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And I write the title of this post without qualifying it with a phrase like "in my opinion."

The dramatic "Inside Edition" video can be found here; but any neurologist worth his or her salt would recognize that the young woman's filmed condition is factitious. I fully suspect that the Hopkins neurologists who reportedly made the diagnosis of "dystonia" believe that it represents a profound case of malingering also.

Jennings claims that her movement disorder appeared 10 days after getting a seasonal flu shot in August—so the obvious secondary gains would appear to be attention and financial compensation.

Other bloggers, like Orac and neurologist Steve Novella, have commented extensively on this case.

For the record, Jennings appears to have recovered with questionable treatments from the questionable Rashid Buttar, a controversial osteopath in North Carolina. God knows, she couldn't have kept it going forever.

11/24/09 update

Two Losers Find Each Other Thanks to a Third Loser

Jenny McCarthy's Generation Rescue evidently recommended Buttar to Desiree Jennings, the Washington Redskins cheerleader ambassador (whatever the hell that is). According to this recent Fox News affiliate report (which, once again, demonstrates that local news reporting simply sucks), Buttar diagnosed Jennings with something he calls "acute viral postimmunization encephalopathy" and "secondary mercury toxicity"—both of which he attributes to the flu shot.

But if Jenning's vaccination delivered any mercury,* she would have received no more than 25 micrograms of ethylmercury in the form of the preservative thimerosal.

And all injected seasonal flu vaccines contain inactivated (ie, split) virus, which is incapable of causing infection.

* And if the vaccine was in the form of a single-use syringe, it did not have ethylmercury-containing thimerosal.

Forever brainstorming, Google is now helping Americans find a flu shot (either against seasonal or pandemic influenza) through the company's beloved Maps feature. The new tool (found here) is the product of a collaboration between Google and the US DHSS, the CDC (flu.gov), and the American Lung Assocation.

For example, here's where residents of the White House can possibly get a seasonal (blue) or pandemic (red) flu shot. (To the left of the map would be a list of the locations, ordered by proximity to the entered address and labeled "A" through whatever.)

Keep in mind that the Goggle tool is in its beta stages: locations for many flu shot clinics may be missing, the company advises, and locations currently listed may be out of stock. Nevertheless, it's a starting point for consumers.

For more information about the tool's development, go here.

HT: Mashable by way of attentionusa.com.

NBA legend Kareem Abdul-Jabbar, 62, has Philadelphia-chromosome-positive (Ph+) chronic myeloid leukemia (CML), according to numerous news sources. ABC News reports that Abdul-Jabbar was diagnosed with the disorder in December of last year. What treatment Jabbar has received to date is unclear; although the LA Times states that the disease is managed with "daily oral medication" (probably imatinib [Gleevec; Novartis]) and regular "blood analysis."

Here are some facts about CML and its treatment, according to the NCCN Clinical Practice Guidelines:

• CML accounts for 15% of adult leukemias. This year, an estimated 5050 cases will be diagnosed, and 470 will die of the disease.
• The median age of onset is 67 years.
• The disease is characterized by a translocation between chromosomes 9 and 22, resulting in the formation of the Philadelphia chromosome. The translocation results in a fusion gene, BCR-ABL, which is believed to play an important role in the development of CML. The fusion protein produced by BCR-ABL is an oncogene, with unregulated tyrosine-kinase (TK) activity.
• CML occurs in 3 phases: chronic, accelerated, and blast. CML is usually diagnosed in the chronic phase.
• Untreated CML will progress to advanced disease in 3-5 years.
• First-line treatment for chronic Ph+ CML is imatinib, a selective inhibitor of the TK portion of the bcr-abl fusion protein. 
• Responses to the initial treatment of CML are monitored periodically (eg, every 3 months), by assessing bone marrow cytogenetics (ie, cytogenic response [CyR]) and transcript numbers of the BCR-ABL gene (ie, molecular response).
• Long-term data (median follow-up, 60 months) for first-line imatinib: complete CyR, 87%; overall survival, 89%.
• The most common high-grade toxicities with imatinib: neutropenia and thrombocytopenia. Rare cardiotoxicity has been reported with long-term therapy.
• The most common adverse events with imatinib: GI disturbances, edema, rash, and musculoskeletal complaints.
• Management of disease progression that occurs during imatinib therapy may include increasing the imatinib dosage; the use of an alternative TK inhibitor (dasatinib [Sprycel; BMS] or nilotinib [Tasigna; Novartis]); hematopoietic stem cell transplantation (HSCT), or enrollment in a clinical trial. Traditional chemotherapy regimens may also be considered for blast crisis.

