Litza Braun
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In the following days, I decided that I should write about this and vlog about it too.. So I started my research. Little did I know that another physician would do a video criticizing the documentary, calling it “fake science.” Mind you, when one doctor says its science, and another doctor says its fake science.. well, it leads to a lot of confusion and doubt. After all, these are doctors, so which one do you believe?!?!
Based on the documentary AND the critiques of the other physician, I have researched and written this post to address a few points made. There were lots of points! So If you think I missed one, LET ME KNOW! So I can send that one too! I have chosen a few points that I believe we’re the most “shocking,” “fake-sounding,” “alarming,” “controversial,” both from the documentary and the “debunking video.” So, if you need a break, take it! Stretch, have some water, even some coffee! And let’s dive in! –1-
Debunker Criticism: Sugar and carbs store as fat, basic physiology. The idea that fat particles deposit on muscle cells and doesn’t let sugar into cells is FAKE SCIENCE! 
High carbohydrates and high sugar diets predispose you to obesity and insulin resistance. Obesity is a risk factor for diabetes type 2, and insulin resistance causes it.
What the documentary said was that high fat in the diet is the real issue. And this is true. The traditional way to help patients control their disease is by controlling their sugar and carb intake. The issue with this is that diets low in carbs makes you eat more fats and protein, so you feel appropriately energized. By minimizing fat, especially saturated fat in the food, improves insulin resistance. This means that even if you are eating sugars and lots of carbs, by lowering your amount of fat consumption, your body can deal with the sugar more adequately.
A study was conducted on diets higher in grains, veggies, and fruits and lower dairy and meat consumption. Results showed that many diabetic patients were able to reduce their medications or go off them entirely. Studies on muscle cell fat content show that athletes and diabetes have higher levels of muscle cell fat, BUT only athletes have higher sensitivity for insulin.
Yes, overeating sugar and carbohydrates may predispose you to obesity, but only if your body cannot adequately deal with the amount of sugar you are putting in it.
Exercise! And lower saturated fats, like the ones found in animal proteins (dairy, steak, chicken, even fish)
– 2 –
Egg yolk is full of cholesterol and fat; it’s main function is to maintain the development of a baby chick. When we eat it, it coats our blood cells; our blood gets thicker, changes our hormones, raises our cholesterol levels; there’s nothing healthy of eating the yolk of the egg. Eating one egg is like smoking five cigarettes? Debunker Criticism: be careful of people finding studies to support what they already believe.
Appears to be on the side of the debunker. One study found that a diet high in eggs, but lower in saturated fats, or food that is high in eggs but replaces saturated fats with healthier fats, actually had a positive or no effect on harmful cholesterol levels. Another study found that short-term egg consumption did not severely affect arterial function in healthy people. In the International Journal of Cardiology, the same one that was referred to in the documentary, concluded that eating 1-2 eggs a day did not adversely affect blood cholesterol or LDL (bad cholesterol).
This same study supported the debunker physician’s view that dietary cholesterol “may be less detrimental to cardiovascular health than previously thought”. So, I’m not sure why they chose a section of the ‘methods’ to say eating a sausage and egg sandwich was equivalent to McDonald’s McMuffin. It did say that but as a comparison. Another study showed that “dietary cholesterol and Coronary Heart Disease (CHD) is small, as most subjects can effectively adapt to higher levels of cholesterol intake. Nevertheless, lowering dietary cholesterol content might reduce the risk of CHD considerably in a subgroup of individuals who are highly responsive to changes in cholesterol intake”. A meta-analysis on eggs and risk of coronary heart disease showed a dose-response. Basically, more eggs (up to 1/day) was not found to be associated with coronary heart disease.
A Canadian study did find that one egg was comparable to smoking five cigarettes, BUT what they didn’t add in the documentary was that the study itself said more research was needed to find any other dietary confounders, as well as the role of waist circumference. The study concluded that people at risk should lower their egg ingestion. This is similar to other studies that also show eggs are not bad for your arteries.
