Articles

A favorite tactic of the antivaccine movement: When science doesn’t support you, use the law

As I’ve joked about before, I’m a bit like Dug the Dog from the movie Up whenever a squirrel goes by. In other words, I’m easily distracted by things that interest my primal urge to chase pseudoscience. I originally had a cancer-related topic in mind for this week’s foray into science-based medicine, but then on Friday our favorite group of antivaccine activists over at the antivaccine crank blog Age of Autism induced a squirrel to run in front of me, and the rest is history, at least for the moment. I’ll try to get back to my original topic either as a bonus post later this week or as next week’s post (unlike the topic of today’s post it’s not really particularly time sensitive). In the meantime, I’ll chase this squirrel. Sorry about that. But Dug’s gotta do what Dug’s gotta do. Besides, the topic I had in mind for this week is sufficiently complex that my ultimate post will probably end up being much better if I have a few more days to a week to think about it. At least, that’s what I keep telling myself.

If there’s one thing I’ve learned over the years opposing the antivaccine movement, it’s that these days its “Holy Grail” (well, a “holy grail”) is to have a “vaccinated versus unvaccinated” study performed, or, as it’s frequently abbreviated, a “vaxed verus unvaxed” study. The reason they want such a study so badly is not because they think there’s a scientific question that genuinely cries out for an answer. Rather, they believe it will confirm their fixed, unalterable belief that vaccines are the root of nearly all chronic health conditions children suffer today, particularly autism and autism spectrum disorders. In particular, they believe that a “vaxed versus unvaxed” study would demonstrate once and for all that vaccines are the cause of the “autism epidemic.” Hilariously, a few years back, the antivaccine group Generation Rescue tried to do such a study. It was more an utterly incompetently administered and analyzed telephone survey than anything else, and, ironically, its results actually were just as consistent with the conclusions that vaccines protect against autism as that they predispose to autism. And don’t even get me started on an even more hilariously incompetent vaxed versus unvaxed study by a German antivaccine homeopath (I know; “antivaccine homeopath” is redundant) that antivaccinationists were touting a while back. That took attempts to ape science to depressingly ridiculous extremes.

Meanwhile, other than incompetently performed studies by antivaccinationists (this one, for instance) many large, well-performed epidemiological studies have failed to find even the suggestion of a link between vaccines and autism or between mercury in the thimerosal preservative that used to be in childhood vaccines and autism, such that the Institute of Medicine reaffirmed this finding just this year. Yet, antivaccinationists remain undeterred. True, they seem to have accepted that their original Holy Grail, namely a prospective randomized, placebo-controlled trial in which one group is vaccinated and another is not, is considered highly unethical because it would intentionally leave one group of children unprotected against vaccine-preventable diseases. (I say “considered” because antivaccinationists are so convinced of the harm done by vaccines that they do not accept that a randomized controlled trial of vaccinated versus unvaccinated children would be unethical in the extreme.) Unfortunately, however, that doesn’t stop them from demanding other forms of vaxed versus unvaxed studies, even though such a study would be difficult, bias-prone, and unlikely to provide a definitive result, as I explained in detail before.

Well, they’re at it again. Antivaccinationists are trying to legislate where they have utterly failed to convince using science. It’s a standard tactic of cranks, but unfortunately there are nearly always credulous legislators who will be duped into going along or who are cranks themselves and therefore go along. Remember Dan Burton? He was antivaccine to the core and used his position as a Representative from Indiana to cause a lot of mischief with hearings on vaccines. Fortunately he’s retired now, but there are still Representatives who are either antivaccine themselves or easily duped into carrying antivaccinationist’s water.

Here’s what I mean. The other day, posted on the antivaccine crank blog, was a call for help by the antivaccine group SafeMinds to support a resolution by the House of Representatives, specifically HR 1757, The Vaccine Safety Study Act:

What is HR1757? – Also known as “The Vaccine Safety Study Act,” this bill, introduced by Rep. Bill Posey (R-FL) and Rep. Carolyn Maloney (D-NY), directs the National Institutes of Health to conduct a retrospective study of health outcomes, including autism, of vaccinated-versus-unvaccinated children, and to determine whether exposure to vaccines or vaccine components is associated with autism spectrum disorders, chronic illnesses, or other neurological conditions.

