Category Archives: Science

Sybil’s Multiple Personality Hoax

Posted in General, Health, Science by

The creator of Sybil more than likely suppressed a remembrance of how it began once they got into the thick of it. Once it became a financial success there was no turning back. In the final analysis Sybil is a phony multiple personality case at best.

Further more, this tendency to go over the top and not know where to stop with multiple personalities will continue to persist until we cease to be proud of those things we should be ashamed of.

Robert W. Rieber History of Psychiatry, X  (1999), 003-011

False memories and suggestibility. Extreme examples aside, I wonder at times if they aren’t related to confirmation bias and the rationalisation of cognitive dissonance.

Without intent we’re all suggestible at a certain level and almost certainly carry a few false or rather, completely erroneous memories – no matter how small. Certain illusionists and entertainers have strong links to skeptic groups and are at pains to forewarn of our brains’ suggestibility to stimuli. Psychology. Science. With knowledge and copious practice the better performers can perform “magic” 18 inches in front of us. Or more to the point inside our heads, using our own “software”.

Then there’s polarised views of the self and how it relates to the world. Why is it that some of us immediately know rubbish (and really bad rubbish at that) whilst other Conscious Living or Mind Body Spirit types wear their gullibility like a para-glider’s sail? Those of us that speak of the Conscious Lying or Mind Body Wallet expo’s don’t have anatomically different brains to those that believe. In fact what ever you make of psychics Myrtle Harvey and Ros Booth over at Dave The Happy Singer‘s blog is likely down to experience and environment.

To stop myself launching into studies on brain activity, neuropsychology and neuroscience I’d better mention Sybil. “Sybil” was the title of the 1973 book by magazine editor Flora Rheta Schreiber written about Shirley Mason. Shirley supposedly had 16 different distinct personalities. The dramatic story of how she got this way and how the narcosynthesis (drug induced hypnosis) loving, Sodium Pentathol (“truth serum”) injecting and self obsessed Dr. Cornelia Wilbur “helped” her is the theme of the book. The sensational aspect in treatment was that Mason was tortured hideously by her mother, was encouraged to believe so and hate accordingly.

However as you’re probably now realising, by the time Wilbur hooked up with Schreiber to write the book, what was actually documented in the treatment notes and on tape and what made it into print are two entirely different stories. The former fact, the latter fiction and omission of fact. Regarding the diagnosis itself a fascinating deconstruction [below] written by Robert W. Rieber, Ph.D in 1998 makes it clear that Wilbur was “planting the truth as she wanted it to be”. He writes:

I have been able to tell the story of how it is possible to manufacture a multiple personality. [….] As to the question of whether or not the Sybil case was an out and out fraud, that of course depends upon your personal definition of that term. No matter what you wish to call it, it was a conscious misrepresentation of the facts. The fine line between self-deception and deception of others is an important issue here. Unquestionably, Schreiber and Wilbur wanted to make Sybil a multiple personality case no matter what.

The New York Times write about a “confession” from Mason 15 years before the book was published:

… 1958, Mason walked into Wilbur’s office carrying a typed letter that ran to four pages. It began with Mason admitting that she was “none of the things I have pretended to be. “I am not going to tell you there isn’t anything wrong,” the letter continued. “But it is not what I have led you to believe. . . . I do not have any multiple personalities. . . . I do not even have a ‘double.’ . . . I am all of them. I have been essentially lying.”

We now know that sodium pentathol induces false memories and fantasies whilst under the influence. Wilbur would patently suggest scenarios to Mason whilst drugged then prompt her to “recall” the memory later. Wilbur also prescribed large doses of drugs that proved less than ideal. Secobarbital (Seconal) which is now only used for 10 days to two weeks due to dependence and Daprisal which proved so addictive as to be removed from the market and was associated with amphetamine induced psychosis. According to the NYT this transcript is stored amongst Schreiber’s papers at John Jay College of Criminal Justice, in New York City:

“What about Mama?” the psychiatrist asks her patient. “What’s Mama been doing to you, dear? . . . I know she gave you the enemas. And I know she filled your bladder up with cold water, and I know she used the flashlight on you, and I know she stuck the washcloth in your mouth, cotton in your nose so you couldn’t breathe. . . . What else did she do to you? It’s all right to talk about it now. . . . ”

“My mommy,” the patient says.

“Yes.”

“My mommy said that I was a bad little girl, and . . . she slapped me . . . with her knuckles. . . .”

“Mommy isn’t going to ever hurt you again,” the psychiatrist says at the close of the session. “Do you want to know something, Sweetie? I’m stronger than Mother.”

According to her baby book at the age of 7 Mason had a tonsillectomy in the home office of a doctor. She was brought there without being told why and told to put on a white treatment shirt and forced onto a table. Whilst struggling she was held down and the town pharmacist held a cloth soaked in ether over her nose. Mason felt like she was suffocating before she passed out. A flashlight was used to examine her throat and sliver bottles were nearby. Mason did tell Wilbur about the actual event years later. But under pentathol and during a time of Freudian psychology, Wilbur concluded this forceful treatment was not just rape but sexual torture.

Shirley Mason was indeed very unwell suffering from anorexia, anxiety, feelings of hopelessness and worthlessness. She also reported unusual memory blackouts, at times coming to in places, suburbs or towns she had no memory of travelling to. Dr. Wilbur assumed these were fugue states during which a patient may lose touch with the self for hours or days and continue to act reasonably normally but as if someone else. Or rather the state would be forgotten and preceding events with it, giving the tempting illusion that one had “been” someone else.

