One week of schlepping bags across the Upper Mazaruni area of Guyana’s rainforest, as part of the latest Ve’ahavta medical team, and I’m finally in the Georgetown airport, awaiting my flight home… just in time for whatever Hallowe’en festivities await.

Since internet connectivity was not available in the interior, I saved up my blog posts.  Have at ‘em!

Oct 22

What a charmed life I lead.  Hours ago I was hunched in front of a computer in frigid Toronto, and now I’m… hunched in front of a computer inside a tent in the Amerindian village of Waramadong in the remote interior of Guyana.

Arriving in Georgetown early morning, I hightailed it to Ogle airport to catch a bush plane to Kamarang, which is a remote community near the Venezuela border.  The plane only had two passengers: me and a young man who was transporting a birthday cake. Yes, a birthday cake.

Here’s a pic of the view from my seat on the bush plane, of the rainforest below:

Here’s a pic of the front of the plane’s cockpit.  My mobile’s camera is able to detect the propeller:

There I met up with my contacts who filled both my hands with bottles of Guinness and loaded me onto a dug-out canoe.  So there we were, tipsy on beer, making our way down a jungle river, stopping only to piss.  Weird life.

Over for now.

Oct 23
Jawallah Village

Day 2 of the current expedition to Guyana.  My good friend and strong-like-ox team leader Bekkie departed for Canada today.  We took a long leisurely boat ride to Kamarang village to drop her off at the airstrip before continuing on another two hours to Jawallah.

Last night was sort of interesting.  After traveling for close to 24 hours straight, I bedded down in a palatial tent inside the Waramadong health centre, with my new compatriots fast asleep in adjacent tents.

I was awakened in starts, first by the lovely growl of distant howler monkeys, and then by the less than pleasant cantankerous outbursts of a drunken and profane man, whose voice indicated that he was inside the health centre.  I could hear the snores of my colleagues.  Why weren’t they awakened by this man?

I would drift back to sleep, quite confused, only to be awakened by a long string of very loud four letter words.  I had the presence of mind to reach for my knife, never far from hand.  But being semiconscious and very confused, I never found the wherewithal to get up and investigate.  Was it a dream?  Heck, I’d been in Ottawa earlier that day, and now I was in a tent in the South American jungle, possibly hearing a drunken AmerIndian man wander in our midst.  I was confused and dazed.

In the morning I learned that the drunk had been our boat captain, who was engaged in either an inebriated argument with persons real or imaginary, or having night terrors.  I lean to the former.  A weird first night.

After exhausting ourselves lugging our bags about 200 metres from the boat landing to our tenting location, we relaxed into a delicious swim in the black waters.  (For me, more like a splash than a swim… I can’t bring myself to swim in river waters that are too black to see more than an inch beneath the surface.)

Afterwards, I was overcome with a desperate desire for carbonated pop. A can of coke goes for US$3 here.  A colleague bought me an ice cold sprite, and I cherished it like my firstborn.

The evening ended with us lazily enjoying the full moon reigning over the Kamarang jungle river.  A tropical thunderstorm forced us back to our tents.  A long, hopefully sleep-filled night awaits.

Oct 24
Jawallah village

The village is nestled in a gorgeous section of the interior, with a moonlit river snaking between two banks of somewhat well developed human settlement.  The problem is that, frankly, people suck.  The young men seem perpetually drunk. Sexual assault is highly prevalent. Even the women of our team, usually deemed beyond such unwanted attentions, suffer vile comments and innuendos.  Indeed, one of our doctors witnessed what seems to be a rape attempt within the confines of our very clinic.

I’m afraid to say that my impression of Jawallah, despite its gorgeous children and friendly villagers, is one of drunken louts and sexual predators.

Nonetheless we had a productive clinic today, with about 70 patients seen.  One in particular ate up a fair amount of clinical time: an older man needing a circumcision after suffering an inflamed foreskin.  Not the most pleasant thing to watch.

I find myself strangely worried about some water purification kits I gave out to scores of villagers.  I gave strict instructions for one packet of the agent to be used for 10 litres of water…. but I’m worried that someone might create an over-concentrated batch as drinking water, and end up feeding his children insufficiently diluted bleach!

I think the fears are unfounded.  But I’m a worrier.

Off to sleep now… in a tent on concrete, as a dying generator and howling dogs scorch the background soundscape.

Oct 25
Kamarang

A half day clinic in Jawallah was instructive.  The day began with a house call to a house down the way, where an elderly woman had split her knee open after a bad fall.  Doing triage, I had my joyous fill of wrestling with adorable AmerIndian kids fighting to avoid having their temperatures taken.

I’ll never forget one particularly adorable 2 year old girl with undiagnosed Down’s Syndrome and partial paralysis resulting from a stroke.

Heartbreaking, yes, but as one of our doctors reminded me, each child is –as cliched as this may sound– a source of hope.

We took down our clinic and went off by boat to Kamarang, transporting two patients in the process, one of whom had to be carried the agonizing 60 feet or so of stairs going straight up from the boat landing to the health centre.

And here we are now, camped out in a local guest house.  The rest of the team is bedded down in tents on the guest house grounds.  I opted to pay the $20 for a private room and a bed.  Hey, I’ve got nothing to prove.

Tomorrow, off to Bartica…. and a chance to upload these blog posts!

Oct 27

Bartica

It’s 10:30 pm and I’m drunk off my ass.  We’re toasting the early departure of Dr Louis , a fascinating and hardworking man who easily won my respect and affection.

Today was a profoundly interesting day.  We provided a full day of clinical services to the inmates of the Mazaruni Prison (for long term offenders) and of Sibley Hall (for first time offenders).

The prisoners were uniformly respectful and pleasant.  A brief altercation arose after someone called someone else an “Auntie Man”, but otherwise things went swimmingly.  We saw 110 patients, much more that we would have seen in a community clinic, due to the regimented nature of the prisoner consults.

Some observations…

I don’t ever intend on being in a Third World prison.  Please Zod, never.

Almost everyone had a low back pain complaint.  Our physiotherapist had to see them four at a time.  Increasingly, I am convinced that the fastest growing global health needs are for psychiatric counseling and physiotherapy.

There were many cases of men who thought they had TB, but who just had migraines.

There were many cases of men with headaches and coughs who likely had TB.

There were a great many cases of swollen testicles (a result of undiagnosed STI perhaps) and at least one likely case of testicular cancer.

Language continues to be a barrier in providing services.  Yes, everyone speaks English, but not all English is alike.

I’d like to give more anecdotes, but I don’t think it would be ethical.  Suffice it to say that this visit has been downright fascinating, and certainly justifies my participation in this mission, as I hope to write a paper about it all.

Okay, off to bed.  Tomorrow we provide a clinic to the community of Itaballi then do a call-in TV show.

Oct 30

Toronto

So glad to be back in Canada.  The Customs dude caught me bringing back more rum than  what I am allowed, but let it pass since my mission had been a humanitarian one.  See, kids?  Volunteering pays off!

I didn’t mention than on our last day in the frontier, as we took a boat ride toward the city, we passed a bloated body that had been washed up on the beach.  This is officially the 4th random dead body I’ve seen in my various trips to Guyana.  What is it about this place?

Awaiting my flight to Ottawa now, and a frantic search for a Hallowe’en costume.  I have soooo much work to catch up on, and now I can add getting a TB skin test.  I’m concerned about my exposure, particularly in the Mazaruni prison.

