Definitive proof: Vaccines Do Not Cause Autism

http://pediatrics.aappublications.org/cgi/content/full/118/1/e139?maxtoshow=

Fombonne E, Zakarian R, Bennett A, Meng L, McLean-Heywood D. Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. Pediatrics. 2006 Jul;118(1):e139-50. PMID: 16818529

I read through this published study last week and am thoroughly impressed. Going into the study, I was skeptical for two reasons: 1) Politically/emotionally charged health issues tend to throw bias into what and how studies are designed, written up, and published; and, 2) Population-based epidemiological studies tend to inherently miss variables in their vast data that can epically change research conclusions -all to often, they're like drawing the bullseye after the shots are fired at a target already riddled with holes.

However, novice that I am, I found that the researchers here leave very little for the champions of vax=autism to empirically attack. The population in the study is well-defined and the authors carefully explore details within it to find things that may influence their data. They plot the discrepancies in vaccine administration. They explore disease definitions in context and address potential anomalies in the historical reporting of the data. In short, it is very convincing that there are no links between mercury in vaccinations and autism, and suggest a "rise" in developmental disorders probably has more to do with recognition and definition within society.

I'm reminded of the political discussions some years ago over a report of extremely high breast cancer rate on Long Island. Despite extensive and detailed scientific investigations showing there was no environmental cause for the rate, the come-back
argument was, "all I know is that many more woman on Long Island are getting breast cancer than anywhere else and something must be done about it!"

So, if you'll excuse my exaggerated cynicism: I'm sure that even in the face of this (and other) convincing science, all the money grubbing, autism-exploiting,
conspiracy theory-creating, establishment-bashing, mercury-phobic anti-vaxers will continue to chant, "all I know is that babies getting vaccines turn into kids with autism, and something must be done about it!"

dras
(The son of a Nevada nuc-testing down-winder

Why doctors don't perform office procedures the same day as an evaluation

My doctor's practice has
> signs up specifically requesting that you make
> additional visits to bring up other issues.
>
> >>>>>>>>>>>>>>>>>>>>>>

Medicare part b physician payment methodology (and therefore most payer methodology) has evolved to encourage this, I think. If a Doctor bills an office visit that was a follow-up on a patient's sugar diabetes, and the patient uses this visit to also have the doctor look at his ingrown toenail, Medicare (and most other payers) will likely deny the toenail service, even if it took up most of the time, and only pay for the office visit.
(http://www.cms.hhs.gov/NationalCorrectCodInitEd/)

Coding and claims. Welcome to a difficult world where everything should make sense and be fair, and few things ever do or are.

dras

"Healing conference" promo

The real advertisment promo tract for an Adam Dreamhealer healing seminar:

> > Nicki says:
> > "Many blessings of beauty and creativity on this
> summer solstice. The
> > ideas that gestated through the dark of winter
> became the seeds that
> > sprouted in the spring. As we enter summer, we
> begin to see the fruits of
> > the splendid, diverse creation that surrounds us
> blossom in the myriad
> > ways of expression that bring fulfillment into our
> lives. Whether you are
> > passing through a joyous, sorrowful or difficult
> time this summer, take a
> > moment to breathe deeply of the spirit of love,
> and let that permeate and
> > nurture whatever surrounds you, your garden, your
> work, your family, and
> > your self.


My attempt at cynical parady:


I was thinking of organizing a conference as well. I'm working on the press release and invitation tract. How's this so far?:

Proliferance of abundant contraband for this somnolent season. The enigmas that digested in the darkest weather are revived as flourishing flowers. As we begin the new season, we revel in the joyous exuberance of the myriad creations of the mind's eye to the fulfillment of our souls. Whether you feel to express the wondrous, tearful, or flavorful tacits of time, take a refreshing sigh and permeate in nature's
lustrous reminiscence with comfort in knowing security at home, fond family memories, and the spirit of your garden.