The problem here was that Wilbur went looking for a fractured personality disorder. It was all downhill from there and introducing narcosynthesis in consonance with Wilbur’s urging was clinically disastrous. Mason had fantasies about being a doctor – perhaps a psychiatrist. More so, she had fantasies about Wilbur and developed a strong crush. The only child of Seventh Day Adventists Mason felt like Wilbur understood her like no other. Obsessed, in need, doped up and subject to drug induced hypnosis she latched onto the tether of Wilbur’s highly suggestible treatment.

There were signs earlier that Cornelia Wilbur, unashamedly fascinated with multiple personalities, was practicing very poor medicine. Shirley Mason visited Herbert Spiegel when Wilbur was absent. Speigel was an eminent hypnotherapist and psychiatrist. In the 1990’s he informed reporters of his concerns at the time that Mason would ask if she should “shift to the other personalities” as Dr. Wilbur liked her to do. Spiegel had clearly diagnosed Mason with hysteria. Which in truth was almost certainly the correct diagnosis for that era.

Wilbur spent her career with hysterical patients, often jabbing them full of sodium pentathol and using suggestion to manage symptoms. It is unlikely she did not know of Mason’s proper diagnosis. Rieber (below) points out the prospects of a book on MPD outweighed Spiegel’s attempts to reason with Wilbur and Schreiber. Robert Rieber breaks the tape recordings into ten distinct sections from Wilbur’s “diagnosis” to inventing the “crimes” of her mother to sustaining Mason’s hatred toward her mother to projection of guilt on Wilbur’s part. It’s a great read.

Alarm bells also rang in skeptical quarters. Prior to the book’s publication less than 80 cases world wide of “something resembling MPD” were documented. Following this, several thousand diagnoses followed in areas where the book was being read and in the demographics reading the book.

The hard work has been done by investigative journalist Debbie Nathan, author of Sybil Exposed, who who is interviewed in the video below. She has trawled through the documents kept in Schreiber’s papers to put together the truth. It wasn’t until it was discovered in 1998 that Mason was deceased, that her identity was revealed.

One must wonder. What ever became in the meantime of this very ill woman treated by an ambitious and unethical doctor, who failed completely to care for her patient?

ABC 7:30 Report

A Trinity of Affinity History of Psychiatry, X  (1999), 003-011

Berkeley Earth Project supports global warming trend

Posted in climate change, Science by

In the wake of the much touted UEA “climategate” emails, climate change denial took on a new confidence. Although shown to be a storm in a teacup, denialists still claim that data was manipulated to show exaggerated anthropogenic global warming – AGW.

Other concerns thus spread to the IPCC, National Oceanic and Atmospheric Administration (NOAA) and National Aeronautics and Space Administration (NASA) and other climate scientists about secretly reviewing each others data. These claims have and do attract genuine concern. In effect this arguably limited opportunity for criticism prior to publication, watering down the veracity of peer review. It also gave a ready weapon for politically motivated denialists and conspiracy theorists alike to dismiss on an ad hoc basis conclusions of global warming, regardless of data origin.

Aiming to deal directly with both the stain of climategate and a number of misconceptions seized on by denialists is the Berkeley Earth Project. Established by University of California physics professor Richard Muller the project was funded by a number of groups including those lobbying against action on climate change such as the Koch brothers. Muller was “deeply concerned” that discordant data had been concealed. According to the BBC;

Funding came from a number of sources, including charitable foundations maintained by the Koch brothers, the billionaire US industrialists, who have also donated large sums to organisations lobbying against acceptance of man-made global warming.

Physicist Saul Perlmutter, who won the Nobel Physics Prize this year for research on the accelerating expansion of the universe was one of a team of ten. Broadly speaking the Berkeley team has validated the warming trends documented before, reinforcing a global temperature rise of at least 1 ℃ since the mid 1950’s. This followed a review of 40,000 weather recording stations, looking at the global temperature trend over land since 1800.

Global warming is real according to a major study released today (October 20th, 2011). Despite issues raised by climate change skeptics, the Berkeley Earth Surface Temperature study finds reliable evidence of a rise in average world land temperature of approximately 1 ℃ since the mid-1950s.

Comparison of NASA GISS, NOAA and Berkeley temperature anomaly data

More so, they have addressed some standards amongst the cynics camp, such as islands of warmth distorting a global view. This rather logical criticism of an urban heat island effect, notes that weather stations are located close to or within cities thus cannot be a reliable reference point for global temperatures. Only 1% of the globe’s surface is industrialised.

It’s arguably a slightly selective criticism because another flawed criticism of a warming globe is that over the last 50 – 70 years many weather stations have shown a decrease in temperature trends. However, the ratio of warming sites to cooling sites is roughly 2:1. This global trend was mimicked in the USA. Clumping is evident yet it’s possible to find “long time series with both positive and negative trends from all portions of the USA”. The authors stress that detection of long term trends should never rely on individual records.


USA and surrounding weather stations: Red – Net warming. Blue – Net cooling.

A comparison of all weather sites (blue line) and very rural (red line) that would be immune from the heat island effect yields a striking challenge for proponents of this criticism of AGW data. It was also noted that weather stations ranked as “poor” showed the same overall trends as stations ranked as “OK”.

Recorded Temperature: All sites and rural sites from 1800 – present

In general their findings have been summarised as:

 ¤ The urban heat island effect is locally large and real but does not contribute significantly to the average land temperature rise. That’s because the urban regions of the earth amount to < 1% of land area.