In addition, I have a special treat for my students on Monday.  First they get to see my various bites.  Here’s a pic of my ankle:

Then they get to watch me take my medication for possible intestinal worm infection.  I don’t know that I have worms, but so many of the kids that we saw did have them.  And so many cute little toddlers –whom I was holding while their mothers received treatment– stuck their dirty little hands in my mouth.  There are no toys in my mouth!

Okay, off to get a stiff drink.

Hey, dig the latest produce from my rooftop garden.  I’m a farmer!

Here’s a photo of a little known street behind the Central Reference Library in downtown Toronto:

I get it. Sherlock Holmes was a major literary character, and the street is behind a big building full of books. But what an odd choice for a street name in Toronto! Are there any Canadian literary characters worth celebrating? Actually, I can’t think of any.

More concerning is that City Council chose to celebrate Holmes and not his creator, Sir Arthur Conan Doyle.  Makes me wonder how many Torontonians actually realize that Holmes was fictional, and that Conan Doyle was real.  Hmm.

The last photo I will share with you is essentially a follow-up of my 2007 post called “Abuse of Numbers“.  In that post, I railed against a well-meaning ad by a women’s shelter that presented statistics in such a way that, in my opinion, ended up being propagandistic.  Go have a quick look at that post before continuing to read.  Go.  I’ll wait.

Okay, back?  Cool.  Now check out this ad I saw in a Toronto subway station:

It’s put out by the Canadian Foundation for AIDS Research (CANFAR) and says, “Did you know that 86% of HIV Positive Canadians are male, And 2/3 of boys, aged 15 to 19 are sexually active? You think your kids aren’t at risk? Think again.”

All right, epidemiology fans, who sees the problem with this quote? (Other than the questionable grammar, that is.)

Well, the concept of risk is a touchy thing.  It’s not a lie: everyone is at risk for pretty much everything.  And HIV/AIDS is a serious disease worldwide that needs our attention and resources….

…BUT, the data as presented in this ad are propagandistic because they have been selected for their largeness and their emotional appeal moreso than for their accuracy in representing the true scenario.  It is true that about 86% of Canadian HIV Positive people are male.  CANFAR itself states that about 58000 people are living with HIV in Canada.  Using their 86% statistic, that means that 49880 males are living with HIV.

Note that the ad says “male”, not “men”.  According to the same CANFAR page, “youth between the ages of 15 and 19 account for 1.5% of all reports”.  So atuomatically we see some duplicity in the ad, trying to conflate “male” with “men”, when in fact the thrust of the ad is to warn of youth behaviour.  Yes, I know the implication is that male youths grow up to become men, but I think the propagandistic elements here are obvious.

So, of our 49880 males with HIV, about 98.5% are adults, giving us 49132 cases, to be generous.  Each case is a tragedy that should have been avoided, to be sure.   But 49132 cases, divided by a denominator of  16,332,277 total adult males gives us a prevalence estimate of adult men living with HIV of 0.3%.    Obviously, 0.3% is not as impressive a number as 86%.

But let’s consider the thrust of the ad again: it warns of sexual activity among male youths and the risk of HIV.  Okay, but not all of the prevalent HIV cases were the result of unprotected sex.  Some were the result of drug abuse, or transfusions, for example.  So let’s break down the transmission stats.  It is believed that sex of any kind is responsible for the bulk of HIV cases in Canada, with the bulk of those cases due to gay sex (or as we in the business call it, “MSM” or “Men Who have Sex With Men”).  According to Avert.org, sexual contact constitutes about 44% of cumulative HIV cases over the past 15 or so years.

Using the most recent complete data of 2007, it seems that sex was responsible for 37% of male HIV diagnoses in that year alone, and that includes cases of mixing sex with IV drug use.  Among those, heterosexual contact accounted for 18% of all sex-based cases, or 7% of all adult male HIV cases overall.  And heterosexual contact still remains the most prominent form of sex among Canadian males.  (Looking at cumulative stats from 1985 to 2007, heterosexual contact accounted for 6.2% of all Canadian male HIV cases.)

Overall, then, the prevalence of Canadian males currently living with HIV who likely got it from sex (including sex mixed with IV drug use) is about 44% of 0.3%, or 0.13%.  In my opinion, then, 0.13% more accurately represents the risk of of being sexually active, where HIV is concerned in Canada.

To get even more sticky (no pun intended), the risk of being a Canadian man living with HIV, having contracted it through heterosexual contact, is about 6.2% of 0.3%, or 0.02%.  (Another way to look at it is to divide the 3000 cases of known male HIV cases due to heterosexual contact by the 16 million at-risk male population, which also gives 0.02%).

Obviously, neither 0.13% nor 0.02% are as impressive numbers as 86%.

Lastly, the ad makes a sly connection between a problematic allusion to HIV rates (i.e., 86% of HIV positive cases are male) and sexual activity among young people (i.e., 2/3 of males aged 15 to 19 are sexually active).  The slyness is in not spelling out the connection, which is fraught with issues, many of which are outlined above.  I hope it’s obvious that one particular pitfall really throws a wrench into the ad’s wording: sure, maybe 2/3 of youthful males are indeed sexually active; but are they having risky sex?

Risky sex is unprotected sex.  If the ad-makers knew the proportion who are having unprotected sex, or knew that proportion to be substantial, I assume they would have included that bit of information.  Without it, we are left with the following message: “sex is bad, mmkay?”

Sex is not bad.  Unprotected sex is problematic and probably unwise.  That is all.

So, are sexually active male youths not at risk for acquiring HIV?  Of course they are!  But not nearly to the extent that the misleading ad suggests.

Draw your own conclusions, but I call shenanigans on a very sloppy and anti-intellectual ad campaign by CANFAR.

I already posted this back in November of 2009, but it’s so good it deserves new life…  Last Fall, I was having issues with mushrooms in my houseplants.  Facebook “friend” G.S. documented this development in The Chutney Times:

In other news, statistical gadabout Nasty Nick Barrowman wants y’all to answer this single question.  Seriously, it will take less than 20 seconds to answer, so please click the link.  It’s in the name of science.

I’ve lost count of the number of people sending me links to stories about Prahlad Jani (or “Mataji”), the yogic mystic who claims to have survived for decades without food and water, and who just recently submitted himself to a two-week study by Indian physicians, under the auspices of the Indian military, to validate his claims.  This is not the first time Mr. Jani has made the news, as the Discovery Channel made a documentary about him back in 2006.

Now, I am a scientist.  I declare it so proudly.  But I think many people have a distorted conception of what a scientist is, and, frankly, what science itself is.  Science is not truth, not a body of knowledge and not a set of technologies.  Science is a philosophy and a methodology that assists one in seeking the truth, or at least some approximation of the truth.  For example, science allows us to observe and measure in a rigorous format the falling of a object from the sky to the ground.  From these observations arise theories which are, one at a time, discarded as our methodology systematically allows us to discount them.  The theory that remains is not truth, but merely the best approximation of truth, given the observations available up to that point, and must remain plastic and non-dogmatic as future observations compel us to refine our theories.

