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312 posts categorized "Medicine "

February 09, 2010

Did the fathers of modern obstetrics murder more women than Jack the Ripper?

Latoya Peterson of Jezebel spotted this disconcerting story in Sunday's Guardian:

They are giants of medicine, pioneers of the care that women receive during childbirth and were the founding fathers of obstetrics. The names of William Hunter and William Smellie still inspire respect among today's doctors, more than 250 years since they made their contributions to healthcare. Such were the duo's reputations as outstanding physicians that the clienteles of their private practices included the rich and famous of mid-18th-century London.

But were they also serial killers? New research published in the Journal of the Royal Society of Medicine (JRSM) claims that they were. A detailed historical study accuses the doctors of soliciting the killing of dozens of women, many in the latter stages of pregnancy, to dissect their corpses. [Guardian]

This story has all the makings of an anti-science urban legend. Regardless of the quality of the underlying research, this story is going to get embellished in the retelling and used to bash scientific medicine.

The allegations are already being mentioned in the same breath as documented atrocities like the Tuskegee syphilis study, and Dr. Joseph Mengele's infamous concentration camp experiments.

I checked out Don C. Shelton's original paper. It's a very good read. Shelton raises credible suspicions about where these two doctors got their anatomical specimens. He, shamelessly overstates his case, however. Shelton flatly asserts that Hunter and Smellie were "responsible" for the murders of more women than Jack the Ripper.

The subjects of the anatomy books were women who died in childbirth, or during their final month of pregnancy. Shelton's argument is that there simply weren't enough heavily pregnant and birthing women dying of natural causes in mid-18th-century London to account for all the thirty-plus cadavers that Smellie and Hunter examined to write their respective anatomical classics.

Based on a review of their atlases, Shelton says that the two anatomists came up with a total of 20 cadavers between 1750 and 1754; and that Hunter somehow located another dozen between 1766 and 1774. That works out to four or five such bodies a year for the first stretch and fewer than two a year for the second period.

Shelton concludes that the doctors must have had these women murdered-to-order, a practice known as burking. The term burking is an allusion to the murderers Burke and Hare who smothered their victims in Edinburgh between 1837 and 1838 and delivered them to Dr. Robert Knox, a private anatomy lecturer. 

Shelton acknowledges that there is no research on burking in the mid-18th century.  He doesn't cite any documented cases of burking during that era.

There is no question anatomists of Smellie and Hunter's day got their cadavers from grave robbers. That's how it was done in those dark and superstitious days.

Shelton's case boils down to two rather plausible, but non-dispositive claims: i) very few women died in their 9th month of pregnancy or during childbirth to begin with, and, ii) it's unlikely that ordinary grave robbers would have been able to zero in on these rare cases.

Grave robbers tended to exhume corpses at random, Shelton explains. Or else they targeted the unclaimed bodies of people who died in poorhouses. But he notes that most of those who died in poorhouses were old and sick, not otherwise healthy pregnant women.

Death rates for infectious disease were very high in mid-18th-century London, but Shelton claims that pregnant women would have accounted for small percentage of the death toll. As he points out, they're a subset of the general population and a relatively young and healthy one at that.

Shelton cites statistics to show that the childbed death rate in the mid-18th-century was less than 2%. Based on the birth and death rates and the population of London at the time, he estimates that there would have been about 200 childbed deaths per year.

He argues that women who died in their 9th month of pregnancy would have been rarer still. Shelton suggests that very pregnant cadavers would have been extremely rare because a significant percentage women who suffered lethal illnesses or accidents in their 9th month would have miscarried before they died.

But even at their most productive, the two doctors were only seeing about five of their target subjects a year, on average. Five out of 200 doesn't seem that incredible.

The author also maintains that it would have been very difficult for grave robbers to find these rare specimens: Death notices were rarely published in those days and corpses usually went directly from home to the graveyard without a detour through a funeral home or some other central location that thieves could monitor.