 ¤ About 1/3 of temperature sites around the world reported global cooling over the past 70 years. Bur 2/3 of the sites show warming. Individual temperature histories reported from a single location are requently noisy and/or unreliable and it is always necessary to compare and combine many records to understand the true pattern of global warming.

The large number of sites reporting cooling might help explain cynicism toward global warming. Humans can’t feel global warming and information suggesting your local temperatures are the same or cooler than a century ago can be mistaken for representative of the entire globe. It is difficult to measure weather consistently over decades or centuries. Sites reporting cooling is a symptom of the noise and variation that occurs. A good determination of global land temperature takes hundreds or thousands of stations to detect and measure the average warming. Only when many nearby thermometers reproduce the same patterns can we know that measurements were reliably made.

 ¤ Stations ranked as “poor” in a survey by Anthony Watts and his team of the most important temperature recording stations in the USA, (known as USHCN – the US Historical Climatology Network), showed the same pattern as global warming as stations ranked “OK”. Absolute temperatures of poor stations may be higher and less accurate, but the overall global warming trend is the same, and the Berkeley Earth analysis concludes there is not any undue bias from including poor stations in the survey.

The Berkeley Earth Study authors are anxious for open and honest discourse, peer review and criticism of their work. To this end it will be available on their website for review:

The Berkeley Earth team has now submitted four papers for peer review. We are making these preliminary results public, together with our programs and data set, in order to invite additional scrutiny. The four papers are:

The aim of the Berkeley Group was to confirm AGW and the extent to which this is occurring. This appears to have been done. Some conclusions differ from earlier views of annual climate changes in that global temperature correlates more strongly with the Atlantic Multidecadal Oscillation (AMO) index. This is a measure of north Atlantic sea surface temperature. Whilst El Nino Southern changes have traditionally been attributed to annual changes, the team now want to examine long term AMO cycles for impact on the rise-fall-rise seen over the 20th century.

As the final touches were being put to this report popular “theatrical” shock jock Alan Jones (left) was dodging questions and pushing ye olde climategate email conspiracy line on the ABC.

Under a heading Time for Apology the BBC write:

Prof Phil Jones, the CRU scientist who came in for the most personal criticism during “Climategate”, was cautious about interpreting the Berkeley results because they have not been published in a peer-reviewed journal.

“I look forward to reading the finalised paper once it has been reviewed and published,” he said. […]

In part, this counters the accusation made during “Climategate” that climate scientists formed a tight clique who peer-reviewed each other’s papers and made sure their own global warming narrative was the only one making it into print. […]

Bob Ward, policy and communications director for the Grantham Research Institute for Climate Change and the Environment in London, said the warming of the Earth’s surface was unequivocal.

“So-called ‘sceptics’ should now drop their thoroughly discredited claims that the increase in global average temperature could be attributed to the impact of growing cities,” he said. “More broadly, this study also proves once again how false it was for ‘sceptics’ to allege that the e-mails hacked from UEA proved that the CRU land temperature record had been doctored.

“It is now time for an apology from all those, including US presidential hopeful Rick Perry, who have made false claims that the evidence for global warming has been faked by climate scientists.”

Given the nature of denialism and creatures like Jones, I would suggest reasoning with the rusted on cynics is futile. Any apology will only be forthcoming from those with an appreciation for science, not faith based movements.

I predict regular stormy seas ahead for this manufactured “debate”, for some time to come.

 

Alan Jones on Alan Jones

Posted in climate change, Denialism, General, Science by

I think it would be good for Australia if Tony Abbott was the Prime Minister of Australia

– Alan Jones, influential conservative “shock jock” media identity, climate science denialist and Abbott supporter –

Leigh Sales of ABC’s 7:30 Report hosts an extended interview with radio broadcaster, climate science denialist and beacon for conservative anger, Alan Jones.

Covering issues from mining, to respect for the office of PM, to potential for sustainability, to denial of climate change Jones argues Australia is “entitled” to a better Prime Minister. Side stepping a few points such as flaws in the science challanging climate change vs the wealth of science supporting it, Jones suggests topics choose him. His science illiteracy and propensity for ad hominem attacks against those of differing opinion is at times mixed liberally with logical fallacies as Jones insists on maintaining the upper hand.

Whilst denying using abusive terms Jones immediately defends those he uses as justified. Rob Oakeshott is “brain dead” for supporting climate change agendas and will unlikely get another job. On Greens Senator Sarah Hanson-Young, calling her “a fool is flattering… that’s flattering”. One would have been delighted if the irrelevant anti-Greens sentiment – indeed anti-Left sentiment – buoyed by claims of anti-Right climate conspiracies could be supported with evidence.

Perhaps most regrettably Jones falls back on the commonly debunked climate science denialist tactic of citing ICPP emails as legitimising any and all denial of climate change. Now well established as a careless use of language entirely divorced from the volume of data, the leaked emails are of no moment. One can only imagine if Aussies applied the same logic to Jones’ illegal “cash for comments” scam [Wikipedia entry]. Should his criminal conduct and breach of media codes be seen as cause to mistrust his transparency?

Unusually, despite the platform of the ABC and given the impact of his show on community opinion, Jones produced not one cogent argument to support his irrational position on climate change. His best appeal to authority is to reference interviewing “some of the leading scientists in the world… finest minds” who said anthropogenic climate change affirming science is “a hoax”. Having interviewed a senior IPCC scientist, Jones completely loses track by noting he “agreed with most of the statistics I offered”. Then his famous fallacy gets a run.