The NCCN guidelines conclude, "The development of imatinib...has revolutionized the treatment of CML." Before the advent of imatinib, CML was treated medically with interferon alpha and low-dose cytarabine. According to ABC, Abdul-Jabbar is a spokesperson for Novartis, the manufacturer of imatinib. 

The FDA approved imatinib for the first-line treatment of CML in December 2002.

NCCN = National Comprehensive Cancer Network.

Image of Abdul-Jabbar in 2007 from Flickr.

Like white on rice, rational bloggers have been all over Bill Maher's goofy ideas about vaccines and vaccination. It's too bad, though, that the man has a nationally televised show, HBO's "Real Time With Bill Maher," which affords Maher an opportunity to influence potentially gullible viewers in front of (like many a talk/variety/comedy show) an audibly fawning studio audience.

Nevertheless, begrudging props may be given to Maher for inviting retired Republican Senator and physician Bill Frist on Friday to discuss vaccination. In this segment, it's not entirely clear that Maher "gets schooled" by Frist about vaccines (despite the clip's title). Schooling requires that Maher's thick skull be penetrable. And schooling requires time—much more time than television typically allows.

But a blog provides an enduring, leisurely format for dissecting and refuting some of the utterly fallible anti-vaccine statements that Maher made on Friday and that Frist didn't have the chance to challenge.

Maher comment #1: Conservatives always say, about healthcare especially: You gonna let the government run healthcare? They screw everything up. So why would you let them stick a disease into your arm? I would never get a swine flu vaccine or any vaccine. I don't trust the government, especially with my health. [Applause.] And that seems to be a conservative opinion: not to trust the government.

Dissection: The usually liberal Maher tries to create a bit of oh-gosh irony here by aligning himself with traditionally government-distrusting conservatives. He then jumps to make a very broad and loose association between government incompetence and government-recommended vaccination. However, if Maher were familiar with the monumental benefits of historical vaccination programs (eg, against smallpox and polio), the association actually supports organized intervention into healthcare (whether instigated by a government or some other authoritative entity, like the World Health Organization).

At the same time, Maher indicates that vaccination is a process whereby "disease" is injected into the body. First "disease" is a clinical manifestation of bodily dysfunction; it is not something that can be confined in a syringe. But we sort of know what Maher's means here, so we'll give him a pass on this semantic point. What Maher is really implying is that disease-causing virus is injected during vaccination. But that idea is also false.

With respect to the injected 2009 H1N1 (swine flu) vaccine, the inoculant is a killed (actually chemically "split") virus—which is incapable of causing infection (but is capable of inducing protective immunity). The nasal-spray vaccine from MedImmune contains live, attenuated H1N1 virus. The attenuated virus is engineered (ie, cold adapted and temperature sensitive) so that it can replicate in the cooler confines of the nose to induce immunity, without causing influenza-like illness.

Maher indicates that he would never get the swine flu vaccine, which is fine (assuming that Maher isn't at baseline risk for influenza complications and doesn't care for an infant younger than 6 months of age*). The 53-year-old isn't a CDC-recommended candidate for the 2009 H1N1 vaccine (although he should get a seasonal flu shot).

Maher comment #2 (in response to a Frist anecdote about a patient dying of swine flu): I cannot believe that a perfectly healthy person died of swine flu. That person was not perfectly healthy. Medical—Western medicine misses a lot.

Dissection: Maher's just flat-out wrong here. Regardless of what he believes, serious H1N1-related disease preferentially affects persons younger than 65 years of age, and about 45% of Americans who have died of swine flu were healthy, according to the CDC. With his last sentence, Maher also betrays a broad, inherent distrust of Western (really, allopathic) medicine. 

