Time for a vacation blog. I’m on vacation this week, and I can’t help noticing all the ads in the local paper for various scams. Are pseudoscience and hoaxes are a necessary part of our tourism industry? People seem to enjoy being taken on ghost tours and trying out various sham treatments at resort spas, and buying whatever bogus “lucky” artifacts the locals are selling. But today’s post is prompted by a recurring back injury that I aggravated this week. It’s slowly getting better, aided by ibuprofen, but there are plenty of hucksters here who would love to give me a spinal “adjustment” to cure my pain – or so they claim in the local newspaper.
No thanks, I’ll stick with ibuprofen and rest. Chiropractic is, in the words of a recent book, “the greatest hoax of the century.” (See the book by L.A. Chotkowski at Amazon.com.)
Perhaps I should be amazed that chiropractic still flourishes after over a century in which not a single study has shown it to be effective. One reason is that chiropracters are numerous and well-organized – the reviews of Chotkowski's book on Amazon.com are mostly negative, and many are likely written by chiropracters. (If any of them read this blog, I’m sure I’ll get some similar comments.) Chiropracters call themselves doctors and use “Dr.” in front of their name, but they do not have medical training and are not M.D.’s. They have their own schools, with woefully low standards, and some of their beliefs are so strange that they would be laughable, except for the fact that these people actually inflict treatments on unsuspecting patients. The “profession” thrives despite the fact that the U.S. Department of Health, Education, and Welfare concluded 40 years ago that chiropractic education is inadequate and that chiropractic theory was not based upon any valid science.
(You want to know one of their wacko beliefs? Well, chiropractic teaches that correcting “vertebral “subluxations” will cure infections, by “boosting the immune system.” I have to put that last phrase in quotes because the very notion of boosting the immune system is questionable – listen to Mark Crislip’s excellent QuackCast for more on that topic. Even more crazy – and harmful – is their opposition to vaccines. A former president of the International Chiropractic Association said in 1993 that he was “a firm opponent of artificial immunization and the antiquated germ theory on which it is based.” Apparently the ICA doesn't believe that bacteria and viruses cause disease. Eventually, Darwinian selection will weed these crazies out of the population, but that will take too long for me.)
The evidence against chiropractice is voluminous, and I won’t try to summarize it here, but Chirobase has a long list of links, including comments on how chiropracters lure people in, on the various scientific studies – all negative – testing the effectiveness of chiropractic, and on the harm that chiropractic can cause. One of the scariest is the risk of stroke from their neck manipulations. Chiropracters claim (of course) that the risk is small, but why take any risk for a treatment that has never been shown to be effective? The risk is great enough that a Chiropractic Stroke Awareness Group has been formed to try to educate the public.
I’ll stick with ibuprofen and rest. Meanwhile, perhaps the local spa can offer me some aromatherapy. Hey, at least there’s no risk of stroke – and it smells nice.
Creationism in a science journal, redux
It’s been a month since the controversy over the stealth attempt to sneak creationism into the well-respected journal Proteomics, but one outstanding question remains unanswered: how did this happen? Several of us have agreed to blog simultaneously today to demand an answer – see these blogs today for new postings:
http://scienceblogs.com/pharyngula (P.Z. Myer’s science blog)
http://pimm.wordpress.com (Attila Csordas’s science blog)
http://larsjuhljensen.wordpress.com (Lars Juhl Jensen’s science blog)
When the article appeared originally (in the online version of the journal), we all pounced on the bizarre claim of a “mighty creator” that appeared in this paper. We also pointed out that the Editor-in-Chief (Michael Dunn) should have noticed that something was amiss from the title alone, which was “Mitochondria, the missing link between body and soul” – and also in the abstract, which claimed to “disprove the endosymbiotic hypothesis of mitochondrial evolution.”
Some astute readers further discovered, after a quick investigation, that most of the article was also plagiarized. In fact, so much of it was plagiarized that I suspect the only original text was the creationist nonsense. The EIC was able to force the authors to retract the article before it appeared in print, and all that remains is this retraction. The journal website says only that the retraction is “due a substantial overlap of the content of this article with previously published articles in other journals.”