Quoting the percentage of CO2 in the atmosphere, the percentage of that arising from from emissions and the percentage of that which is derived from Australia, he triumphantly reinforces the 0.000018% of atmospheric CO2 attributable to Aussie emissions. The child-like reasoning here is shocking. It’s a little number thus cannot be of menace. That climate is certainly effected by tiny, cumulative changes leading to dramatic and devastating consequences seems beyond him. As is the impact of only a couple of degrees increase in average temperature. But is he really serious?

CFCs make up a tiny fraction of 1% of our atmosphere. Yet CFC-11 has 17,500 times carbon dioxide’s capacity to trap heat in the atmosphere. That 0.04% of CO2 Jones loves to quote. Jones has no problem with the science of ozone depletion, nor action taken to preserve the ozone layer. Surely then, a bright chap like him could further appreciate the power of minor changes to atmospheric chemistry. Though there’s no political gain to be found in denying ozone preservation. No cleverly crafted junk science making up cushy rebuttals. What if we applied this dismissal approach to human health?

The size of the HIV or Ebola virus is microscopic. The percentage of body surface area opened by a bullet wound is insignificant. The number of cardiac cells to misfire and lead to a lethal infarction is minuscule compared to the total. A tiny blood vessel amongst hundreds of thousands, effecting 0.000018% or less of brain neurons can change a life, wipe memory, destroy speech, render us blind and so on. No doubt he could comprehend such simple notions. Suffice it to say it pays to remain skeptical of Jones’ motives. Or indeed, respect how effective the climate change denialist movement has been.

There was of course, no defence of the scurrilous and unconscionable abuse of science behind the entire denialist movement. For example, consider this from an article by Donald Prothero published in e-Skeptic, late last September:

As Oreskes and Conway documented from memos leaked to the press and published in their book Merchants of Doubt, in April 1998 the right-wing Marshall Institute, SEPP (Fred Seitz’s lobby that aids tobacco companies and polluters), and ExxonMobil, met in secret at the American Petroleum Institute’s headquarters in Washington, D.C. There they planned a $20 million campaign to get “respected scientists” to cast doubt on climate change, get major PR effort going, and lobby Congress that global warming wasn’t real and was not a threat. Then there was the famously cynical 2002 memo from GOP pollster and spinmeister Frank Luntz to the Bush White House:
The scientific debate is closing [against us] but not yet closed. There is still a window of opportunity to challenge the science… Voters believe that there is no consensus about global warming within the scientific community. Should the public come to believe that the scientific issues are settled, their views about global warming will change accordingly. Therefore, you need to continue to make the lack of scientific certainty a primary issue in the debate, and defer to scientists and other experts in the field.

Incredibly Jones says at one point he “finds it hard to believe people in politics behave the way they do, and expect people to take them seriously”. It’s a brilliant example of Poe’s Law colliding with the Dunning-Kruger effect.

Enjoy…

http://vimeo.com/30841685

Needle, Syringe Programs needed in Aussie prisons

Posted in Anti-Drug Lobby, Denialism, Drug Free Australia, Health, Human Rights, Illicit Drug Policy, Science by

Needle Syringe Programs in prisons have proven successful across the globe, including in Iran.
Gains are directly transferred to
individuals, family members, community members, custodial officers, law enforcement officers and health professionals.

Australia once led the world in Harm Reduction initiatives, a number of which pertain to safe injecting of illicit drugs.

Because of the illegality, potential for tragedy and high risk associated with IV drug use it is very easy to be led astray from the evidence base supporting harm reduction initiatives. Primary amongst these is the funding of over 1,000 Needle, Syringe Programs (NSPs) across Australia. Although introduced against considerable opposition, community acceptance is now very high. More to the point, similar misinformation and conservative opposition was raised against another harm reduction initiative when introduced. Condom use amongst men having sex with men (MSM).

Harm Reduction measures were introduced by then federal health minister, Neal Blewett in 1985, ushering in unprecedented acceptance, understanding and management of high risk behaviour leading to the spread of HIV in Australia.

Led by the Minister for Health under the Hawke government, Neal Blewett, Australia undertook several unprecedented and pragmatic steps: it introduced a needle exchange program for intravenous drug users, encouraged open discussion of safe sex, and created the famous Grim Reaper advertising campaign.

There was fierce opposition from the religious right, but 25 years after the initial AIDS outbreak, Australia’s decision to accept human nature in policy making has saved thousands of lives – especially when compared to the USA where ‘morality’ has outweighed practicality in dealing with the illness.

Harm Reduction (HR) is one of the three major prongs of Australia’s illicit drug policy. The policy is called Harm Minimisation. Not “tough on drugs”, not “zero tolerance”. Harm Minimisation includes Supply Reduction, Demand Reduction and Harm Reduction. Over the years the gay lobby and LGBTQ community has forged itself a formidable legal and social identity. I pity the conservative zealot who would insult their ontology. Not so for IV drug users. This is due to many reasons, the more obvious being the transient nature of drug use (experimentation), the social, professional and personal cost of outing oneself as a chronic addict, the complete lack of intention to politically mobilise and the volume of comorbid mental health problems.

To be rather crude whilst it is demonstrably bigoted to discriminate against Australia’s disabled population they are not a force of reckoning. Our communities remain poorly suited to accommodate disabilities. Stigma persists leading to discrimination and inequality.

Similarly whilst we clinically accept the disease model of addiction, many community members still remain blinded to this very real health problem in favour of pop culture “bad guy” stereotypes. This is sheer manna for those with political interests to be seen to be “tough on drugs” or who seek to exploit individuals with a range of disabilities, including drug dependence.

