There is a second thread on this topic. Bloodletting
Cecil’s comment was:
I believe there is some confusion in the phrasing of the sentence. While a possible (likely?) reading of that sentence is to take it to mean that the sludginess of the blood causes leukemia and bone marrow diseases, another reading could in fact catch that it is the polycythemia vera that is leading to leukemia et al. I suppose sloppy sentence structure is above Cecil, so we cannot account for the confusion by unintentional poor phrasing?
[[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.]]
First of all, I’d say you read a lot of stuff into my post that wasn’t there and wasn’t intended, Notthemama. Second, yes, I’d appreciate it if this thread kept close to the topic, too.
Jill
Melin’s father had the disease, or condition, or whatever it is (yes folks, it’s true, I am Melin’s husband, and you heard it here first!).
I’d be interested to know what the credentials are – and what the specialty is – of the doctor who JillGat says reviewed Cecil’s column before it went out. It helps to know where one’s information comes from. As we all know, when medical information is posted on this or any other board, nobody should rely on it, since we don’t know the experience or credentials behind the writing (and we know that Cecil is not a doctor). And I suspect that a cardiologist and a hematologist would look at this from different perspectives.
In this column Cecil increased people’s awareness of Hemochromatosis and other medical conditions that are treated by regular blood donations. I hardly see where he insulted the people who have these conditions. He called these diseases “exotic” and I think that’s where the problems with misinterpretation are coming in - some people are overreacting to that one word. Exotic has other meanings besides “rare.” Most of us think of blood donation as a simply altruistic move. It may sound exotic to some of us to hear that there are diseases that are actually treated this way.
Jill, I couldn’t agree with you more - Cecil has indeed increased awareness about HH, which is the name of the game. The more people who know about it, the more people will (hopefully) get themselves tested and find out they have it, which (with treatment) will save their lives. I do have HH, and I didn’t take offense at Cecil’s use of the word exotic (see my previous posts - under “Bloodletting” thread too); in fact I praised him for bringing up the topic. But some posters dismissed the number of people with HH as being very few. I don’t want to repeat myself regarding numbers of people who have it (and many others who have it & don’t know it!), so I’ll just say that I’m glad it is being discussed, and everyone should go to the websites offered in some of the posts to find out what tests should be done and HAVE YOURSELVES TESTED!! If a thousand of you get tested, odds are 5 or 6 (is that “a few”? even if it is, wouldn’t it be nice if they could live past age 50?) of you will have it, and if you’re young enough can completely prevent symptoms. (I had never even heard of it when I was diagnosed, but boy am I glad I was!!)
While I’m far from an expert, it appears that PUNdit is arguing that the word congenital is hardly used?
Not to let Cecil off the hook here (“Cecil is Wrong” does seem to be a popular topic title around here, isn’t it) but since he is writing to a general audience, perhaps he wanted to emphasize the fact that the disease is not contagious?
Wouldn’t want hypochondriacs to start taking up amateur bloodletting 'cause they thought they’d caught it off a co-worker…
[[While I’m far from an expert, it appears that PUNdit is arguing that the word congenital is hardly used?
Not to let Cecil off the hook here (“Cecil is Wrong” does seem to be a popular topic title around here, isn’t it) but since he is writing to a general audience, perhaps he wanted to emphasize the fact that the disease is not contagious?]]
I don’t think that’s what Sue/PUNdit said. The term “congenital” is used for conditions that are acquired in utero, and this word was incorrectly used in the column. Hemochromatosis is a hereditary or genetic condition, not a congenital one. And congenital doesn’t mean contageous, either.
Right, that’s what I meant.
Congenital is probably not contagious, therefore, people don’t have to worry about catching it.
But if what was meant was a hereditary disease then congenital was probably the wrong term.
agrees with your definition.
Although with synonyms like “inherent” it’s fairly clear how the confusion occurred.
Excuse my delay in replying; it was a busy week. Let me begin by addressing the following, from Highlander:
As you are aware, I’m the world’s smartest human, and know everything. However, it’s always smart to get a second opinion. In preparing this column I consulted with Dr. Daniel Brubaker, who has served as CEO and medical director for several blood banks. (You’ll recall that the column was mainly about the health benefits of blood donation.) Dan describes his qualifications as follows:
“I am board certified by the American Board of Pathology in anatomic pathology, clinical pathology, and immunohematology and have 20 years of experience in blood banking. I have been assistant professor of laboratory medicine at University of Oklahoma School of Medicine, UCLA School of Medicine, and UCSF School of Medicine, and have published about 100 papers in medical journals. My CV is attached.”