Currently before the US House Committee on Energy and Commerce, the bill, if implemented, “should bring an answer to this decades-long question,” Rep. Posey stated on the House floor.

No. It. Won’t. It would be expensive, and it would be highly unlikely to provide an answer, for the reasons I pointed out before. Moreover, contrary to the claims in the SafeMinds press release reposted by AoA, there is no compelling scientific rationale for such a study. There are no preclinical data or epidemiological observations that would mandate (or even justify) such a study from a scientific standpoint. Before such a study would be mandated, there would have to be strong evidence of a problem with vaccine safety or indication that vaccines cause autism and chronic health problems. There is no such indication. Fevered dreams of antivaccinationists don’t count.

SafeMinds cites “findings” discovered through a Freedom of Information Act (FOIA) request claiming that “risks of autism, ADD, sleep disorders and speech/language delay were consistently elevated in the more exposed group: Increased autism risk in one-month-old infants with the highest exposures ranged from 7.6 to 11.4 times higher than zero-exposure infants.” No links are provided, but my best guess is that SafeMinds is referring to Verstraeten et al., which is a very old gambit on the part of the antivaccine movement that has no validity but is frequently used to try to provide the impression of a conspiracy and government cover-up. There wasn’t. It’s Simpsonwood all over again, eight years later. Safeminds then cites another study that claims that unvaccinated children had significantly lower emergency room visits. The implication is that unvaccinated children are healthier, but, as has been pointed out before, despite what Brian Hooker says, the study shows nothing of the sort. Indeed, let’s look at what the investigators themselves said about this result:

These results suggest inherent health care–seeking behavioral differences between the 2 groups of parents. For example, published survey data31-32 have shown that parents who choose not to have their children vaccinated are less likely to trust health care professionals and more likely to use complementary/alternative medicine providers than are parents who have their children fully vaccinated. It is therefore possible that parents who delay or refuse immunizations are less likely to use the traditional health care system when their children contract minor acute illnesses but will seek medical care when their children become seriously ill. Such differences could create a selection bias in studies that attempt to examine the risk of potential adverse events following vaccination.

Emphasis mine. There was nothing in the study that claimed to show that unvaccinated children use the ER less because they are healthier.

So what about the bill itself? The introduction and background (called the “Findings”) in HR 1757 start out paying lip service to the importance of vaccines and then move on to a whole bunch of antivaccine tropes before getting to the “meat” of the bill. The bill itself is sponsored by Rep. Bill Posey (R-FL), who appears to be vying for Dan Burton’s position as the most antivaccine member of Congress, so much so that he even participated in a “Congressional panel” at this year’s antivaccine quackfest Autism One in May, following in the footsteps of prior years’ Autism One quackfests.

But what about the bill’s co-sponsor, Rep. Carolyn Maloney (D-NY)? Well, it turns out that she’s very much into antivaccine pseudoscience as well. A quick Google search of her name plus the term “vaccines” brings up a plethora of embarrassment (from a scientific viewpoint that is), much of it right on her very own website. For instance, here she touts Dan Olmsted’s incompetent and incomplete series of news stories claiming that the Amish don’t vaccinate and don’t get autism from back when he was actually a reporter (they do, and they do; it’s a myth that they don’t). She has also been known to grill CDC officials about vaccines, as shown in this YouTube video:

The above video comes from a hearing held by by the House Oversight and Government Reform Committee, chaired by Rep. Darrell Issa (R-CA). One notes that Darrell Issa is not exactly known for being a fan of science. Besides being an anthropogenic global climate change denialist, he’s prone to meddling in peer review and trying to micromanage the National Science Foundation. He’s also at the very least sympathetic to antivaccine views, holding a hearing about the “autism epidemic” and “environmental causes” (translation: it’s the vaccines) last November, a month before Rep. Dan Burton (R-IN) retired. Dan Burton, the chair of the same committee in the 1990s and into the 2000s, used it for no end of antivaccine legislative mischief when he was in control, and Darrell Issa appears to be taking up the antivaccine mantle left behind now that Burton has retired.

