Cecil Is Wrong

[PUNdit]

In Does giving blood reduce your chances of getting heart disease?, Cecil is wrong. He does an adequate job discussing a fringe theory, and had he stopped there would have had an acceptable, if incomplete, column. But with the last paragraph, he adds so much junk, that leaving people with their mistaken belief in “junk science” may have been the lesser of two evils.

But let’s not give up on bloodletting too quickly. For a few conditions it remains the treatment of choice. For example, in congenital hemochromatosis(1), an ailment that usually doesn’t surface until you’re in your 30s(2), toxic levels of iron build up in your tissue, eventually leading to heart failure(3). The treatment is to have blood drawn periodically to keep iron levels under control. An equally serious disease is polycythemia vera, in which your red-blood-cell count is too high and your blood gets “sludgy,” as one of my informants puts it, possibly leading to leukemia or other bone marrow diseases(4). Bloodletting helps keep the cell count down, so the practice isn’t always as barbaric as it seems. But unless you suffer from an exotic disease(5), chances are it won’t help you to be a quart low(6).
Numbers added by me.

1. Anyone interested in further research on hemochromatosis should be advised to omit the congenital, and just look up hemochromatosis. This is how it is indexed in medical texts, home medical guides, and on common internet sites. Sometimes, it is called hereditary, or even familial, hemochromatosis.
   Here is a Mayo site on the condition:
   http://www.mayohealth.org/mayo/0001/htm/hemo.htm

2. The age at which hemochromatosis is diagosed is highly variable. Typically, men manifest the disease in their 40s, while women show complications from hemochromatosis later in life (50s or 60s) due to the protective effects of menstrual blood loss, and the loss of iron to their babies during pregnancy. Some people, however, can develop problems from hemochromatosis in their 20s, especially if they are heavy drinkers, as the combined harmful effects of iron & alcohol are more multiplicative than additive. Some people with the disease do not suffer complications until very late in life for unknown reasons. Due to genetic testing now available, infants & children can now be diagnosed and treated to prevent all complications of this disorder.

3. Heart failure… and liver failure/cirrhosis/liver cancer, diabetes, low testosterone levels, poor pituitary function, arthritis, bronzed skin, among other things.
   Also, the heart failure caused by hemochromatosis is very different from the heart problems alluded to in the earlier parts of the column. Heart failure from hemochromatosis is due to iron deposition in the muscle cells causing the muscle cells to contract less effectively, so that the heart as a whole pumps a smaller amount of blood out with each contraction. In the column, atherosclerosis possibly accelerated by high iron levels causes portions of the heart to receive too little oxygen leading to reversible cell damage (angina) or irreversible heart muscle cell death (heart attack = myocardial infarction/MI.)

4. In polycythemia vera (PCV) the bone marrow overproduces red-blood-cells (RBCs) – as well as too many white blood cells and platelets. The percent of blood volume occupied by RBCs can go from the usual 40-45% up to 50-70%, leading to increased viscosity (or sludginess if you prefer.) The increased viscosity means slower blood flow through arterioles and capillaries, and poor delivery of oxygen & other nutrients to cells, and a higher rate of things like strokes and heart attacks which result from poor blood flow.
   This, not progression to leukemia, is the danger posed by the increased viscosity. Since PCV is already a bone marrow disorder of abnormal cell division, its natural course includes the possibility of it progressing to leukemia, but this is unrelated to the hyperviscosity caused by it.

5. Exotic? Among Americans of northern European ancestry, hemachromatosis is the most common genetic disorder. It is an autosomal recessive disorder which affects about 4 in 1000 people; 1 in 10 are carriers. It is underdiagnosed, meaning that many more people have it than are diagnosed with it.

6. Sheesh. Remind me not to let Cecil ever draw my blood! In standard blood donations, people typically donate 450-500 cc; this is equivalent to a pint, not a quart.

Um, Cecil? Are there any people with medical backgrounds on your staff? I don’t know who your informant was, but I strongly recommend teaching them to ask “Do you want fries with that?”

NOTE: Information in this post provided by Sue aka Majormd

• PUNdit

[PUNdit]

Sorry - not used to vB code yet.

the first link should read:

Does giving blood reduce your chances of getting heart disease?

[Saltire]

Whoa, dude. When I saw the title, I expected to find your bleached bones here on this thread. It’s only a matter of time, you know.

[Louie]

Cecil said:

But unless you suffer from an exotic disease(5), chances are it won’t help you to be a quart low(6).