Most Aussie addicts are alcoholics and cigarette smokers. The bulk of public health money dealing with drug induced harm is spent here. Illicit drug addiction consumes under 5% of the total expense. Writing in, Redefining Addiction in MJA Insight Paul Haber noted:

The American Society of Addiction Medicine (ASAM) grappled with this problem for 5 years before releasing its new definition of addiction, which has stimulated interest from around the world with commentaries in The Lancet, Time and elsewhere. ASAM proposes that addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. It is a chronic relapsing and remitting disorder that manifests in continuing use of substances or alcohol despite accumulating harm to the individual and to others. [….]

This addiction disease concept facilitates a medical approach to management, including the need for quality evidence to support clinical interventions and it encourages engagement of medical professionals in this field. Acceptance of the disease model can also reduce the stigma of the disorders. Specific neurobiological abnormalities have been identified such as certain dopamine receptors in the reward system and these are targets for therapeutic intervention.

The funding pittance that is dealt to illicit drug harm reduction in part reflects the dwarfing of this demographic alongside drinkers, smokers and gamblers. The rest is explained in that the lions share is consumed by futile supply reduction efforts in the endless cycle of importation, distribution, dealing and administration. Demand reduction – fighting the demand for drugs through education, rehabilitation and disincentives also receives more money than harm reduction. It remains far, far too easy to raise a voice of ignorance and accuse HR initiatives of “allowing” or “encouraging” drug use.

The ABC news items below discuss the need for needle exchange programs in Australian prisons and the potential for a trial beginning in Canberra’s Alaxander Maconochie prison. It’s probable an HIV epidemic beginning in injecting drug users, and placing the wider Australian community at risk, would begin in Australian prisons. Questions are also raised as to the “shameful” state of Australia’s Harm Reduction initiatives that have fallen behind what is considered effective evidence based practice for prison population health. This is further evidenced by successful programs in other countries around the world. Needle Syringe Programs are strongly supported by a large global evidence base. Significantly, one public health success story is Australia.

Indeed return on investment research in 2009 [PDF] show that “investments in needle and syringe programs were yielding a twenty seven fold return in health, productivity and other gains.” Gino Vumbaca, Executive Director of the Australian National Council on Drugs wrote at the time:

What is striking is the level of public support for the program. The largest regular survey on drug use issues we have, the National Household Survey on Drugs, now records public opposition to the program at less than 20%. The Hawke, Keating, Howard and now Rudd Governments, as well as a myriad of state and territory governments of varying hues over the past 20 years have all lent their support to the program. For some this was in the face of strident opposition. A truly admirable achievement based on evidence, common sense and humanitarian grounds

Discussing the 2009 report findings Anex wrote:

The World Health Organization commissioned a review of evidence of the effectiveness of Needle and Syringe Programs to reduce HIV which concluded:

There is compelling evidence that increasing the availability and utilisation of sterile injecting equipment for both out-of-treatment and in-treatment injecting drug users contributes substantially to reductions in the rate of HIV transmission. Research from around the world clearly indicates that NSPs make a significant contribution to preventing the spread of HIV/AIDS and hepatitis C.

Between 2000 and 2009, the Australian Government invested $243 million in Needle and Syringe Programs. This resulted in the prevention of an estimated 32,050 new HIV infections and 96,667 cases of hepatitis C. $1.28 billion dollars were saved in direct healthcare costs. [….] The report states: “If NSPs were to decrease in size and number, then relatively large increases in both HIV and hepatitis C could be expected with associated losses of health and life and reduced returns on investment. Significant public health benefits can be attained with further expansion of sterile injecting equipment distribution.”

Countries, like Australia, that have implemented NSPs have averted HIV epidemics among injecting drug users and, therefore, the community at large.  Those countries that have not implemented these measures have often experienced uncontrolled HIV epidemics. There is strong evidence to suggest that when HIV becomes endemic among the injecting drug user community it can then spread to their sexual partners and children, resulting in high mortality rates and large social and economic costs to the entire community.

Conservative ideologues and those with vested interests in punitive measures, have attempted to discredit NSP efficacy. Nations without proper NSPs, such as Sweden are deemed in breach of the UN International Right to Health. See page 3, item D. Religious fundamentalists & other totalitarian belief systems frequently reference Sweden’s “war on people” mentality, obfuscating the human rights abuse. As revealed by WIKILEAKS, the USA work actively to sabotage Harm Reduction initiatives as part of their War On Drugs policy, citing Stockholm as a reliable ally. An excellent discussion of this matter is to be found at Neurobonkers. The Global Commission on Drug Policy has demonstrated the failure of the Drug War. [CNN News]

With respect to needle exchange, rather than advance challenges to NSP efficacy with new research the tactic of a small minority is to attack existing methodology in an out of context, subjective fashion creating the illusion of an argument. An analogue today might be “pertussis diagnoses have increased, therefore the vaccine is ineffective” – a claim advanced by comparison of unrelated data sets.

In May 2010 Norah Palmateer et al. produced a meta-analysis using what they called “Critical appraisal criteria” to challenge the methodology of NSP research. However, even whilst selecting particular modes of distribution and leaving out others, a conclusion that “New studies are required to identify the intervention coverage necessary to achieve sustained changes in blood-borne virus transmission”, was delivered. This is scarcely revolutionary, yet is falsely cited as discrediting NSP efficacy by fundamentalist conservative groups. In truth Palmateer et al actually argue for a shift in analytical focus to biological rather than behavioural data. More so, they write:

The findings of this review should not be used as a justification to close NSPs or hinder their introduction, given that the evidence remains strong regarding self-reported IRB and given that there is no evidence of negative consequences from the reviews examined here. [….] We recommend a step change in evaluations of harm reduction interventions so that future evaluations: (i) focus on biological outcomes rather than behavioural outcomes and are powered to detect changes in HCV incidence; (ii) consider complete packages of harm reduction interventions rather than single interventions; (iii) are randomized where possible (preferably at the community level); and (iv) compare additional interventions or increased coverage/intensity of interventions with current availability.

