ve created a seemingly limitless array of products that they are forcing, literally, down our throats. Toothbrushes, toothpaste, floss, mouth wash! There appears to be no end to the number and type of products they insist we must buy to fuel their corporate ambitions. And even if we behave like sheep and buy their tainted wares, their allies the dentists insists that we must visit them not merely once a year, but twice.

We’re supposed to believe that we benefit from this meddling with the natural order. Really? So please explain how the human race survived just fine to this point without Big Floss. Clearly we didn’t need toothbrushes to survive and even thrive. So why, suddenly, should we be gullible enough to believe that every person should brush his or her teeth after every meal? Has there been even a single randomized controlled double blind study that proved that brushing saves teeth? No, there hasn’t.

Big Floss insists that it has a product for every person, often more than one. Toothpaste to prevent cavities, toothpaste for kids, toothpaste for dentures. Is there any limit to what they will sell in order to increase their profits? And are we really supposed to believe that four out of five dentists recommend Crest? Where’s the data for that claim?

They tricked people into brushing ever day and using toothpaste each time, but that’s not enough for Big Floss. They say that toothpaste prevents plaque buildup and then they turn around and insist that we need mouthwash, too, to kill the harmful germs that cause plaque. Do we look that gullible? And what’s wrong with plaque anyway? It’s natural and probably exists to strengthen our immune system, which has been weakened by constant exposure to toxins and Frankenfood.

Big Floss is not content with tricking us into buying toothbrushes, toothpaste, floss and mouthwash. They insist that we see a dentist twice a year. If their products are so great, why would we ever need to see a dentist? We wouldn’t, but the unholy alliance of Big Floss and Dentistry has colluded to increase the profits of both. Don’t believe me? The dentist always tells you that you should brush every day, and Big Floss always recommends dental checkups. What more evidence do you need?

It’s time to end our reliance on Big Floss. It’s time for alternative dentistry. Those who truly educate themselves about teeth in nature know that toothbrushes and toothpaste are unnecessary. If our ancestors didn’t need them, we don’t need them, either. We can care for our teeth with a diet of fruit, vegetables and vitamin supplements.

In the rare situation in which more is needed, we can dose ourselves with ancient herbs or pull out rotten teeth the natural way, by tying a string around the both the tooth and the doorknob and giving the door a big shove. Forget novocaine. Why would we dose ourselves with medication to numb the pain of a tooth extraction? Those who really care about their teeth want to savor every natural feeling, not deaden it with chemicals.

And let’s not forget preventive care. If you want to be sure that you have healthy teeth, all you need to do is buy powdered Bio-identical Teeth®. Unlike artificial toothpastes or mouthwashes, powdered Bio-identical Teeth® is all natural, made from human teeth with no fillers or animal products. Because it is “bio-identical” it is more effective than artificial toothpaste could even be.

It’s time to unite and fight the corporate conspiracy of Big Floss. No more toothbrushes, no more toothpaste, and no more visits to the dentist. Let’s live as Nature intended with no artificial colors or preservatives. Let’s care for our teeth naturally for as long as they last.

Brought to you as a public service by the American Pureed Food Industry

This has got to be the greatest fundraising slogan of all time. That’s one of many superlatives that can be applied to an amazing organization, funded by the strangest source, engaged in a most poignant quest.

The organization is Clitoraid and the name was chosen for accuracy, not shock value. Clitoraid raises money to pay for reconstructive surgery on women who have undergone female genital mutilation. The procedure was pioneered by a most extraordinary humanitarian, Dr. Pierre Foldes. According to a profile in the New Scotsman:

Dr Foldes first encountered the traumatic effects of excision 25 years ago … in Burkina Faso, West Africa.

“Some women came to me complaining of scarring which was very painful for them every time they moved,” he recalls. “A special type of scar tissue called a keloid can develop on black skin and in these cases it grows hard and thick and attaches itself to the pubic bone. The women asked me if I could do something about it. While I was operating I began to do some reconstruction surgery on the vagina and labia as well as clearing scar tissue.”

The surgery had to be carried out secretly because of death threats from community members. Later, when it became known he was continuing his operations in France, the death threats continued. “The police take them very seriously,” he says, “but I won’t let them stop me doing this.” …

Foldes trains other surgeons to perform the procedure. Dr. Marci Bowers had 20 years of experience as a reconstructive surgeon before she journeyed to Paris to learn Foldes’ technique. She now performs the surgery in Trinidad, CO.

The location has special significance. Trinidad is known as the “sex-change capital” of the world, and Dr. Bowers herself was born male and underwent sex reassignment surgery to become a woman 11 years ago. Like her mentor, she charges nothing for the delicate and complex surgery and the hospital caps its fees at $1700. According to Bowers: “As Dr. Foldes has said, you cannot charge money to reverse a crime against humanity,” she says. “Sexuality is a right.”