And PUNdit said:

6. Sheesh. Remind me not to let Cecil ever draw my blood! In standard blood donations, people typically donate 450-500 cc; this is equivalent to a pint, not a quart.

Wow, PUNdit that punchline went “whhoooooosh” over your head. He was talking about a car being a quart low on oil and comparing it to the body with a pint less of blood.

[PUNdit]

Wow, PUNdit that punchline went “whhoooooosh” over your head. He was talking about a car being a quart low on oil and comparing it to the body with a pint less of blood.

Whoosh back atcha dude. Sheesh = “I’m being sarcastic here. Pay close attention.” A tongue-in-cheek response to an inapt metaphor seemed appropriate.

[Una_Persson]

From my SO, the Internal Med Doc:

“What PUNdit said.”

[JillGat]

[[“What PUNdit said.”]]

Pundit didn’t actually say it - his wife who asked us to “deregister” her from the Straight Dope message board did, through him. This column was approved by a physician who specializes in this field, though the language (and jokes) were Cecil’s. I have passed it onto Cecil and maybe he’ll respond.
Jill
ps --Some may call it a “fringe theory,” that regular blood donation could possibly aid in the prevention of heart disease. But I found a medical school textbook on Hematology that devoted a whole section to a description and discussion of this (unproven)theory.

[DSYoungEsq]

Ok, no offense, Sue, but I think ya went a bit overboard with the response. Cecil wasn’t wrong, he simply didn’t provide full detail, because it wasn’t central to the question.
The main issue from the question was: should you donate blood to avoid heart disease. Cecil’s main thrust was, “Maybe, but it ain’t really proven to be effective, yet.” He gives some pretty good explanation of the theory, the evidence, and the counter-argument.

He then, as he is want to do at times, offers some added information of interest on a related issue: bloodletting. He does so solely because the questioner said the idea of giving blood to avoid disease sounded a lot like medieval practices which most today think of as not very effective. Without saying anything wrong, Cecil provided general examples of two medical conditions for which bloodletting is of value. I read your notations, and all you are saying is: there is more here than you are saying, Cecil. Well, duh.

Let’s be a little less apt to try and catch Cecil out, and more willing to say something like: “And if you’re interested, here is some more information about these diseases.”

[PUNdit]

[[“What PUNdit said.”]]

Pundit didn’t actually say it - his wife who asked us to “deregister” her from the Straight Dope message board did, through him. This column was approved by a physician who specializes in this field, though the language (and jokes) were Cecil’s. I have passed it onto Cecil and maybe he’ll respond.
Jill

I am sure there was a point to this post, but I’m danged if I see it. Yes, Sue is “deregistered” but she was not banned. We certainly didn’t try to make people think I had suddenly become a medical authority. Note the last line of the OP:

NOTE: Information in this post provided by Sue aka Majormd

You might say that this post was approved by an award winning MD, but the jokes (that seem to have fallen flat) were mine.

PUN

[PUNdit]

DSYoungEsq defends Cecil:

Ok, no offense, Sue, but I think ya went a bit overboard with the response. Cecil wasn’t wrong, he simply didn’t provide full detail, because it wasn’t central to the question.

I will grant you that of the 6 corrections I made, several were not about truly “wrong” (as in false) statements. But some were…

The main issue from the question was: should you donate blood to avoid heart disease. Cecil’s main thrust was, “Maybe, but it ain’t really proven to be effective, yet.” He gives some pretty good explanation of the theory, the evidence, and the counter-argument.

He then, as he is want to do at times, offers some added information of interest on a related issue: bloodletting. He does so solely because the questioner said the idea of giving blood to avoid disease sounded a lot like medieval practices which most today think of as not very effective. Without saying anything wrong, Cecil provided general examples of two medical conditions for which bloodletting is of value. I read your notations, and all you are saying is: there is more here than you are saying, Cecil. Well, duh.

Well, no.

My notations went into considerably more depth than the column because when one is refuting a statement made by another, the burden of proof is on the refuter. But my statements went beyond merely clarifying Cecil’s misstatements:

1. Congenital Hemochromatosis - if someone interested in this condition actually tried to look this up, they would probably miss 90+% of the available information, because this is not how the information is listed. To wit, a MEDline search of congenital hemochromatosis yielded 100 results from 1966 to 2000; hemochromatosis alone yielded 3870 papers.
   Conclusion: Cecil’s statement, while not factually wrong, includes an unnecessary distracter.

