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More on Jahi McMath

Hi Reader.

The macabre spectacle that is the case of Jahi McMath just keeps getting ridiculouser and ridiculouser. I wrote a summary of the story yesterday, but for a Twitter version, it can be summarized thusly: Jahi is dead. Tragic. Those involved with poking, prodding corpse should be shunned as they prevent family from grieving.

Today, there is additional information about the case, which is getting more vile by the second. Yesterday, I read an interesting article about Christopher Dolan, the attorney for Jahi’s family, and felt a soupçon of understanding for his position in working for the family. This feeling was utterly nuked today when he opened his yap again and stated that Jahi is”improving” now that she is “getting the treatment she should have gotten 28 days ago”.

First, there is NO “treatment” for death. Dolan seems to be slithering right by that understanding, which is hardly surprising since, by his own admission, he knows absolutely nothing about brain death. Second, to state that a deceased person is “improving” is quite possibly the most ignorant thing that has ever been said in the Annals of Ignorance–and as you know, Reader, we see quite a bit of it in the world of anti-vaxxers. Dolan may think that he is advocating for the family, but what he is actually doing is apparently confusing large numbers of people, who do not understand that Jahi is dead. Further, Dolan is executing an even crueler trick. He is preventing a family that needs to properly grieve for a child from doing so.

I have heard people who have lost loved ones wish that they could fast-forward a year, so that they could reach a time when the pain would not be so horribly acute. If Jahi’s family had been able to accept her death, and were not encouraged to perpetuate this circus, then they would already be nearly a month past the death of a child. I am not at all implying that they will ever get over her death–they will not. But a month of grieving is still a month when the healing, however slowly, could have begun.

Those involved in encouraging this magical thinking are nothing short of vermin. And while Dolan claims that he will not be involved an any potential lawsuits against the hospital should they be filed, he sure appears to be trying to set it up for a buddy.

Jahi McMath, the media, and the science

Hi Reader,

Unless you’ve been under a rock, you have heard of the Jahi McMath saga. Jahi is the 13-year-old girl from California who was declared brain dead on December 11th, 2013. Along with many others, I have been following this case since it hit major media outlets around Christmas. It has been fascinating to watch the media turn from giving major support to the family to providing a somewhat better understanding of Jahi’s condition and questioning the ethics of transporting a dead body from the coroner to an “undisclosed facility”.

I must first state that I do feel a great deal of sympathy for Jahi’s family. I have a child who had his adenoids removed, and though his particular procedure was very straightforward and quick, I was on high alert for the duration, as any parent would be if their child is under anesthesia. I can only imagine my grief and outrage had my son been one of the extremely rare cases who had a severe adverse event afterward. However, a few things must be pointed out regarding Jahi’s surgery. First, it was not, as has been widely reported, “a simple tonsillectomy”. Apparently, Jahi had a tonsillectomy, adenoidectomy, and also had her uvula and palate tissue removed. This combination of procedures considerably ups the ante from a mere tonsillectomy.

What happened next is not completely clear, due in part to the attorney for the McMaths duking it out with the hospital, Children’s Hospital & Research Center Oakland. However, all parties appear to agree that Jahi suffered tragic complications from her surgery, including heavy bleeding, and went into cardiac arrest. As mentioned above, she was declared brain dead on December 11th. Sadly, many in the media expressed outrage over the hospital’s stance that Jahi should be taken off of a ventilator. The family felt that Jahi might actually “wake up”. Unfortunately, a judge humored their belief just before Christmas, by ordering that Jahi’s body could not be removed from the ventilator until December 30th; this order was later extended to January 7th.

The outrage amped up a notch all over the media. How can a hospital decide to take a person off of life support? Isn’t this the parents’ decision? The answer is no, it is not the parents’ decision in this case. A hospital does not have an obligation to leave a dead person on life support. If that sentence sounds ridiculous, then that’s okay, because it sums up the entire arc of this story. Even before Jahi was moved to an “undisclosed facility” on January 5th, at least three physicians had testified in court that she has no activity or blood flow to the brain, and therefore, Jahi is dead. Nonetheless, the attorney for the McMaths as well as members of the McMath family continued to make statements indicating that Jahi was “improving”, and that other physicians had told them that she is “definitely not dead”. Unfortunately, both of these things are impossible in Jahi’s situation. As has more recently been clarified, Jahi’s condition is no way analogous to that of a person in a coma, or even a person with any brain stem function. She is dead, and that is the sad fact. Yet people continue to express their outrage about this situation, arguing among other things that the parents should get to decide when Jahi is dead.