The story of Prahlad Jani, then, is not one of science versus mysticism, though many seem eager to promote it as such.  Rather, it is an opportunity to explore our motivations and impulses with respect to our evolving society’s relationship with both rationalism and mysticism, as we all seek some compromise between our spiritual and physical lives.  So let us parse the phenomenon of the Man Who Does Not Eat through the following filters: is it real, is he lying, are the scientists studying him lying, and so what?

Is It Real?

When discussing with my physiotherapist Mr Jani’s supposed ability to live without food and water, she exclaimed, “That’s impossible!”

She is correct, it is indeed impossible –according to our present paradigm of understanding.  In fact, the entire science of biology is based upon the assumption that life is an energetic process that acts to combat the natural state of entropy that exists among all things.  This anti-entropic process is made possible through regular injections of energy, i.e. the eating of food, which contains chemical energy locked within molecular bonds.  To live without the regular ingestion of energy violates the Laws of Thermodynamics.

It has been proposed many times in history that an animal might be able to receive energetic sustenance from a source other than food.  After all, plants convert solar energy into chemical energy through the process of photosynthesis.  Some ocean floor unicellular creatures do a similar thing near lava eruptions, using the heat and light of the geothermal event to fuel their biology.  Within the existing paradigm of understanding, one can conceive of a complex “higher order” animal, like a human, developing a similar trait, however improbable that might be.

Another yogi, Hira Ratan Manek, once claimed, essentially, to be able to photosynthesize.  In fact, every few months a handful of stories about seemingly meta-human individuals pops up in the media.  For example, in 2004, many reputable news outlets reported on the Russian teenager Natalia Demkina, who apparently had x-ray vision.   Demkina has vanished from the news wires, and Manek now makes a living selling his “sun gazing” lectures, CDs and DVDs.

Probably over a trillion people have walked the Earth since the rise of humanity on this world.  The distribution of genetic variability is the crux of evolution, what allows our species to select from a vast menu of mutations in response to whatever environmental challenges present themselves.  This is the nature of natural selection.  Therefore, it is not only unsurprising, but indeed necessary, that extremes of biology be reflected within our diverse species.

For instance, the youngest human mother on record was Lina Medina, a Peruvian girl who in 1938 gave birth to a healthy baby boy when she was only five years old.  It is not typical, expected or even desired for such an extreme genetic tendency toward early puberty to manifest itself, but given the size and breadth of our species, some outliers from the norm will occur.

An outlier, however, is different from a physical impossibility.  To survive without eating, or more precisely without measurable energetic input, is called “inedia“; and inedia, according to our present paradigm of understanding, is impossible.  Inedia is a popular claimed manifestation of this biological outlier phenomenon, particularly among Indians.  Separate from the mostly Western movement called “Breatharianism“, Indian versions of inedia are typically associated with religion.  Mr Jani himself claims that a goddess blessed him as a child, allowing him to live on a magical nectar that flows from a hole in his palate.  (I’m sure he meant this metaphorically, as physical examinations have revealed no such hole.)

It can be argued that a land uniquely beset simultaneously with deep, all-pervading religion and brutal poverty and famine is the ideal breeding ground for religion-based claims of  inedia.  In the fat, wealthy West, claims of living without eating are received with incredulity and some mild curiosity.  In a place where every rice grain counts, to thrive without food is to provide the best kind of hope.  (Perhaps the equivalent in the West would be claims of being able to ingest copious amounts of fatty foods while not exercising and watching hours of TV, without ever getting fat or sick.)

Jainism is particularly well-suited for embracing claims of inedia.  The ancient religion prescribes extreme non-violence as one of its ancient tenets, and features saints who eschewed eating in order to protect the “life force” of the food that would otherwise be consumed.  Not surprisingly, both Jani and Hira Ratan Manek are followers of Jainism, as is Dr. Sudhir Shah, the physician tasked with observing Jani’s extreme fast.

In the Indian paradigm of understanding, then, inedia is not necessarily an impossibility.  Which provides objective truth, then? The Western paradigm or the Indian paradigm?  For that matter, does objective truth really exist?

Is He Lying?

Obviously, we cannot know what lies in the heart of another man.  But approaching the phenomenon from the Western paradigm, we must conclude that the claims of inedia are false, regardless of the data presented.  (More on the data later).

Famed quack-debunker and skeptic James Randi has not yet spoken on the recent news about Prahlad Jani.    But based on his comments about the photosynthesizing yogi, I think it’s safe to assume Randi would call Jani a deliberate liar and faker.  I’m not so distrustful.  Assuming that the inedia phenomenon is not real (and I will give you my conclusions later, don’t worry), it does not necessarily follow that Jani is intentionally fabricating his life story.

Ever meet a vegetarian who gives you a hard time about your burger, then goes ahead and orders a plate of fish and chips?  She is not necessarily a hypocrite, but simply defines “vegetarian” a bit differently than you do: fish don’t count, since they’re a kind of moving vegetable.  It’s an issue of semantics.

My very first yoga teacher was a nut who would preach endlessly about the fall of Atlantis, the Pyramids, aliens, and about his extreme fasts, denying himself food for days to “purge the body and the soul”.  During one of these fasts, I found him sipping a very large tankard of fresh fruit juice.  “Oh this doesn’t count,” he said.  “This isn’t food.”

Similarly, some have claimed that Jani has lived for decades without ingesting a drop of water.  But he gargles daily with water.  He may or may not spit most of it out, but it’s pretty much guaranteed that he’s ingesting or at least absorbing some of it.  Frankly, we don’t know how he defines food, ingestion, eating, drinking or fasting.  This is not a failing on his part, but on the part of those describing and reporting on his phenomenon.

Are The Investigators Lying?

And now we get to the science portion of today’s adventure.  You can access a PowerPoint presentation by Dr Shah, the leader of the investigation on Mr Jani, summarizing the results of the study, on Dr Shah’s website.

I do not know Dr Shah.  By all accounts he is an intelligent, respectable and well trained neurologist with the best of intentions.  The following comment is not directed to him or about him, but rather is for the consumption of the general population.  Ready?  Here it comes: medical doctors are not scientists.  Read that again and remember it, because it will serve you well in life.

I have lost track of the number of times I’ve had to rebut very unscientific comments made by physicians about the nature of scientific research.  Medical doctors employ the products of science, its technologies and conclusions, in their everyday practices.  A good medical school will have also taught its graduates basic epidemiology and the foundations of research, but nothing very advanced.  Having lectured in three respectable North American medical schools, let me assure you that medical schools do not produce scientists.  That is not their goal, and that is not what society needs them for.  Medical schools produce practitioners of medical knowledge.

Of course, there are many physicians who are also excellent scientists.  But they have taken the time to acquire the necessary skills to do so at an acceptable level.  My point is that one should always be skeptical of when a non-specialist makes a conclusive statement about something in which he or she is not an expert.  For example, I wrote about this article back in 2007.   A physician said something about the calculable risk of infection due to an STI.  My argument was that the statement was one requiring epidemiological expertise, not medical expertise.

Thus, unless the expertise to design a rigorous, testable scenario is demonstrated, I am not sanguine about Dr Shah’s team’s ability to produce convincing data, vis-a-vis Mr Prahlad Jani.

