The Blaylock Report: December Excerpt

[kimmers]

That's for sure Toebin.
And I always listen to my body.
I spent 4-5 weeks with a supposed muscle strain and I kept asking my primary family practice doctor, "Is this just a muscle strain?"
Kept getting the answer, "Yes."
I kept asking and told him, "This is like no muscle strain I had"
Later on, he laughed when I reminded him to look for the zebras in his patients.

Take care. Trying to stay warm. It got down to frost levels last night here in sunny California.

Kimmers

[Justin]

Kimmers,

Thanks for your comments. You bring up many good points. I was actually underscoring the point that medicine is not cut and dry. Also, as doctors we are trained to look for everything and anything--the horses and the zebras. I never tried to imply there aren't zebras. Doctors treat these everyday.

I agree that the best tool physicians and nurses can use is active listening skills -- I'm not questioning that. What I am questioning is inaccurate information, which is based on opinion or is anecdotal in nature, being presented as fact. In my opinion, it is unethical.

One last thing before I go, evidence-based medicine actually isn't a "buzz word" -- it is the way modern medicine is practiced, as I am sure you know.

Physicians and nurses (and other medical staff) treat patients based on the best available treatments and research. However, the world of medicine is ever-changing.

The "Quacks" I am referring to are the ones that promote ideas, drugs, or medical interventions that are not only based on dubious science, but that can also endanger the well-being of patients.

I will never forget my first day of medicine school. The first four words of our first lecture were: First do no harm.

PS annapurna ... I will reply to your post shortly. However, I want to give it the attention it deserves and I've got to run.

[annapurna]

Originally Posted by Justin

What I am questioning is inaccurate information, which is based on opinion or is anecdotal in nature, being presented as fact.

I believe that the essence of everyone's argument here is the way you've worded that statement. You, whether or not you intend this, are suggesting that opinion and anecdotal information are unacceptable in modern medicine. I believe that the collective experiences of most of this board suggest that they are valid, if handled correctly. I've often talked on this board about the dangers of going from anecdotal information to a statistical estimation of the population or a likelihood for a single individual. On the other hand, anecdotal information is valid proof that the situation presented happened once. You have to separate the interpretation of the situation from the facts, of course, but it can and should be considered evidence that it can happen.

Opinion is a more complicated tool. Truth to tell, evidence based medicine is just like engineering or science in that we expect data to support our conclusions and decisions. The running joke is "In God we trust, all others bring data." The truth behind the truth, so to speak, is that opinion drives the testing performed to generate the data we have. Nobody tests out of the blue with no idea of what to check. Everyone goes into the situation with a preconceived notion of what will happen. The best researchers accept what the data tells them regardless of what it says about their notions and the worst don't but everyone structures their tests and questions based on their opinion of what is happening.

Often we discover strongly held 'truths' are really fiction. In my world, the apparent belief that foam can't come off the Space Shuttle external tank in large enough quantities to damage anything was graphically demonstrated to be false. The solution we've used to avoid these unpleasant graphic demonstrations is to listen to the anecdotal evidence long enough and hard enough to see if there might be reason to form an opinion and structure a test around the opinion.

I admit to having seen a staggering amount of bad science in the research my wife and I have done on our medical problems. Often the argument for a given treatment devolves down to "because I said so and I've not killed anyone yet." I also admit that I've found some treatments that work well for me or my wife and the only argument for them is empirical: "it worked, so it's worth continuing." I find that I sift through what is presented and find an occasional nugget of, well, not truth, but something close enough to make me think and do more research on my own. I recognize that those nuggets will be covered in a large pile of (be glad that Rich doesn't have an emoticon for what it really should be) that needs to sifted through but that is part and parcel of reading a public board for medical advice.

Rich is posting this information because it worked for him and a group of others he's talked with. On the bad side, the group is still too small for their results to be meaningful in any statistical sense. On the good side, it did work for that group of people and it's worth the time it takes for basic research if someone else starts realizing their problems aren't being solved by conventional medical opinion. You are right, though, when you argue that Rich is presenting ongoing research efforts and opinion too forcefully. As ongoing research, it needs to be looked at with skepticism but the good it has done some people means that it does deserve to presented to the community for their review and thought. As quoted by many, "If it's crazy and works, it ain't crazy."

[Justin]

Originally Posted by Justin

What I am questioning is inaccurate information, which is based on opinion or is anecdotal in nature, being presented as fact.

Originally Posted by annapurna

I believe that the essence of everyone's argument here is the way you've worded that statement.

annapurna, thanks for your thoughtful post. I'm confused who the "everyone's argument is the way you've worded that statement," as you’re the first person to reply to my post that includes my quoted text from above. I'm not trying to be a pain in the ***, I just don't know who "everyone" is.