Personally, if I were an 18th-Century anatomist who needed a steady supply of "special" cadavers, I'd start bribing vicars. If you pay for the new church roof, I'm sure it's amazing what you can find out about who's buried where.

So, the paper gives us good reason to doubt that Smellie and Hunter got all their cadavers through the standard grave-robbing channels. But that's hardly proof that the two men commissioned mass murder for hire.

Smellie and Hunter were famous obstetricians. They worked with pregnant and birthing women. In an era where most childbirth was handled at home, they probably served a disproportionately sick patient population.

Let's not forget that primitive obstetrics was really dangerous--no doubt in part because because science was still sketchy on pregnant female anatomy. If anyone was well-situated to tip off grave robbers about dead pregnant women, or take liberties with their corpses, it would have been 18th-century obstetricians.

As the author points out, Smellie and Hunter were rich and well-connected men. He implies that they could have gotten away with murder. On the other hand, if they could have gotten away with murder, they presumably had enough privilege to get what they wanted by less drastic, if socially unacceptable means. 

Shelton claims the following passage, written in 1818, is a smoking gun. The author was describing a plate in Smellie's atlas that features twins:

“Dr MacKenzie being then an assistant to the late Dr Smellie, the procuring and dissecting this woman without Dr Smellie’s knowledge, was the cause of a separation between them, for the leading steps to such a discovery could not be kept a secret."

Smellie died in 1763 and 55 years later, some guy claimed that an associate of Smellie's obtained the corpse by unspecified (but presumably sketchy) means without Smellie's knowledge. This is supposed to be a smoking gun? Really?

Shelton gives us no reason to assume that Smellie and Hunter were monsters. Why immediately jump to the conclusion that they were murderers? There have been killers in the name of science and medicine, but they've always been a tiny minority among scientists and for that matter, a very small subset of murderers. Shelton's wild allegation seems absurd unless you buy into some nasty stereotypes about doctors and scientists.

He makes no attempt to rule out less brutal schemes by which they might have improved their odds relative to common grave-robbers. Could they have performed unauthorized autopsies on pregnant patients who died of natural causes? Bribed the families of the deceased? Stolen the bodies of their own indigent patients? If a body was returned to the family with an incision in the abdomen, the obstetricians could always claim it was a cesarean section.

Were all their subjects even dead? Presumably they could have learned from examining and treating live women. It's a mundane possibility, but who's to say these guys didn't exaggerate the number of corpses they actually looked at? Academic dishonesty is more common than murder.

Obviously, I'm speculating here, but so is Shelton. He makes probabilistic arguments, so I'll make one too: If same end can be achieved through subterfuge or serial murder, most people will opt for subterfuge. Dead pregnant women are rare, but mass murderers are rarer still. Of course, tall tales of body snatchers, natural and supernatural, are as common as dirt.

Shelton is right to question how these doctors got their cadavers, but he simply does not have enough evidence to conclude that these pioneers of modern obstetrics killed more women than Jack the Ripper. This paper is just going to give the science bashers unearned ammunition.

January 23, 2010

UK skeptics plan mass homeopathy "overdose"

Kudos to the UK skeptics planning a mass homeopathy "overdose" to protest the fact that the National Health Service wastes public funds on these quack remedies:

There is still time to sign up for one of the most rational dates of 2010: next week's mass homeopathy overdose. At 10.23am on Saturday 30 January, anti-homeopathy activists, organised by the Merseyside Skeptics Society, will down entire bottles of homeopathic remedies outside branches of Boots, the better to demonstrate that these preparations are worthless.

Even though sales of Hahnemann's potions are likely to be unaffected, there remains a chance that the survival of hundreds of sceptics might persuade officials at Nice, the National Institute for Health and Clinical Excellence, to re-examine the funding of homeopathy within the NHS. It remains one of the world's great mysteries that the health service, with its austere, cash-strapped commitment to evidence-based medicine, should continue to spend an estimated £4m a year on sugar pills. [Guardian]

At least sugar pills contain actual sugar. Homeopathic tinctures are so heavily diluted that they are unlikely to contain any active ingredient whatsoever. It's such an egregious ripoff that I wouldn't even buy a bottle of homeopathic "medicine" in order to chug it. So, next Saturday, I'll homeopathically OD on a glass of New York City tap water. Same difference.