Maher comment #3: Let me read you a quote from the former control officer at the US FDA. His name is Dr. J. Anthony Morris. He said, "There is no evidence that any influenza vaccine thus far developed is effective in preventing or mitigating any attack of influenza. The producers of these vaccines know they are worthless, but they go on selling them anyway."

Dissection: By quoting J. Anthony Morris, Maher reveals a lazy reliance on an ostensibly authoritative source, about which he probably knows nothing. 

Finding reliable information on Morris (at least on the web) is a challenge; at first blush, he appears to be a quotable favorite among anti-vaccinationists—probably because of the specious appeal-to-authority angle (ie, Morris reportedly has/had a PhD in bacteriology and was an FDA employee). An archived newspaper search reveals that Morris was a virologist in the Division of Biologic Standards, which was part of the NIH until 1972 when the division was transferred to the FDA.

In the fall of 1971, Morris made news by arguing to Congress that influenza vaccines were not just useless, but dangerous (see Lyons RD. Influenza shots held ineffective. NYT. October 15, 1971). He claimed that "not only has there been little or no benefit from the use of influenza vaccine in man, but harm has resulted." However, a federally appointed, 12-person scientific committee rejected Morris's claims of incompetence within his NIH division; although the committee did concede, in ho-hum fashion, that "inactivated influenza vaccines are imperfect instruments for the prevention of influenza." (The committee may have been referring to subpotent lots of influenza vaccine that were distributed in the 1960s.) The committee then proceeded to reject Morris's claims that influenza vaccines are harmful (see Lyons RD. Charges of poor vaccine regulation rejected. NYT. November 30, 1971).

A related news story in June 1972 indicates that Morris had been demoted within his division, which was now (presumably) a part of the FDA. But later news reports indicate that Morris was appointed director of the Slow and Temperate Virus Branch of the agency.

In July 1976, Morris, then 57, was finally fired from the FDA for "insubordination" and "inefficiency." Morris claimed that he was sacked from his $35,000-a-year job because he opposed President Ford's swine flu vaccination program. FDA officials acknowledged, at the time, that it was very unusual for an FDA employee to be fired, but the process that led to Morris's departure began long before anybody recognized the swine flu threat. Later Morris showed up on fear-mongering talk shows like "Phil Donahue" and provided anti-vaccine quotes to news reporters as recently as 1988. 

A phrase search of various archived newspapers fails to return a source for the exact quote cited by Maher, except in 1 instance: Donald Harte, in a November 2007 editorial for the Marin Independent Journal ("Is there a vaccine that protects against non-science?") requotes Morris from a citation in a contemporary issue of Health & Fitness magazine. The quote was described as being 30 years old, but the original source was not identified. 

Morris, if alive this year (and I haven't been able to confirm whether he's alive or dead), would be about 90. 

Maher comment #4: But a virus is always mutating. You would agree with that? [Frist: Yeah.] So, so the vaccine that they produce back in March—that's not really what's gonna prevent what's, what's going on now. Because—I know a lot of people on the conservative side don't believe in evolution—but—and you can't see evolution in advanced species, but you can see—[Frist interrupts: We know this vaccine is 98% effective...]

Dissection: Here Maher tries to discount the efficacy of the swine flu vaccine by implying that the virus has mutated so much since the creation of the vaccine (in March) that it will evade whatever immunity is produced by inoculation. However, on October 9 (the same day that Maher's show aired), the CDC reported that the 2009 H1N1 viruses "have not undergone substantial antigenic change since they were first characterized in April 2009 and should be well-matched to the monovalent vaccine strain." 

Last month, data published in the NEJM indicated that significant antibody titers were generated in 97% of adults after 1 dose of the inactivated vaccine. Rates of antibody production among children aged 6-35 months, 3-9 years, and 10-17 years were 25%, 36%, and 76%, respectively. These data are the foundation for recommending 2 vaccine doses in children younger than 10 years of age. The suboptimal immune response in younger children is probably related to their limited immune experience with influenza viruses and is clearly not the result of viral mutation.