I'm not saying that anecdotal evidence and opinion are unacceptable in modern medicine. What I do have a problem with is when someone implies that correlation definitively equals causation based upon anecdotal evidence or opinion only. That’s unacceptable in modern medicine.

Trust me, I appreciate the fact that this forum is full of anecdotal evidence, but at the end of the day, it is just that--anecdotal. I'm not questioning the opinions of patients that post here regarding their spine health and surgical procedures, etc. They should feel free to post whatever they want--the more opinions the better!

I've learned so much from other patients on this forum. I'm active on this forum because I enjoy helping people that are in / were in my "pre-ADR shoes" not so long ago contemplating ADR (or fill in the blank) surgery. The support on this forum is amazing, and I truly enjoy giving back.

Anyway, what I am really questioning is the "research" that has been done on this site by loosely tying studies together and proclaiming that medicine is deficient in diagnostics, or that doctors are purposely neglecting those patients that suffer from chronic, degenerative diseases. This couldn't be further from the truth.

The conclusions based upon tying this information together and the sweeping assertions that follow becomes troublesome (in my opinion) when it is stated as fact or recommended to patients to "email me ASAP...make sure to have your doctor screen for such and such pathogen and make sure to read the attached studies."

Just to beat a dead horse: in my limited experience, most people "are in medicine" for the right reason(s): to find answers to the diseases that affect patients and to strive to give patients the best possible quality of life by using every tool we have available to us as physicians. One university in which I've spent some time at received $450 million dollars in National Institutes of Health grants last year for research. This is only one medical university in the country. Ultimately, this research money is being used to help devise new therapies, genetic screening, diagnostics, devices, a better understanding of metabolic and biochemical pathways that lead to drug discovery, etc. for patients. Great advances have been made in regard to spine in the last 5 years and hopefully will continue well into the future.

Originally Posted by annapurna

You are right, though, when you argue that Rich is presenting ongoing research efforts and opinion too forcefully. As ongoing research, it needs to be looked at with skepticism but the good it has done some people means that it does deserve to presented to the community for their review and thought. As quoted by many, "If it's crazy and works, it ain't crazy."

At the end of the day, I truly appreciate what Rich does with this site and the time he dedicates to it. We have been good friends for many years, even before this site was started. I just want patients to be well-informed and not assume "well, if the editor of the site is posting this information, it must then be true." I believe that transparency on issues such as accuracy and bias will ultimately build a stronger community.

(Just for the record: I never give medical advice on this forum, and I only point patients in the right direction or post a link where they can learn more about a question they had. I don't claim to know everything either, as it is obvious I don’t. I am still learning as I progress in my career, as medicine is changing everyday and I haven't been in the SICU for 30 years.)

[Harrison]

Hi everyone,

I am sorry that this topic has gotten out of hand. Yes, I am closing it again. I’ve responded to Justin’s (and other) emails and PMs in the past few days, and also asked Justin to keep this private (twice, by email and private message) and he did not honor that (see above comments about "ethics.") We’ve not come to an understanding on these topics.

As long as my credibility and time to this forum is being challenged, I will jealously guard them both by closing topics, issuing warnings, and doing whatever it takes to preserve peace in this community. In this case, both are being challenged here. And I really resent this -- especially since the evidence I provide privately was explicitly ignored.

In the meantime, I’ll ask you all to read the following below; which I sent twice earlier today to Justin. I am bending over backwards to be cooperative and inclusive, but when I am being chastised, then corrected with misinformation, I can’t be that nice!

I hope you all understand what is at stake here – actually many crucial issues germane to patients – but the intracellular bacteria issue is a big one to make. Look at the first presentation!

I am closing this topic for now; please don’t email or PM me. When and if Justin and I can come to terms of understanding, I will open it back up. Thanks for understanding.

This is crazy stuff.
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Justin, I really am alarmed by your post for a few reasons:

- The amount of time you spent collecting my previous posts, then attacking them, is something between scary and flattering!
- You’ve taken a different position, which is at times constructive and corrective; but there are some misunderstandings and outright inaccuracies exactly in the critical areas where you attempt to correct me.

Out of the many points you made that warrant comment or correction, here is just one I’ll address:

“…B. burgdorferi does not have a mechanism that helps to protect it from antibiotic therapy—it is only seen extracellularly in affected tissues. This means it has NOT been shown to “hide out” in intracellular locations, thereby evading antibiotic exposure…”

I only have the time and desire to shed some light on this one point; albeit the most important one: the Lyme causing spirochete (Bb) has several forms, and is well-know to penetrate cell walls. Not only has this been heavily documented by photographs and videos by numerous scientists around the world, it has been recognized for a century; so I am distressed and puzzled why you would make this mistake.

