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Parents Vs. the State

When I wrote about HIV dissidents earlier this week, I ended my post with a postscript that stated I didn't necessarily think legal action should be taken against an HIV-positive mother whose untreated child recently died of AIDS:

As a postscript to this analysis, let me comment on the case as it stands now. Rumor has it that the child’s parents are being investigated with the intention of possibly charging them with a crime for exposing their child to HIV and failing to treat. Most people who have written about this case who also agree with my conclusions support this course of action.

But I think I can, at the very least, make a good argument why this should not happen. In all I have read regarding this case, and from all I have read of Christine Maggiore and her activism, I have seen no evidence that she has an agenda that exceeds advocating for what she finds to be the truth. Also, I choose to believe, until presented with evidence otherwise, that she was a loving mother who is very saddened by the loss of her daughter. Though her beliefs, and the actions that extended from them, may have directly led to the infection of her daughter with HIV, its progression to AIDS, and her death from its complications, I believe the pain that Ms. Maggiore now suffers from the consequences of those beliefs is more than any punishment that she should have to endure.

She shares responsibility in this child’s death. But she was acting in good faith in what she thought was the best interests of her child. I don’t see any crime in that.

Charles Johnson correctly pointed out in the comments that this analysis was incomplete. I purposefully did not flesh out the arguments to make it an airtight (or even good) argument. Thus, I left myself open to criticism of these views; I didn't help by some randomly and thoughtlessly thrown together statement in the comments. So, I expanded the argument in the comments to present the case to the many who disagree with me. He it is:

So a body of scientific evidence exists that comments on the hypothesis that a) HIV causes AIDS and b) drugs that control the virus are beneficial to exposed children. Now, I, and almost everyone else, read that evidence to say that the hypotheses should be accepted. Overwhelmingly. Christine Maggiore does not. It follows from her belief then, that treating her child would be harmful. Read more »

HIV Dissidents: The Continuing Saga

Nick Bennett, MD, PhD (here's his blog) has weighed in on the current debate. You can read his report (pdf). While my post focuses on the pathology, his focues on the clinical issues. It's well worth the read.

In addition, I would like to reply to a comment made by Dean Esmay in the comment of my last post. Wrote Dean: Read more »

HIV Dissidents, continued

A while back I wrote about the case of HIV-dissident Christine Maggiore and the death of her three-year-old daughter. To recap: mother is HIV positive, she refuses anti-retrovirals while pregnant and after daughter's birth, she breastfeeds daughter (a known risk for HIV transmission), daughter dies at 3-and-a-half-years-old two days after starting amoxicillin for a proposed ear infection, medical examiner reports "AIDS-related pneumonia", family is livid, LA Times chronicles all in this article. The crew at Dean's World, who deny the HIV-AIDS hypothesis, support the family, who has the report reviewed by a pathologist. You can read his report here.

This is where it gets interesting. The pathologist who reviewed the report is Dr. Mohammed Ali Al-Bayati, PhD, DABT, DABVT, and he finds that the medical examiner in LA is in error. He is being passed off as an expert by Dean and by others. Writes David Crowe:

Dr. Mohammed Al-Bayati is a respected pathologist (PhD) and a dual board certified toxicologist with over twenty-five years experience and over forty articles published in the scientific and medical literature.

All true, but extremely misleading. Dr. Al-Bayati may be perfectly competent at what he does, I don't know. But he has no particular expertise that makes him qualified to refute the medical examiner's (ME's) report. What an autopsy report includes is a summary of the clinical events and medical history, a gross description of the body and internal organs, and a description of microscopic histologic findings. The last two are the job of a pathologist, something Dr. Al-Bayati proclaims to be. However, it is helpful to know that the world of pathology is split into two: clinical pathology and anatomic pathology. When a pathology resident sits for board exams, he actually takes two different tests, one for clinical and one for anatomic. It is possible to become board certified in one and not the other. In fact, it is possible to become board certified in one with zero experience in the other; and it is possible to become board certified in clinical pathology without any training in skills required to create or understand an autopsy report that addresses mainly anatomic findings.