Newsweek described Dr. Bowers operating on a patient named Sila:

Dr. Bowers cut away the thick scar tissue that had formed over Sila’s wound and had obscured the remains of her clitoris. She then scraped away layers of a black, sooty material—the decades-old remnants of the ash poultice the local women had used to stop the bleeding. It had caused a low-grade infection that still hadn’t healed—one reason Sila was always in pain… The root of the clitoris, which extends several centimeters beneath the surface of a woman’s skin, is much larger than … ever suspected. Bowers exposed the remaining flesh of the organ and drew it out, securing it in place with delicate stitches that eventually dissolve. Finally, Bowers also did some cosmetic work to restore the appearance of Sila’s labia.

In France, the surgery is covered by the national health surface, but insurers in the US have balked at paying for the procedure. For some women, even $1700 is too much to pay. Enter Clitoraid.

The organization is managed and funded by the Raelian movement described by Newsweek as “the pleasure-promoting “UFO religion” whose members believe life on Earth was created by a race of advanced aliens and who emphasize human sexuality.” They have concentrated their primary effort in building and running a hospital in Burkina Faso dedicated to surgical repair of female genital mutilation. In addition Clitoraid provides financial assistance to patients and funds the training of doctors like Marci Bowers.

According to the Clitoraid website:

The goal of Clitoraid’s “Adopt a Clitoris” program is to create real, long lasting changes for women who have been forced to experience clitoral excision or genital mutilation against their will… The procedure takes 6 weeks for a woman to completely heal, with sexual pleasure and genetic normality being the end result.

Most of the women in Burkina Faso cannot imagine having the money for such an operation. For most of them, it would be like spending two year’s salary!

Clitoraid is committed to provide these operations for free to as many women as possible.

The results are extraordinary:

A California nurse, Ngozi, who was circumcised as a newborn in Nigeria and also had her labia entirely cut away, came to Bowers in August. She is already feeling results, she tells NEWSWEEK. “Before, I would look at my textbook and look at myself and they were two different things. I wasn’t even human.” Bowers performed not only the clitoral operation but also plastic surgery to create labia for Ngozi, 34. “Now when I look at myself I feel like a woman,” says Ngozi, who says she has even experienced orgasms for the first time in her life. “It’s beautiful, I just love it, it feels like you’re melting. Before it irritated me when my husband tried to touch me, now I reach out to him.”

To learn more about Clitoraid or to adopt a clitoris visit the website at Clitoraid.org.

Doctors have understood for some time that it was inevitable. The American Cancer Society acknowledged today that cancer screening has been oversold.

It seems like every day you read in the newspaper that what was standard medical care yesterday is now no longer recommended. Don’t doctors know anything? Well, actually they do. And what seems like paradoxical behavior, no longer recommending aggressive screening for certain cancers, actually represents a more sophisticated understanding of the way in which cancer behaves.

The classic understanding of cancer is that once a cancer forms it will continue to grow steadily until it kills the patient. Cancer was viewed as if it were an infectious disease like syphilis. It starts small and easy to treat, may remain hidden for long periods of time, but eventually spreads to other parts of the body becoming incurable along the way. If cancer did indeed spread like that, the aggressive screening programs would make perfect sense.

But decades of research and clinical experience have led to a more sophisticated understanding of cancer. It has always been known that cancers from different parts of the body behave in very different ways. Ovarian cancer is extremely aggressive, while basal cell cancer of the skin grows very slowly. Breast cancer can and does spread to bones and brain, while colon cancer is most likely to spread only to the liver.

More recently we’ve learned that each cancer can be broken down into different subtypes, some more aggressive than others, and some better treated with one regimen instead of another. For example, breast cancers are now analyzed for the presence of hormone receptors on the outside of the cancer cells. The presence or absence of certain receptors tells us whether specific treatments will be helpful or useless, making it easier to target the cancer with the treatment most likely to work.

We have also learned that some cancers follow the model of an infectious disease like syphilis, starting small and curable and ending up throughout the body and incurable, many do not. Some cancers start small and explode aggressively. Others start small and stay small for decades. This more sophisticated understanding is a direct result of being able to diagnose cancer earlier. We now have a much better and far more nuanced understanding of the natural history of various cancers. It has become apparent that rather than finding all cancer, we need only find cancers that are aggressive and can ignore those that are known to grow very slowly if at all.

What’s the big deal? Isn’t cancer screening beneficial regardless of the natural history of the particular cancer? No, it’s not and therein lies the reason for the American Cancer Society’s call for less screening of certain cancers.

The goal of cancer screening is and has always been to reduce cancer deaths and disability, and therefore, that’s how cancer screening should be judged. By that standard, some forms of screening are total successes. For example, the Pap smear, the screening test for cancer of the cervix, has been an unalloyed bright spot in the war against cancer. The test is inexpensive and reliable, the follow up test to actually diagnose cancer (biopsies of the cervix) is harmless, and very few if any women are treated unnecessarily. Screening for cervical cancer saves many lives and has few long term side effects.