There have been scattered reports of 2009 H1N1 virus that is resistant to oseltamivir (Tamiflu), but all of these isolates were susceptible to zanamivir (Relenza).

Maher comment #5: Dr. Jonas Salk: "Live virus vaccines against influenza and paralytic polio, for example, may in each instance cause the disease it's intended to prevent."

Dissection: Another appeal to authority by Maher. Salk, as everyone knows, was the creator of the inactivated polio vaccine. The quote cannot be confirmed and, again, appears to be a favorite among online anti-vaccinationists. An archived newspaper search fails to return relevant hits, and without context, it's useless to interpret a statement that Salk may or may not have made.

* And don't we all hope that's the case.

Senator Ted Kennedy succumbed approximately 15 months after his diagnosis of glioblastoma multiforme. In June of 2008, Kennedy underwent neurosurgery at Duke, followed by unspecified chemotherapy (probably temozolomide [Temodar; Schering-Plough]) and radiation therapy at MGH. Kennedy's survival was about 4 months longer than his expected median survival.

Fault the New York Times for what you will, but the paper consistently prints top-notch obituaries. Kennedy's is no exception (although there's been plenty of time to draft it).

Photo: Biographical Directory of the United States Congress.

Addendum: Highly irreverent, but funny bit from The Onion, America's Finest News Source.

A newly released affidavit reveals the last hours of Michael Jackson's life, as told to an LAPD homocide detective by Jackson's personal physician, Conrad Murray. The affidavit, which was used to support a search warrant of Conrad's storage locker in Houston, Texas, also reveals the preliminary and not-so-surprising cause of Jackson's death: a lethal dose of propofol, aka Diprivan. Contrary to popular speculation (and common sense), Jackson did not receive the anesthetic until the mid-morning hours on the day of his death, June 25th (at least that's what the doctor reportedly claimed).

Here's what allegedly went down on that day at Jackson's rented home in Los Angeles:

@ 01:30—Murray gives Jackson a 10-mg tablet of diazepam (Valium) for insomnia. Jackson is unable to sleep.

@ 02:00—Murray gives Jackson lorazepam (Ativan) 2 mg by slow IV push. Jackson is unable to sleep.

@ 03:00—Murray gives Jackson midazolam (Versed) 2 mg by slow IV push. Jackson is unable to sleep.

@ 05:00—Murray gives Jackson another 2-mg dose of lorazepam by slow IV push. Jackson remains awake.

@ 07:30—Murray gives Jackson another 2-mg dose of midazolam by slow IV push. Jackson remains awake.

@ 10:40—After repeated demands by Jackson, Murray administers propofol 25 mg IV after lidocaine pretreatment.

@ 10:50—Murray leaves Jackson's bedside to go to the restroom.

@ 10:52—Murray returns to find that Jackson is not breathing. (Murray stated to investigators that Jackson had been continuously monitored throughout this time with pulse oximetry.) Murray begins CPR (presumably while Jackson remains on the bed) and administers 0.2 mg of flumazenil (Anexate), a benzodiazepine antagonist. Using his cell phone, Murray also calls Jackson's personal assistant and requests that security personnel be sent upstairs for an emergency.

A few minutes later, Murray runs downstairs to the kitchen and (inexplicably) asks the chef to send up Jackson's oldest son. Murray returns to Jackson to continue CPR. Jackson's son responds and summons security detail.

11:18-12:05—Phone records reveal that Murray was on his cell phone for approximately 47 minutes with 3 separate callers; although Murray did not reveal these calls to investigators at the time of the interview.

@ 12:21—Michael Jackson's bodyguard, Alberto Alvarez, goes to Murray and calls 911 on his cell phone.

@ 12:22—An LA Fire Department ambulance responds to Jackson's home. Murray informs the paramedics that he is Jackson's personal physician and that he had continuously administered CPR, for respiratory arrest, until their arrival. Murray also divulges that he had given Jackson lorazepam before his respiratory arrest.

While continuing resuscitation efforts, the paramedics transport Jackson and Murray to the UCLA Medical Center.