Even on its surface, there are questions of accountability and bias that go unaddressed.  Dr Shah’s eagerness to “detect an effect”, as we say in my profession, is evidenced on his website, where he expounds the virtues of Jain philosophies.  This in and of itself is not a failing, but does need to be considered.  It is made worse by the revelation that India’s leading debunker of extraordinary paranormal claims, Sanal Edmaruku, was prohibited from observing Dr Shah’s study of Jani.  According to Edmaruku:

“I asked to be allowed to send an independent team to survey the room where this test is taking place, but I was repeatedly turned down…”

“…Dr. Shah has been in charge of three similar investigations over the past ten years, and he has never allowed independent verification.”

This is not the path of rigorous science.   Let us not jump to the conclusion that Dr Shah is intentionally skewing his data.  Rather, I would accept that his personal drive to observe evidence of inedia firsthand may have biased his development of a suitable protocol for proper testing of Jani’s claims.

So what are the methodological flaws implicit in Dr Shah’s attempts to test Prahlad Jani’s claims of inedia?  These are hard to gauge since I can find no thorough description of the protocols or the degree to which they were adhered.  However, based on the skeletal bits of information gleaned from news reports and from Dr Shah’s own website, here are some areas of discontent for me:

• Invasive procedures were disallowed, which means no continuous intravenous monitoring was performed.  According to the data on Dr Shah’s website, biochemical reports (presumably using extracted blood) were performed every fourth day.  Over a 10 day testing span, this amounts to 2-3 tests only.  What many would have liked to have seen is real-time –or at the very least daily– measurements of key indicators, such as blood glucose levels.  If there was any cheating (e.g., adding sugar to the gargled water), it would have been easy to have done so on any of the 7 non-testing days.

• The study was run for a mere 10 days.  It is very possible to live without food for 10 days or more.  For most of us, this would not be pleasant.  But for a disciplined yogi capable of slowing his metabolism through meditation, this is well within the realm of known possibility.  An Australian nutritionist commented that:  “So even though the yogi might be able to slow his metabolism right down so that it might only be 20 or 30 per cent of normal … there’s still going to be a point, about 100 to 120 days without food – and without water, it might be 24 days – that he’ll die.”  Since Jani claims to have lived for decades without eating, why was the study not conducted for, at the very least, several weeks?

• The subject should not have been allowed to gargle or bathe.  The photo above shows Jani dowsed in water, while this link provides a looping video of his bathing practice.  I hope it’s clear to people that it’s not only possible, but quite likely, that he ingested water during these episodes.

• Where was the rigour?  This may sound harsh of me, but it’s very possible to smuggle sprinkles of sugar in one’s beard or clothing, that would be easily dissolved in gargled water.  A packet of sugar can go a long way toward sustaining a person on a starvation diet.  I am not accusing Jani of doing this, merely pointing out that it is unclear whether the study’s protocol controlled for such a possibility.  Neither is it clear where his bathing and gargling water came from.  Was it brought by an assistant, or given by the scientists after testing it for dissolved nutrients?

There are some other niggling points, like the study’s lack of control subject, uncertainty about whether Jani was ever left alone, or about who was allowed to visit him.  But I think my points above are sufficient to cast a lot of doubt on whatever conclusions arise from this venture.

So What?

First, let me answer the question that I’m sure most readers want me to answer: I do not feel qualified to pronounce whether or not inedia is a real phenomenon.  I further do not feel qualified to pronounce whether or not Prahlad Jani is a genuine example of true inedia.  But I am quite confident in pronouncing that Dr Shah’s  study of Prahlad Jani, making so much news everywhere, does not provide anything resembling convincing evidence of the veracity of Jani’s claims.

As a representative of the paradigm of Western science –true Western science, the one that seeks the truth, not the one that decries apostates– I adhere to the practice that extraordinary claims require extraordinary evidence.  Inedia is indeed an extraordinary claim.  Dr Shah’s study is not only not extraordinary evidence, it isn’t even passable ordinary evidence.

But to me the more interesting question is, what if it was ?  What if Dr Shah had adhered to the most stringent and rigorous of scientific protocols?  What if he’d used the finest tools in the arsenal of Western science and managed to produce viable evidence that Jani’s claims were defensible?  What then?

As I noted, inedia is impossible according to the present paradigm of understanding.  But this is not the first time that the present paradigm has been challenged.  And history has shown that it can be successfully challenged.

When Einstein first introduced General Relativity to the world, it was met in some orthodox circles with cries of voodoo.  (Sort of like Christwire’s depiction of Jani’s feat as “Satanic”.  Please not, of course, that Christwire is satire.)  After some extraordinary bits of evidence, Relativity was absorbed into mainstream physics dogma.

A similar thing happened when a handful of clever European physicists developed the theory of quantum mechanics, whose tenets were so fantastical that under the existing paradigm of understanding –that of Newtonian physics– they were deemed impossible.  Decades of extraordinary evidence later and quantum mechanics is at the heart of much of what we in Western science consider the truth of reality.

Science does not know truth.  Science approximates truth.  With each discovery, test and observation, that approximation becomes more refined.  Skepticism is healthy.  The vaunted scientific method has as its engine the steam of skepticism.  But when that method is satisfied, the challenge of incorporating new knowledge into the prevalent paradigm of understanding becomes a human one.  It is based more on emotion, values, prejudice and ego than on the rigours of philosophy.

And so I ask again: what if Dr Shah had done everything right, and, according to our present models of scientific rigour, presented real evidence of inedia?  Do we as a culture have the maturity and humility to re-examine our assumptions about the world?

I am sooooo overworked these days. So I’m doubling up on responsibilities. Today’s post is actually a preview of my MicroSoft Small Business Forum column:

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Recently, I attended a scholarly conference on the topic of evidence-based decision making. For those not in the know, “evidence” has been a hot topic in all areas of physical, medical and now social and political science for many years now. The idea is that one should base one’s decisions on the best available information, rather than on other, presumably softer, criteria.

It might be surprising to many lay people to learn that Evidence-Based Medicine, or EBM, was fairly revolutionary when first introduced a few years ago. The assumption that most people make is that medical therapies, supposedly rooted in the rigour of Western science, is informed by clinical observations in controlled surroundings. For the most part, they are. But a large part of an individual doctor’s decisions about his patient is also based on personal experience, or anecdote, and the personal experiences and hearsay of his teachers and colleagues.

The conference pitted two seemingly opposing viewpoints against one another. On one side was the hard science argument, that good evidence must always be at the core of decisions, especially decisions made by government in response to important phenomena, such as the appropriate policy responses to medical crises. The H1N1 pandemic is a good example.

On the other side was a proponent of the so-called “precautionary principle”, which holds that sometimes it is not possible to wait for sufficient evidence to make a fully informed policy decision. Rather, sometimes it is incumbent upon policy makers to act within a milieu of great uncertainty.

Arguments about the degree of evidence required to justify official action are themselves tainted by ideologies. Climate change is a good example. Those convinced that the phenomenon is real (and I count myself among that number) hold that the evidence is sufficiently convincing and the threat is sufficiently dire that the precautionary principle holds: we must act now and not wait until 100% are on side. The deniers would argue that we must wait until every last scientific hold-out is on-side.

But ultimately it is a false dichotomy. First of all, pitting “evidence” against the “precautionary principle” is misleading because the first involves a discussion about the nature of scientific rigour, while the second is a discussion of the nature of decision making.