2. Hemochromatosis appears in people in their 30s. Even with the “usually” qualifier, this statement is such a gross oversimplification as to become untrue. One danger in writing medical information for the popular media lies in creating false impressions because of such simplifications. One certainly can become seriously ill from hemochromatosis much earlier in life; making it through the 30s or 40s without showing signs of it doesn’t make one exempt from it later.
   Conclusion: Cecil’s statement is a gross oversimplification while mentioning a feature of hemochromatosis which is not central to the question at hand.

3. Hemochromatosis causes heart failure. Period. Another gross oversimplification. People at risk (with a grandparent with the disease for example) may fail to recognize the disease because grandma’s iron overload caused cirrhosis and then liver cancer, not heart failure. I can’t think of any good reason to mention only one manifestation of a systemic disease.
   Conclusion: Cecil’s statement is a gross oversimplification while mentioning a feature of hemochromatosis which is not central to the question at hand.

4. Here is where Cecil really loses contact with the facts.
   Fact one: Polycythemia vera (PCV) is a bone marrow disorder in which the marrow overproduces all 3 lines of blood cells (RBCs, WBCs, and platelets).
   Fact two: PCV can evolve, over time, into leukemia.
   Fact three: The increased number of RBCs (and platelets, while we’re clarifying things) makes the blood thicker, more viscous, or more sludgy.
   Fact four: Sludgy blood doesn’t go through arterioles and capillaries very well; clots happen more easily leading to strokes, heart attacks, and other tissue damage.
   Fact five: (from 1 & 3) Sludginess is NOT responsible for PCV’s being a bone marrow disorder, since by definition, PCV is a bone marrow disorder. This is in direct contradiction to one of Cecil’s assertions.
   Fact six: (from 1, 2, and 3) Sludginess is also NOT responsible for PCV’s (one bone marrow disorder) evolving into leukemia (another bone marrow disorder), since this is an inherent characteristic of PCV. Bloodletting does nothing to prevent the PCV from evolving into leukemia; in theory, it may even increase the chances of this happening. This is also in direct contradiction to one of Cecil’s statements.
   Conclusion: Cecil doesn’t know what he’s talking about when he is discussing polycythemia vera. Anyone reading this as their introduction to this condition would likewise be clueless.

5. Hemochromatosis is an exotic disease? Every primary care doctor should be diagnosing this condition in 1 out of every 250 patients s/he sees, or several times a year. Hemachromatosis is not a rare or exotic disease. 10% of Americans with northern European ancestries are carriers, and may be mildly affected by this condition (more likely to get cirrhosis from alcohol abuse, than homozygous non-carriers, for example.)
   Conclusion: Cecil’s minimizing the prevalence of hemochromatosis is misleading, to say the least. I feel that it is misleading to the point of being factually wrong.

6. “quart low” - OK, I’ll give Cecil some benefit of the doubt here, but I do hope he doesn’t moonlight at the local blood bank… :rolleyes: for Louie’s benefit…

So the tally:
1 sentence (4) with two major factual errors.
2 (2,3) gross oversimplifications.
1 trivialization (5) of a common serious condition.
1 misnomer (1)
1 stretching (6) of a phrase to make a joke.

The main point I am making is that most of the things I take issue with were completely superfluous in describing situations in which periodic bloodletting certainly does benefit the patient.

Let’s be a little less apt to try and catch Cecil out, and more willing to say something like: “And if you’re interested, here is some more information about these diseases.”

Perhaps Cecil should go with the less is more concept. If he’s near the end of his alloted space, instead of adding confusing, misleading, or just plain wrong detail, he should stick to something like:

“But let’s not give up on bloodletting too quickly. For a few conditions it remains the treatment of choice. For example, in hemochromatosis, a hereditary ailment, toxic levels of iron build up in many different tissues. The treatment is to have blood drawn periodically to keep iron levels under control. An equally serious disease is polycythemia vera, a bone marrow disease in which too many blood cells are made. This makes the blood too thick, or viscous, and can lead to strokes or heart attacks. Regular bloodletting keeps the cell counts down, thus preventing these complications, so the practice isn’t always as barbaric as it seems. But unless you suffer from one of these disorders, chances are it won’t help you to be half a quart low.”

I stand by my characterization of Cecil being wrong.

NOTE: Information in this post provided by Sue aka Majormd

• PUNdit

PS - On the off chance it wasn’t a typo, “in the habit of” is wont to, not want to…

[RM_Mentock]

You might say that this post was approved by an award winning MD, but the jokes (that seem to have fallen flat) were mine.

