Thursday, January 13, 2011

Autism Fraud -

The report that first triggered scares that a vaccine to preventmeasles, mumps and rubella might cause autism in children has received another devastating blow to its credibility. The British Medical Journal has declared that the research was not simply bad science, as has been known for years, but a deliberate fraud.

The study, led by Dr. Andrew Wakefield, was published in The Lancet in 1998. It was based on just 12 children with supposedly autismlike disorders and purported to find a link between the vaccine, the gastrointestinal problems found in many autistic children, and autism.

While parents around the world were understandably alarmed, many scientists rejected the claims, including, eventually, 10 of Dr. Wakefield's co-authors. A high-level British medical group, after an exhaustive fitness-to-practice hearing, found Dr. Wakefield guilty of dishonesty and misconduct. The Lancet retracted the article in part, it said, because the authors had made false claims about how the study was conducted.

Now the British Medical Journal has taken the extraordinary step of publishing a lengthy report by Brian Deer, the British investigative journalist who first brought the paper's flaws to light — and has put its own reputation on the line by endorsing his findings.

After seven years of studying medical records and interviewing parents and doctors, Mr. Deer concluded that the medical histories of all 12 children had been misrepresented to make the vaccine look culpable. Time lines, for example, were fudged to make it seem as though autismlike symptoms developed shortly after vaccination, while in some cases problems developed before vaccination and in others months after vaccination.

Dr. Wakefield has accused Mr. Deer of being a hit man. But the medical journal compared the claims with evidence compiled in the voluminous transcript of official hearings and declared that flaws in the paper were not honest mistakes but rather an "elaborate fraud."

Some parents still consider Dr. Wakefield a hero, and others have moved on to other theories, equally unsupported by scientific evidence, as to how vaccines might cause autism.

They need to recognize that failure to vaccinate their children leaves them truly vulnerable to diseases that can cause enormous harm.

Tuesday, January 11, 2011

Hospital initiative aims to stamp out superbugs - The Globe and Mail

They are nasty drug-resistant bacteria that haunt hospital hallways, infecting thousands and killing an estimated 12,000 Canadians annually, and now a new initiative aims to put the squeeze on superbugs.

What started as a pilot project at five hospitals about two years ago expanded Monday to another 30. The bug-fighting approach places the onus on front-line staff, not infection-control doctors, to come up with practical strategies for their particular floors to reduce the spread of hospital-acquired infections.

"We've been trying to control these things for 40 years now, and the rates keep going up. It will just keep getting worse and worse," said Michael Gardam, who leads the initiative and is the medical director of infection prevention and control at the University Health Network. "[With this program,] they own it now. They're doing it."

Over the next few months, and perhaps even a year, the 30 hospitals that have signed on to the superbug initiative will develop tactics for specific wards that take aim at Clostridium difficile (C. difficile), methicillin-resistant Staphylococcus aureus (MRSA) and a host of other superbugs that kill at least as many people in Canada annually as breast cancer and car accidents combined.

More than 200,000 patients suffer from hospital-acquired infections each year, a consequence of three factors: overprescribing of antibiotics that have helped create drug-resistant bugs; old and overcrowded hospitals; and health-care workers not following basic hand hygiene. An outbreak of C. difficile at Joseph Brant Memorial Hospital in Burlington, Ont., in 2006 and 2007 led to the deaths of 91 people.

Infection-control experts in hospitals find that messages around controlling infection rarely stick with front-line staff. Dr. Gardam said his thoughts on prevention used to involve placing more gel dispensers in wards or educating health-care workers about hygiene. But the pilot project involving three Ontario hospitals and two in British Columbia opened his eyes to the changes that happen by empowering hospital workers.

Those working on the superbug project at Toronto East General Hospital, for example, put green tags on IV poles to indicate they've been disinfected (they're analyzing the effectiveness of that initiative). At Vancouver General Hospital, staff on a particular floor carry hand sanitizer to clean patients' hands before they receive meal trays. And at the long-term continuing care unit at Trillium Health Centre's west Toronto site, don't be surprised if you hear one staff member calling another Nurse Jackson – a code word used to address poor infection control.

Project leaders say they've noticed the number of superbug infections decrease as a direct result of nurses and hospital staff being involved. "They all of a sudden realize that their units are in a mess, that they're chaotic, they're disorganized," said Katie Procter, quality leader at the BC Patient Safety and Quality Council. "So, then they start looking and seeing things that are right in front of their eyes that they can change."

Patients are often taken aback by infections after what may seem like a routine hospital visit. In a conference call involving the 30 hospitals Monday, patient Mavis Churchill described how she developed a postoperative MRSA infection at a Toronto-area hospital. "I never want to put people through that pain again," she said.