Second, and most interesting to me, is that the discussion is ultimately a non-starter. Cynics (and again I count myself among them) would argue that decisions are almost never made with evidence prominently in mind. Rather, policies –especially those stated by governmental bodies– are more likely to be informed by values, ideologies, politics and utility. Only after those avenues have been exhausted do decision-makers turn to the evidence, and then usually it is to justify a decision that has already been made.

I cannot estimate the extent to which this process is also prevalent in the business world, but I would not be surprised to find evidence getting short shrift there, either. But is this really a problem? I hope to explore this in a later segment.

As some of you are aware, I’m the new editor of the national newsletter of the Canadian Society for Epidemiology and Biostatistics (CSEB). The first issue with me as editor was just published this morning. The newsletter is only available to paying members, but I am reproducing the first feature article here:

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Nothing To Do With Skin
By Raywat Deonandan

I remember well the first time I saw an epidemiologist on a movie or TV show. It was the creepy 1995 John Carpenter remake of the classic British horror flick, Village of the Damned. In the film, Christopher Reeve heroically tries to understand why all of his town’s children are blonde and demonic and possibly alien. At one point, the entire town goes unconscious simultaneously, long enough to attract the attention of the CDC (Centres for Disease Control), who send an epidemiologist to investigate.

A sveldt Kirstie Alley plays Dr. Susan Verner, a tough no-nonsense outbreak investigator who arrives –get this—brandishing a badge and a gun and leading a battalion of policemen. Ahhh, thought I, this is the career for me! Aliens, guns, badges, excitement, action… why doesn’t every young person want to be an epidemiologist?

A more serious portrayal of the outbreak investigation aspect of epidemiology was presented in the 1995 film, Outbreak, in which Dustin Hoffman played a military epidemiologist studying a new, weaponized type of haemorrhagic fever. He not only carried a gun, but also had a helicopter! The famous stills from the film include Hoffman in the biocontainment “spacesuit” that so many lay people now falsely associate with epidemiology. I’ve been trying to buy one on eBay ever since.

And, really, this is the crux of society’s misunderstanding of our science: their conflation of epidemiology with virology and other bench sciences. We all have stories of being introduced at parties as an epidemiologist, and being met with uncomfortable silence, or worse, medical questions about skin rashes. For the last time, epidemiology and dermatology are different sciences! (I’ve been toying for some time with the idea of writing an epidemiology-for-the-masses manifesto called, “Nothing To Do With Skin”!)

A former professor of mine was once held at the US border as inspectors searched her luggage for “possible dangerous insects” after she self-identified as an epidemiologist. All the border guard could hear, apparently, was “entomology”. And I’m surprised that people don’t regularly ask me about the origins of words. (That’s an etymology joke, by the way.)

Now, Village of the Damned and Outbreak were both released over a decade ago. In the interim, we’ve seen real epidemiologists all over the mainstream media in the wake of such emergencies as the SARS outbreak, the Walkerton disaster and last Fall’s H1N1 pandemic. Surely, the media has learned some sophistication in the mean time?

Well, one of my favourite current TV shows is Fringe, which is an American science-fiction program about weird science and its intersection with crime. In one episode, someone was systematically murdering “epidemiologists” by infecting them with a virus that that grows to the size of your head. Yes, a single virus the size of your head. Leave aside the fact that such a thing would physically have to be multi-cellular, and therefore not a virus, and we’re left with the disappointing realization that once more the media has confused epidemiology with a bench science; because every murder victim on the list of “epidemiologists” turns out to actually be a virologist or microbiologist.

Yes, I know that some epidemiologists actually are lab scientists, as well. And even more epidemiologists are also physicians. But most are not, at least not in this country. So who is responsible for the failure of society to appreciate the role and contribution of the population epidemiologist? The lowly cubicle jockey with his SAS licence and penchant for odds ratios needs his day in the sun.

Our contributions are profound and dramatic, after all. It was epidemiologists who figured out how to address AIDS at the population level, long before the HIV virus was discovered. It was epidemiologists who eradicated smallpox from the face of the Earth. It’s epidemiologists who regularly figure out where governments should best apply their dwindling health care dollars, and which vaccines to manufacture, and whether something that appears serious really is serious. But you know the drill; I’m preaching to the converted here.

Maybe the responsibility is ours? Maybe we need to engage the world more openly and actively and push for our worth to be acknowledged and our function accurately portrayed? I recall fondly one of my favourite New Yorker cartoons, in which a party hostess is congratulated by her friend, “And it was so typically brilliant of you to have invited an epidemiologist.”

Well, I thought I was doing my part some years ago. I advised a script-writer for the Canadian TV show ReGenesis on some protocols for outbreak investigation and infection control, in order to make the content of the show more reflective of real life. ReGenesis is (supposedly, I’ve never watched it) about bioterrorism and the brave, shiny and young crime fighters and scientists who take on global biological evildoers.

To thank me, the writers created an extremely minor character who would be an epidemiologist and who would be named after me. This new, accurately portrayed Dr. Deonandan would only appear in one or two episodes, but would at last be a fairly representative example of Canadian epidemiology. Better yet, I was promised, she would be female and really quite attractive.

As an enterprising, self-obsessed, heterosexual man, I began to wonder whether I could engineer a new DSM diagnosis, based on me, for someone who is sexually attracted to his own fictional portrayal on television. Some sort of “trans-media narcissism”?

Imagine my disappointment when the Dr. Deonandan of TV turned out to be, not only male, and not only a physician, but a surgeon. Yes, a surgeon-epidemiologist. I’m sure such a thing does exist, and I’m sure they are superstar intellects who do extraordinary niche research. But it’s not exactly the representative portrayal of the population epidemiologist I was hoping for.

Sigh.

So what’s the lesson here? I’m not sure that there is one, except that maybe we should never expect our media to accurately portray any profession and any aspect of science. And that maybe we epidemiologists need to take a more active role in promoting the details of our work, responsibilities, skills and accomplishments to greater society.

A few days ago I hunkered into a lecture hall at the University of Ottawa to watch the most recent Munk Debate, this time between the teams of Nigel Lawson & Bjorn Lomborg vs Elizabeth May & George Monbiot, streamed live from Toronto. Had I known the debates could be accessed from the web, I would have stayed home to watch it with several strong glasses of port. But no….

The topic: Be it resolved, Climate Change is Mankind’s defining crisis, and demands a commensurate response.

Nigel Lawson came across as a fussy old fuddy-duddy, underinformed and full of ideological bluster.

Elizabeth May I’ve never really taken a liking to, given her screechy delivery and overly confrontational demeanour. However, she at least said the one thing that needed saying: that these four are the not the experts; the scientists are the experts. This lack of true expertise hindered further substantial debate, I think. She is a lawyer/politician. Lawson is a journalist/politician. Monbiot is a journalist. And Lomborg is a statisition cum self-promoter.

George Monbiot has been a favourite figure of mine for some time. What an eloquent, passionate and well informed speaker. His website’s earlier incarnations were actually the model for the direction my own website eventually took, so I admit to having a slight bias for all things Monbiot. Having said that, even the great George came across as slightly unscientific, given his background as a journalist. His famous self-imposed travel ban, meant as a gesture to encourage minimal carbon footprints worldwide, was suspended for this special occasion, allowing him to physically be in Toronto. I always felt this self-restriction to be a bit precious, if you know what I mean.