The EIC should post more of an explanation at the journal website than this. We’d like to know if
The obvious plagiarism made this easy for the EIC to force a retraction. What if it hadn’t been plagiarized, though – what then? I’d like to see a statement from the EIC repudiating the creationist claim and making it clear that such non-scientific claims won’t be permitted to slip through again.
Finally, I noticed that the Warda and Han article is listed by the journal’s website as the most-accessed article for the past month. Controversy brings attention, obviously, and Proteomics should use the attention to provide a full explanation of the Warda and Han fiasco.
http://scienceblogs.com/pharyngula (P.Z. Myer’s science blog)
http://pimm.wordpress.com (Attila Csordas’s science blog)
http://larsjuhljensen.wordpress.com (Lars Juhl Jensen’s science blog)
When the article appeared originally (in the online version of the journal), we all pounced on the bizarre claim of a “mighty creator” that appeared in this paper. We also pointed out that the Editor-in-Chief (Michael Dunn) should have noticed that something was amiss from the title alone, which was “Mitochondria, the missing link between body and soul” – and also in the abstract, which claimed to “disprove the endosymbiotic hypothesis of mitochondrial evolution.”
Some astute readers further discovered, after a quick investigation, that most of the article was also plagiarized. In fact, so much of it was plagiarized that I suspect the only original text was the creationist nonsense. The EIC was able to force the authors to retract the article before it appeared in print, and all that remains is this retraction. The journal website says only that the retraction is “due a substantial overlap of the content of this article with previously published articles in other journals.”
The EIC should post more of an explanation at the journal website than this. We’d like to know if
- the authors, Warda and Han, snuck their bogus claims into the article after the peer review process was complete,
- the reviewers were sloppy and missed these claims, which were present in earlier drafts,
- the reviewers were incompetent, or
- the article wasn’t reviewed by independent peer reviewers.
The obvious plagiarism made this easy for the EIC to force a retraction. What if it hadn’t been plagiarized, though – what then? I’d like to see a statement from the EIC repudiating the creationist claim and making it clear that such non-scientific claims won’t be permitted to slip through again.
Finally, I noticed that the Warda and Han article is listed by the journal’s website as the most-accessed article for the past month. Controversy brings attention, obviously, and Proteomics should use the attention to provide a full explanation of the Warda and Han fiasco.
Scientist wins surprise victory for Congressional seat
I try not to post on politics - we have enough political bloggers! - but when science and politics intersect, I feel it's appropriate for scientists to weigh in. Coming on the recent bad news about the public's understanding of science concerning autism and vaccines, yesterday saw a surprising bit of good news. In the race for a "solidly conservative" Congressional seat, a scientist - Bill Foster - who is also a Democrat, defeated his strongly favored Republican opponent. Why is this a surprise? Because Foster won the seat in Illinois that was held for the past two decades by Dennis Hastert, who was Speaker of the House until 2006. The Republican in the race was Hastert's hand-picked successor, but the voters had other ideas.
Bill Foster worked for 22 years as a physicist at Fermilabs (the Fermi National Accelerator Laboratory), one of the country's top physics research facilities. A group that I belong to, Scientists and Engineers for America, supported Foster's campaign, but I thought it was a real long shot. His victory is a win for rationalism and science. Bravo to the voters of Illinois for choosing him! Perhaps there is reason for hope for more progress like this in the future.
Bill Foster worked for 22 years as a physicist at Fermilabs (the Fermi National Accelerator Laboratory), one of the country's top physics research facilities. A group that I belong to, Scientists and Engineers for America, supported Foster's campaign, but I thought it was a real long shot. His victory is a win for rationalism and science. Bravo to the voters of Illinois for choosing him! Perhaps there is reason for hope for more progress like this in the future.
Vaccines, autism, and bad science
The controversy over vaccines and autism just took a turn for the worse, due to an unfortunate decision by the U.S. vaccine court. For the first time, the court has awarded compensation to a family who claim their daughter's autism was caused by vaccines. What the court actually decided was that an underlying disorder - in this case a genetic defect in the girl's mitochondria - was made worse by the vaccine shots she received in July 2000, when she was 18 months old. Her parents say that her autism appeared soon after those shots.