Why is this proposal a problem? Well, to answer this I have to be horrifying blunt. Jahi has no blood flow to her brain. If you can imagine a finger with a tourniquet around it for a week, it may help to understand what is happening and is going to continue to happen to Jahi’s brain. It is, quite simply, decomposing, as is the rest of her body, which cannot function properly without messaging from the brain stem, even if she’s on ventilation. Her muscles and internal organs cannot process the signals that would normally tell them how to function–for example, how to clear toxins from the system. According to a physician who testified in court, Jahi has not had a bowel movement since the brain death, apart from what appeared to be secretions that were the body releasing the gut lining, as Dr. Heidi Flori, a pediatric critical care physician, testified to in court. As might be expected, Jahi’s body is going to continue to decompose.

This is not a matter of faith or God’s will. Jahi is, tragically but undeniably, dead. A death certificate that was issued this week has given the date of death as December 12, 2013. Nothing is going to bring her back, and that is the sad truth. It seems clear that sometime in the near future, Jahi’s family will reach a state where they can no longer deny that the 13-year-old is dead, due to the continued decomposition of her body. Hence, this story has reached a macabre nadir.

This is just one more example of the media getting it wrong and the lack of scientific literacy in the United States.

My solution to gun violence: Only women get to own guns

Hi Reader,

In the wake of the latest school shooting in Colorado, one year after the most horrific mass shooting in United States history, my thoughts have returned to rampage violence and potential solutions to this epidemiological phenomenon. A major role of epidemiology is to identify risk factors for adverse health outcomes, and regarding gun violence, one factor that has quite clearly emerged is the possession of a “Y” chromosome.

Last year I wrote a post about the potential approaches to studying this problem in a scientific manner. Indeed, two extremely heroic individuals who lost their daughter in the Newtown shooting have established a foundation dedicated to studying the scientific causes of brain pathologies that lead to violence. I applaud them in their efforts, as this course of action will likely aid in understanding why certain disease states lead to outward-directed violence, while others tend toward inward-directed self destruction. This leads me directly to my proposed gun control solution: to allow only women to purchase, own, and use guns.

Let me first say that I have only developed this public health recommendation after realizing that in the United States, there will never be a total elimination of personal armaments. So the question becomes: how can we minimize the risks to the population at large while allowing for gun ownership? The somewhat obvious answer is that approximately 50% of our population is at far lower risk of committing a crime with a gun. We can start with rampage violence, where the odds of a woman committing such an atrocity are so much lower that they approach zero. As summarized at Mother Jones and further distilled in my previous post, the profile of a rampage shooter is a white male, mean age of 35 years, with a previous history of mental illness. In the past 30 years, only a single female mass shooter has been identified. Give a woman a gun and it is exceedingly unlikely that she will set out to conduct rampage violence. Given the comparative rarity of mass shootings, however, it is worth also considering the number one outcome of gun violence in the United States. It is not homicide, it is suicide.

Similar to mass shootings, suicide rates are substantially higher among white men than among any other population group, including women. And as you may have guessed, firearms are the number one method for committing suicide, and again, men are significantly more likely to use a gun than women. This quite possibly accounts for a large chunk of the explanation for why male suicide rates are higher. Bottom line: using a gun to kill oneself is much more likely to result in mission completion than other techniques. And recent work shows that owning a gun is a significant risk factor for suicide. Again, for whatever reasons, a woman is less likely to use a gun to commit suicide than a man and therefore, guns are safer in the hands of women.

One aspect that cannot be forgotten in this calculus is garden-variety homicide. Here, too, it is men who commit the vast majority of murders, to the tune of representing 90% of offenders. And yes, most murders (67%) are committed with the aid of a firearm. Further, even looking at accidental deaths by firearms shows a major imbalance by sex, with male children comprising approximately 80% of these preventable tragedies. This is an interesting and terrifying bit of data that may indicate that boys, for whatever reason, are indeed drawn to guns more than girls, even from a very young age.

