Recently in Media Category
In a Pharmalot interview, money manager, blogger, and diabetic David Kliff absolutely excoriates "Buttah Queen" Paula Deen and insulin-maker Novo Nordisk for their newly announced, and arguably duplicitous, promotional relationship. Kliff easily tosses out words like "hypocrite," "shyster," and "bastardizing" like so many fat calories in a bacon-and-fried-egg hamburger with doughnut buns.
First Jeffrey Kindler, then Lipitor, and now this: Pfizer announced today that * Bloody hell.
In its search (some might say crusade) to link repetitive head injury with chronic traumatic encephalopathy, or CTE, in professional sports, Boston University's Center for the Study of Traumatic Encephalopathy revealed that another NHL player, NY Rangers' enforcer Derek Boogaard, had the condition at a remarkably advanced stage. Boogaard died in May of this year, at the age of 28, as a result of an overdose of alcohol and prescription narcotics, and the Center solicited Boogaard's family to examine the athlete's brain. The results of the examination, which are convincingly described and displayed in a multipart NYT video piece, were reported by the paper on December 3rd. Boogaard is now the fourth NHL player with the condition in the Center's case series of this particular sport.*
Among the disturbing facets of the NYT coverage, NHL commissioner Gary Bettman downplays the risk of brain injury as a result of brawling in his league* and minimizes the Center's research as "preliminary" and "great for headlines." One is reminded of neurologist Ira Casson's essential denial of the association between repetitive head injury and CTE in January of 2010. Casson was co-chairman of the NFL's panel on brain injury until he resigned November of 2009, largely owing to his perceived insensitivity toward a possible link.
* The Center's case series of NFL players with CTE, 13 of 14, is substantially larger.
** Which he, inexplicably, denies is allowed.
Among the disturbing facets of the NYT coverage, NHL commissioner Gary Bettman downplays the risk of brain injury as a result of brawling in his league* and minimizes the Center's research as "preliminary" and "great for headlines." One is reminded of neurologist Ira Casson's essential denial of the association between repetitive head injury and CTE in January of 2010. Casson was co-chairman of the NFL's panel on brain injury until he resigned November of 2009, largely owing to his perceived insensitivity toward a possible link.
* The Center's case series of NFL players with CTE, 13 of 14, is substantially larger.
** Which he, inexplicably, denies is allowed.
And probably rightly so, given a number of issues.- The Harvard press release is terribly (and irresponsibly) overdramatic, emphasizing the "endocrine-disrupting" effect of bisphenol A (which is only documented in laboratory animals, to my knowledge) and the >1200% increase in urinary BPA after consuming canned soup (Progresso) for 5 days. There is no mention of absolute numbers in the attention-grabbing press release, just the astonishing percentage jump.
- The JAMA report, available here (courtesy of JunkScience.com), is actually published as a letter and not a more stringently peer-reviewed article.
- JunkScience.com takes the letter authors to task for not distinguishing between the urinary measurement of BPA (which is evidently not possible or very difficult) and that of a quickly produced metabolite. BPA is evidently rapidly processed in the body, and its "biologically inactive" metabolite (not BPA per se) was actually measured in urine, says JunkScience.com (the blog further claims that at least some of the authors should have known or do know this fact).
- While the percentage increase of mean urinary BPA values among canned-soup eaters is very impressive, we're talking about differences in MICROGRAMS PER LITER: 1.1 mcg/L after 5 days of fresh-soup consumption vs 20.8 mcg/L after 5 days of canned-soup consumption, for a difference of 19.7 mcg/L.*
- The urinary spike in BPA (or its metabolite) was probably transient, and the authors themselves acknowledge, "The effect of such intermittent elevations in urinary BPA concentration is unknown."
* In the updated National Health and Nutrition Examination Survey, levels of BPA were detected in all subjects older than 6 years of age. Geometric means were approximately 2 mcg/L, but levels rose to 20 mcg/L (or thereabouts) in the 95th-percentile groups.
Image of can of Progresso vegetable minestrone soup from progresso.com.
Forbes's Matthew Herper on Bill Gates on vaccines and pharma: There's sufficient ink for undeniably venerable ideas and acts, but an "unimpressed" Gates disparages Novartis's Gleevac, a molecule that has completely revolutionized the treatment of CML.
“There’s always this divergence between what’s financially attractive and what has dramatic profit and the number of life years that you really save...Do the math on [Gleevac] versus, says, preventing Parkinson’s or preventing Alzheimer’s. It’s in a different universe."