I found evidence that they’re bad, evidence that they’re not bad. So I conclude that anything in excess is bad! People at risk of certain problems should not eat certain things. This is the trend with every disease. An important topic to discuss, obviously, but dramatizing it as feeding your child five cigarettes is a bit extreme, in my opinion. – 3 –
Debunking criticism: plutonium is vegan
YES. All of the above mentioned are labeled as group 1 carcinogens on the WHO website. By the way, its W-H-O, not the who (like the group.. each letter is pronounced individually, it’s not a word if that makes sense).
Is plutonium vegan as the debunking physician said? I didn’t find any evidence that plutonium is found in plant foods. I’m not sure what drove him to say something like that. Whether or not he has supporting evidence to this, or he just wanted to make a shocking statement, no clue. I was shocked, and it made me look it up. If you are anything like me, you might do the same, and if you do find something that I missed, please share it with me! – 4 –
Debunker Criticism: NO! People were told cigarettes are harmful, and they still smoke, so people will keep up with bad habits even if told how bad they are.
It’s 50/50. Sure, we’re all told smoking is terrible, not exercising is terrible, sodas are bad, etc. etc. How many of us make changes may not be as big as we’d like. But, ever since smoking awareness has gone up, the rates of smoking have gone down.
The video shown in class showed a small portion of what an actual investigation entails. The investigation began when local health departments called the CDC because of concerns of an outbreak. The video shows the CDC arriving and speaking with the families, acquiring what is called descriptive epidemiology: when, where, who, and how many (Gregg, Michael B, 156-157). They looked for connections between all three victims now in a coma, intubated, and in the ICU. They then conducted a series of lab tests and imaging on all patients to diagnose the cause, but their efforts remained unsuccessful, and they could not make the diagnosis. 
The CDC went to the patient’s home and spoke to friends and family. Luckily, this led to information about a bat bite on the donor’s chest in the previous weeks. The CDC then requested an autopsy and sent investigators to the donor’s home looking for the bats with infrared lenses. Multiple bats were found and taken into the CDC, where they tested for the rabies virus. They found the same rabies virus in both donor and bat, and the source of the infection found (“Fatal Infestations”).
The video ends with the death of the last living victim. Any situation where an individualis still alive and on the brink of death due to an unknown cause, which has already killed others, the involvement of local health departments and the CDC is crucial to determine the cause and source to treat and prevent further spread. Any initial investigation requires a case count and case definition (Gregg, Michael B, 157). In this situation, the case definition would have been: erratic behavior, seizures, and coma. The count would have been three with the first victim as patient zero. The video revealed that the symptoms began approximately 3 -7 days after the organ transplant surgery, meaning that whatever the cause, its symptoms occur rapidly and effects catastrophic.
This would add pressure on me as an investigator to conduct my work not only accurately, but also very quickly (Gregg, Michael B, 10-13). My next step would be to begin data collection. Descriptive epidemiology: Demographics, exposures, similarities between all three cases, hospital information, and discussions with the doctors to determine if the infection was from the surgical room, the tools used, the staff present, etc. Since it is unknown whether or not any of these things are the source, I would be concerned about a larger range of exposure and possible epidemic. 
This information helps form a hypothesis of the possible source of infection and diagnosis; it would also help me decide whether or not to launch a full investigation (Gregg, Michael B, 186). In this case, I would because of the high risk of an epidemic of an unknown disease that can kill within 3-7 days. Once I ruled out the organ recipient hospital as the source of infection, I shifted my hypothesis to the donor hospital and the donor himself as the possible sources.
I would use visual aids and maps to help graph the case count orient them in place (Gregg, Michael B, 191-196). Will help as I gather information from the donor hospital. Doing this may show the point of origin of infection and narrow down the possible source. This shows that as investigators progress through the investigation, they will also change and narrow the hypothesis until they find the true source.
The information I would require about the donor includes: symptoms of the donor on arrival to the hospital, which included: erratic behavior, seizures, and drooling. Information gathered from friends and family on recent exposures, which would reveal the bat bite weeks back. The combination of the bat bite and the symptoms, the doctor in me, would immediately be concerned about rabies.