The attached document is 24 pages long. It doesn’t prove Dan is infallible, but he does have some claim to authority.
As for the allegations of error by PUNdit:
Guilty as charged. I knew the disease was genetic and the word “congenital” popped into my head as a descriptor. The disease is commonly cited in the literature as “hereditary hemochromatosis” and sometimes as “genetic hemochromatosis.”
I was attempting to give a brief characterization of the disease, not a detailed account. Dan was of the opinion it began to manifest in the 30s, as I wrote. The literature I have seen on the subject suggests that it commonly occurs in middle age, but sometimes earlier. Let’s compromise and say it “typically doesn’t surface until adulthood.”
I take it the complaint here is that I didn’t describe all the possible consequences of hemochromatosis. To repeat, I was attempting to BRIEFLY DESCRIBE the condition.
My point was that PCV sometimes leads to leukemia. You concede as much. I made no claim that sludginess per se causes leukemia.
This is ludicrous nitpicking. AS GENETIC DISORDERS GO, hemachromatosis is common. But it’s not a common disease, occurring in roughly 1/2 of 1 percent of the population. Few have heard of it (which I agree is unfortunate). In light of its obscurity and relative rarity, the term “exotic” seems apt.
I was making a joke. J-O-K-E. Cars are often “a quart low.”
In fairness to PUNdit’s wife I’ll assume this oafish comment was his contribution, not hers.
First off, please note from my previous posts (also look at “Bloodletting” thread) that all along I agreed that criticisms of Cecil were way too heavyhanded…
Being a person with HH (Hereditary Hemochromatosis, the mis-nomer of which was I believe the only point that Cecil conceded), I may have taken slight offense to my condition being labelled as “exotic” or “rare”. The fact that I regularly speak to numerous other HH patients certainly blurs my outlook (in the same sense that someone who’s into “crush” flicks might think that since everyone in their circle of friends enjoys watching high-heel clad chicks step on… well possibly baby chicks, EVERYONE must enjoy it too). In fact, I had never heard of HH when I was first diagnosed, so I’d feel pretty silly claiming that’s it’s “common”.
Bottom line is, I personally am very glad that this topic came up in Cecil’s column. If a thousand people in Cecil’s audience get themselves tested for HH, odds are a handful of them will find out they have it and never knew it; and with treatment (I thought phlebotomies were pretty barbaric when I first heard I’d have to have them, but you get used to something pretty fast when it saves your life) they will live past their fifties (otherwise unlikely, if left diagnosed).
Thank you Uncle Cecil, for bringing this subject to light. You have undoubtedly saved the lives of a decent-sized handful of faithful readers (and book-purchasers). Now we just have to push through legislation that will allow our “phlebotomized” blood to be used by blood banks! Anyone out there know any Congresspeople…?
Cecil did mention Hemochromatosis, which could help raise public awareness of a potentially lethal, highly treatable condition. Unfortunately, if all you knew about hemochromatosis was what you read in that column, you would have a very skewed idea of what hemochromatosis is, AND Cecil’s labelling of it as “exotic” would make it seem hardly worth your while to look it up to learn more… assuming, of course, that you could find anything about it under “congenital heomchromatosis.”
In a column such as this, there is limited space, and while mentioning hemochromatosis as an exception to what is discussed in the main body of the column is highly appropriate, a full description is not feasible. But a general description such as “a hereditary condition characterized by deposition of excess iron in tissues throughout the body leading to organ failure” is preferable to a haphazard selection of specifics which proves only that someone looked Hemochromatosis up, but leaves open the question of whether anyone working on the column really understood this disorder.