December 12, 2009

Naturopath tells Fox viewers that coffee will make them fat

In other woo news: Fox News invited Ann de Wees Allen to tell its viewers that black coffee will make you "fatter than a pig." This segment is a textbook example of how not to do science journalism. The voice over identifies de Wees Allen as "Doctor"--without mentioning that she claims neither a medical degree, nor a doctorate. Her website says she's a doctor of naturopathy. Fox also neglects to mention that Allen appears to have a sideline selling something called "Skinny Coffee"--an alternative to that fattening old joe.

The segment gives roughly equal time to a real dietitian who explains that coffee can't cause weight gain on its own, on account of it having no calories. Besides, she says, if plain coffee were causing massive weight gain, dietitians would have noticed by now.

Obviously, if you drink cream and sugar with your coffee, or use it to wash down cookies, those calories add up the same as any others. And there's evidence that even non-caloric sweeteners can stimulate the release of insulin, which in theory could make some people hungrier and/or more likely to store extra calories as fat--but that hypothesis hasn't been proven. But if coffee is "worse than five hot fudge sundaes" as "Doctor" Allen claims, there are a suspiciously large number of skinny coffee drinkers out there.

There are equally plausible mechanisms by which coffee might contribute to weight loss. Caffeine is, after all, a stimulant. As such, it tends to increase activity and boost metabolism.

I couldn't find much evidence that coffee consumption affects body weight either way.

By putting Allen up against a real dietitian, Fox News is inviting the inference that her views should be considered on par with those of a licensed health care professional. Like quacks throughout history, naturopaths have schools that hand out credentials, but naturopathy is pseudoscience. It is irresponsible of Fox News to give this quack a platform.

December 08, 2009

The Skeptical Gawker: "Cleanses", "toning shoes", and cookie diets

Thank you, Hamilton Nolan of Gawker for shattering illusions with science and reason:

You know what else is bullshit, besides juice cleanses? The idea that wearing some ugly Reeboks with a curvy sole will give you an Ass of Steel. Bullshit. Also, cookie diets? Bullshit.

The cleansing craze is a socially acceptable variant of bulimia.* Crash diets are no longer socially acceptable. These days, even the women's magazines that promote crash diets insist they are offering healthy, sustainable 1200 calorie meal plans.

There is so much evidence that starvation diets are ineffective and dangerous that even quacks now claim to reject them. But evidently, people still want permission to subsist on 800 calories a day and use lot of laxatives. Marketers have responded to the demand. 

Continue reading "The Skeptical Gawker: "Cleanses", "toning shoes", and cookie diets" »

November 16, 2009

Continuing Medical Propaganda Education

A little known provision in the House health care bill would require the $1 billion continuing medical education (CME) industry to disclose more about what it's teaching the nation's doctors:

WASHINGTON—Health legislation moving through Congress would force drug makers to disclose how much they spend on continuing medical education classes for doctors, sparking some resistance from the industry.

For-profit continuing medical education companies have seen revenue fall by double digits in the last year, according to industry statistics, following congressional investigations into the influence of drug makers on medical research and course content. [WSJ]

Good.

I used to write CME modules on high blood pressure drugs, sleeping pills, anti-malaria medicines, anti-depressants, hepatitis vaccines, and other remedies. Keep in mind that I quit medical writing several years ago and the rules have changed a lot since I left.

Sometimes these CME modules were financed by drug companies. In which case, they'd often consist of PowerPoint slide decks summarizing industry-funded research, which had been presented by industry-funded experts at industry-funded conferences.

The drug companies would give these training modules away. Doctors could answer multiple choice questions to earn points towards renewing their medical licenses. Sometimes CME companies would commission CME modules to sell to doctors for a profit. Some CME is produced by non-profit corporations and/or independent academic or professional outlets.