::was that “employee of the week?”::

uhh…well…some jokes work better when they don’t accompany pissing contests. The title of your thread is “Cecil is Wrong.” I’d like to try to paraphrase your points:[ol][li]Cecil is right but the name hemochromatosis would have been better than congential hemochromatosis[/li][li]Cecil should have said “later in life” rather than “in your 30s”[/li][li]Cecil is right but there is more than just heart failure[/li][li]Cecil is right but could have been misinterpreted by some people[/li][li]Cecil misused the word “exotic”[/li][li]Cecil joked, you joked back.[/li][/ol]So, where is the justification for the topic title?

[PUNdit]

RM Mentock posts:

I’d like to try to paraphrase your points:

Italicized additions by PUNdit
[ol]
[li]Cecil is right but the name hemochromatosis would have been better than congential hemochromatosis. Well, sort of. It just sounds uneducated, like saying “sugar diabetes” - not the style for which Cecil normally strives.[/li][li]Cecil should have said “later in life” rather than “in your 30s” Cecil should have not said anything, or said “at any point in life”; “in your 30s”, even with “usually” is too narrow, and well, wrong.[/li][li]Cecil is right but there is more than just heart failure And saying that poliovirus causes gastroenteritis is technically right, too. Just woefully incomplete.[/li][li]Cecil is right but could have been misinterpreted by some people No. Cecil is wrong here. He states that sludginess causes PCV to become a bone marrow disease or leukemia. This is like saying that having a fever with a middle ear infection causes the eardrum to rupture. Fever and eardrum rupture can both be associated with middle ear infections, but neither causes the other. Or it could be like saying that having otitis media could cause an infection - since otitis media IS an infection, this is redundant/wrong. Tylenol (in an analogy to bloodletting) treats the fever (sludginess) but does nothing to decrease the risk of eardrum rupture (leukemia).[/li][li]Cecil misused the word “exotic” leading people to think that both diseases are rare entities with little chance of affecting them. If 1/6 of the registered posters read this column, approximately 4 of them will have hemochromatosis. Add in the readership of the Reader, and other papers carrying the column, and a lot of people with this diagnosis might be led to believe it’s probably too rare to affect them.[/li][li]Cecil joked, you joked back.Um, OK.[/li][/ol]So, where is the justification for the topic title?
In italics

• PUN (with information from Sue)

[TubaDiva]

If 1/6 of the registered posters read this column, approximately 4 of them will have hemochromatosis. Add in the readership of the Reader, and other papers carrying the column, and a lot of people with this diagnosis might be led to believe it’s probably too rare to affect them.

My mother worked as a nurse for one of the larger serological companies for several years. She estimates she saw several thousand clients/patients, she stuck people all day long; in all that time, she saw ONE case of hemochromatosis.

I doubt Atlanta is a hemochromatosis-free zone and I would think working in such a place would increase your chances of encountering people with this condition. One in several thousand isn’t even close to your quote.

I’m gonna go ask my friend that used to stick people for the Red Cross, but I bet his situation is similar.

In the same vein :), I probably know or know of several thousand people in my life; friends and neighbors and family and working relationships and acquaintainces and folks I just meet from time to time. Out of all those people, I personally know ONE man with hemochromatosis. If your numbers are real, I should know more. Heck, we should be slopping over with 'em!

your humble TubaDiva

[PUNdit]

TUBA posts:

In the same vein :), I probably know or know of several thousand people in my life; friends and neighbors and family and working relationships and acquaintainces and folks I just meet from time to time. Out of all those people, I personally know ONE man with hemochromatosis. If your numbers are real, I should know more. Heck, we should be slopping over with 'em!

My numbers are supported by the Mayo Clinic cite provided in the OP. Also, in the OP, I mentioned that hemochromatosis is an underdiagnosed disorder. This means that you know more people with hemochromatosis than you think you do…(even assuming you know everything about all several thousand acquaintances’ medical histories.) For at least a few SDMB posters, one of those people could be the one in the mirror.

• PUN (with Sue)

[system]

FWIW, I think Cecil and PUNdit are BOTH right.

Cecil wrote a humorous column intending to fight a little ignorance. He accomplished this.

PUNdit wrote a serious post also intending to fight a little ignorance. He accomplished this.