What follows are some articles documenting Bb (and other types of bacteria) “doing their naughty intracellular thing.” The first PDF really says it all, as there are some rather striking, detailed photos of Bb inside these types of cells: nerve, neuron, endothelial, macrophage, et al.
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http://www.borelioza.cz/download/Intracellular_Parasitism_UNH_May_19_2007.pdf
Borrelia Attack Models - PowerPoint in PFD

This document explicitly notes the sophisticated morphing attributes of Bb, notably its intracellular capabilities.
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If you would like to see actual microscopy videos and pictures which show the Bb spirochete inside other cells (e.g., blood cells), see:

http://lymerick.net/videomicroscopy.htm

Video-microscopy and pictures of Borrelia burgdorferi and other spirochete like structures links collection

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http://www.jneuroinflammation.com/content/5/1/40
Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme Neuroborreliosis (also on PubMed). Also details the cystic, rolled and granular forms of the spirochete.
Excerpt:

Conclusion

The results indicate that atypical extra- and intracellular pleomorphic and cystic forms of Borrelia burgdorferi and local neuroinflammation occur in the brain in chronic Lyme neuroborreliosis. The persistence of these more resistant spirochete forms, and their intracellular location in neurons and glial cells, may explain the long latent stage and persistence of Borrelia infection. The results also suggest that Borrelia burgdorferi may induce cellular dysfunction and apoptosis. The detection and recognition of atypical, cystic and granular forms in infected tissues is essential for the diagnosis and the treatment as they can occur in the absence of the typical spiral Borrelia form.
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http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=321306



2004, American Society for Microbiology
Intracellular Symbionts and Other Bacteria Associated with Deer Ticks (Ixodes scapularis) from Nantucket and Wellfleet, Cape Cod, Massachusetts

The diversity of bacteria associated with the deer tick (Ixodes scapularis) was assessed using PCR amplification, cloning, and sequencing of 16S rRNA genes originating from seven ticks collected from Nantucket Island and Wellfleet, Cape Cod, Mass. The majority of sequences obtained originated from gram-negative proteobacteria. Four intracellular bacteria were detected including strains of Ehrlichia, Rickettsia, and Wolbachia and an organism related to intracellular insect symbionts from the Cytophaga-Flavobacterium-Bacteroides group. Several strains of members of the Sphingomonadaceae were also detected in all but one tick. The results provide a view of the diversity of bacteria associated with I. scapularis ticks in the field.
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http://www.cdc.gov/ncidod/EiD/vol11no12/05-0898.htm
Human Granulocytic Anaplasmosis and Anaplasma phagocytophilum
Human granulocytic anaplasmosis is a tickborne rickettsial infection of neutrophils caused by Anaplasma phagocytophilum. The human disease was first identified in 1990, although the pathogen was defined as a veterinary agent in 1932. Since 1990, US cases have markedly increased, and infections are now recognized in Europe. A high international seroprevalence suggests infection is widespread but unrecognized. The niche for A. phagocytophilum, the neutrophil, indicates that the pathogen has unique adaptations and pathogenetic mechanisms. Intensive study has demonstrated interactions with host-cell signal transduction and possibly eukaryotic transcription. This interaction leads to permutations of neutrophil function and could permit immunopathologic changes, severe disease, and opportunistic infections. More study is needed to define the immunology and pathogenetic mechanisms and to understand why severe disease develops in some persons and why some animals become long-term permissive reservoir hosts.
First paragraph….


Human granulocytic anaplasmosis (HGA) was first identified in 1990 in a Wisconsin patient who died with a severe febrile illness 2 weeks after a tick bite (1). During the terminal phases of the infection, clusters of small bacteria were noted within neutrophils in the peripheral blood (Figure 1), assumed to be phagocytosed gram-positive cocci. A careful review of the blood smear suggested the possibility of human ehrlichiosis, an emerging infection with similar bacterial clusters in peripheral blood monocytes among infected patients in the southeast and south-central United States. All blood cultures were unrevealing, and specific serologic and immunohistochemical tests for Ehrlichia chaffeensis, the causative agent of human monocytic ehrlichiosis (HME) were negative. Over the ensuing 2 years, 13 cases with similar intraneutrophilic inclusions were identified in the same region of northwestern Wisconsin and eastern Minnesota (2). Aside from the bacterial clusters, common features among these persons included fever, headache, myalgia, malaise, absence of skin rash, leukopenia, thrombocytopenia, and mild injury to the liver.