The data seem to identify a particularly dangerous segment of society with regard to gun violence: men. Thus, allowing only women to purchase, own, and use firearms would seemingly reduce violent gun crime in a trice. Sure, there would be some challenges to this proposal, but the invention of estrogen-sensitive gun safes would surely evolve quickly thereafter. And naturally, we would need to give some deep thought to possible exceptions for law enforcement and the military. But then again, if women took over those areas, too, perhaps that would be a step in the right direction anyway.

Thanks for stopping by, Reader.

Dear Anti-vaxxer: This is why I still do not care for you.

Hi Reader,

A while ago I wrote a post entitled, “Dear Anti-vaxxer: This is why I do not care for you”. It is coming up on two years since I wrote it, and I’d hoped that things would change in that time, but for the most part they have not–with one exception. The online presence of people who are fighting back against the misinformation and lies of the anti-vax movement is increasing daily. Voices for Vaccines is one new group that is organizing around the promotion of science to combat the anti-vax movement. I recommend that you look into their group if you haven’t already. I am not personally involved in this group, by the way, so before any anti-vaxxers reading this start screaming “conspiracy!” you can stick a cork in it already. I am not even sure if they want to be mentioned on this blog, but too late now.

In the meantime, I present my updated version of why I still do not care for anti-vaxxers.

1. You still believe that your opinion should be respected

One of the most common angry responses to my original post was that “all opinions should be respected”. This is bullshit. The people responsible for spreading this fallacy are ruining the next generation. For example, I do not need to respect the opinion of racists, bigots, or people who believe that Uggs are still fashionable, right? This type of attitude is bleeding into classrooms everywhere (though, as you might imagine, not mine).  I must again refer to the Poland and Jacobson quote

Ultimately, society must recognize that science is not a democracy in which the side with the most votes or the loudest voices gets to decide what is right“.

Anti-vaxxers still fail to understand that to have a scientific debate, you must have some science.  The notion that I or anybody else must respect an opinion about a scientific subject, but about which the co-debater has absolutely no knowledge, is beyond ludicrous. Your opinion is dangerous and misinformed. No respect is forthcoming, now or ever.

2. You still think that you know more than 99.99% of the scientific community.

I have to wonder how you get out of bed every day when everyone around you is so stupid and you are so smart. How can you board an aircraft when the aerospace and mechanical engineers who built it do not know as much as you do? Oh yeah, that’s right. For almost every technological advance, you trust the experts. But not for vaccinations–oh, no.  In a phenomenal feat of mental gymnastics, you and your peeps  are still convinced  that the more qualified a person is to talk about vaccination, the less he or she actually knows. You call them arrogant. You call them elitist.  And yet, there can be no greater arrogance than that possessed by one with no degree in any field of biological sciences who still believes that she knows more than 99.99% ofthe healthcare community.  Why have you decided that you are smarter than folks who have dedicated their lives to the science that keeps you from dying of infectious disease? It remains a mystery.

3. Yep, you are still selfish.

One meme circulating widely in the anti-vax community this year said something to the effect of “I am not responsible for the herd. I am only responsible for my children”.  It is downright hilarious that you folks do not realize how selfish and disgusting this viewpoint remains.  First of all, being responsible for your children means you should not be a numbskull and that you should listen to your doctor when it comes to medical advice. Second, the concept that you need to tend only to your little snowflake is a great example of how our society has devolved.  By not vaccinating, you are jeopardizing every person in your community. But you really don’t care about your newborn niece or nephew, do you? I saw a lot of angst being posted online this year ,where anti-vaxxers were not being allowed to visit newborn family members, to which I say: HELL YEAH! You don’t think measles is disease to be concerned with, because you are not very smart, but your sister/aunt/niece/brother does. What is most amazing is your self-victimization when someone calls you out on your anti-vax crap. Here’s a novel idea: why don’t you try listening to their concerns? You are quite happy to parasite away off of the good health of your vaccinated community instead, and you are proud of it. There is something profoundly wrong with that.