This is bad news in several ways. First off, there is still no evidence that vaccines cause autism, despite this case. This is a legal ruling, not a scientific study. But the public won't understand the difference, and it's being reported all over the media (yesterday and today) as "evidence" that vaccines cause autism. I doubt that the public can make the distinction between legal evidence and scientific evidence.
The Institute of Medicine published EIGHT REPORTS examining the supposed link between vaccines and autism. They concluded that "the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism." This conclusion hasn't changed, but court rulings such as the one this week are likely to muddy the waters. Why? Because there are thousands of people out there, many of them parents of autistic children (perhaps some who will reply to this blog) who insist that there is a link.
This all started with some spectacularly bad science by a British doctor named Andrew Wakefield, who published a study in The Lancet in 1998 claiming to have discovered a link between vaccines and autism. This study was later revealed to be fraudulent in several ways, including the fact that the lead author, Wakefield, had recruited children to join the study through a small-time UK lawyer named Richard Barr, whose goal was to file a lawsuit against drug companies that manufactured the MMR vaccine. Wakefield was paid a large sum of money, 435,000 pounds (about $780,000), for consulting work supporting this lawsuit. There are many other blatently fraudelent aspects to this study, summarized in a lengthy article by Brian Deer here. 10 of his 12 co-authors retracted the article when they learned of his fraud.
Wakefield is under investigation for fraud in the UK, but he left long ago and set up shop in the U.S. (How nice that we are so friendly to medical frauds!) He travels the country promoting the vaccine-autism link, and unfortunately he continues to attract attention, much of it positive. He has convinced many parents that he is a hero, fighting the medical "establishment" who just won't see the truth of his claims.
Autism is a tragic illness, and the parents' tales are heartbreaking. Autism usually becomes evident in children at about the same time they get their vaccines, which means that many parents make the understandable - albeit erroneous - inference that vaccines caused the autism. However, study after study has shown that this just isn't true.
Now along comes this vaccine court case that has awarded compensation to the parents of an autistic child based on a supposed vaccine link. There are nearly 5000 other autism cases pending, and if the court starts awarding funds in many of them, the vaccine fund will quickly go bankrupt. This fund has been a tremendous success - it was created by Congress (along with the vaccine court) as a mechanism to compensate people who are, in very rare cases, hurt in some way by vaccines. Vaccines provide a tremendous public good, and in order to be successful, we need to have as many people vaccinated as possible. The vaccine fund sets aside federal money to achieve this public benefit, and to avoid scaring off vaccine manufacturers from producing vaccines (a very real possibility in our overly-litigious society).
The press and many parents are reporting this as a "landmark" case. It may be, but it isn't a good one. The impact on the public, sadly, is likely to be a decreased rate of vaccination among children whose parents hear about this. Most parents aren't going to investigate carefully, and even if they do, most of the media outlets are reporting this as if there is a genuine link that has now been discovered.
If fewer children are vaccinated, the result will be that hundreds, possibly thousands, of children will die from childhood diseases that are currently under control in the U.S. and Europe. Public memory is short, and no one with young children today is old enough to remember the (recent) era when children got ill - and some died - of a host of diseases such as measles, mumps, rubella, polio, and meningitis. I hope we don't have to experience a new epidemic of childhood deaths to re-educate people on the importance of getting their children vaccinated.
This is bad news in several ways. First off, there is still no evidence that vaccines cause autism, despite this case. This is a legal ruling, not a scientific study. But the public won't understand the difference, and it's being reported all over the media (yesterday and today) as "evidence" that vaccines cause autism. I doubt that the public can make the distinction between legal evidence and scientific evidence.
The Institute of Medicine published EIGHT REPORTS examining the supposed link between vaccines and autism. They concluded that "the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism." This conclusion hasn't changed, but court rulings such as the one this week are likely to muddy the waters. Why? Because there are thousands of people out there, many of them parents of autistic children (perhaps some who will reply to this blog) who insist that there is a link.