Just as the CDC did, I would request an immediate biopsy of the donor looking specifically for Negri bodies in the brain (CDC, 2011), as well as send investigators to the home to look for bats. After confirmation of the diagnosis of rabies, no one can do much for the surviving victim who received an organ from the infected donor. Unfortunately, they already presented with symptoms, and as mentioned previously, recovery is not likely.
Now, although the video did not discuss what happened after the surviving victim passed away, it is important to know that any epidemiological investigation does not end there. It is imperative to continue assessing risks of exposure to other people besides the initial victims. Knowing that the latency between exposure to rabies and symptom manifestation of the disease is between 1 week and three months, it is essential to determine whether an exchange of bodily fluids between the donor and any family and friends occurred (CDC, 2011).
If the transmission of rabies is likely, they should administer PEP, especially if the patients have not presented with neurological symptoms, and in this way, they can prevent more casualties. Furthermore, I would be concerned about the presence of bats in the neighboring areas of the donors’ homes.
If his home had bats, it is also likely that there are bats in other homes, which would place its inhabitants at risk of acquiring rabies if bitten. A very important step in an epidemiological investigation is the formation of a written report outlining the findings and recommendations (Gregg, Michael B, 3-13, 73-76).
Even more important is the execution of the recommendations as well as the implementation of prevention measures to keep healthy people healthy and risk-free of the disease. This includes surveillance for bat, wild carnivore, and rabid dog sightings. Bats and rabid animals may infect other domestic animals, and therefore, there is a need to conduct surveillance of changes in domestic animal behavior.
I would thus release educational pamphlets to the population, alerting them of the possible risk of rabies if bitten by these animals and instructions on what to do if bitten, such as 1) Immediately spray with soap and water; as the saliva of the animal transmits the virus. 2) Make an appointment with their doctor and be evaluated for possible risk of exposure and, if needed, receipt of PEP. To aid in reducing rabies-infected animals from streets, I would ask for assistance from Animal Control to retrieve any raccoons, bats, and other possible reservoirs from the roads.
As explained, I would do some things differently from what was seen in the video. Because of my medical background, I believe I may have been able to detect the possibility of rabies sooner and avoid the delay in diagnosing. I would have also used visual aids to help identify the common area of exposure and the pattern of transmission. Although, in this situation, the investigation took place in the United States, certain risk factors were more important than others, such as bats versus domestic animals. If the research had taken place on an international level, there would no doubt be different obstacles to overcome, such as a language barrier, cultural differences, and political issues. These would cause significant delays in acquiring data and arriving at a diagnosis quickly.
Moreover, certain places of the world do not trust the western world, and this would affect the swift formation of the hypothesis by precluding data collection, as well as the creation of prevention and treatment plans to contain the infection. My focus, in an international setting, would be less on wild animals and more on domestic animals, which rarely get rabies vaccines and the most common causes of rabies outside of the United States (WHO, 2017). The plan would include vaccinating as many dogs as possible with the aid of veterinarians, both local and international, watching street dogs for signs of rabies, and putting them down if confirmed. They are teaching the population about ways to protect themselves and others. Inform families that those most at risk of acquiring rabies are their children (Finnegan, C. J., S. M. Brookes, et al., 2003).
It is essential to educate the population about all the likely reservoirs to avoid the issues mentioned earlier that Thailand faces. Preventing re-emergence and epidemics of a disease is the goal. They implement prevention measures. Certainly, they will face challenges in supplying enough rabies vaccines for all the dogs, and they cannot prevent every risk of exposure. Another thing to consider is access to health care.
If a dog bites someone, do they know where to go to get PEP? Can they get there quickly and safely? Will it be affordable? Public health officials must address these obstacles, especially in international settings where limited access to healthcare makes arriving with a clear plan essential. Overall, the investigation conducted during the rabies video does show the typical course of an epidemiological investigation.
I do think there were some time delays in reporting the issue to the CDC and diagnosing the donor with rabies, but fortunately, the disease had only been transmitted to the three victims. It is important to keep people as well as practicing physicians informed about rabies, its hosts, transmissions, treatment options, and prognosis.
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