4. You are still purposely trying to manipulate others.

Yes Virginia, the news story comment bombing by anti-vaxxers has finally met its match this year. You march right in after a vaccine news piece declaring that you shall educate us, one and all. Sadly, you still don’t have any useful information to share.  You post emotional anecdotes and sketchy “articles” that don’t survive any sort of critical analysis whatsoever. Your strategy is to come in great numbers and make it difficult for any rational person to actually address all of your assorted links to anti-vax websites and articles. You don’t actually want to have a debate. You want to shout so loudly that no one can hear over you. You do not care that your posts are flat-out lies, because they support your worldview that you.are.on.to.something. But you’re not. You are, quite simply, WRONG.

5. You wield autism as a club in the most offensive way possible.

This is a tremendously sensitive issue, but one of the things that broke my heart when I wrote this post originally was hearing from parents of autistic children who are outraged that the anti-vax movement uses their children as warnings about vaccines. Yes, I have family members who are on the spectrum. No, vaccines did not cause them to develop autism. This has been shown over and over and over again. So, first of all, any statements warning parents not to vaccine or their child might develop autism is quite simply factually incorrect. Second of all: piss off. Your message seems to be that you would rather have a child who dies than one with autism. So, again: piss off.

6. You are still causing disease outbreaks.

Yeah, I know, you still don’t think measles are dangerous, but you are, as usual, wrong. In addition, the head of the CDC called you out this year for being a responsible party for the measles outbreaks worldwide.  You don’t agree. You are, as usual, wrong. Your contorted attempts to rationalize why anti-vaxxers are not to blame for these outbreaks have been amusing to some degree, but they are yet another example of your inability to think clearly through this issue.

7. You still don’t understand that by spreading the anti-vaccine message, you are endangering your own children.

I understand: You refuse to vaccinate your own children. There is nothing I can say to change your mind about this subject. However, the vaccinated are protecting your children, every day.  You crow about how “healthy” your unvaccinated kids are (though many posts and comments  put the lie to these claims). You do not understand that the reason your unvaccinated child has not gotten a vaccine-preventable disease is because your neighbors did vaccinate. So why are you so insistent about spreading the word to eschew vaccination? You are popping your own protective bubble.

And that, dear anti-vaxxer, is why I still do not care for you.

Katie Couric tries and fails to undo the damage

Hi Reader,

I’ve shied away from the Katie Couric/HPV vaccination thing because it’s been covered by luminaries too numerous to list. However, I have noticed a defensive post regarding her misleading show on her website, and I feel compelled to address it, because it suggests that Ms. Couric and company simply do not get it. Among other things, the post states:

While many appreciated us raising the topic, others were critical of us for providing what they felt was a disproportionate amount of time to two families who faced the rare circumstances of seeing their children’s health deteriorate after receiving Gardasil. The health problems may or may not be linked to the vaccine.

This suggests that Couric show personnel still believe they were responsible in having these families on to discuss what they think were adverse reactions to the vaccine. The problems here are several-fold. First, the emotional testimony of these families is not scientific fact, but it does pack a wallop that panders to fear. The HPV vaccine has been shown many times to be safe and effective, period. The direct appeal to emotion such as presented on Couric’s show can often have the effect of over-riding logic and common sense, even if factually correct data are presented immediately following these statements.

We believe this is an important topic for discussion and wanted to share multiple viewpoints, so we included the doctor who oversaw the clinical trials of Gardasil, and who shared the clinical trial results that the vaccine only provides protection for a finite amount of time. She also questioned, given the overall success of Pap testing to screen for cervical cancer, whether the vaccine is necessary or just optional.

I am sure this is just an error on behalf of Couric’s staff, but Diane Harper is not “the doctor who oversaw the clinical trials of Gardasil”. She is one doctor who oversaw trials of Gardasil. There are many, many others out there, along with other scientists who have been actively investigating vaccine efficacy and safety. Why not bring them on the show, too? Ms. Couric could start with Dr. Rowhani-Rahbar and colleagues, who demonstrated that Gardasil may likely be protective for at least 8 years post-vaccination. At least. And that actually might be enough to get someone who is vaccinated through one of the most dangerous periods for HPV infection–the teenage years.