This all started with some spectacularly bad science by a British doctor named Andrew Wakefield, who published a study in The Lancet in 1998 claiming to have discovered a link between vaccines and autism. This study was later revealed to be fraudulent in several ways, including the fact that the lead author, Wakefield, had recruited children to join the study through a small-time UK lawyer named Richard Barr, whose goal was to file a lawsuit against drug companies that manufactured the MMR vaccine. Wakefield was paid a large sum of money, 435,000 pounds (about $780,000), for consulting work supporting this lawsuit. There are many other blatently fraudelent aspects to this study, summarized in a lengthy article by Brian Deer here. 10 of his 12 co-authors retracted the article when they learned of his fraud.
Wakefield is under investigation for fraud in the UK, but he left long ago and set up shop in the U.S. (How nice that we are so friendly to medical frauds!) He travels the country promoting the vaccine-autism link, and unfortunately he continues to attract attention, much of it positive. He has convinced many parents that he is a hero, fighting the medical "establishment" who just won't see the truth of his claims.
Autism is a tragic illness, and the parents' tales are heartbreaking. Autism usually becomes evident in children at about the same time they get their vaccines, which means that many parents make the understandable - albeit erroneous - inference that vaccines caused the autism. However, study after study has shown that this just isn't true.
Now along comes this vaccine court case that has awarded compensation to the parents of an autistic child based on a supposed vaccine link. There are nearly 5000 other autism cases pending, and if the court starts awarding funds in many of them, the vaccine fund will quickly go bankrupt. This fund has been a tremendous success - it was created by Congress (along with the vaccine court) as a mechanism to compensate people who are, in very rare cases, hurt in some way by vaccines. Vaccines provide a tremendous public good, and in order to be successful, we need to have as many people vaccinated as possible. The vaccine fund sets aside federal money to achieve this public benefit, and to avoid scaring off vaccine manufacturers from producing vaccines (a very real possibility in our overly-litigious society).
The press and many parents are reporting this as a "landmark" case. It may be, but it isn't a good one. The impact on the public, sadly, is likely to be a decreased rate of vaccination among children whose parents hear about this. Most parents aren't going to investigate carefully, and even if they do, most of the media outlets are reporting this as if there is a genuine link that has now been discovered.
If fewer children are vaccinated, the result will be that hundreds, possibly thousands, of children will die from childhood diseases that are currently under control in the U.S. and Europe. Public memory is short, and no one with young children today is old enough to remember the (recent) era when children got ill - and some died - of a host of diseases such as measles, mumps, rubella, polio, and meningitis. I hope we don't have to experience a new epidemic of childhood deaths to re-educate people on the importance of getting their children vaccinated.
Boost your immune system?
Boy is this stupid. Sorry to be so blunt, but when the media makes “news” out of a bunch of non-scientific advice from someone who has no business making health claims, I can’t help myself.
Where this starts: the CNN website today has a link to a story with the headline: “Boost your flu-fighting power.” That link takes you to an article by Ashley Johnson on MyRecipes.com with the subtitle, “Go to battle against colds and the flu by arming yourself with a supply of immune-boosting foods.” Johnson writes: “Even if you missed this year's flu shot, it's still possible to fight off the seasonal cold and flu viruses with a rainbow of tasty dishes.” Sounds yummy!
The article then lists the top 10 “most powerful immune-boosting foods.” The only problem is, none of these foods has been shown to “boost” the immune system at all. In fact, the whole notion of “immune-boosting” is seriously flawed: your immune system isn’t a muscle that you can strengthen by exercise or diet. The only remotely plausible step you can take to strengthen immunity is to get vaccinated. CNN should be ashamed of including this nonsense under their “Health” category.
But I digress. What does MyRecipes.com recommend? Well, they have some truly newsworthy ideas, beginning with #1: drink orange juice! While there’s no scientific evidence whatsoever that this will fight off the flu, the article breezily dismisses that concern with this: “While there's no real proof that loading up on the stuff will help once you've been bitten by the bug, there is power in keeping your immune system in top shape.” Huh? Sorry, OJ, there’s no evidence for this either. See my comment above: the immune system isn’t a muscle. Although orange juice is certainly good for you as part of a balanced diet, and it’s tasty.