By the same standard, prostate cancer screening has been a terrible disappointment. The PSA blood test, the screening test, is notoriously unreliable. Even more problematic is the fact that many prostate cancers grow extremely slowly and are unlikely to spread. Most problematic is that the treatment has very serious side effects, impotence and incontinence. Screening for prostate cancer with the PSA test (and finding tiny cancers) saves no more lives than screening with a prostate exam (which can find cancers that are somewhat larger) and leaves many men with unnecessary long term side effects.

Whereas every cervical cancer is probably dangerous to the patient and the treatment has few long term side effects in any case (since cervical cancer is most commonly diagnosed in women who have completed childbearing), most prostate cancers are not dangerous to the patient and the treatment is often undertaken unnecessarily. It’s bad enough to endure impotence and incontinence as the side effect of life saving treatment. It is tragic to endure it as the side effect of unnecessary treatment.

Breast cancer is similar to prostate cancer. While frequent mammography is more likely to diagnose cancer, there has not been a corresponding decline in breast cancer deaths. Treating many more women with chemotherapy, lumpectomy and mastectomy has produced very few additional lives saved.

The solution to this conundrum, of course, is to develop more sophisticated screening tests, tests that can discriminate between life threatening cancers and non-life threatening cancers. In the meantime, the existing screening tests should be judged on their ability to save lives, not on their ability to diagnose cancer, since many cancers don’t need to be treated.

Screening everybody for everything and screening them often is a very blunt tool that seemed appropriate when we had an unsophisticated understanding of cancer. Now that our understanding of cancer has deepened, the use of screening tests should reflect our new knowledge.

Simply put, screening tests should be reserved for situations in which they save lives. Dialing back on screening tests is not a step backward, it is a step forward in treating only those who need to be treated and not harming anyone else in the process.

I blog in a variety of places with a variety of different audiences, but I am struck by the uniformity of the arguments of vaccine rejectionists. It’s not surprising, though, when you consider that they are not reaching their conclusions independently, but rather regurgitating seemingly “impressive” arguments they have read on vaccine rejection websites.

The latest such “argument” is that the safety and efficacy of vaccines have never been proven because they have not been subjected to a controlled randomized double blind study against a placebo. This “argument” is designed to impress those with a minimal knowledge of statistics. In other words, it is designed to impress those who know enough statistics to realize that anecdotes are not a substitute for scientific studies and are familiar with the concept that a controlled randomized double blind study against a placebo is the “gold standard” in some areas of drug research.

Unfortunately, they don’t know enough to realize that controlled randomized double blind studies are unethical in certain circumstances, including the testing of vaccines. So what is presented on vaccine rejection websites as a startling and inexplicable refusal of scientists to test vaccines is actually the inevitable result of complying with ethical rules for scientific investigations.

There are many situations in which controlled randomized double blind studies are unethical. Consider infant carseats:

Do carseats minimize the risk of injury and death of infants?

There never been a controlled randomized double blind study of carseats. Why not? Because it is unethical to randomize some infants to be unbelted in cars simply so we can check how many will be injured and die.

Does that mean we don’t know if carseats reduce the risk of injury and death? Of course not. There are a myriad of statistical investigations that allow us to determine whether carseats reduce injury and death, including large scale population studies, retrospective cohort studies and many others.

So the fact that there are no controlled randomized double blind studies of vaccines is a red herring. It works only on those who don’t understand science and statistics. On them, of course, it works very well.

Vaccine rejectionists, like many Americans, simply don’t understand statistics. This is a serious problem because Americans are exposed to a tremendous amount of statistical information and are required to make many decisions based that information.

An article in the journal Public Understanding of Science explains:

We live in a statistics-rich society: statistics permeates many aspects of life—from media, health, and work to citizenship. In the media, we can observe a growing emphasis on statistical results. This is particularly the case in health and medical reporting which tend to be the most compelling scientific issues for citizens … The understanding of these statistical components is crucial to help citizens participate in public debate and arrive at political decisions.

Statistical misunderstandings are very common and lead to cynicism about science and medicine.

Statistics requires the ability to consider things from a probabilistic perspective, and to employ quantitative technical and abstract concepts such as significance, margin of errors, and representativeness. Since these concepts are difficult to understand, statistical misunderstandings can often be observed in the everyday but also in the media and research results. It is important to clear up these misunderstandings, as they lead to the misuse of study results, and the development of a distrustful or cynical attitude toward statistics.

Vaccine rejectionists, you’ve been tricked … again. How many times do you have to be tricked before you realize that you are being victimized by your lack of knowledge of science and statistics?

N.B. I’ve closed the comments for this thread because it is in danger of crashing the site. Feel free to continue the discussion at The extraordinary conceitedness of being an anti-vaxxer.