In any case, Maloney begins by complimenting Dan Burton for “doing such a fine job” back in the day. She then demands to know why autism prevalence has gone from 1 in 10,000 to 1 in 88, dismissively saying that she “doesn’t want to hear that we have better detection” and claiming that detection would not account for a jump from 1 in 10,000 to 1 in 88. That is, of course, a straw man argument. As I’ve pointed out many times, screening programs, broadening of diagnostic criteria, diagnostic substitution, and better detection can easily account for huge increases in the prevalence of a condition. My favorite example is ductal carcinoma in situ, whose incidence increased 16-fold in 30 years just because of mammographic screening. Other examples include hypertension and hypercholesterolemia. In reality, the prevalence of autism is probably not higher (or at least nowhere as much higher as the antivaccine movement would like you to believe) than 30 years ago. When careful studies are done, it is found that autism prevalence is the same now as it was then. So, right off the bat, we know that Maloney doesn’t want to hear the science-based answer, namely that diagnostic substitution, broadening of the diagnostic criteria, and more intensive screening programs have led to a massive increase in autism prevalence without a real, biological increase. She’s convinced that the vaccine program or some other environmental factor is causing an “autism epidemic,” and she falls for the “too many too soon” trope beloved antivaccinationists. Unfortunately, Colleen Boyle, the hapless CDC official who had to answer, appears completely unprepared for the hectoring about vaccinations to which Maloney subjects her.

I also learned that Rep. Maloney marched with Jenny McCarthy in her infamously pointless antivaccine Green Our Vaccines rally in 2008. I think that says it all about Rep. Maloney. Well, maybe not all. Her performance in last year’s hearing shows that she values anecdote above scientific evidence; she attacks straw men explanations for the increase in autism prevalence (i.e., that it’s just better detection, when it’s a combination of factors); she makes spurious and downright dumb analogies between vaccine manufacturers and tobacco companies; and she’s just plain scientifically ignorant. In other words, she fits the very picture of being antivaccine. The video above demonstrates it beyond debate. Sadly, she is not alone among our legislators.

Rep. Maloney’s clearly the Democratic counterpart to the Republican antivaccine fringe represented by Rep. Posey and former Rep. Dan Burton and has been pushing the dubious vaxed versus unvaxed study resolution for a long time. Indeed, she’s been doing this for years. I do give her some credit for making at least one change from previous versions of the bill, namely pointing out that “Nothing in this Act shall be construed to authorize the conduct or support of any study in which an individual or population is encouraged or incentivized to remain unvaccinated.” One also notes a quack-friendly clause that “To facilitate further research by the Secretary or others, the Secretary shall ensure the preservation of all data, including all data sets, collected or used for purposes of the study under this section.” One wonders whom the “others” are, one does. Does anyone want to take any bets that this clause is designed to make sure that antivaccine groups like SafeMinds have access to the complete data set of such a study to use and abuse for their ideological purposes? One wonders who provides her with these anecdotes, one does. Could it be SafeMinds, The Canary Party, and Age of Autism? Sure, it could.

But what about this time around? Amusingly (if you can ignore the waste of taxpayer money and the antivaccine impetus behind HR 1757), the bill itself demands that the each investigator of the required study:

  1. is objective;
  2. is qualified to carry out such study, as evidenced by training experiences and demonstrated skill;
  3. is not currently employed by any Federal, State, or local public health agency;
  4. is not currently a member of a board, committee, or other entity responsible for formulating immunization policy on behalf of any Federal, State, or local public health agency or any component thereof;
  5. has no history of a strong position on the thimerosal or vaccine safety controversy; and
  6. is not currently an employee of, or otherwise directly or indirectly receiving funds from, a pharmaceutical company or the Centers for Disease Control.