This is important to know - because Dr. Al-Bayati is not a board certified anatomic pathologist! This matters, because an autopsy report is the purview of an anatomic pathologist, someone who is trained and educated in the recognition and interpretation of anatomic data, mainly microscopic histology. Dr. Al-Bayati could have reached his current station without ever once taking a single anatomy, histology, or anatomic pathology course. Indeed, there is no indication from his credentials that he is the least bit qualified to claim expertise in reviewing the medical examiner's findings. So how could he be considered an expert in anatomic pathology? (He isn't a board certified clinical pathologist either; however, he does have education and experience in clinical chemistry and toxicology, so any expertise in these areas will be granted).

This is not an ad hominem attack. He (and others) is passing himself off as someone with special expertise in evaluating these anatomic pathological findings, and he simply does not; the American Board of Pathology would agree with me. It certainly does not mean he can't have an opinion or that his arguments don’t deserve refutation (if I were saying that, then that would be ad hominem). It just means it is very misleading to say his opinion has any special sway over any other average person's. I should disclose that as a pathology resident, I am not board certified in anatomic pathology, either. However, one day soon I will be, and I am currently learning and training in basic skills that allow me to evaluate Dr. Al-Bayati's report. The opinions that I render here are based on my education as a pathology resident and the materials available to me in pathology texts and the medical literature. I reserve the right to change my mind based on more information - I am not an expert, but I am competent and knowledgeable of anatomic pathology. Read more »

They Said It

Radley Balko:

It's a sad state of affairs when the most eloquent defense of free markets, private initiative, and limited government uttered by a politician in two decades has come from a fictitious presidential candidate played by an actor with leftist politics.

Also see: Russell Roberts

The Gift That Keeps On Giving

Last year, I blogged Giant Microbes just in time for Christmas.

Radley Balko linked to this and added:

I'm waiting for the plush STD microbes. Just so I can say, "Yeah, I gave my girlfriend the clap last Christmas. She thought it was really cute."

Marathons and Cancer

Division of Labour's Robert Lawson cites UC-Irvine economist Art DeVany's "Top Ten Reasons not to Run Marathons" (in which, among other reasons, he claims that running marathons might actually increases the risk of cancer) along with some literature regarding exercise and cancer. Go read both.

I wrote the following email to Lawson, which I forwarded to DeVany: Read more »

In Defense of Disco

Well, maybe just if it's naked disco:

The craze for letting it all hang out on the dancefloor is pulling in punters to South Central in Kennington Lane.

Clubbers have to wear shoes to protect their feet in case of smashed glass but the only pants to be seen in the whole place belong to the bar staff.

The best part?: Read more »

Free Market Medicine Links

Galen Log's Ben England is selling personal medical records for the low, low price of of $10.95! Get yours today.

Get quotes and compare prices from around the world for your health care at MedSIM. Read more »

HIV Dissidents

The posts ignited a little cyber-dust-up over merits of arguments by self-professed HIV-dissidents and/or insurgents. Prominent critic Harvey Bialy appeared on the thread there, as well as one at Dean Emsay's... Read more »

The Holmes-Cruise Baby

Happy Constitution Day

My garage door opener has decided to entrap my car in the garage, so I suppose I have the morning off until the garage dude gets here. What a better way to practice my federally-mandated celebration of Consitution Day (which is actally tomorrow) than to blog about it. Read more »

Makeshift Medicine

A classmate of mine sent this email to our medical school:

To all faculty, students and friends of the College of Medicine, I am a 2005 graduate of the College of Medicine and a General Surgery intern at Tulane. I wanted to write and let everyone know that the three members of the 2005 graduating class at Tulane including (name omitted), (name omitted) and myself are well. My fiance, (name omitted) is here as well. She was scheduled to do a month of infectious diseases at Tulane. We have been evacuated and are out of harm's way. We

A \"Cure\" For Rape

It's sure painful to read about, but it sounds cool:

So what is this device, for which design Ms Ehlers was inspired after meeting a traumatised rape victim who told her, "If only I had teeth down there", all about? A medieval device built on hatred of men? Or a cheap, easy-to-use invention that could free millions of South African women from fear of rape, in a country with the world's worst sexual assault record?

Wasted Years

I have no idea about law school, but I can echo the sentiment as far as medical school is concerned. Read more »


From Galen's Log:

The general response of the medical community has been to ignore them, and hope they go away. It is a tempting strategy. Arguing with the alties and their followers is a Sisyphean struggle to overcome the religious zeal of alternative medicine. Logic has no place in a debate where anecdotal stories carry the same weight as randomized, double blinded, controlled trials. You may try to ignore the problems posed by alties, but the problems don't ignore you...