Naturopathy promoted in middle school text book

Following are comments from the pasted textbook text below:

I think we see the propagandist approach of this text; the facts littered with speculation, the subtle undermining of MD medical practice, and the allusions
to hokey diagnoses and treatments. Where do you start in explaining what is wrong with a text that's so overwhelmingly bad?

"Most MDs don't talk to their patients about their diets,"

*****beeeeep********
Not according to the American Association of Family Practitioners: "Nutrition plays a major role in both health promotion and disease prevention, in addition to being a therapeutic tool in the treatment of medical, surgical and emotional illness. Physicians should develop the basic skills necessary to assess nutritional status and provide nutrition therapy." http://www.aafp.org/online/en/home/aboutus/specialty/rap/eduguide/nutrition.html

"Dr. Kargman treats many HIV and AIDS patients."

*****?????*****
The terms "hiv+aids+naturopathy" returned only 4 pubmed journal references, and no clinical trials demonstrating feasibility of treating HIV and AIDS with Naturopathic medicine.

"Food allergies can cause an immune reaction in the body -- anything from depression to skin problems to migraine headaches."

***beeeeep**** According to AAAI patient information, depression and migraine are NOT on the list of symptoms associated with food allergy, and there is no mention of chronic skin problems either.
(http://www.aaaai.org/patients/publicedmat/tips/foodallergy.stm)
This AAAI publication also states "An allergist/immunologist is the best qualified
professional to diagnose food allergy." ...Not a nutritionally trained naturopath. Also, though IgE blood testing may eventually provide essential information, initial "Diagnosis requires a carefully organized and detailed assessment of the problem" rather than just sending away a blood sample for testing. --Which, incidentally, doesn't sound like the Naturopath is treating the "whole" person, does it?

Dras


PASTED FROM THE TEXT:
> I have been reading the 2001 version of the
> middle-school textbook
> _Holt Science & Technology: Life Science_. This
> book, issued by
> Holt, Rinehart and Winston (one of the four
> companies that produce
> most of the schoolbooks used in the United States),
> includes
> several feature articles that appear under the
> rubric "CAREERS" and
> that purport to tell students about occupations that
> supposedly have
> something to do with science. The "CAREERS" article
> on page 652
> is devoted to promoting naturopathy. Here is the
> material that Holt
> presents:
>
> Immediately under the "CAREERS" rubric we see a
> photograph
> of a woman who is equipped with a stethoscope.
> Under the
> photo we see the caption "NATUROPATHIC PHYSICIAN"
> and this bit of text:
>
> Dr. Stacey Kargman of Tucson, Arizona, is a
> doctor of
> naturopathic medicine (NMD), commonly
> referred to as
> a naturopath. An NMD has similar training to
> an MD but
> is less likely than a traditionally trained
> doctor to use
> prescription drugs or surgery to treat a
> patient's
> symptoms. Naturopaths tend to look for a
> natural way
> to treat a patient, using drugs or surgery
> as a last
> resort. Dr. Kargman tries to strengthen her
> patients'
> immune systems by focusing on things like
> nutrition.
>
> Then comes a longer run of text:
>
> Dr. Kargman attended the Southwest College of
> Naturopathic Medicine, where she studied all
> the
> sciences a medical doctor would study -- like
> biochemistry, anatomy, pharmacology, and
> physiology. Beyond the standard medical
> school
> sciences, naturopaths spend an additional
> four years
> studying subjects like botanical medicines,
> homeopathy,
> acupuncture, counseling, and nutrition.
>
> [boldface subhead] The Keystone to Good
> Health
>
> Many naturopaths believe that nutrition is
> the keystone to
> good health. "Most MDs don't talk to their
> patients about
> their diets," Kargman explains. "I'm in a
> position to talk to
> them about what they eat and how it may be
> affecting their
> health. Food allergies can cause an immune
> reaction in the
> body -- anything from depression to skin
> problems to
> migraine headaches. Even though I can
> prescribe
> prescription medications, I usually defer to
> MDs when it
> comes to prescription medications."
>
> Dr. Kargman treats many HIV and AIDS
> patients. She
> encourages these patients and others who need
> prescription medications to work with their
> medical
> doctor and their naturopath at the same time.
> That way,
> patients get the best care.
>
> [boldface subhead] A Fulfilling Career
>
> Dr. Kargman says the best part of her work
> is making
> people feel better. "Someone might come to
> me and
> say they have terrible migraines that they
> can no longer
> live with and that they've seen every doctor.
> After
> examining them, I might be able to tell them
> something
> as simple as, 'Stop eating wheat.' The
> simplest thing can
> change someone's life. . . It's not like
> putting a bandage
> on it. It's fixing the cause of the
> problem."
>
> Next, another photo of Stacey Kargman, with this
> caption:
> "Stacey Kargman, NMD, tries to treat the patient as
> a whole."
>
> In the teacher's edition of Holt's book, page 652
> also carries
> a "Background" item for the teacher:
>
> One kind of sensitivity involves what are
> called IgE
> antibodies. These antibodies engender an
> immediate
> reaction. For example, when a person who is
> allergic
> to strawberries eats a strawberry, and a few
> minutes
> later that person breaks into hives or
> notices that he
> or she has a swollen, irritated tongue, that
> is an IgE
> response.
>
> To help establish which foods are problematic
> for
> someone, naturopaths such as Kargman rely on
> specialized blood tests. After taking blood,
> the
> naturopath will send it to a lab, where it is
> exposed
> to different substances and tested for
> reactions. Once
> a sensitivity has been discovered, a patient
> can avoid
> the foods that have a negative impact on his
> or her
> immune system.