I won’t go through the whole list, but here are a few more real howlers. Number 5 is oysters, which don’t have any particular health benefits. Not to be bothered by the lack of evidence, Johnson writes:
Of course chicken soup is on the list, at number 10: “This magical elixir has long held the throne for cold and flu fighting foods. Whether it's the chicken (packed with zinc), the hot temperature (to loosen congestion), or the veggies (loaded with vitamins) that should get the credit, no one's sure.” That’s right, no one’s sure because there's no scientific evidence at all that chicken soup fights colds or flu. But hey, a bowl of hot soup always feels good when you’re miserable, so there’s no harm in eating it. At least it tastes better than oysters.
Every one of Johnson’s top 10 items is linked to a recipe, which at MyRecipes.com is what they’re pushing, of course. I have no objection to that – who doesn’t like good food? But I do object to her bogus health claims (and by the way, Johnson appears to have no medical or scientific training – she’s a food writer, and not even a good one). “Instead of a pill,” she argues, “a balanced diet of immune-boosters and bacteria balancers just might help you ride out the final months of winter's chill.” Bacteria balancers? What the ...? This kind of fluff is so stupid that I almost feel guilty ridiculing it. Almost, but not quite.
Where this starts: the CNN website today has a link to a story with the headline: “Boost your flu-fighting power.” That link takes you to an article by Ashley Johnson on MyRecipes.com with the subtitle, “Go to battle against colds and the flu by arming yourself with a supply of immune-boosting foods.” Johnson writes: “Even if you missed this year's flu shot, it's still possible to fight off the seasonal cold and flu viruses with a rainbow of tasty dishes.” Sounds yummy!
The article then lists the top 10 “most powerful immune-boosting foods.” The only problem is, none of these foods has been shown to “boost” the immune system at all. In fact, the whole notion of “immune-boosting” is seriously flawed: your immune system isn’t a muscle that you can strengthen by exercise or diet. The only remotely plausible step you can take to strengthen immunity is to get vaccinated. CNN should be ashamed of including this nonsense under their “Health” category.
But I digress. What does MyRecipes.com recommend? Well, they have some truly newsworthy ideas, beginning with #1: drink orange juice! While there’s no scientific evidence whatsoever that this will fight off the flu, the article breezily dismisses that concern with this: “While there's no real proof that loading up on the stuff will help once you've been bitten by the bug, there is power in keeping your immune system in top shape.” Huh? Sorry, OJ, there’s no evidence for this either. See my comment above: the immune system isn’t a muscle. Although orange juice is certainly good for you as part of a balanced diet, and it’s tasty.
I won’t go through the whole list, but here are a few more real howlers. Number 5 is oysters, which don’t have any particular health benefits. Not to be bothered by the lack of evidence, Johnson writes:
“Long hailed as an aphrodisiac ... oysters also offer a hearty punch of calcium, niacin, and iron. But the reason these slippery suckers have gotten the good date-night PR is their powerful zinc levels. Zinc, said to help fight off colds by boosting the production of immunity-boosting white blood cells, also controls progesterone levels, which can alter the libido.”Look at how that first sentence is written: Johnson repeats the common but utterly unfounded claim that oysters are an aphrodisiac, and says they “also” offer other benefits – with that one word, “also,” she makes it clear she agrees with the aphrodisiac claim. What about zinc? Well, there was some weak evidence that zinc might help reduce the severity of colds, but the evidence has not held up to further, more careful scrutiny. So if you like oysters, go ahead and eat them, but don’t expect any health benefits. As for me, I’d rather leave the slimy suckers on the bottom of the bay where they belong.
Of course chicken soup is on the list, at number 10: “This magical elixir has long held the throne for cold and flu fighting foods. Whether it's the chicken (packed with zinc), the hot temperature (to loosen congestion), or the veggies (loaded with vitamins) that should get the credit, no one's sure.” That’s right, no one’s sure because there's no scientific evidence at all that chicken soup fights colds or flu. But hey, a bowl of hot soup always feels good when you’re miserable, so there’s no harm in eating it. At least it tastes better than oysters.