It does truly sound, Cecil, as though Dr. Brubaker is thoroughly qualified to discuss the “iron hypothesis”. I would, however, question whether a pathologist would be the best source of information about either hemochromatosis or polycythemia vera. An Internal Medicine specialist would be a good source for both conditions. If you wanted a lot of detail, a specialist in either Hematology (entirely different field than Immunohematology=Blood Banking) or Endocrinology & Metabolism would be an expert in diseases of iron metabolism such as hemochromatosis; a Hematologist would be a subject matter expert on bone marrow disorders such as polycythemia vera.
Nothing to add.
That’s a much better way to describe it.
Mentioning ONE manifestation of a multi-system disease is like going into a mixed forest, and describing one tree. I think it is safe to say that most readers would NOT have heard of hemochromatosis before this. While the details of every system affected are not particularly important (and my list is by no menas exhaustive) leaving the teeming millions with the idea that hemochromatosis causes heart failure with no mention of its being a systemic disease is misleading.
a. PCV transforms into leukemia in about 1-2% of cases. The majority of deaths from PCV are due to heart attack & stroke caused by the “sludgy” blood.
b. You said:
Does “possibly leading to leukemia…” modify “gets ‘sludgy’”? If so, it implies that the sludginess causes the leukemia, which is not true.
Or does “possibly leading to leukemia…” modify “…red-blood-cell count is too high”, in which case, it becomes a dangling participle. Surely the world’s smartest human did not make that mistake!
c. Which brings me to the most serious ambiguity/misstatement here - the suggestion that keeping the cell count down by bloodletting could help decrease the chances of the PCV transforming into leukemia.
d. You conveniently omitted explaining how PCV could lead to to bone marrow diseases when it already is one.
Obscure? Yes. Exotic/rare? No. And here I thought the semantics-playing in my first point was nitpicking. Cecil, there is a huge difference between how common a disorder is, and how well-known it is. Hemochromatosis is 7-8 times as common as Cystic Fibrosis (CF). CF kills cute little kids, and is heartbreaking, and, largely because of its emotional impact, is much better-known than hemochromatosis. You had a golden opportunity to correct that misperception; your characterizing it as exotic instead added to the idea that it is nothing that most of us will ever encounter. If I had to pick ONE of my criticisms of your column, Cecil, I would argue that this is the most important, not the most nitpicking. For those who read the message board, excellent discussions by several other posters have helped disabuse anyone of the notion that hemochromatosis is too rare to be worth thinking about. The TMs who only read your column, OTOH, are left with this misperception.
For illustration, here are some lifetime incidences of other disorders. I claim only ballpark accuracy, since many had to be converted from prevalalence, or annual incidences:
Diseases with incidence similar to that of hemochroamtosis.
[quote]
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.
I was making a joke. J-O-K-E. Cars are often “a quart low.”
[quote]
I was J-O-K-I-N-G back, Cecil. I guess “dry” (bad pun intended) humor is not your forte.
You’d assume wrong, Cecil. It seemed in keeping, however, with the fine tradition you’ve established:
And from http://www.straightdope.com/classics/a4_198.html
This is not a problem that requires infinite wisdom, Benj. This is a problem that requires enough neural organization to qualify as a vertebrate, apparently a stretch for some folks these days.
Seriously, I am curious as to whether your last paragragh was ever reviewed as published by a medical professional. If so, I would recommend finding someone else.
OK, picmr but if you follow that logic you will never have a well, never strike oil. In this case, we are digging for the truth. Cecil has a long tradition of ignoring the mud and rocks and delving until the truth is reached. I hope that in a small way I am doing the same.
One of the biggest criticisms I have seen is with the name of this thread. My answer is that, like the tabloids, you have to sucker in the readers. If I had named this thread
“The truth about Hemochromatosis” it would have had about 12 hits and died. Look at the number of hits this one has had. If a few more people read this thread to see why someone said Cecil is WRONG and learned more about hemochromatosis, then this is a good thing.
My last point is that I attacked Cecil, not some wallflower newbie making his first post. I assumed that Cecil could stand up for himself and not get all bent out of shape. His reply above, though I still have arguments with it, proves that.
I would nonetheless suggest that keeping going along the “how exotic” and “who’s oafish” lines is beginning to detract from what informative tone there is here.
Incidentally, I should have attributed the “first rule of holes” line: it is from Dennis Healey.