Dr. Gardam cautions that the hospital-specific strategies will not halt the spread of superbugs, but hopefully reduce the number of cases. "Right now, in most of our facilities, the spread of these things is kind of a free-for-all," he said. "We can do way better than what we're doing."

Monday, January 10, 2011

Brain Injury Treatment Is a Long, Uncertain Process -

The bullet that a gunman fired into Representative Gabrielle Giffords's head on Saturday morning in Arizona went straight through the left side of her brain, entering the back of her skull and exiting the front.

Trauma surgeons spent two hours on Saturday following an often-performed drill developed from extensive experience treating gunshot wounds in foreign wars and violence in American homes and streets. On Saturday, that drill really began outside a supermarket, with paramedics performing triage to determine the seriousness of the wounds in each of the 20 gunshot victims.

Ms. Giffords, 40, was taken to the University Medical Center in Tucson, where, 38 minutes after arrival, she was whisked to an operating room. She did not speak at the hospital.

As part of the two-hour operation, her surgeons said on Sunday, they removed debris from the gunshot, a small amount of dead brain tissue and nearly half of Ms. Giffords's skull to prevent swelling that could transmit increased pressure to cause more extensive and permanent brain damage. The doctors preserved the skull bone for later replanting.

Since surgery, they have used short-acting drugs to put Ms. Giffords in a medical coma that they lift periodically to check on her neurological responses.

They said early signs made them cautiously optimistic that Ms. Giffords would survive the devastating wound.

"Things are going very well, and we are all very happy at this stage," Dr. Peter Rhee, the director of medical trauma at the hospital, said at a news conference.

Dr. G. Michael Lemole Jr., the hospital's chief of neurosurgery, was more cautious. "Brain swelling is the biggest threat now," Dr. Lemole said, "because it can take a turn for the worse at any time."

Such swelling often peaks in about four or five days, then begins to disappear.

The doctors said that it was far too early to know how much long-term functional brain damage, if any, Ms. Giffords would suffer. They also say they will carefully monitor her over the next few days as she faces a number of potential complications, like infections, that can hamper her recovery. Full rehabilitation could take months to years. Long-term complications could include seizures.

The optimism expressed Sunday was based on Ms. Giffords's ability to communicate by responding nonverbally to the doctors' simple commands, like squeezing a hand, wiggling toes and holding up two fingers. The tests are part of a standard neurological examination after head injuries. In Ms. Giffords's case, the doctors were encouraged because the simple tests showed that she could hear and respond appropriately, indicating that key brain circuits were working.

"If she's following commands, that's great and a very big step toward recovery," Dr. Eugene S. Flamm, chairman of neurosurgery at Montefiore Medical Center in the Bronx, said in an interview. Dr. Flamm is not involved in Ms. Giffords's treatment.

Functional neurological recovery from a gunshot wound depends on a number of factors, including the specific area of the brain that is injured, the number of bullets, their trajectory and velocity, and luck.

Ms. Giffords was shot once in the head, according to Sheriff Clarence W. Dupnik of Pima County, Ariz., and the doctors who treated her said that tests showed the bullet did not cross the geometric center line dividing the brain's left and right hemispheres.

"That's very good because bullets that affect both hemispheres have a much higher mortality because the swelling affects both sides," said Dr. Flamm, who has treated many gunshot wounds in his career, including 25 years at Bellevue Hospital Center in Manhattan, 11 years as chief of neurosurgery at the University of Pennsylvania in Philadelphia and 11 years at Montefiore.

In traversing the left side of Ms. Giffords's brain, the bullet went through what is the dominant side in about 85 percent of people, whether they are right- or left-handed, Dr. Flamm explained.

"It sounds simple to raise fingers and squeeze hands," he said, "but the ability to do it is a very good sign in a brain-injured patient because it shows that the dominant hemisphere was not knocked out."

The doctors in Tucson did not cite the bullet's trajectory — that is, whether it entered at the top of the back of the skull and exited at a lower point or whether it went straight through.

If the bullet went through the visual area in the occipital part of the back of the brain, it could affect the right side of Ms. Giffords's peripheral vision, Dr. Flamm said, adding, "It is hard to piece that together without more information." Ms. Giffords is unable to speak because she is connected to a ventilator and unable to open her eyes, which doctors have covered with patches.

It is usually several weeks before doctors can fully evaluate cognitive function in a patient who has suffered a gunshot wound to the brain, and the body has a significant capacity to compensate for serious injuries.

Although Ms. Giffords's ability to follow commands is encouraging, her doctors said that it would take several weeks to know what her recovery would be. That is a caveat that Dr. Flamm well understands. "I can understand the impatience of wanting to know it now," he said. "But even if I wanted to know and examined her myself, I wouldn't be able to answer that question at this stage."