Every one of Johnson’s top 10 items is linked to a recipe, which at MyRecipes.com is what they’re pushing, of course. I have no objection to that – who doesn’t like good food? But I do object to her bogus health claims (and by the way, Johnson appears to have no medical or scientific training – she’s a food writer, and not even a good one). “Instead of a pill,” she argues, “a balanced diet of immune-boosters and bacteria balancers just might help you ride out the final months of winter's chill.” Bacteria balancers? What the ...? This kind of fluff is so stupid that I almost feel guilty ridiculing it. Almost, but not quite.
Resistance is inevitable
Today’s Washington Post has an article by David Brown reporting on an alarming upsurge in the number of cases of tuberculosis that are resistant to some or all known antibiotics. The headline is that 5% of TB cases are now drug resistant, but the substance is much more alarming. In some regions of the former Soviet Union, drug-resistant TB accounts for 20% of cases, and the true rates might be even higher. These TB strains are not only drug resistant, but deadly: as David Brown reports, the death rate in untreated cases is “close to 100 percent.” 100% mortality is truly frightening.
Why should we worry about this? Well, there are (at least) two reasons:
1. Spread is inevitable. The countries of the former Soviet Union, where these new TB strains are spreading, are no longer isolated from the rest of the world. Humans travel freely among all countries now. And tuberculosis doesn’t make everyone sick – some people can carry it without knowing that they have it. A major TB outbreak could pop up anywhere before we even realize that a carrier has been spreading the disease.
2. Resistance is inevitable. The Borg on Star Trek: TNG liked to warn their targets, “resistance is futile.” In the world of infectious diseases, though, we have a different saying, thanks to Mark Crislip of Quackcast: resistance is inevitable. What that means is that whenever we come up with a new drug, the bacteria or viruses will inevitably develop resistance to it. For the bacteria, resistance is not futile – it’s an extremely effective way to survive. Multi-drug resistant (MDR) TB, which is resistant to the two most commonly used drugs, rifampin and isonizid, is spreading rapidly. Even worse, a new strain of “extremely” drug-resistant (XDR) TB is resistant to those two drugs plus two others, leaving basically no effective means of treatment.
I was surprised to read in Brown’s article that Mario Raviglione, the head of the WHO’s tuberculosis department said that the rate of multi-drug resistant infections “wouldn’t go over 10 percent.” I guess he’s much more optimistic than I am. I wouldn't be surprised if the rate went to 50% or even higher. Whenever we get a new drug, we use it – of course. But when we use it, we begin the evolutionary process of selection in favor of drug-resistant strains. Unless you can make sure that every patient is completely cured – an unrealistic goal – then some amount of resistance will begin to emerge.
In the 19th and early 20th centuries, TB was a scourge of all civilized countries. Countless millions, including many famous authors and artists, died of TB (including Balzac, the Bronte sisters, Camus, Kafka, Keats, Thomas Wolfe, and many more). Most of us probably assume that era will never return – but it might. What can we do to prevent it? We need better surveillance of the TB strains now spreading, and even more urgently, we need new drugs. I think that our government(s) should develop these drugs, rather than leaving it to the whims of private companies, but that puts me in a rather small minority here in the U.S. Our best hope for new drugs right now is probably the Gates Foundation, which has made combating TB and malaria its top two priorities. In a much smaller way, everyone can do their part by warning others against the mis-use and overuse of antibiotics. We can’t stop the spread of drug resistance, but at least we can slow it down.
Why should we worry about this? Well, there are (at least) two reasons:
1. Spread is inevitable. The countries of the former Soviet Union, where these new TB strains are spreading, are no longer isolated from the rest of the world. Humans travel freely among all countries now. And tuberculosis doesn’t make everyone sick – some people can carry it without knowing that they have it. A major TB outbreak could pop up anywhere before we even realize that a carrier has been spreading the disease.
2. Resistance is inevitable. The Borg on Star Trek: TNG liked to warn their targets, “resistance is futile.” In the world of infectious diseases, though, we have a different saying, thanks to Mark Crislip of Quackcast: resistance is inevitable. What that means is that whenever we come up with a new drug, the bacteria or viruses will inevitably develop resistance to it. For the bacteria, resistance is not futile – it’s an extremely effective way to survive. Multi-drug resistant (MDR) TB, which is resistant to the two most commonly used drugs, rifampin and isonizid, is spreading rapidly. Even worse, a new strain of “extremely” drug-resistant (XDR) TB is resistant to those two drugs plus two others, leaving basically no effective means of treatment.