One notes that requirements #3 through #6 pretty much destroy any chance the NIH have of being able to find an investigator who meets requirement #2. As an aside, it’s also amusing to note a reaction to HR 1757 from our old buddy, now the antivaccine Robin to the crazed “health freedom” Batman (Patrick “Tim” Bolen) after having been the Boy Blunder at the antivaccine crank blog Age of Autism before he betrayed AoA and SafeMinds, Jake Crosby, who rants No More Federal Research Fraud – OPPOSE HR1757! His reason for opposing HR 1757 (other than because SafeMinds and AoA are for it)? Because he doesn’t trust the NIH:

In other words, this bill aims to mandate the National Institutes of Health (NIH) to conduct a vaccinated vs. unvaccinated study of autism and other disorders before the NIH and other federal agencies are forced to clean up their act and stop engaging in the institutional research misconduct that causes the vaccine-autism cover-up to persist. Although the initiatives of congressional representatives like Bill Posey and Carolyn Maloney to investigate malfeasance by government agencies should be commended, HR1757 only helps to legitimize and facilitate federal research misconduct by agencies like NIH, while distracting from efforts to expose government corruption. Autism Investigated supports vaccinated versus unvaccinated research conducted by independent researchers at academic institutions, but not conducted by federal agencies that merely pursue predetermined results. NIH is one of those agencies.

Poor Jake. Back when he was in high school and maybe even college I could (sort of) forgive such ignorance, but he’s a graduate student now. Unfortunately, it’s now utterly clear that he is utterly clueless about how the NIH works, which could be a real problem for him if he ever becomes an epidemiologist and wants to apply for research funding. Note that HR 1757 says that the NIH “shall conduct or support” such a study. That means the NIH, if so instructed, could simply issue an RFA (request for applications) for a grant to do a vaxed versus unvaxed study. In fact, that is almost certainly what would happen if this unscientific bill passed; the NIH almost certainly wouldn’t do the study itself; it’s not really well set up to do such a study, but, more importantly, by the very language of the bill it couldn’t. Indeed, perhaps the most amusing part of Jake’s tirade is the lack of insight into this very point. He clearly didn’t even bother to read the bill. Note the clause listed above that the investigators can’t be “currently employed by any Federal, State, or local public health agency.” Here’s a hint for Jake: The NIH is a federal agency. Seriously, I think that Jake’s just phoning it in these days.

I rather suspect that antivaccinationists are so deluded that they don’t realize that this bill actually is against their interests. What do I mean? Easy? Look at criteria #1, 2, and 5 required of any investigators recruited to do such a study. The bill states that any such investigator must (1) be objective; (2) be qualified; and (3) have “no history of a strong position on the thimerosal or vaccine safety controversy.” These three criteria alone completely rule out any investigator that would be acceptable to SafeMinds, as none of their favored investigators fit any of them! I’m also going to emulate Matt Carey the next time I see an antivaccine study and ask if the investigators have a history of a strong position on the thimerosal or vaccine safety controversy. I presume that I can just dismiss studies based on this reason alone; after all fair’s fair. That’s often the main reason why antivaccine groups dismiss the plethora of studies failing to find a link between vaccines and autism.

No, I’m all about the science; so I couldn’t do that.

Antivaccinationists have been trying to legislate science for a very long time now, and Rep. Maloney is just ignorant or antivaccine enough to be willing to be their contact person. Meanwhile, Bill Posey seems to be relatively new at the antivaccine game, but he’s clearly up and coming, and, given that the House is currently controlled by the Republican Party, he’s more likely to do more damage in the short term because he’s part of the majority party. Either way, although I realize that this bill has little chance of passing and that the lack of appropriations for the study suggest that even Reps. Maloney and Posey know it, skeptics and supporters of science-based medicine should still fight fire with fire, I say. I’m willing to bet that there are a lot more science-based people out there than antivaccinationists; so I’ll finish echoing exactly what AoA said. Only, do it from the science-based perspective and use the same tactics to oppose HR 1757:

  • First identify your own Representative in the House by clicking here: http://www.house.gov/representatives/find/.
  • Call and schedule a meeting at their district office and urge them or their staff to sign on to this absolutely critical bill.
  • If they will not commit, indicate you will call back in one week to check on progress and check with Rep. Posey’s office to confirm their commitment to co-sponsor.
  • After Labor Day confirm everything has happened and thank them for their support.
  • Also, let SafeMinds know! Answer the few simple questions on our online survey at: https://www.surveymonkey.com/s/HR1757

At the very least, write letters to your Representatives, real letters on real paper, and to Bill Posey and Carolyn Maloney as well. (E-mails are easier to ignore.) I plan on doing that much at least, even though I’m not a big fan of my current Representative (to say the least). I realize that HR 1757 is a resolution, and I realize that it probably doesn’t have a lot of support. I also realize that it appears to be stuck in committee. Let’s do our best to keep it that way. Never underestimate the antivaccine movement.