So Cecil wasn’t exactly wrong, he just maybe could have described Hemochromatosis more explicitly (remember, this wasn’t even a column about HH, HH was an ancillary point). Cecil even agreed that some of his wording could have been clearer - and we all know Cecil doesn’t much like to be corrected (who does?).
But keep in mind, if Cecil HAD worded his original column in exactly the way you wanted, you never would have begun this thread (& I wouldn’t have started “Bloodletting”), and lots of the Teeming Millions wouldn’t have learned this much about HH!! They would only know the brief description given in the column. So as a direct result of Cecil’s actions, thousands of people have been informed about HH!!
Maybe that was Cecil’s plan all along. Being the world’s smartest human, I wouldn’t put it past him…
I’ve asked Dr. Brubaker to respond in this thread, as he has done research and written about many closely related topics. However he’s a pretty busy physician and serves as medical director for a blood bank, so may not have time to spend on a message board.
PUNdit, I appreciate your motivations for responding, and this thread has been informative.
My remaining comment is about the joke on “quart low”. Somehow your response joke was not picked up as such. Maybe it’s because the rest of your response was a serious criticism of the content of Cecil’s column, so that line snuck under the radar. In fact, the way it reads it is hard to tell you are joking. It sounds like a serious correction of the volume of liquid in a quart vs. pint.
Hey, I’m willing to accept you meant it as a joke. I think it just didn’t fly, for whatever reason.
Anyway, let’s drop worrying about the joke that didn’t take and concentrate on the important parts, like your criticism of the use of the word “exotic” to describe the condition.
[ul][li]Exotic doesn’t necessarily (or even usually) mean rare. To my mind exotic means ‘different’ or ‘from a different place’, like bananas. This seems to match up with http://www.m-w.com 's definition of exotic. Sludgy blood sounds pretty freaking exotic to me.[/li]
[li]PUNdit writes: “Which brings me to the most serious ambiguity/misstatement here - the suggestion that keeping the cell count down by bloodletting could help decrease the chances of the PCV transforming into leukemia.”[/li]
Where did you get your ability to parse sentences? It’s like watching a failed Turing test candidate. Do you get some satisfaction out of misunderstanding what people say?
Let’s say Cecil dangled a participle or two. Big freakin’ deal. He said “…count is too high and your blood gets ‘sludgy,’… Bloodletting helps keep the cell count down…” Again, sludgy blood doesn’t sound that great. Maybe it’s my lack of medical training that causes me to understand what Cecil is saying, but I got the impression that the bloodletting prevents sludge, not leukemia. It seems to me that sludge is a Bad Thing, which you back up in your points above about most people dying from the sludge and its effects on the heart etc. I also got the point about PCV, not sludge, leading to leukemia.
[li]“PCV is already a bone marrow disease…”[/li]Fine. Cecil said transforming into other bone marrow diseases!! Maybe that statement is not strictly correct either - for all I know there are no other bone marrow diseases. Do I really have to care? Is there some medical student somewhere who will flunk because they read the Straight Dope instead of their textbooks?
CECIL:
PUNDIT:
CECIL:
PUNDIT:
That wasn’t dry humor, that was positively arid. No human being could have interpreted your remark as humorous. While “Sheesh - remind me not to let Cecil draw blood” could almost be witty, it isn’t when it is followed up by a clear demonstration of a misunderstanding of the idiom by contesting the value of a quart when referring to blood donations. “A tongue-in-cheek response to an inapt metaphor seem[s] appropriate” only when the metaphor is inapt.
Other inapt metaphors you may encounter in the future: [list][li]“A few bricks short of a load.” This is completely inapt when used to describe the state of a persons mental competence! If you mean to imply that the brain is diminished by the equivalent of a few grams of gray matter, the metaphor just doesn’t work! Bricks weigh up to several kilograms a piece![/li][li]“He really took the wind out of my sails”. That’s what’s so funny! By saying something that made me realize my idea sucked, he actually expelled air from his mouth, thus physically adding air to my sails! Besides that, I get seasick if I go sailing, so I should be grateful when he takes the wind out of my sails! How utterly inapt![/li][li]“It’s a dog eat dog world.” Dogs don’t eat other dogs![/li][/ul]
[/list]
OK,OK. Some minor mistakes were made. Cecil owned them. Now let’s go talk about homosexuals converting in the Pit.