I was surprised to read in Brown’s article that Mario Raviglione, the head of the WHO’s tuberculosis department said that the rate of multi-drug resistant infections “wouldn’t go over 10 percent.” I guess he’s much more optimistic than I am. I wouldn't be surprised if the rate went to 50% or even higher. Whenever we get a new drug, we use it – of course. But when we use it, we begin the evolutionary process of selection in favor of drug-resistant strains. Unless you can make sure that every patient is completely cured – an unrealistic goal – then some amount of resistance will begin to emerge.
In the 19th and early 20th centuries, TB was a scourge of all civilized countries. Countless millions, including many famous authors and artists, died of TB (including Balzac, the Bronte sisters, Camus, Kafka, Keats, Thomas Wolfe, and many more). Most of us probably assume that era will never return – but it might. What can we do to prevent it? We need better surveillance of the TB strains now spreading, and even more urgently, we need new drugs. I think that our government(s) should develop these drugs, rather than leaving it to the whims of private companies, but that puts me in a rather small minority here in the U.S. Our best hope for new drugs right now is probably the Gates Foundation, which has made combating TB and malaria its top two priorities. In a much smaller way, everyone can do their part by warning others against the mis-use and overuse of antibiotics. We can’t stop the spread of drug resistance, but at least we can slow it down.
Lament from a flu outsider
Dear CDC,The news this week has been filled with reports of a new flu outbreak around the country. My own university has reported over 400 cases, the worst flu season in many years. Those of you who’ve followed this blog may remember that I predicted this would happen in a November blog post. Part of me wanted to be wrong – I didn’t want a bad flu season – but it turns out I was right.
Oh, if only you wouldn’t spurn me. Don’t you know we both want the same thing? Like you, I want the flu vaccine to work. I want everyone to get their flu shots. I know I’m an outsider, but maybe you could at least listen to my ideas? Is it my fondness for sequencing over serotyping? Or maybe my insistence that you should share all your sequencing data? Why not invite everyone to the party? It’d be much more fun. And think of all the flu viruses we could keep out.
Fondly,
Steven
The CDC had a press conference on Friday (15 February) acknowledging that the vaccine was a bust, but they didn’t explain why they’d chosen an old strain of H3N2 (from 2005!) for inclusion in the vaccine. As I explained in November, they already knew it was a bad choice – or they should have – last year.
So what is happening out there? Well, from the CDC website we can see results from the week of Feb 3-9 (the most recent data they have) summarized in this figure:
The red cases are H3N2, which are clearly dominant. The blue cases are H1N1 (the vaccine works against that strain!), and the yellow are influenza A but not typed as H3 or H1 – most of these are probably H3N2 as well.The raw numbers for the season tell an even more compelling story of vaccine failure. Out of 65 H3N2 viruses that the CDC has genotyped, only 9 (14%) matched the vaccine strain. The remaining 91% are a new strain, for which the vaccine either limited or zero efficacy. (The CDC doesn't say when those 9 cases appeared, but I'm betting they were early in the season.) A newer, 2007 strain, which they have decided to put into the vaccine for the Southern hemisphere for the 2008 season, should provide far better protection. (The flu season down under occurs in their winter – our summer – so it peaks 6 months after ours, and they can use a newer vaccine.) We’ll get the newer strain in our vaccine next year too, assuming the FDA agrees when they meet next week to decide. Unfortunately it’s too late for this year.
Here’s a proposal to the CDC: release all the sequence data you have from this year’s strains right away, and put it in GenBank. And release any other data you use to pick the strains that go in the vaccine – and do this every year. Then everyone can look at it and double-check your decision about which strain should go in next year’s vaccine. Sure, it might be annoying to have other scientists checking your work. But wouldn’t it be great if researchers – including students – all over the world could look at the flu data and make their own predictions about what strain would dominate next season? The science would only get better.
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