“The findings of this review should not be used as a justification to close NSPs or hinder their introduction”. Yet this is exactly what the enemies of reason have done, misquoting Palmateer at every turn. The “AVN” of Blood Borne Virus control is a group of far right evangelical lobbyists known as Drug Free Australia. Their “Meryl Dorey”, as it were is their “secretary”, young earth creationist and climate change denialist, Gary Christian. The similarities between Dorey and Christian are striking. No medical or health qualifications, citing of global conspiracies, “social experiments” – not evidence based public health, saving Australians, provision of “truth”, attacking certain research identities, cherry picking of data and outright lies.

When a 27 fold return on investment for NSPs was claculated after years of research, Mr. Christian promptly dismissed this claiming NSPs actually serve to promote drug use and spread viruses. WHO data would prove this if properly adjusted he cried, mimicking Dorey’s claims to “properly read research”. Thus he was able to immediately dismiss what is absolute proof opposition to NSPs is baseless. Indeed, Christian went further.

Harm Reduction is the “normalisation of illicit drug use” not just correlating to, but causing a rise in drug use. Hands up if knowing about NSPs motivates you to experiment with IV drugs. This new take on “condoms cause AIDS” is demonstrably flawed. Just as abstinence, not condoms will prevent STD’s, Christian claims “free HIV testing” not NSPs or harm reduction will control HIV, citing discredited non peer reviewed sources.

Thus arguments raised against the value of exchange program efficacy in cutting blood borne virus spread are emotive, supposedly backed by misrepresented, spurious and/or biased “research” and driven by discredited, conservative fringe lobby groups.

Unsurprisingly the opposition to NSPs in Aussie prisons is based on misinformation and a lack of evidence.

ABC TV News October 15th

ABC AM Program October 15th

NSP Information, Q&A. Australian Government

“Vaccine Shedding”: Time Up For Another Vaccine Myth

Posted in Anti-Vaccination Lobby, Denialism, Health, Science by

One myth often pulled out by antivaccination lobbyists to malign vaccine safety is the senseless term “Vaccine Shedding”.

Whilst in context we all know what is meant, it’s worth pausing to consider that the term is a byproduct, if you will, of the antivaccination movement’s skill at sowing misinformation. The unrivaled ability to scan a headline and regurgitate some ghastly tale about vaccines. To squeeze another fallacious vaccine “danger” onto the shelf, content in the knowledge it will soon have a life of it’s own.

The colloquial use of this nonsensical term seeks to convey that an individual who has been vaccinated can readily shed part of the vaccine and cause infection in the unvaccinated. Which by definition demands them to have shed not a vaccine but an infectious agent. Indeed a virus or bacterium. Which by extension demands the vaccine to contain a live virus or bacteria. This then opens the door to viral shedding the vast complexities of vaccine induced immunity and viable modes of excretion – aka shedding. That won’t stop your garden variety anti-vaxxer claiming any vaccine can lead to infection of the unvaccinated via this ghastly “vaccine shedding”.

But that’s only part of the story. “Vaccine shedding” is a double barrelled myth in that transmission is assumed to occur ipso facto. Shedding is not transmission. Period. Yet denial of vaccine efficacy requires internalisation of some whacky stuff. Including the erroneous belief that viral shedding follows MMR vaccination. Yet worse is the myth that inactivated vaccines pose the risk of infection due to “vaccine shedding”.  Pertussis often brings out the malicious side of anti-vaxxers. DTaP is inactivated. Indeed the pertussis component is acellular. Update: The acellular pertussis vaccine is an example of a subunit vaccine.

So, you may wonder at the nature of Cynthia Janak who writes in Will the vaccinated infect the unvaccinated? That is the question with Whooping cough:

Before I continue I want to tell you about a fact that is known by the CDC, etc. That is called vaccine shedding. This is the transmission of the virus from a vaccinated person to an unvaccinated person. [….] I want you to understand that this is true for vaccines including the Whooping Cough. What you could have happen is that all these parents and child care workers are going to get the vaccine and then take care of children. [….] The vaccinated have the potential to infect the unvaccinated child. This could cause the next epidemic of disease like what happened with the small pox epidemic.

So, in Cynthia’s mind “vaccine shedding” is, “…transmission of the virus from a vaccinated person to an unvaccinated person”. Wrong. And it’s true for whooping cough. Impossible. Yet Cynthia Janak asserts there’s potential for an epidemic like smallpox? Pure fiction. Contracting pertussis because an unvaccinated and infected child or adult who ignores boosters has breathed on someone is, however, a simple fact. Aiming to inflate the danger of her misguided concern about “vaccine shedding” as “known by the CDC”, Cynthia uses references to FluMist.

FluMist a live attenuated influenza vaccine (LAIV) sprayed into the nostrils and well understood regarding shedding. Concerns about administering a live virus this way should be respected. So should the facts about any risks. It sheds in low concentration for short periods via nasal discharge. It is not associated with person to person transmission. Given that wild type influenza sheds at far higher concentration, is found on fixtures, objects, skin and is strongly associated with transmission, severe illness and complications it seems Cynthia has been selective about what’s “known by the CDC”.