I have to say that the most astonishing finding from President Obama's most recent routine physical examination is not that he's smoke-free or that his LDL fell with presumptive dietary changes or that he even got a PSA test but that he has 20/20 vision, near and far, without correction. Who the hell doesn't have to wear glasses for something after the age of 50? Photo of a glassless #44, from http://www.whitehouse.gov/about/presidents/barackobama.
From this week's issue of Neurology.Using MR venography and ultrasound* in 40 patients with MS, German investigators failed to replicate the 100% prevalence of chronic cerebrospinal venous insufficiency (CCSVI) defined famously (and notoriously) by Zamboni et al in 2009 (for background, start here or search Pathophilia for "Zamboni"). This newly published study, by the authors' account, is at least the 13th study** that has failed to validate Zamboni's theory of venous insufficiency in MS and his follow-up idea that the stenting of cerebral veins (ostensibly to improve the egress of iron) could be somehow objectively clinically beneficial.
Here's the parade of negative studies cited by the German authors (Doepp et al); 11 of these studies have been published in English-language peer-reviewed journals (all of which are reasonably well regarded).
Ultrasound studies
- Doepp F, Paul F, Valdueza JM, Schmierer K, Schreiber SJ. No cerebrocervical venous congestion in patients with multiple sclerosis. Ann Neurol. 2010;68:173-183.
- Baracchini C, Perini P, Calabrese M, Causin F, Rinaldi F, Gallo P. No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol. 2011;69:90-99.
- Krogias C, Schroeder A, Wiendl H, Hohlfeld R, Gold R. "Chronic cerebrospinal venous insufficiency" and multiple sclerosis: critical analysis and first observation in an unselected cohort of MS patients. Nervenarzt.
- 2010;81:740-746. (article in German)
- Mayer CA, Pfeilschifter W, Lorenz MW, et al. The perfect crime? CCSVI not leaving a trace in MS. J Neurol Neurosurg Psychiatry. 2011;82:436-440.
- Centonze D, Floris R, Stefanini M, et al. Proposed CCSVI criteria do not predict MS risk nor MS severity. Ann Neurol. 2011;70:52-59.
- Sundstroem P, Wåhlin A, Ambarki K, Birgander R, Eklund A, Malm J. Venous and cerebrospinal fluid flow in multiple sclerosis: a case control study. Ann Neurol. 2010;68:255-259.
- Wattjes M, van Oosten BW, de Graaf WL, et al. No association of abnormal cranial venous drainage with multiple sclerosis: a magnetic resonance venography and flow-quantification study. J Neurol Neurosurg Psychiatry. 2011;82:429-435.
- Zivadinov R, Lopez-Soriano A, Weinstock-Guttman B, et al. Use of MR venography for characterization of the extracranial venous system in patients with multiple sclerosis and healthy control subjects. Radiology. 2011;258-562-570.
Measurement of intraocular venous pressure
Measurement of CSF ferritin levels
* Specifically dynamic extracranial color-coded duplex sonography (ECCS).
** The cited studies do not include the essentially negative ultrasound study from the University of Buffalo, which was recently published in April in Neurology. Consequently the peer-reviewed tally comes to 14 negative studies.
Image of neck veins from Gray's Anatomy (1918).
There are journalistic programs in which we (I) place more credit than others—possibly owing to their style, possibly owing to their length and supposed care with a subject, and possibly owing to the fact that they air on the Public Broadcasting System. "Frontline" is one such show. However, credit afforded to news programs can be easily and permanently eroded when they showcase a subject of which we (I) know something about—like medicine—and present a terribly biased or outrightly incorrect view of an issue. This is presumably done for the sake of generating controversy and attention (irresponsibly) or, I can only guess, because the show's producers are lazy or stupid or both.
Last evening, "Frontline" aired a documentary of the FBI's investigation of the so-called anthrax attacks of 2001, a subject of which I know something about, at least on an amateur basis. The program, "The Anthrax Files," was heavily informed, it appears, by input from ProPublica, an amorphous collection of "independent" journalists, that partners with all sorts of more tangible news organizations like "60 Minutes"* and NPR. And from ProPublica, the format and theme of the program—that being, that USAMRIID scientist Bruce Ivins was not the perpetrator of the anthrax attacks—were heavily informed by ProPublica's curiously perpetually suited managing editor Stephen Engelberg.