Bjorn Lomborg, meanwhile, is no stranger to this blog. I have discussed him in the March 5, 2004 post, the Jan 14, 2005 post, the Aug 31, 2007 post, and the Oct 17, 2007 post. In short, I detest everything Bjorn Lomborg stands for. I will not mince words here. The man is insidious and, in my opinion, simply for sale. His landmark book, The Skeptical Environmentalist, was the Climate Change denier’s bible for years, effectively used as ammunition to slow down change on the policy front.

In recent months/years, Lomborg has begun to rehab his reputation. He no longer denies that Climate Change exists, is a big deal or is human-caused. This is rather convenient, now that the book has made him insanely wealthy and positioned him as a preferred champion for the anti-Climate Change business sector. There is speculation, implied by May during the debates, that his position earns Lomborg a pretty penny. Instead, Lomborg’s new mantra is that:

(a) there are more important things we can be focusing on; and
(b) since we don’t seem to be making headway on Climate Change, why not apply these energies and monies to –I dunno– eliminating poverty or disease?

On the face of it, this is not a bad position to have. Indeed, his position seems to have won over many in the audience. The debate statistics show that public response was thus:

In essence, more people changed their minds in favour of the Lomborg/Lawson position than in favour of the May/Monbiot position.

Apparently, Time Magazine once listed Lomborg as one of the most important 100 intellectuals in the world, according to his intro during the Munk Debate. This surprises me, given his brazen anti-intellectual behaviour during the debate itself. Lomborg’s position, as I summarized above, is fundamentally untenable, and I’m afraid May and Monbiot did a poor job of explaining this to the audience. It comes down to this:

It doesn’t matter that poverty and disease remain as plagues upon the world. Climate Change exacerbates those things, making them increasingly worse. And it doesn’t matter that pro-environmental legislation slows down economic development. What is the point of creating wealthy nations if there’s no food or water left to buy with your newly created wealth?

These were the basic aspects of environmental and health science poorly conveyed during the debate. I proudly commented afterward that I’m certain my undergrad students could have debated Lomborg into a corner, given how much I’ve tried to encourage them to think in terms of interrelated networks and systems.

Let’s look at Lomborg’s claim that we are better off tackling global health than Climate Change. The world needs to understand that many of the problems in global health are either as a direct result of Climate Change, or will be exacerabted beyond repair as a result of Climate Change. As Stephen Lewis once commented during a live address in Ottawa, “I fear we are looking at an Apocalyptic event.”

When Monbiot (or was it May?) commented that Climate Change makes HIV/AIDS worse, Lomborg gave us his theatrical hands-in-the-air disbelief pose. “How is that even possible?” he demanded to know. Sadly, only Monbiot bothered to explain a mechanism, but only told part of the story. The incident, though, causes me to ask whether Lomborg is really so uninformed (causing me to wonder how Time would dare list him among the world’s top intellectuals) or is he instead disingenuous. If the latter, then he is insidious and dangerous indeed.

Monbiot’s mechanism was basic: Climate Change is causing droughts, which forces men off the land and into the company of prostitutes, hence spreading sexual disease, including HIV. In truth, it’s more than this. Drought leads to poor nutrition, which prevents proper uptake of the anti-viral drugs that treat HIV (which need good nutrition to work properly). Environmental collapse causes economic collapse and produces more disease issues, further overwhelming healt care systems and prventing a society from addressing its HIV epidemic.

The ecology of much of the developing world, including sub-Saharan Africa, which has the greatest HIV burden in the world, is already operating at the margins. The crops there already subsist at the very edge of tolerance for temperature and humidity perturbations. With Climate Change comes more dramatic perturbations and thus a certainty of widespread famine in those regions.

No amount of structural adjustments, as Lomborg champions, will give such nations the economic might to overcome such famine, not when most of the region is similarly affected.

In short, unlike crises in the past, Climate Change represents humanitarian challenges that one cannot buy one’ s way out of. Again, you can’t buy water that does not exist. In response to Lomborg’s assertion that human societies will develop adaptations, Monbiot powerfully retorted (and I paraphrase): in these parts of the world, the only adaptation is the AK-47.

There are many other mechanisms by which Climate Change exacerbates health, and thus wealth. Among them:

The changing of vector behaviour. Mosquitos and their like determine their ranges by temperature and humidity. As these factors change, the nature of related diseases will also change.

Water quality. Because rivers are changing paths and rainfalls are misscheduling, the predictability of the safety of drinking water is uncertain. Already, 2 million deaths a year, mostly among young children, are due to diarrhea, directly caused by unsafe water. WHO estimates that today 2.4% of diarrheal deaths are due to climate change. (WHO uses very conservative methods to reach these estimates.)

Changing agriculture. Agriculture is affected by temperature, precipitation and soil quality. According to a 2008 article in Science: southern Africa could lose more than 30% of its main crop, maize, by 2030. In South Asia losses of many regional staples, such as rice, millet and maize could top 10%.

Migration. There is a long established intersection between migration and health. The sudden stress of large numbers of people is ecologically bad. Environmental refugees must be fed, sheltered and cared for, and the world has a poor track record of caring for mass migrants. According to a 2007 article by Christian Aid: “The growing number of disasters and conflicts linked to future climate change will push the numbers far higher unless urgent action is taken. We estimate that between now and 2050 a total of 1 billion people will be displaced from their homes.”

Insecurity. Ecological collapse can cause war. According to a 2007 report by The Pentagon:
Global warming constitutes a security threat to the USA, as there will be wars based on diminishing fresh water supplies, refugees, and higher rates of famine and disease.

Economic effects. Less money means less spent on health and poverty reduction. As an example, according to a 2008 article in the American Journal of Preventive Medicine, Coral bleaching can lead to collapse of the world’s fisheries in a matter of decades.

Air pollution. One US model predicts that by 2050, due to global warming, ozone-related
deaths will increased by 4.5% and there will be 60% more alert days.

Heat waves. According to WHO, heat deaths in California alone will double by 2010.

Natural disasters (floods and storms). According to WHO, flooding will affect 200 million people by 2080.

Here is an interesting little graphic showing deaths due to Climate Change in the year 2000, almost a decade ago. The truth today is much more daunting:

There are a lot more data and many more details. There is no dearth of studying on the topic. I don’t know how anyone who’s familiar with even a fraction of the data can conclude anything other than Climate Change is indeed the single most important crisis facing humanity now and in the next two centuries. More than the threat of nuclear war, and possibly on par with the threat of direct cometary impact, runaway greenhouse affect might very well drive civilization itself into the dust within our lifetimes.

Ever read Maximum City? It’s one of the best non-fiction books I’ve read in decades. It’s about life in Bombay (Mumbai). I had the pleasure of meeting its author, Suketu Mehta, a couple of years ago in Ottawa. There, we talked about a scene in the book in which Suketu is given “one hit for free” by the leader of India’s biggest organized crime syndicate. That’s right: he’s got a coupon for one free assassination. When asked to whom the crime lord should turn his attentions, many thoughts in the room flirted with members of the outgoing Bush administration.

(Very important disclaimer, for any members of US security reading this: I advocate violence against no one, not the least of which a sitting US President. So please don’t send scary men with guns, body armour and baseball caps to my door.)

Fast forward to 2009 with Bush gone and the saviour Obama in his place. Much has been expected of Obama and, I must say, the fellow has not quite delivered. This is particularly true for US involvement in global health and development initiatives around the world.