Can we all get on with our lives now? Or is this fight gonna go all the way to “first blood”? (I can hear the crowd down in the Pit chanting, “blood, blood, blood…”)

But, hey, I don’t wanna rain on PUNdit’s parade here. After all, you don’t get many chances to post a topic like “Cecil is wrong” and get away with it.

And P.S. I really feel a need to mention how I’m getting just a teeny, weeny bit tired of reading a post, and then two or three posts later, having to hear somebody point out how the poster is actually the cousin’s hairdresser’s sister-in-law of such-and-such a banned poster, or unregistered poster, or poster who left in a snit and hasn’t been heard from since. It’s, like, totally irrelevant, folks. Is the info less correct just because it comes from someone you don’t like?

If Cecil wrote a column saying, “Second-hand smoke isn’t bad for you after all,” and Michael Masterson posted saying oh yes it is and gave 15 minutes worth of facts and figures from the Centers for Disease Control, I wouldn’t get all huffy and say, “I’d like to point out that the previous poster is a troll.” It wouldn’t be relevant to the discussion.

Okay, granted, I don’t know the people involved IRL and you folks do. But I don’t understand how you all seem to expect Sue and her husband to simply stop reading the boards, after it’s been such a big part of their lives for so long, and you all seem to think that if, when they are reading the boards, they see what they consider to be an egregious error, they should just shrug and go back to reading the paper.

Sheesh.

[system]

And, yes, Tuba, I do grasp the fact that you are only springing to Cecil’s defense by pointing out what you perceive as an obvious bias in his critic. But that’s only necessary when a critic is posting unfounded criticism, e.g. sock puppets, trolls, etc. Then, of course, it’s nice for the attackee to have all his friends rally 'round and jump on the attacker.

But when the critic is posting facts, it isn’t necessary for us all to be given “the story so far…”

Also, this isn’t GQ or ATMB or even the Pit. It’s Comments, and when Cecil writes a column, I should think that he ought to be able to defend it himself reasonably well. Of course, one expects other Dopers to join in posting reasonable rebuttals to the critic, but there have been other times when somebody jumped hard with both feet on something he wrote, and nobody felt a need to do the “protective mother bear” bit.

So. ::: shrug :::

[system]

Whoops, sorry, it was Jill who pointed that out, not Tuba. But my point remains the same.

[DSYoungEsq]

At the risk of hijacking,
notthemomma, Jill was simply correcting an incorrect assertion that PUNdit had posted. Sue posted, through the use of PUNdit’s UserName, a fact Sue indicated when making the post. I don’t think Jill was trying to denigrate Sue with that statement; she was advising all and sundry who might be similarly confused that a) it wasn’t PUNdit and b) it WAS Sue (who is known to have some expertise in the area). My suggestion would be not to assume that it’s all part of some sort of overall effort or conspiracy.
Back to the original thread:

I’m not gonna argue any more about the situation, other than to note that I am not the only one who sees what was originally posted as A) lots of helpful information that hardly proves that ‘Cecil Is Wrong’, and B) perhaps a bit of a rant by someone who thinks that the situation is more grave than some would like to believe (and thought the ox was being gored). Perhaps Sue might want to take that into consideration.

[system]

DS: yeah, I know. I’m not checking under the beds for conspirators just yet, but it is a little bit like being invited over to someone’s house for dinner and sitting there in the living room, listening to the Mr. and Mrs. argue out in the kitchen. Mostly embarrassed for them.

And all these doctors!

You know what they say:

One doctor is an opinion.
Two doctors is a second opinion.
Three doctors is a malpractice suit.

[DropOfaHat]

Hi all.

Tuba, you dismiss PUNdit’s figures regarding the percentage of people with Hemochromatosis based on second-hand anecdotal evidence. Putting aside for a moment the usefulness of such evidence, let me address the heart (HA!) of the issue: there are TONS of people walking with HH who DON’T EVEN KNOW IT (and probably never heard of it). Worse, people die all the time of heart failure, heart attack, liver cancer, and other seemingly clear reasons (often at a relatively young age - 50’s, 40’s) and it is never discovered that the original reason for the damage to their tissues & organs was HH!!

I myself happen to have HH (I have another thread running with a similar topic - “Bloodletting”), and I understand why PUNdit wants to get this information out there - because it SAVES LIVES. Granted, I happen to agree with the folks who think PUNdit’s attack was a wee bit strong (to go up against a mind like Cecil’s is a task I would not want to undertake…) but PUNdit’s heart (HAHA!) was in the right place.

“We all need… someone… to bleed on…”