Girl in Utah dies under Chiropractic care

I have not heard about this story. Nevertheless, I agree with what's been said by the list so far, and I'm always full of comment.

Good Samaritan laws don't usually apply to allied health professionals, maybe even when they are the mother. I've been out of clinical practice for 8 years, but still keep up my ACLS. Not to make any assumption or accusation, but, I believe that any
nurse must distinguish between nursing practice, and the practice of religious faith. Even when done at the same time (c'mon, all you clinicians have prayed on
the job.)

It's terrible a girl has died. And frightening to think it could have been prevented. It is hard to see that something good can come from prosecution when
seen from the Bundy's point of view. And, I suppose it's easy to reciprocate what's perceived as a personal attack on religion-based values.

But I disagree with the apparent bold play of the religion card by the website, and the personal attacks against the prosecutor. They are distracting and as yet unvalidated. I would caution anyone following this case to not confuse presentations of some aspects of perhaps Mormon-based culture in Utah Valley with formal LDS Church position or doctrine. Get the facts at LDS.org.


From the website http://www.therachelbundystory.com

"Unfortunately, as the Bundy’s have been consulting with the professionals they have learned that they are only one of the many families that are being attacked in a very similar manner. We all know that the family is under attack in the world now days, but the Bundy’s never fathomed it would happen to them and they are appalled at how often this same sort of thing happens. Let’s realize that the time to take action is NOW, not just for the Bundy family, but for the many others out there suffering the effects of this sort of abuse."

Soil nutrients are being depleted?

> It has been said that "Over the past century or so it [soil] has become so deprived of valuable nutrients that very little food has much more than trace amounts of the vitamins and minerals it once had."



I grew up on the farm, and I thought this was one of the most nonsensical things I've ever heard -next to the whole "organic foods" thing.

I googled the terms for some of the practices we did to counter soil nutrient depletion and came up with this very nice document from Ohio State University:
http://southcenters.osu.edu/soil/n_cycle.htm

The first part of the paper talks about the essential nutrients food crops need to grow, and how they occur and are used in the soil. Toward the end talks about
the ways farmers maintain nutrients in the soil.