@ 14:26—After a protracted effort to revive Jackson at UCLA, Jackson is pronounced dead. Murray allegedly did not reveal to emergency physicians that he had given Jackson propofol. He also refused to sign Jackson's death certificate.

Early in the course of their death investigation, the LAPD evidently could not locate Murray. At Jackson's home, "numerous" bottles of medications were found, which had been prescribed by Murray for Jackson—including the benzodiazepines diazepam, lorazepam, and temazepam (Restoril). Bottles of clonazepam (Klonopin) and the antidepressant trazodone (Desyrel) were also found, which had been prescribed by internist Allan Metzger. And a bottle of the muscle relaxant tizanidine (Zanaflex) had been prescribed to Jackson by his dermatologist, Arnold Klein.

Four days later, investigators, armed with a search warrant, discovered vials of lidocaine, propofol, lorazepam, midazolam, and flumazenil at Jackson's home. None of these medications were associated with an identifiable prescription. The affidavit also reveals that the Drug Enforcement Agency (DEA) could not find a record of Murray purchasing, ordering, or obtaining propofol with his medical license number or DEA number.

Murray admitted that he had been treating Jackson's insomnia with propofol 50 mg IV every night for the last 6 weeks. According to the affidavit, he had successfully reduced the propofol dose to 25 mg on June 22nd, while also administering lorazepam and midazolam to Jackson. The following night, Murray claimed that he was able to induce sleep with only lorazepam and midazolam.

Sweeping the web with lightening speed, unlike the glacial pace of a classical zombie!

News of the newly available, When Zombies Attack!: Mathematical Modelling of an Outbreak of Zombie Infection, by 4 Canadian mathematicians. Their mothers, despite the authors' statistically probable dateless existences,* must be so proud. The web server for the University of Ottawa math department is inundated, just like the Winchester pub in Shaun of the Dead!

For the mathematically unsophisticated, the bulk of the paper is a blur of italicized English or Greek letters and a few arabic numbers, organized by the obligatory parens, brackets, and braces. The occasional chart and what look like electrical diagrams (really model flow diagrams) make the paper unreadable to the ignorant. At least, until the amusing Discussion section.

Making a half-hearted nod to similarities between a zombie attack and an of-this-world biologic pandemic, the authors conclude, "An outbreak of zombies infecting humans is likely to be disastrous, unless extremely aggressive tactics are employed against the undead." Eradicating the zombies, which requires removing the head or destroying the brain, is not predicted by their formulas—unless attacks are "sufficiently frequent" and with "increasing force."

The best possible scenario is humans coexisting with zombies in some kind of equilibrium. The 2 big problems with zombie-ism are that a) there is no immunity and b) the dead can always rise. Also, if the zombie attack is prolonged, the authors predict that zombies will completely eradicate humans; ongoing human births and deaths will provide the zombies with a limitless supply of infectees. (But this doomsday scenario begs the question: What happens when the world is populated solely by zombies?)

The authors propose that their mathematical models may be applied practically to cases of "allegiance to political parties" (heh-heh, way to slide one in) or infectious diseases with a dormant phase.

* Okay, I really have no idea. The authors could be totally cool operators, with children (ie, zombie noshes) peppering the globe.

Zombies from Night of the Living Dead from Wikipedia.

Addendum: The "?" after the anchor author's name (Robert J. Smith?) is evidently not a typo.

In a mind-blowing report, today's Los Angeles Times indicates that Dr. Conrad Murray, Michael Jackson's personal physician, left the singer alone on the morning of his death, June 25th, while Jackson received IV propofol (aka Diprivan) as a sleep aid in his home. The Times cites 3 unnamed sources who are "familiar with the investigation."

Murray allegedly left Jackson for an unknown period of time to make calls on his cell phone, and when he returned, Jackson was not breathing. Murray's evidently cavalier attitude toward this highly renegade use of the anesthetic agent, which he reportedly acquired legally from a Las Vegas pharmacy (possibly Applied Pharmacy Services), suggests that the doctor had administered propofol in this manner on more than one occasion. One law enforcement source told the Times that Murray admitted to giving IV propofol repeatedly to Jackson since May.