The drug companies did hire real doctors and lawyers to make sure that non-doctors like me didn't accidentally recommend anything lethal or fictional. This was called "med/legal review." Med/legal sent stuff back to us all the time when creative excess got the better of us and we started making claims that were "too promotional." This was a necessary check because we answered to marketing executives.

Review was thorough because the company didn't want to get sued. But a CME module that will stand up in court isn't automatically a quality teaching tool for your doctor. The standard for a true claim was basically whether the statement had been accurately paraphrased from an approved source, typically a peer-reviewed study. Usually, the drug company would tell us which papers to use. More often than not these were write-ups of research sponsored by the company. 

It was obvious to me at the time that this was no way to go about educating the nation's doctors. It wasn't that the information was false, it was just profoundly biased in favor of whoever was selling the drug. The drugs with the most money got the most exposure. Doctors could learn about the latest blockbuster for free, but they'd have to pay out of pocket to learn about a less heavily marketed alternative. So, doctors being much busier versions of normal people, were more likely to learn about whatever the industry literally put in front of them.

The overriding goal was to familiarize doctors with the key sales points for that drug. The specific claims were backed up by research, but at the end of the day doctors were getting a heavily-footnoted sales pitch. The primary object of the exercise was to hype a product, not to disseminate scientific truth.

At a time when the future of health reform depends on cost control, it might not be such a good idea to let pitchmen educate doctors.

More transparency in the CME industry can only be a good thing. The public might not like what it sees.

October 16, 2009

Nurse whistleblowers face jail time for reporting quack to medical board

Dr. Dave Gorski reports on a stunning miscarriage of justice: Two nurses face possible  jail time because they filed an anonymous complaint against a doctor who was peddling natural remedies out of the ER of their small rural hospital in Kermit, TX.

The quack turned out to be a vindictive quack. When the Texas Medical Board informed Dr. Rolando Arafiles, Jr. that he was under investigation, he lodged a complaint of criminal harassment with the Winkler County Sheriff, who worked tirelessly to unmask the anonymous tipsters:

To find out who made the anonymous complaint, the sheriff left no stone unturned. He interviewed all of the patients whose medical record case numbers were listed in the report and asked the hospital to identify who would have had access to the patient records in question.

At some point, the sheriff obtained a copy of the anonymous complaint and used the description of a "female over 50" to narrow the potential complainants to the two nurses. He then got a search warrant to seize their work computers and found a copy of the letter to the medical board on one of them. [New Statesman]

This is a a caliber of detective work scarcely seen outside of TV cop shows, especially for non-violent, non-crimes like complaining to a medical board. How did Dr. Arafiles get such vigorous policing from the Winkler County Sheriff's Department? Dave wonders if Dr. Arafiles and Sheriff Robert Roberts, Jr. are buddies. I think I found the answer. According to a lawsuit filed by the nurses, Arafiles and Roberts were--wait for it--associates in the herbal supplement business!

In theory, the Texas Medical Board allows anonymous tips, but privacy protections are so weak that the sheriff was able to figure out who blew the whistle.

The nurses, Anne Mitchell and Vickilyn Galle, were charged with improper use of official information, i.e., the state alleges that they improperly divulged confidential patient information in their complaint to the medical board. In fact, complaints to the medical board are HIPAA-exempt, which means that the nurses didn't have to get patient permission to share medical information with the board.

Dr. Arafiles was familiar with the workings of the Texas Medical Board, having already been disciplined in 2007. That time, the board fined him $1000 for failing to properly supervise a nurse practitioner and ordered him to educate himself on ethics, medical records and the treatment of obesity.

The Texas Nurses' Association has set up a legal defense fund for the Kermit Two, which you can support by clicking here. Dave is encouraging his readers to write polite letters to the Wikler County District Attorney's Office protesting the charges. 

October 14, 2009

Drug policy FAIL: LSD for cluster headaches

Newsweek has an interesting feature on LSD as an experimental therapy for cluster headaches. Cluster headaches are excruciatingly painful and often resistant to existing treatments. Anecdotal reports suggest that LSD can help sufferers.