Soil depletion due to overuse (both farming and livestock) has been a brier in the advancement of civilization since ancient time. It's hypothesized that soil depletion paid a significant part of civilization decline in ancient central America. I'm sure there are hundreds of other documented historical examples (like the "dust-bowl" in American history.) The Law of Moses had the "the Sabbath Year" where they let their farmland sit dormant every seventh (or eighth) year. That was good for the soil, whether they realized it or not. But, it's only been in modern
times that humankind has the scientific understanding and ability that enables us to use the land year-after-year.

One simple observation is that if there are not enough nutrients in the soil for the food, rather than produce food that is deficient in nutrients, the soil won't produce the food at all.

Much of the organic movement is based on misconception and lies generated by those with a stake in the creation of a market-share. This makes it hard to find the pearls of truth within it. Nutrient management can go too far, as when it sets us at risk for mad cow disease. Or, when we ingest the hormones and insecticides intended for our food, not us.

dras

"Road Rage" is a disease

> The Archives of General Psychiatry has discovered a
> new disease:
> "intermittent explosive disorder" that makes people
> lose control when they
> become angry and accounts for road rage. The average
> sufferer has 43 attacks
> during a lifetime, resulting in $1359 in property
> damage. They estimate that
> 16 million Americans have it. Most sufferers also
> have other emotional
> disorders or drug or alcohol problems and had gotten
> treatment for them, but
> only 28% had ever received treatment for anger.
>
> In my opinion, this is nonsense. Anger is not a
> disease but an emotion, and
> people who can't control their behavior are having
> childish temper tantrums
> and need to grow up. This is the latest in a long
> series of attempts to
> "medicalize" normal aspects of human behavior, and
> is reminiscent of the
> Twinkie defense. It is quackery to persuade people
> they have a disease and
> are therefore not responsible for their own
> behavior.
>
> Harriet Hall, MD



PLoS Medicine open access journal
(http://medicine.plosjournals.org/perlserv?request=index-html)
recently revisited the issue of how drug companies and others create and sell conditions and diseases in order to build a market for their products. Though
surrounded by what passes for detailed scientific credibility, the entire presentation often boils down to being no more meaningful than what you'd see on a
self-assessment nutrition survey on a vitamin-seller website.

For years I have followed the insurance coverage for rehabilitation associated with children with "special needs." If anyone wants to be in the very thick of
controversy regarding emotions, behaviors, and disease, welcome to that world.

Playing devil's advocate, why can we more readily excuse the behavior in a child or adolescent and diagnose them with a "special need" and not hold an adult to the same standard? If my child is labeled "developmentally delayed" in some aspect of maturation and qualifies for medication and rehabilitation because he bites his sister and bangs cans together at the supermarket, why can't we do the same for Uncle
Charlie when he talks back to police officers and pops the clutch at every stop light?

Health Policy: The Dartmouth Atlas Project gets it wrong

Big, big news in the world of national health policy is the release of this data and report:

http://www.dartmouthatlas.org/press/2006_atlas_press_release.shtm

The Dartmouth Atlas Project studied the records of 4.7 million Medicare enrollees who died from 2000 to 2003 and had at least one of 12 chronic illnesses. The database is based on Medicare claims data for more than 4,300 hospitals in 306 regions. Using this database, researchers compared every region in the country to three regions that provide high-quality/low-cost care: Salt Lake City, Utah,
served primarily by Intermountain Health care; Rochester, Minn., served largely by the Mayo Clinic; and Portland, Ore., the largest and most metropolitan region in a state that has made improvement in end of life care a public policy goal.

The study points out that Salt Lake City, Utah, Rochester, Mn., and Portland, Or. are the high quality / low cost winners. The researchers of the data present the case that Salt Lake City and Rochester are dominated by Integrated Health Care markets, and Portland has taken (unstated) initiatives to improve itself in end of life care, and these are why these communities became the winners.

However, the data cannot clearly make this assertion. The limited data points collected versus the huge numbers within the population studied will naturally
leave broad gaps in detail about individual populations. These missing details can epically influence what we may otherwise understand from the data that was collected.