Although Jackson's autopsy results have not been officially released, leaked information indicates that propofol and an anxiolytic (possibly alprazolam [Xanax]) were present in Jackson's system.

Image of Diprivan formulations from APP.

Not sure which is more shocking: The report that at least 20 non-OTC drugs were recovered from Michael Jackson's home or the fact that ABC News is sourcing The Sun on this one. Maybe ABC's reporters were impressed by alleged autopsy information printed last week by the tabloid—namely that Jackson's arms were riddled with needle marks. Yesterday ABC reported the same ("Jackson's arms were scarred with track marks"), citing "investigators."

On the basis of reportage from ABC and The Sun, the partial, cobbled-together list of drugs (save propofol [Diprivan]) found in Jackson's home includes the following (in alphabetical order):

1. Demerol: Generic names, meperidine and pethidine. A fast-acting opioid available in injectable and oral formulations. Legitimate use has become unpopular during the last 2 decades, owing to the drug's potential neurotoxicity and abuse potential. Jackson allegedly took Demerol daily and possibly several times a day.
2. Dilaudid: Generic name, hydromorphone. A morphine derivative available in injectable and oral formulations. Typically used for pain management.
3. Fentanyl: A highly potent synthetic opioid available in injectable, transdermal patch, and "lollipop" formulations. Typically used in anesthesia induction and pain management.
4. Lidocaine: Presumably in the form of low-concentration vials to produce local anesthesia. Possibly used in conjunction with propofol to reduce injection-associated pain.
5. Methadone: A synthetic oral opioid. Most commonly used as a maintenance medication when kicking opioid addiction.
6. OxyContin: Generic name, oxycodone. A wildly popular, semi-synthetic oral opioid. Jackson allegedly took the medication daily.
7. Paxil: Generic name, paroxetine. An orally administered, selective serotonin-reuptake inhibitor (SSRI). Indicated for the treatment of depression, OCD, panic disorder, anxiety disorders, and PTSD.
8. Percocet: Generic ingredients, oxycodone (same as OxyContin) and acetaminophen (eg, Tylenol). Typically prescribed short term for pain relief.
9. Soma: Generic name, carisoprodol (a metabolite of meprobamate, aka Miltown). An orally administered, centrally acting muscle relaxant that potentiates opioid-induced analgesia.
10. Versed: Generic name, midazolam. A very-short-acting benzodiazepine in oral and injectable formulations. Typically used as a premedication before surgical or medical procedures.
11. Vicodin: Generic ingredients, hydrocodone and acetaminophen. Orally administered and should be prescribed short term for pain relief. (N.B.—I've witnessed physicians dispense this drug like Pez candy.)
12. Xanax: Generic name, alprazolam. An orally administered, short-acting benzodiazepine. Prescribed for anxiety and/or sedation.
13. Zoloft: Generic name, sertraline. An orally administered SSRI. Indicated for the treatment of depression, OCD, panic disorder, anxiety disorder, PTSD, and premenstrual dysphoric disorder (which Jackson presumably did not have).

There are a number of permutations for lethal combinations of these drugs, some of which can kill all by themselves. Perhaps more surprising than Jackson's death is his survival—given the duration of his alleged polypharmacy use and dependence.

OCD = obsessive-compulsive disorder; OTC = over the counter; PTSD = posttraumatic stress disorder.

Props must be given to TMZ. Multiple news sources have been citing the entertainment news-gossip web site in the widespread coverage of Michael Jackson's suspect death.

The latest: Edward Chernoff, criminal defense lawyer for Conrad Murray (Michael Jackson's doctor), won't confirm or deny that Murray gave Jackson propofol (trade name, Diprivan). In a phone interview last night, Chernoff reportedly told TMZ, "I have no statement on whether the Dr. prescribed or administered Propofol." Although the lawyer was apparently willing to repeat that Murray did not administer Demerol or OxyContin to Jackson.

In its update, TMZ implies that Chernoff is now backtracking somewhat on last night's statements and "can't speak for anything that was in the [Jackson] home."

Image of Diprivan formulations from APP.