Unfortunately, US drug laws preclude clinical trials. LSD is a so-called Schedule 1 drug, which means that the Drug Enforcement Agency has decreed a priori that it has no medical application.

The DEA is a law enforcement agency dedicated to drug prohibition. It has neither the expertise nor the inclination to evaluate the medical potential of controlled substances dispassionately. What if the DEA is wrong about the medical value of LSD? We'll never find out because it's illegal to do research on Schedule 1 drugs.

Update: In theory it's possible to apply for waivers to study Schedule 1 drugs, but according to Newsweek, "[t]hese drugs are so restricted by the DEA that researchers at the country's top universities find it almost impossible to get the permission and funding necessary to study the substances in humans." Legal clearance for a large scale clinical trial is inconceivable in the current climate. 

October 01, 2009

Cervical cancer vaccine didn't kill U.K. teen

It turns out that the Cervarix cervical cancer vaccine was not responsible for the tragic death of 14-year-old Natalie Morton of Coventry who died earlier this week within two hours of receiving the shot.

An autopsy showed that the young woman died from a previously undiagnosed chest tumor. Doctors said it was an advanced malignant growth that was so far gone that it could have killed her at any moment.

Statistically, if you give a vaccine to enough people, a certain percentage will end up dying within hours, even if the vaccine doesn't kill anyone. Such deaths must be investigated, especially if they happen to young healthy people with no apparent risk of sudden death.

This case is a reminder of the risks of conflating correlation and causation in advance of the facts.

September 20, 2009

Canadian health care as good as American, 47% cheaper

Foes of health care reform are making up all kinds of scurrilous nonsense about Canada's universal health care system.

Canadians have slightly longer life expectancy than their American counterparts and are just as likely to survive heart attacks, breast and cervical cancer, and childhood leukemia:

Sept. 18 (Bloomberg) -- Opponents of overhauling U.S. health care argue that Canada shows what happens when government gets involved in medicine, saying the country is plagued by inferior treatment, rationing and months-long queues.

The allegations are wrong by almost every measure, according to research by the Organization for Economic Cooperation and Development and other independent studies published during the past five years. While delays do occur for non-emergency procedures, data indicate that Canada’s system of universal health coverage provides care as good as in the U.S., at a cost 47 percent less for each person. [Bloomberg]

The U.S. had the highest rate of deaths preventable by health care in the entire OECD, 110 deaths per hundred thousand people. Canada had the sixth-lowest rate, 77 deaths per 100,000. 

Canada covers everyone with results as good as, or better than, the U.S. health care system, all for 47% less per person.

I grew up in Canada and I can attest that the system offers excellent care--equaling or surpassing any medical care I've received in the states, and with none of the bureaucratic nightmares of the private insurance system. 

Continue reading "Canadian health care as good as American, 47% cheaper" »

September 17, 2009

Wombs for Rent: Surrogacy scams

Tomorrow NOW will broadcast an expose of scams in the surrogate motherhood industry, supported by my friends at the Nation Institute. Old school investigative reporting meets cutting edge medical technology:

Many European countries, from Spain to Germany to the Netherlands, have banned surrogate motherhood. But in the United States it's the Wild West -- an almost completely unregulated industry that has left some surrogate mothers with thousands of dollars in unpaid medical bills and would-be parents with pilfered bank accounts. "If you compare surrogacy to buying a used car," says one expert in the field, "there are many more rules when you buy a used car."

Investigative Fund reporters Habiba Nosheen and Hilke Schellmann traveled the country speaking with surrogate mothers, agency operators, and intended parents to expose the human costs of this lack of regulation and produced a segment for NOW on PBS, "Wombs for Rent," which takes a close look at one of the industry's many bad actors, SurroGenesis.

"Wombs for Rent," which was supported by the Investigative Fund at The Nation Institute, airs Friday, September 18, at 8:30 p.m. in New York City. Go to https://www.pbs.org/now/sched.html for broadcast times nationwide.