“Vaccine shedding” is better suited to mid 19th century notions like the infectious miasma, wafting about in terrifying unseen clouds held aloft by our lack of knowledge. Nor does the rare instance of shedding suddenly turn any agent into a virus with the infectious capability of Ebola. But anti-vax voices are often raised in triumph that the crime of “vaccine shedding” places the community at greater risk than the rising numbers of unvaccinated.

The scale of error associated with this belief is akin to the myth of potential vaccine injuries outweighing the benefits of vaccination. Serious injuries that do occur are primarily in populations genetically predisposed to latent complications and manifestation is extremely rare. Injuries, disability and death from vaccine preventable disease would occur at magnitudes many hundreds or thousands of times greater and can manifest in anyone. Vaccine injuries are artificially inflated by confusing correlation (sometimes years apart) with causation, and by including red marks, crying, sleep disturbance or omitting that event X was a serious allergic reaction to latex syringe components. Similarly, arguing ones unvaccinated child is at risk from, or has been infected by, a recently vaccinated child is quite a claim.

Viral shedding itself is by no means ignored by the medical community. It’s of primary concern in the management of immune compromised patients, pregnant women and newborns. Varicella is an excellent example in that a.) viral shedding is well understood and b.) the risk from shedding can be discerned from precautions taken. Following varicella vaccination, viral shedding can be detected in the stools for six weeks.

In the case of immunodeficiency disorders or immune suppression from drugs, transfusions, stem cell transplant, chemotherapy etc, the recommendations are to avoid contact with fecal matter of vaccinated subjects and to observe good hygiene. To put this in context, unvaccinated children who spend one hour in a room with an infected child (shedding varicella) stand a 95% chance of contracting varicella (chicken pox). This is why vaccination against varicella is vital and choosing to not vaccinate your child places him or her and by extension countless others at risk of serious complication.

For nursing mothers post natal varicella vaccination need not be delayed if they are varicella-susceptible as varicella hasn’t been found in breast milk post maternal vaccination. There is no problematic risk of viral shedding to newborns provided hand washing and other hygiene measures are followed.

Whilst rare, a post-varicella immunisation vesicular rash can form. Again whilst quite rare, viral shedding can occur at this site. Plainly stated it’s incredibly rare for an unvaccinated child to be infected with varicella from a vaccinated subject and a series of events, including transmission, must occur within a small window of opportunity. Greatest precautions must be taken in the case of immune suppression. Writing in Vaccines in immunocompromised patients, Janet R. Serwint, MD Consulting Editor notes:

Because the varicella virus rarely can be shed through a postimmunization vesicular rash that may develop, recommendations include avoiding contact until the rash resolves.

In March this year there was an interesting case of viral shedding. The antivaccination lobby bellowed that Varicella zoster virus DNA had been found in the saliva of people over 60 vaccinated with the live Zostavax vaccine manufactured by Merck. In this age group Herpes zoster (shingles) is the target. Shingles is the result of infection with VZV earlier in life which may reactivate as immunity declines or from novel infection. Despite blog headings like Vaccinated people SHED LIVE HERPES for up to a month AFTER vaccination, be aware it was 2 of 36 “vaccinated people” who made the grade.

There was no indication of infection risk at the time. Today transmission is considered rare. Packet inserts carried the standard warnings found in varicella immunisations to avoid contact with infants, nursing mothers and immunocompromised individuals. “Doctors never tell you this”, lied the anti-vax lobby. The end result is that, fortuitously, it appears a saliva test could be developed allowing for detection and antiviral therapy before the painful rash appears. All up with rare potential for transmission from about 5% of recipients of a vaccine that’s not widely used it was a non event.

With MMR the lack of viral shedding renders any risk of horizontal transmission in this manner null and void. If challenged with the claim of “vaccine shedding” specific to Measles, Mumps, Rubella vaccination you’re being misled.

Peak shedding of Rotavirus occurs on “post-vaccination days 6 through 8”. Published in The Lancet Rotavirus vaccines: viral shedding and risk of transmission, notes:

Immunocompromised contacts should be advised to avoid contact with stool from the immunised child if possible, particularly after the first vaccine dose for at least 14 days. Since the risk of vaccine transmission and subsequent vaccine-derived disease with the current vaccines is much less than the risk of wild type rotavirus disease in immunocompromised contacts, vaccination should be encouraged.

The “vaccine shedding” bogeyman got a free kick with the FluMist LAIV vaccine. You may remember the hype. The spraying of “living influenza virus” straight into children’s brains was going to lead to mutation and death on an unprecedented scale. It would genetically revert to the wild type. Transmission would thus be uncontrolled. It would quickly prove useless against changing seasonal strains. ADR’s would rise…. and so on. Ultimately the cost proved to be a deterrent. Mayo Clinic have produced a welcome article on LAIV Myths.

In a comprehensive 2008 study with a sample aged 2 – 49 years, shedding “of short duration and at low titers” was detected in nasal swabs on days 1 – 11. LAIV recipients “should only avoid contact with severely immunocompromised persons for 7 days after vaccination”.

On Shedding and Transmission of Vaccine Viruses, in a larger piece on influenza vaccination of HCP, the CDC write:

One concern regarding use of LAIV among HCP has been the potential for transmitting vaccine virus from persons receiving vaccine to nonimmune patients at high risk. Available data indicate that children and adults vaccinated with LAIV can shed vaccine viruses for >2 days after vaccination, although in lower titers than typically occur with shedding of wild-type influenza viruses. Shedding should not be equated with person-to-person transmission of vaccine viruses, although transmission of shed vaccine viruses from vaccinated persons to nonvaccinated persons has been documented in rare instances among children in a day care center.