Finally, I’m serious about that last bullet point. After all, we’d like SafeMinds to know that they’ve inspired us to stand up for science, wouldn’t we?

Posted in: Politics and Regulation, Vaccines

Leave a Comment (215) ↓

215 thoughts on “A favorite tactic of the antivaccine movement: When science doesn’t support you, use the law

  1. Jay Gordon says:

    David, I do not align myself with the statement you’ve made here:

    “Rather, they believe it will confirm their fixed, unalterable belief that vaccines are the root of nearly all chronic health conditions children suffer today, particularly autism and autism spectrum disorders.”

    But I think that continuing to make certain we’re vaccinating children in the safest way possible is worthy of scientific investigation rather than your persistent disdain and ridicule.

    Over and over again, you seem to be the one with “fixed unalterable” beliefs. These posts deviate so far from scientific curiosity that I find them at odds with your best work which I actually enjoy immensely.

    Something about the topic of vaccines causes you to perseverate and adopt your illogical curmudgeon persona. It’s far from your best.

    On the other hand, mighty courageous that you have a little corner of the Internet where you actually use your own name.

    1. David Gorski says:

      David, I do not align myself with the statement you’ve made here:

      “Rather, they believe it will confirm their fixed, unalterable belief that vaccines are the root of nearly all chronic health conditions children suffer today, particularly autism and autism spectrum disorders.”

      It’s good that you don’t align yourself with that statement, but plenty of your friends and allies do, which is why I’m not entirely convinced that you aren’t at least fairly sympathetic to that perspective. Let’s find out, though, shall we? Which chronic conditions are not, in your opinion, impacted by vaccines? For example, do vaccines cause or contribute to asthma? How about diabetes?

      Second: Do you believe that vaccines cause or contribute to autism and autism spectrum disorders yes or no? As I recall, you did speak at Jenny’s “Green Our Vaccines” rally five years ago, did you not? You are, after all, a person who compared vaccine manufacturers to tobacco companies in their abuse of science, are you not? Yes, I do remember that gem, and many more. Shall I start quoting your writings? There are plenty to quote over the years. Or have you changed your mind? If so, let’s hear it!

    2. Ren says:

      Dr. Jay,

      Are you familiar with the pre- and post-licensing safety and effectiveness studies done on vaccines by the manufacturers, FDA, CDC, NIH, academic institutions, competing manufacturers, independent researchers, and others? When a new vaccine is developed, everyone and their brother goes looking for the monster under the bed that will inevitably be called-out by those who fear the “medical industrial complex” in general and vaccines in particular.

      The “continuing to make certain we’re vaccinating children in the safest way possible” that you mention IS being studied, researched, and observed. It’s not like we throw our hands up and say, “Yep, we have 50 years of data on polio vaccine. No more studying it is necessary.” We don’t. (“We” meaning people in public health and infectious disease.) If that were the case, we would not do more surveillance for adverse events related to that vaccine, or any vaccine for which we’ve done pre- and post-licensing studies.

      The problem here is that the bill, as I several of us have read it, keeps asking for a study that is unethical. We’ve explained why it’s unethical at worst and useless at best. It’s been explained to the very authors of the bill. But they won’t listen to reason. There are plenty of studies with just as much internal and external validity as the one being called for in this bill but, because they don’t say that vaccines are evil, they keep being dismissed by the anti-vaccine lobby.

      You know what’s funny? Whenever I’ve proposed to anti-vaccine types that they should enroll their kids in the “vax v. unvax” randomized controlled trial, but that they should be ready for their child to be randomized into the vaccinated group, they scour away and say they’d never participate in such a study. As Dr. Gorski correctly pointed out, cohort studies have shown differences in beliefs and opinions between vaccinated and unvaccinated groups, but still no monsters under the bed.