So it was with great interest that I invited superstar epidemiologist Ed Mills to give a guest lecture in my 4th year global health class this past week. I knew Ed would drop the following bombshell on the students, that no one has done more for HIV/AIDS victims in Africa than one George W. Bush. The man is a hero in sub-Saharan Africa. And while Obama has personal, familial, political and racial connections to Africa, the current President has actually dialed back some of Bush’s more impressive accomplishments in the region.

As summarized in this blog post, it was largely through Bush’s PEPFAR program (President’s Emergency Plan for AIDS Relief) that he effected what appears to be widespread positive change. Apparently, after a $15 billion investment, the AIDS mortality rate in 12 of the 15 targeted PEPFAR countries (the other 3 were outside Africa) declined by 10.5% over 5 years.

Even Bob Geldof said of Bush’s commitment to AIDS: “There are no votes in helping the poor of Africa, but Bush did it anyway.”

In the words of Dustin Dehez:

“[George Bush] elevated development assistance to Africa to a serious foreign policy field. Indeed, due to Bush’s Africa policy, development now complements the other two d’s: diplomacy and defence. Under his leadership development assistance has more than doubled from a marginal 10 billion to more than 22 billion. And his anti-AIDS programmes have fostered progress in countering the disease, indeed they are ideal types of how bureaucratic hurdles can be bypassed to make development assistance more effective. Like it or not: In Africa President Bush saved thousands of lives.”

Here is an African voice singing similar praises. How did Bush achieve this feat? Mostly by allowing his investments to focus on ARV (anti-retroviral) access. There are all sorts of barriers to poor HIV stricken people accessing these life-extending drugs, some of them valid and others less so: patent protection driving up drug prices, distribution challenges, lack of trained personnel to dose them accordingly, suspected poor adherence to the drug regimen, poor food quality diminishing the drugs’ ability to be absorbed, the inability to store them long term in a tropical climate, local corruption preventing free and easy access, and so on. PEPFAR funding, it seemed, succeeded to some extent in overcoming these barriers.

But hold on…. is all this praise really well founded? It’s based, after all, on the assumption that declines in AIDS mortality rate have to do with PEPFAR monies. Leaving aside the always present problems with assigning causation, are the mortality data even accurate?

I don’t know. But Mead Over seems to think they are not. As Over details in this article, the mortality data used to pronounce the glories of PEPFAR were based on UNAIDS projections. This is a widely performed and acceptable strategem, since such data are slow to return. However, Over suggests that in this case the data are inappropriate for evaluating PEPFAR success.

Then there are ethical issues with PEPFAR in general. The conditions for receiving PEPFAR money include the inclusion of abstinence as a pillar of prevention and refusal to fund needle-exchange programs. Both conditions were lifted in 2008, but after years of implementation.

In addition, PEPFAR only funded branded drugs, rather than cheaper generic drugs, but started allowing the latter after 2005.

Full criticism of PEPFAR is available here, and an easy to read description of PEPFAR can be accessed here. Obama is continuining the program, but with a few changes.

So what’s the bottom line here? Is George Bush the saviour of Africa? Well, I don’t think it’s wrong to acknowledge that the man seemed to care a fair amount about the plight of HIV victims in Africa, and managed to push through policy directives which, while flawed and beset with ideological caveats, nonetheless managed to improve the lives of tens of thousands of people. For that, he should be applauded.

But let’s not forget that Bush also disassembled many civil liberties domestically, pushed his nation into the deepest debt it has ever seen, started two fruitless wars, invaded a country that posed no threat to him or his people, lied repeatedly to his citizens, and, according to at least one study, is responsible for the deaths of half a million Iraqi children.

Give the devil his due. But let’s not ignore the horns.

What is this? Tow blog posts in two consecutive days? It’s like the old days, no?

For the second consecutive year, I also attended the opening cocktail party of the Harbourfront Festival of Authors. Remember last year’s photo? Here’s the new one:

Before I forget to bring this up, I stole the following from Graham S.’s Facebook page:

I also found an old letter of recommendation I wrote on behalf of myself, to be signed by my former boss. I was just checking to see if he actually read it:

I’m working like a mad man trying to get stuff done before catching a train to tomorrow in the morning. I was in Toronto this morning, Ottawa the day before, and Toronto the day before that. Yes, I know. I know.

Oh, it gets better. I’ll be up all night doing paperwork, then off to the Canadian Conference on International Health at 8:AM to hear Jeff Sachs speak, then hop on the train, then rush to a Board meeting at Harbourfront Centre in Toronto, then rush to the opening ceremonies of the Canadian Conference on Science Policy.

This is the sort of rushed, stressful schedule that can make you sick. Might even allow you to contract the flu! (Nice segue, eh?)

Following up from yesterday’s post, here’s a graphic from InformationIsBeautiful.net:

It’s yet another attempt at providing evidence for the anti-vaccination crowd. See, according to this graphic, the current H1N1 pandemic is no big thang.

Let’s consider this an educational moment. Can you see the problem with using this graphic, assuming it is correct, as an argument against the seriousness of H1N1? It’s the difference between absolute and relative measures.

Here’s an example of what I mean: if you hear that the incidence of cholera in Alberta doubled between 2007 and 2008, that sounds pretty serious, right? “Doubling” is a relative measure. But what if I tell you that the number of new cases went from 1 in 2007 to 2 in 2008? Yes, it doubled, but the actual number of additional cases was one. That’s an absolute measure.

To beat this dead horse, it’s clear that if media and policy makers relied on the relative measure to inform their decisions, a lot of emotional and financial resources would be misspent.

Now, for the graphic above, it’s important to look at the denominators. The case fatality rate is a relative measure. According to it, SARS was a much bigger deal than H1N1 (swine flu), about a 19.2X increase in mortality rate.

However, the number of people who actually contracted SARS in Toronto in the 2003 outbreak was a mere 358. If we believe the graphic’s 9.6% case fatality rate statistic, this translates to 35 deaths in absolute terms.

In absence of the seasonal vaccine, seasonal flu would be contracted by tens of thousands in Toronto. Assuming an infection denominator of a conservative 10,000 unvaccinated people, that translates to 100 deaths in Toronto alone due to seasonal flu.

See the point? The absolute measure provides more meaningful information.

Okay, I’ve got work to do now. As you were.

(Writing this on my mobile phone in the Porter Airlines lounge in Toronto, so please forgive the typos.)

In any given year I receive a handful of emails from random strangers wondering whether they should get vaccinated against certain diseases. With the current H1N1 pandemic, the emails now come weekly.

In the elevator of my spanking new condo last week, I was privy to a conversation between two 30-something construction guys, both of whom had decided to eschew the flu vaccine.

The thrust of their argument was, “I never used to get sick. Last year was the first time I got the flu shot, and I got sick.” So, according to this reasoning, it’s the flu shot that made them sick.

I kept my mouth shut, but I hope the spuriousness of this logic is clear to most people. Spurious logic was best described in The Simpsons, when Lisa told Homer, “It’s like me claiming that holding this rock protects me from polar bear attacks because when I hold it, no polar bears attack me.”

“Lisa, I’ll give you 20 bucks for that rock!”