Further, if Ms. Couric really wanted “multiple viewpoints”, and she really wanted passionate anecdotes, then she should have considered having a person on the show who has or has had an HPV-related cancer. It’s quite difficult to fight emotion with science, so why not present the emotion of the “other side”? How about inviting Michael Douglas on the show, for example? The post goes on to state:

We do not want to leave our viewers with an irrational fear of the vaccine and for that reason we’re going to continue the conversation and invite a number of medical experts, journalists and scientists to weigh in here, on our site. We’ll keep you posted!

To this I say, it is TOO LATE, Ms. Couric. You presented irrational information about HPV vaccination, and now you wonder why there are irrational fears? Judging by the comments on your Facebook page, you have successfully “converted” people against HPV vaccination by failing to provide all of the facts, and by your reliance on anecdotes. Once a person has made a decision based on emotion, it is nearly impossible to pry them away from it. You obviously still have no idea of the damage that you have done, but you may get a glimpse of it when the “conversation continues”.

Congratulations to anti-vaxxers on their success in 2013!

Hi Reader,

As 2013 comes to a close, anti-vaxxers can raise their glasses of organic, free-range eggnog and pat themselves on the back for their continued success in getting other people sick. As you know, people are often unaware of the dangerous consequences of the anti-vaccine movement. The average bear feels safe and sound knowing that most people around him are responsible and are fully vaccinated, and as such, he is not in danger of catching, say, measles. Yesterday, the CDC poked a hole in that bubble of safety in conducting a press conference regarding measles. To date, there have been 175 cases of the disease reported to the CDC, far above the expected number of 60. It must be noted that the U.S. outbreaks have two main features: first, they all arise from imported cases; and second, the outbreaks rage through unvaccinated populations.

CDC director Tom Frieden came forth with a strong statement regarding the effect of those the unvaccinated on the continued spread of measles in the United States and worldwide:

“It is not a failure of the vaccine,” Frieden said. “It’s a failure to vaccinate”.

A small proportion of those who are unvaccinated may be those who face barriers to vaccination. However, it is becoming increasingly clear that the largest group of those who are not protected from diseases like measles are those who choose not to be vaccinated, as illustrated by the outbreak at Eagle Mountain International Church in Texas.

Meanwhile, the anti-vaxxers sneer at measles, conveniently forgetting that:

1. It can cause encephalitis and yes, death; and
2. It will result in serious harm to the healthcare system; and
3. The rest of us don’t want to be exposed to measles because you are too stupid to vaccinate.

So, anti-vaxxers, you are responsible for the measles outbreaks in the United States. Congratulations on your success in using misinformation to prevent vaccination from life-threatening diseases because you, and only you, understand science better than 99.9% of physicians, nurses, and public health practitioners. I’ll bet that makes you feel pretty good right now. But you’re not coming to my holiday party.

I sure wish that George Zimmerman would stop getting in trouble

Hi Reader.

As you know, over the past year or so I have had the distinct displeasure of posting a few times about Frank Taaffe, caped crusader for George Zimmerman. And this is precisely why I wish beyond any measure that George Zimmerman would stop getting himself into trouble. Because every single time Zimmerman is in the news, Taaffe quickly follows like the tragedy leech that he is.

Today, for example, Taaffe appeared on CNN to air his grievances regarding Zimmerman’s latest arrest for pointing a gun at his girlfriend. This is felony aggravated assault, according to the law. According to Frank Taaffe, “it happens”. Yes, domestic violence “happens”, Taaffe, as you may indeed be aware.

Taaffe blathered on and on to host Sunny Hostin about how Zimmerman is being oppressed by the media, and then came the gem. The moment for which we were all waiting. Hostin, in a tone that I took to be sarcastic, asked Taaffe if Zimmerman is the real victim in this current arrest. You know, the arrest for felony aggravated assault by Zimmerman. On his girlfriend. With a gun. Taaffe’s answer? Yes. Yes, Zimmerman is the victim here. What followed was the curse of broadcasting: complete silence. He’s really outdone himself this time.

Like Hostin, I am speechless, and that is why I must write. If you’d like to read more about Taaffe, and the reasons why he gets my goat every time, Mariah Blake wrote an excellent piece that you can find here.

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