The medical basis of vampires and other medical myths [PODCAST]

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“Where did the myth of vampires come from? Like many myths, it is based partly in fact. A blood disorder called porphyria, which has been with us for millennia, became prevalent among the nobility and royalty of Eastern Europe. A genetic disorder, it becomes more common with inbreeding. Porphyria is a malfunction in the process of hemoglobin production. Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body tissues. It seems likely that this disorder is the origin of the vampire myth. In fact, it is sometimes referred to as the ‘Vampyre Disease.'”

Michael Hefferon is a pediatrician and author of Of Plagues and Vampires: Believable Myths and Unbelievable Facts from Medical Practice.

He shares his story and discusses his KevinMD article, “The medical basis of vampires.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Michael Hefferon. He’s a physician in Kingston, Ontario, Canada, and he’s the author of the book Of Plagues and Vampires: Believable Myths and Unbelievable Facts from Medical Practice. He wrote an excerpt from that book on KevinMD, “The medical basis of vampires.” Michael, welcome to the show.

Michael Hefferon: Thank you. It’s my pleasure to get a chance to finally talk to you, Kevin.

Kevin Pho: So we’ll get into your article and book in a bit, but first off, tell me your story and your journey to where you are today.

Michael Hefferon: Well, yeah, I’m still working, although not completely full time, at Queen’s. I’m a pediatrician, general pediatrics, but I’ve spent a lot of time in oncology and diabetes; those two I’ve had a lot of experience with. So I’m still doing the diabetes clinic with child and adolescent diabetes, and we’re doing most of it at the moment by OTN, which is the Ontario Telemedicine Network, and it’s working fine for the emergency we’re in.

But I came from Ireland. I trained in Ireland, I grew up in Ireland, trained in Ireland, trained in Liverpool in England, and came to Canada in ’81. I trained at Queen’s, became chief resident there, and luckily got an appointment at Queen’s. So I’m a general pediatrician as well.

You’re probably going to ask me how I got into these medical myths, Kevin. We do quite a bit of CME in Kingston, very useful for our faculty but useful for the community. I found that doing certain topics over and over again in CME, it was hard to keep people’s attention: failure to thrive and the vomiting infant and stuff like that. You can do it over and over again. But I came up with this format of: Is this a myth or is it not? Does teething actually cause a fever in children, or an elevation in temperature? Does iron actually cause constipation? And I looked at articles from the literature that would back them.

I found this kept the audience right on their toes, and at a certain point somebody said, “You should write a book on this.” And I said, “Yeah, maybe. Maybe when I’m old and gray.” Then I got to that place and decided to try writing it, and I didn’t have too much trouble getting a publisher locally. I’m now on to my second book, which will be out next week. It’s called Medical Myths: A Skeptic’s Journey, and it’s a bigger, better version of the first foray into medical myths.

But these are myths in which there is some truth. You might take the vampire story; that was the signature story in that first book. But really, I remember as an intern coming across a case of porphyria and finding out from an aged consultant doctor I worked for that this condition, porphyria, was common among the nobility of Eastern Europe, and that they would have low hemoglobin and pale skin, their gums receded, and they went out at night looking for blood. I won’t go into any more detail because it’s in the article that you published. But this type of scenario, where there is a myth that isn’t totally untrue, that’s my fascination.

The barber pole with the red and white rags, the red and white pole outside, was from when surgeons weren’t admitted to the College of Physicians. So they lanced boils and cut hair and cut other things, and the pole is those red and white bandages their clients were wrapped up in as they left. So it’s really folklore, medical folklore of sorts, and there’s no shortage.

Kevin Pho: I think that article is fascinating. So for those who didn’t read the article on KevinMD, “The medical basis of vampires,” what are some of the signs and symptoms of porphyria that may be associated with classic vampires that you see in literature?

Michael Hefferon: Well, unfortunately there are families who have the gene, and several members have it. But it is a pale, taut skin, which is photosensitive. So you could have, like a lot of hemoglobinopathies, and it’s a hemoglobinopathy, porphyria, so a lot of hemoglobinopathies are photosensitive. So you go out during the day, and your skin gets more damaged, so you go out at night looking for blood. Doctors told patients to go out and find pigs and sheep and bleed them and drink the blood. That might have even helped, 200 years ago.

So these are the features: the skin, the fangs, the inability to go out during the day. Going out at night made people suspicious. There are other reasons why there are similarities. Garlic is a high-sulfur-containing fruit of the earth, and the sulfur will kick off an attack of porphyria. The other interesting thing is the mirror. The vampire doesn’t like looking in the mirror, but if you go back 200 years, there weren’t mirrors around everywhere like you get today, and when a vampire would look at themselves, they would get quite a shock.