The spuriousness here is the association between getting the flu shot and becoming ill. The fellow probably got sick from the common cold and mistook it for the flu. Whatever the reason, there is no mechanism by which one can get the flu from the flu vaccine: the vaccine does not contain live or whole viruses.

The question of risk always arises. The human animal, it seems, is incapable of feeling its way through risk and probability. Decisions are made emotionally rather than logically.

After 9/11, for example, people were afraid of the “risk” of flying, so turned to the “safety” of driving. Driving is actually much more dangerous than flying, so I suspect that the excess deaths due to traffic accidents increased in the post-9/11 period. (I’m writing a paper on this now, so stay tuned.)

The risks of the flu vaccine in general, and the H1N1 vaccine in particular, are, in my opinion, inflated by the media. A small number of people with egg allergies will have serious reactions. Most people with egg allergies know who they are. About 1 in a million may suffer Guillain-Barre syndrome, which is serious indeed. A hefty number will experience soreness and maybe 24 hours worth of flu-like symptoms just after the injection. The overwhelming majority of recipients will experience no effects whatsoever.

Do keep in mind that no vaccine is ever 100% effective. Remarkably, the H1N1 vaccine is proving to be about 90% effective, which is actually better than the regular seasonal vaccine. This means that some people will get the flu despite being vaccinated, and may mistakenly think the vaccine gave them the illness.

The H1N1 vaccine comes with something called an adjuvant, which is just something that boosts the immune response. As far as I can tell, it’s just vitamin E, polysorbate (a typical food emulsifier) and even some shark liver oil. Some people have freaked out about the latter, but there’s no evidence that it’s bad for you.

Perhaps the biggest nonsense surrounding the flu vaccine, and vaccines in general, is their supposed link to autism. I do not see any convincing evidence for this. The one study that drew a connection was poorly done, and has since been debunked many times over. This is the way that real science works. I’ve talked about this before here, here, here and here.

One commenter put the risk question this way: yes, I suppose the flu vaccine carries some risk. But in terms of severity of that risk and extent of that risk, actually getting the flu is much worse. Conclusion: get the bloody shot.

Keep in mind that every year in Canada, literally thousands of people die from the regular flu. Worldwide, thousands more have died from H1N1. So far in Canada, almost a hundred people have died from H1N1, and hundreds more are seriously ill. I have students who have taken leaves of absence due to serious complications from H1N1.

But how many have died from the vaccine? How many typically die from the vaccine? The number is trivial, if it exists at all. Almost all people who get influenza vaccine have no serious problems from it. Nonsense like this and this don’t help anyone.

Let’s keep the risk of H1N1 in perspective. Depending on who you are, there’s a chance you will not be exposed to the virus. If you are exposed, there’s a good chance you won’t get the disease. If you get the disease, it is very unlikely you’ll get seriously ill. Most likely you’ll end up in bed for a few days, miserable but recovering. So not getting the vaccine probably won’t be too bad for you…. Mostly due to something called “herd immunity”.

Herd immunity is when your unvaccinated ass is protected by everyone else’s more responsible behaviour. The logic is that you are less likely to be exposed to the disease because all your friends took the time to get the vaccine. Dumbasses who regularly crow about they don’t need to get vaccinated because of their “strong immune systems”, evidenced by the fact that they rarely get ill, need to understand herd immunity. Their illness free status may have little to do with their innate superhuman status and more to do with the fact that the rest of society has chosen to be disease resistant.

A small percentage of people who get H1N1 will actually get seriously sick and possibly die. Children are particularly at risk because it seems that we old folks have some sort of partial immunity after having weathered so many flu seasons.

But really, why would you want to be home sick for a week? Why would you want to even risk being home sick for a week? Why not save yourself that little bit of Hell with a simple jab in the arm? More importantly, why risk the lives of the children in your life? If you don’t want them to be vaccinated, at least get vaccinated yourself so you don’t infect them!

This speaks to a wider societal concern that I hope to write about in the future: society’s growing anti-intellectualism and anti-science stance. We flock by the millions to unproven therapies, like reiki or whatever unscientific nonsense Suzanne Summers is selling on TV. But many of us refuse to believe that humans walked on the Moon, despite it having been broadcast on live TV and within living memory. The singular triumph of our technological civilization is denied by a generation tragically divorced from this hard-won heritage of reason’s victory over the darkness of brutish ignorance.

Vaccines are the victim of their own success. Their triumph was too easy, too profound to be valued by our generation inured to things “too good to be true”. People don’t think they need the rubella vaccine, for example, because they’ve never seen anyone with Rubella. You know why you don’t see Rubella? Because people take the Rubella vaccine.

There are those who vocally denounce modern vaccinations as useless and dangerous science propaganda. I’d like to take them in a time machine to Canada 150 years ago, when every neighbourhood had people dead from Measles, Rubella, Smallpox and, yes, the flu. Screw the time machine, how about any number of communities in the global South?

We in Canada are a spoiled lot. We have free, socialized medicine. How incredible is that? We had months of forewarning about the H1N1 pandemic. Our medical infrastructure responsibly kicked into high gear, acquiring for us a sufficient stockpile of high tech vaccination against the pandemic –in mere months! That vaccination is being rolled out all across the country today, absolutely free of charge.

Think about that for a second. In the history of humanity, this is such a rare boon. Pandemics of all stripes have decimated societies and civilizations. Our modern civilization found a solution and implemented it, free of charge and in record time. it’s available to us today. What would have shut down society 100 years ago is but an inconvenient trip to the flu clinic today.

And yet there are significant numbers of people today who will not only eschew this boon but will vocally denounce those who accept it and those who provided it.

With every crisis, humanity continues to prove to me that it’s too stupid to deserve survival.

I will reiterate that everyone has a choice whether or not to seek vaccination. Your choice is your choice. But, as in all things, you are responsible for the consequences of your choice. I don’t need to spell out those consequences, or potential consequences, for you.

The technique of modern vaccination is a veritable gift from science. Like all things, it comes with some risks and with variable effectiveness. But how wonderful is it to have the option? How blessed are we? Never forget that or take it for granted.

And as for those who make the simply retarded argument that the flu vaccine is a ploy by big pharama to make money, I beg you –nay, I implore you– to stick to your guns when you contract H1N1 and are admitted into the hospital’s ICU. Please, refuse to accept those antibiotics, antivirals and steroids that will be needed to save your life since, as you probably know, they too are created by “big pharma to make money”.

End of sermon.

Update:

Some have pointed out to me that there is no data about the vaccine’s safety in infants or pregnant women. This, to my knowledge, is true. The overwhelming medical opinion appears to be that there is no convincing reason to suspect that it is not safe for these groups. However, I would certainly understand if a pregnant woman, or a parent of a child with a developing brain, was hesitant about exposing the infant/fetus to a potential mutagen. If those individuals choose to not become vaccinated (in the case of the pregnant woman) or to not vaccinate their infant, then I hope they would at least advocate for all adults in the vicinity to get vaccinated. I fail to see a strong argument for a non-pregnant adult to eschew vaccination.

Related:

From today’s Globe and Mail:

“Refusing to get vaccinated is selfish” by Juliet Guichon and Ian Mitchell.

“Canadians have a free choice. But they also have responsibilities: not to act as agents of flu dissemination, and to minimize their burden on the health-care system. To perform these obligations, they need to act positively, developing two kinds of literacy…. [scientific literacy and statistical literacy].” -Editorial