There will be other unique similarities not addressed in the study data that these three communities share within their population didactics compared with the rest of the nation. Perhaps there is a predominant ethnicity, family make-up, economic health, or local cultures or traditions that impact the quality / low cost of health care as much or more than the factors the researchers present.

The researchers state that a fundamental problem that contributes to both overspending and worse outcomes is that most acute care hospitals have become first-line providers of services to chronically ill elderly people, whose care would be better managed, safer and less expensive outside the hospital setting.

EMTALA and ERISA legislation essentially prevents even Integrated health systems in Salt Lake City and Rochester from directing sick people away from acute care. Also, if Medicare benefits, hospital admission criteria, and reimbursement methodology are
essentially the same across the country, how do the health care systems in the winning communities influence where or how Medicare beneficiaries go about
getting their care?

The researchers state that there are no recognized evidence-based guidelines for when to hospitalize, admit to intensive care, refer to medical specialists
or, for most conditions, when to order diagnostic or imaging tests, for patients at given stages of a chronic illness. Because there are not any of these formal guidelines, two factors drive decisions:

1. Both doctors and patients generally believe that more services - that is, using every available resource such as specialists, hospital and ICU beds, diagnostic tests and imaging etc. - produces better outcomes.

2. Based on the assumption that more is better, the supply of resources - not the incidence of illness - drives utilization of the services. In effect, the supply of hospital beds, ICU beds, and specialty physicians creates its own demand, so areas with more resources per capita have higher costs per capita.

McKesson Interqual (reg TM) or other such written evidence-based processes and guidelines are in place, and are being used nationwide. I can't imagine that
Salt Lake City, Rochester, or Portland were, or are, any further ahead, or behind, in using such tools than any other US health care community. Additionally, health care is a business nationwide. The the same economic influences are similarly present in the winning communities as elsewhere.

The report speaks clearly to the need to overhaul the way chronic illness is managed - to redirect resources away from acute care and invest in an infrastructure
that can better coordinate and integrate care outside of hospitals, for example home health and hospice care.

I argue that this needed "infrastructure" is not based within the health care delivery system. I am a long-time health care professional in the Salt Lake
City community. There is a predominant strong sense of community here, and a strong sense of family. There is a value system, especially among our Medicare-aged
population, that supports self-reliance and other values. As a home health case manager, my best outcomes were among those with strong family support, and, of course, among those who had planned for their golden years. These chronic-illness folks (with help from family and caring neighbors) managed their chronic illnesses and had prepared plans for what to do when they got sick. The result is a reduced need for acute care facilities and other high acuity care. Their attitudes about their disease and the care they received were, of course, fairly optimistic; hence,
higher quality outcomes are reported.

Contrast this with the chronic illness beneficiary who has no family member who is willing and/or able to help out. With neighbors and community that don't know
or don't care to help out. Who has nurtured the expectation that every level of health care is an entitlement, and who has come to depend on government for their essential domestic as well as health care needs.

I'd be willing to bet that the 3 winning communities are dominated by an educated working class, who still adhere to system of family and community values. Ironically ill beneficiaries have someone checking on them daily, their medications are followed and med-boxes are filled weekly. A responsible person accompanies them to doctor appointments and makes sure their domestic needs are met. And when the time comes, Hospice is served in the home by loved ones. Compared to other US metro areas, they have avoided the degree of societal sickness that fosters a dependence on
government programs. Their health system is not better managed than elswhere in the nation, but the system of values within the family and neighborhood is comparatively strong and intact.

The researchers of the Dartmouth Project do our society and collective health care community a diservice by falsely blaming the health care system itself for high costs and low perceived quality of care. The true blame rests primarily with the
individual. Each of us who do not accept the responsibility to watch out for the aged, chronically ill within our own families and neighborhoods. Each of us who do not plan for our own future health care needs. Each of us who do not foster a sense a values including self-reliance in our own children and communities.

Dale