Perhaps the most fascinating aspect is, if you want to ward off a vampire, you get a cross. You get a Christian cross and you show it to the vampire, and they back off. And this comes from the Inquisition, the Inquisition in Spain and Europe, where vampires were believed to be evil heathens and were burned at the stake. So a Christian symbol was very, very hostile to them.

So they’re the main features, both physically and culturally. The stake through the heart? I guess a stake through anybody’s heart is going to do them in, but we don’t have a link with the stake through the heart.

So there are other myths, like: Does cranberry juice actually ward off recurrent urinary tract infections? A lot of people will drink cranberry juice rather than take prophylactic antibiotics or have surgical intervention, and there is a proanthocyanidin chemical in cranberry juice which interferes with the adherence of E. coli to the bladder wall. So there is some science in this, but what we don’t know is how much cranberry juice, how often, and is this for prevention or is it for treatment? So it sure isn’t any harm to drink it, and there is a scientific basis for it.

So these are the kinds of myths that I like providing: There’s an origin, a story, and a history that perhaps goes back through your teachers and their teachers, going back to a time where they didn’t have the internet.

Kevin Pho: Now, how did you do the research for the book? How did you find the myths, and how did you find the medical facts that may fit and explain those myths?

Michael Hefferon: Well, in each chapter in the book, I have three or four or more articles, references, because both from medics and non-medics, people say, “Well, how do you know this?” In the old days, we used to talk to our senior colleagues, glean as much information as we could. In fact, these are articles from the peer-reviewed literature, and that’s all I will do. I mean, I can’t really. This has to be somewhat original, and it isn’t completely original at all, but some of my own experiences as they weave through these stories are very original; they’re unique. But you cannot just claim that. Yeah, you can refer to what’s believed in rural Pennsylvania, or Transylvania, for that matter, but in these articles I have the peer-reviewed articles. I must say the peer-reviewed studies are looking more and more at interesting topics, not all of them, because they’re not current. But that’s the origin of the material. The material has to be solid.

Now, I do one in my new book where it asks if a caul prevents drowning. A caul is where the baby is born with membranes completely covered over the head, so it looks like they have a veil on them, and that occurs in one in every 80,000 people. Births, should I say, not people. And what link could you possibly have between being born with a caul and not drowning? So I looked into the possibility that we could take something like the Titanic, where 1,500 people drowned but 1,500 were saved. But the reason the 1,500 were saved was that they were rich, women, and children; they were the three groups that survived. Also, a caul is one in 80,000, and there were only 3,000 people on the Titanic. So there isn’t.

So I do go into it and admit defeat, in the sense that here is a myth, here is the folk evidence. People would pay a lot of money; they used to keep these cauls, and sailors would buy them because they believed. So it intersects medicine, it intersects childbirth, but it’s not possible, and that type of myth will never be provable. It is very unscientific. Still, it’s interesting.

Kevin Pho: Do you start with the myth first and then try to fit the medical facts explaining the myth, or do you start with medical facts and find a myth that fits those medical facts?

Michael Hefferon: I start with the myths, or the beliefs. So I’m very interested in people’s beliefs in clinical medicine. I’ve always been interested. I mean, in pediatrics, we’re no stranger to these kinds of stories, and I’m a good listener in that context. We do mainly consulting, general and subspecialty; we don’t do much primary care in this part of Canada. In Toronto, they do a little. But when I would see patients for the first time, I really learned a lot from just sitting and listening: What do they believe? Like if they believe that a child’s developmental delay is because they had two glasses of wine at 18 weeks of pregnancy, I need to know that, first of all, and secondly, I need to bring them along with me.

So we start with the belief, we break it down, and then look: First of all, has somebody looked at this? There’s another one in that first book called “Does prayer affect medical outcomes?” And it’s a very interesting thing to go into. People have been praying for thousands of years for their relatives. These days in ICU, you might get a call from your family saying, “Your uncle Thomas is in ICU. Would you pray?” Cochrane is a database that I do use, and Cochrane is useful; it isn’t by any means complete in this area. But if you went to Cochrane, there are 10 studies looking at outcomes in ICU for people who were prayed for versus not prayed for. So that’s the type of background I’m using to try and develop a story. This second book has 42 myths; the first one had about 35 in it.

Kevin Pho: We’re talking to Michael Hefferon. He’s a pediatrician in Canada and is the author of Of Plagues and Vampires: Believable Myths and Unbelievable Facts from Medical Practice. Michael, my final question: What’s your take-home message for the KevinMD audience?

Michael Hefferon: Gosh. Keep writing and keep reading, because honestly, we’re in a changing world. Don’t believe that myths are confined to history. I don’t have to explain myself there. I think, don’t let go of the experiences and culture of our predecessors, who didn’t have the internet and didn’t have A1C machines. There is skill, and there are medical skills that we need to hold on to.

Kevin Pho: Well, thank you so much for sharing your stories and your wisdom, and thank you for being on the show.

Michael Hefferon: Well, absolutely. My pleasure.

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