One study conducted in a child care center assessed transmissibility of vaccine viruses from 98 vaccinated persons to 99 unvaccinated controls aged 8–36 months; 80% of vaccine recipients shed one or more virus strains (mean duration: 7.6 days). [….] The estimated probability of acquiring vaccine virus after close contact with a single LAIV recipient in this child care population was 0.6%–2.4%.

It was also documented that should HIV positive children be exposed to LAIV shedding, “… serious adverse outcomes would not be expected to occur frequently”. So the combination of live virus shedding and immune deficiency in the case of LAIV presents low risk. Certainly the overall risk associated with the rare transmission following shedding after LAIV is insignificant given the risk of regular influenza virus transmission.

We’re running out of dramatic scenarios for the antivaccination lobby to cling to. With polio the wild virus replicates in the intestine and is shed in stools for up to a month. Transmission in developed nations is thus faecal-oral like other stool shed viral components. It is of course so rare as to be unheard of. However, given that the IOM report into evidence and causality of vaccine adverse effects found a causal link between the oral polio vaccine (OPV) and vaccine associated paralytic polio (or Vaccine Derived Polio Virus), we should seriously consider shedding in areas where this is documented.

In fact the question has been asked if prolonged VDPV shedding could be a source of reintroduction following polio eradication. The more compromised the immune system the more likely the individual is to have problems with vaccine induced immunity. A study looking for VDPV shedding in immune deficient subjects in Abidjan, Cote d’Ivoire found no cases in a sample of 419, and therefore a “minimal risk of reintroduction [after eradication]”. In respect of general exposure to shedding in these environments transmission of the wild type polio virus eliminates any concern over post vaccination viral shedding. Crowding, sewerage, water quality etc all contribute to wild polio spread in ways that do not apply to the developed world.

Remembering that viral shedding is of paramount concern in the management of immune deficiency and immunocompromise, let’s revisit the Janet R. Serwint, MD of Vaccines in immunocompromised patients. Rather than warn against exposure to immunised children the recommendation is to ensure schedules are up to date and an annual inactivated influenza vaccine is on board. Pay attention to reference to MMR, varicella and rotavirus:

One strategy worth emphasizing is the immunization of household contacts, particularly other children and adolescents in the family. This procedure is essential to try to minimize exposure of the immunocompromised patient to household contacts who might contract vaccine-preventable illnesses. Pediatric health-care clinicians need to update and review the vaccine status of all siblings and pediatric-age household members. Annual influenza vaccination of all family members with inactivated influenza vaccine is recommended in addition to ensuring routine immunization of all other recommended vaccines.

MMR, varicella, and rotavirus vaccines, although live viral vaccines, are recommended for immunocompetent household contacts because transmission of the virus is rare. The lack of viral shedding with MMR eliminates concern regarding transmission. Because the varicella virus rarely can be shed through a postimmunization vesicular rash that may develop, recommendations include avoiding contact until the rash resolves. For the rotavirus vaccine, avoidance of contact with the stools by the immunocompromised patient and good hand hygiene measures by all family members for at least 1 week after vaccination should be implemented.

In conclusion it’s clear that “vaccine shedding” is a nonsense phrase. The lack of accounts of children transmitting viruses to younger siblings and friends after vaccination is a dead giveaway. Whilst viral shedding is a reality we can be confident that:

  • Viral shedding applies only to live virus vaccines and is significantly low, low risk
  • Post vaccination viral shedding of rotavirus and varicella is detected in the stools for 4-6 weeks respectively. It’s of such low risk as to be of cautionary interest regarding immunocompromised individuals
  • Genuine concern about viral shedding in these groups is managed with sound hygiene and avoiding contact with stools
  • In rare cases of post varicella immunisation vesicular rash shedding may occur. Transmission is still unlikely
  • The lack of viral shedding following MMR eliminates any concerns about transmission
  • Claims of DTaP shedding and transmission are bogus
  • Stories about whooping cough transmission from vaccine shedding are demonstrably false
  • Stories of polio infection being a risk due to shedding are designed to scare
  • Antivaccination lobbyists use false and incomplete information about shedding to create fear of vaccines/the vaccinated
  • Shedding of LAIV is at markedly low concentration, short duration and transmission is dwarfed by seasonal influenza transmission
  • Accurate information about the topic is drowned out by antivaccination sites and “mothering” forums making inaccurate claims

Update: April 13th 2015 – Added references;
Is the MMR vaccine spreading the measles virus?: The question of shedding

Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20649
Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine): http://www.cdc.gov/flu/about/qa/nasalspray.htm
Live Attenuated Vaccines (LAV): http://vaccine-safety-training.org/live-attenuated-vaccines.html
Measles – Q&A about Disease & Vaccine: http://www.cdc.gov/vaccines/vpd-vac/measles/faqs-dis-vac-risks.htm
Measles: Questions and Answers: http://www.immunize.org/catg.d/p4209.pdf?q=measles
Measles Vaccination: http://www.cdc.gov/measles/vaccination.html
Rotarix WHO leaflet – tube: http://www.who.int/immunization_standards/vaccine_quality/Rotarix_liquid_tube_product_insert_text_2009.pdf?ua=1
Rotavirus: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rota.pdf
Transmission of Measles: http://www.cdc.gov/measles/about/transmission.html