As a recurrent talking head, Engelberg heavily insinuates in his program (and it really does appear to be his program) that Bruce Ivins was not the anthrax killer by first laying out the case of Steven Hatfill. Hatfill, an American physician and virologist, was the FBI's prime initial suspect as the anthrax killer, circa 2002, and the agency basically hounded the guy (for a number of reasons that are not explained in the "Frontline" program) to no success. Engelberg's prelude on Hatfill provides the basis for later suggesting that the FBI pushed another hapless suspect, Bruce Ivins, who was much more mentally brittle than Hatfill, to suicide when the agency pursued the USAMRIID scientist in the same harassing way as it did Hatfill. In other words, according to Engelberg, Ivins didn't commit suicide out of guilt of being the anthrax killer or fear of rightful criminal prosecution, but because the FBI drove him to it.
But here Engelberg's journalistic transgression is one of serious omission. Namely Engelberg utterly fails (and I can only conclude that he intentionally utterly fails) to include essential information from a 2009 court-authorized psychological review of Bruce Ivins. From this review, a 9-member panel concluded in March that "Dr. Ivins was psychologically disposed to undertake the mailings; his behavioral history demonstrated his potential for carrying them out; and he had the motivation and the means." So why wouldn't Engelberg include this important psychological review of Ivins in the "Frontline" program? The answer: Because it gets in the way of his controversy- and attention-generating themes—namely that Ivins wasn't the anthrax killer, and the FBI is an incompetent and/or pernicious government institution.
Engelberg also attempts to undermine the FBI's scientific evidence pointing to the "smoking gun" RMR-1029 flask at USAMRIID (for background on this flask, start here), over which Ivins had control. To my understanding, there were 16 domestic labs that had the RMR-1029 strain before the 2001 anthrax attacks; however, only one of these labs was located where the "federal eagle" envelopes (which were used in the attacks) were distributed and sold (in Maryland and Virginia). And this was the USAMRIID RMR-1029 flask over which Ivins had control. Engelberg completely fails (and again, I can only conclude that he intentionally fails) to provide the information about the envelopes in his "Frontline" program. The fact that the scientific evidence (meaning the genetic evidence implicating RMR-1029) does not solely support the fingering of Ivins is nothing new. It is the confluence of the 2 vital pieces of information—the genetic identification of RMR-1029 and the location of the envelope purchase that points to Ivins.
Engelberg also attempts to erode the FBI's allegations that 1) Ivins worked alone in lengthy late-night shifts during September 14-16, 2001, and from September 28 to October 5, 2001, before the rounds of the NY Post/Brokow and Leahy/Daschle letters were respectively mailed, and 2) Ivins, in highly disingenuous fashion, submitted "unusable" and false B. anthracis spores to the FBI for testing. Engelberg's attempted correction of the FBI's graph of Ivins's late-night hours during the fall of 2001, although less impressive than the FBI's original graph, still reveals a spike in Ivins's work hours during the time in question. And Engelberg doesn't negate the fact that Ivins submitted an unusable sample of B. anthracis to the FBI, but that Ivins also submitted at least 2 workable samples to the agency at some point during their investigation.** Last Engelberg fails to include any information about the 2002 contamination of Ivins's laboratory with B. anthracis spores, outside of the proper containment facility, and Ivins's failure to report the incident.
Whatever easy agenda Engelberg is pushing to some receptive sector of the American population in "The Anthrax Files" (the FBI is a terrible organization—?), it is, in the case of the anthrax attacks and Bruce Ivins, nothing other than irresponsible and, in my view, only serves to undermine the credibility of ProPublica and "Frontline."
* Speaking of a news program in which we (I) have no confidence.
** Apparently because he had no choice but to do so.
Public domain photograph of Daschle "anthrax" letter from Wikipedia.
As demonstrated by grad student Abbie Smith at her ERV blog.
Smith's post heard 'round the Web—which is a major, career-devasting bust to researcher Judy Mikovits—shows how Mikovits clearly used the same Western blot data to describe two different experiments, both of which made the now highly dubious link between XMRV and chronic fatigue syndrome.
Although Smith acknowledges that she was not the first to recognize the identical nature of Mikovits's Western blot images (one of which was published in Science in 2009 and the other of which was presented at a recent conference in Ottawa), she should get credit for the worldwide disclosure.
Snap.
Smith's post heard 'round the Web—which is a major, career-devasting bust to researcher Judy Mikovits—shows how Mikovits clearly used the same Western blot data to describe two different experiments, both of which made the now highly dubious link between XMRV and chronic fatigue syndrome.
Although Smith acknowledges that she was not the first to recognize the identical nature of Mikovits's Western blot images (one of which was published in Science in 2009 and the other of which was presented at a recent conference in Ottawa), she should get credit for the worldwide disclosure.
Snap.
