And now if you excuse me, I'm going to get back to trying to hit Infernape with golf balls. That's how Pokémon works, right?

And now if you excuse me, I’m going to get back to trying to hit Infernape with golf balls. That’s how Pokémon Go works, right?

I don’t have much to write about this week. Yeah, yeah, I know. How is that different than the last 50 blog entries? And I will have even less to say next time.

But nothing of real interest has crossed my screen the past two weeks, not that I have really been looking. One of my favorite stories as a kid was Ray Bradbury’s All Summer in a Day. It takes place in the Oregon of my memory.

It is summer in the great Pacific NW and the outdoors and sunshine beckon. Who wants to skim the SCAM when there is hiking, biking, and golf? Golf has become more interesting this year. I tend to hit the links late and we play until dark. It has been a challenge not no kill the Pokémon Go players who wander the course at sunset, roaming in the gloaming clueless as to the dangerous projectiles flying by. Fore! Those are Titleists, not Poké Balls.

Once the sun goes down it has been the conventions that have trumps my attention, so why not a short entry touching on a few aspects exploring issues and controversies in science, medicine, and politics?

Zika

Zika has arrived in Florida and there is local transmission occurring in Miami. Zika is transmitted by mosquito bites and occasionally sexual contact, and causes microcephaly in the fetus.

The CDC has belatedly issued a travel warning for parts of Miami for pregnant women and their partners. Florida has deserved a travel warning for years.

The southern US is primed for a mosquito borne illness: Dengue, yellow fever, Chikungunya and/or Zika. With widespread disease vectors available it is probably a matter of when, not if. I expect Chikungunya to be the first, but maybe it will be Zika or, probably most likely, some infection we ever expected.

Spread of these infections will depend on many factors such as the availability of animal reservoirs (none for Zika, many for Chikungunya) and perhaps air conditioning. I suspect they will disproportionately affect the poor, who have to sit outside to cool off, exposing themselves to mosquitos.

But in the right population and conditions viri can spread with remarkable rapidity. West Nile spread across the US in a decade and Dengue and Chikungunya ripped through central Africa.

Fortunately Congress has been right on top of the problem. There was a $1.1 billion Zika spending bill that died thanks to partisan bickering over provisions that have little to do with stopping the spread of infections.

Other money is being diverted to fight the Zika virus, but Congress is in recess until September:

“We’re certainly fine probably through the end of the fiscal year, so it’s not like we have to do something today,” said Rep. Tom Cole, R-Okla., chairman of the House panel overseeing funding for the Centers on Disease Control and Prevention and the National Institutes of Health.

So if Congress waits it will give Zika the chance to settle in and we will have to wait for herd immunity to kick in over a few years for a temporary respite from the disease.

But that seems to be the US approach to infectious diseases. Wait until it is too late.

And of course no disease is without a response from hucksters. The New York attorney general has already sent:

cease-and-desist letters to seven companies accused of deceptively marketing ineffective Zika-protection products.

If you google “naturopathic treatment zika” you will find all the usual suspects offering their treatments to cure Zika. Microencephalopathy has many manifestations.

Lyme

It is the people who care who cause change. Those involved in the pseudo-scientific industrial complex, either as consumers or producers, care. And they advocate for their pseudo-science. Those involved in reality-based medicine are by and large too busy too care and for them the name shruggie was devised. We see this in the growth of Integrative Medicine Departments across the US that would have sent Flexner spinning in his grave. That’s not post fracking tremors, that’s Flexner.

We also see it in state legislatures, where attempts at the medical equivalent of defining pi as 3.2 continue apace. Jann Bellamy has a weekly update of this depressing and difficult situation over at SfSBM.

I (and others) have written about Lyme (and it’s fictional counterpart, chronic “Lyme” disease). There is no post-antibiotic Lyme disease amenable to antibiotic (or other) therapies. Chronic Lyme is often a bogus diagnosis treated with equally bogus therapies.

In the heartland of Lyme the Massachusetts legislature overrode the governor’s veto to mandate that health care insurers have to pay for long term antibiotics to treat Lyme. This despite all the clinical trials that have shown antibiotics are not effective, and despite opposition from reality-based practitioners like the Massachusetts Medical Society.

Why?

It’s not the role of the Legislature or the governor to determine what the appropriate course of treatment is for Lyme disease.

Yes, but research has determined that long term antibiotics do not work for Lyme, so why mandate payment?

I suppose that Representative David P. Linsky, proponent of the bill, will next vote for the building of a wall to keep the Lyme out of the state and make the Borellia pay for it. It makes as much sense.

Add Massachusetts to the growing list of states that legitimize nonsense that we have to pay for.

Greening pseudo-medicine

The Green Party candidate for president, Jill Stein, is a doctor, internal medicine, like me. Well, not really. It would appear that her ideas about some pseudo-medical therapies are at best ill-informed and at worst explained away with weasel words that would make any politician proud.

Her vaccination stance has been extensively deconstructed by a box of blinking lights.

For homeopathy? In the current platform of the Green Party states:

Chronic conditions are often best cured by alternative medicine. We support the teaching, funding and practice of holistic health approaches and as appropriate, the use of complementary and alternative therapies such as herbal medicines, homeopathy, naturopathy, traditional Chinese medicine and other healing approaches.

The first sentence is wrong and the second divorced from reality. I read over the Green platform. So much to like, sprinkled with conspiracy paranoia and a big stinky dollop of pseudo-medicine. Her response to her party’s platform hardly inspires confidence in SBM:

The Green Party platform here takes an admittedly simple position on a complex issue, and should be improved.

No. It is a simple issue. Complementary and alternative therapies such as herbal medicines, homeopathy, naturopathy, traditional Chinese medicine and other healing approaches are fantasy and patients should not be defrauded of their time, money, health and life. One would think an internist would know this.

And now she has been quoted as worrying that Wi-Fi damages children’s brains.

Nope.

One commentator suggested that the Green Party may be more anti-science than Trump. No. I do not think so. Being anti-science requires a knowledge of science and reality, however cursory, not evidently an issue for narcissistic self-aggrandizing sociopaths.

 

 

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.

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