    3. qetzal says:

      Jay Gordon writes:

      But I think that continuing to make certain we’re vaccinating children in the safest way possible is worthy of scientific investigation rather than your persistent disdain and ridicule.

      I don’t see Dr. Gorski ridiculing the value of safe vaccination. I see him ridiculing HR1757 and its proponents, because it does exactly the opposite! It proposes to waste money on a study that would provide no new information on a topic that’s already been repeatedly addressed.

      If you or the SafeMinds crew can point to a vaccine safety issue for which there’s actual, believable evidence, then by all means, let’s investigate it. But when Rep. Maloney asks why autism prevalence has apparently skyrocketed, but then immediately rejects the scientifically supported answer, it’s painfully obvious that honest scientific investigation is not on the table.

      1. David Gorski says:

        Vaccine pseudoskeptics frequently try to don the mantle of “vaccine safety” by proclaiming themselves “‘not antivaccine’ but rather ‘pro-safe vaccine.’” As has been pointed out, none of us are not ‘pro-safe vaccine.’” Here’s the problem. Dr. Jay echoes many antivaccine tropes. He’s compared vaccine manufacturers to tobacco companies, making a direct accusation that vaccine manufacturers abuse science in order to hide a link between vaccines and autism (never mind that, despite looking for such a link for two decades science hasn’t found it) the same way tobacco companies did to hide the link between smoking and lung cancer. He’s stated point blank that mercury in vaccines causes autism and “other brain injury,” even though the overwhelming evidence shows otherwise. He’s claimed that formaldehyde in vaccines is dangerous, even though an infant’s body produces far more formaldehyde through normal metabolism than it receives from a vaccine.

        Moreover, Dr. Jay bases all of this on his “thirty years of clinical experience,” not science, even though it’s been explained to him time and time again how individual clinical experience can be profoundly misleading, particularly when it comes to identifying associations between diseases and conditions and environmental exposures like vaccines. Confirmation bias and a non-random clinical population conspire to produce a highly distorted picture. (Dr. Jay, after all, attracts antivaccine parents and “vaccine averse” parents because of his reputation as being sympathetic—friendly, even—to antivaccine viewpoints and his willingness—eagerness, even—not to vaccinate.) No matter how many times this is explained to Dr. Jay, however, he seems unable to grasp the concept and values his clinical experience above science.

        I will remind our audience just what Dr. Jay has said in the past:

        http://www.sciencebasedmedicine.org/dr-jay-gordon-anti-vaccination

        http://www.sciencebasedmedicine.org/dr-jay-gordon-and-me-encounters-with-an-apologist-for-the-antivaccine-movement-who-isnt-antivaccine/

        1. windriven says:

          “never mind that, despite looking for such a link for two decades science hasn’t found [a link between vaccination and autism].”

          Moreover, the link between non-vaccination and serious morbidity and even mortality has been linked decisively for decades. To roll out an old but reliable trope, extraordinary claims require extraordinary evidence. “Doctor” Jay might shut his mouth until he has something other than idle speculation.

    4. Harriet Hall says:

      Elsewhere you said this: “My very strong impression is that children with the fewest vaccines, or no vaccines at all, get sick less frequently and are healthier in general. I truly believe they also develop less autism.”

      Apparently you value your “very strong impressions” over scientific evidence.
      Scientific studies have found no evidence for vaccines causing autism, yet you “truly believe.”

      Mark Crislip has said “In my experience” are the 3 most dangerous words in medicine. It seems you have not learned that lesson. What hubris! To think your personal opinions trump the evidence and consensus of the entire science-based medicine community.

      Your attitude puts you in the disreputable category of “true believers,” http://www.skepdic.com/truebeliever.html like the chiropractors who would rather give up randomized, double-blind controlled experiments than admit that applied kinesiology doesn’t work.

      And don’t you dare say that all you are advocating for is safer vaccines. That’s a cop-out. We all want vaccines to be as safe as possible; but they’re safe enough now, and not giving them on schedule puts children at risk.

    5. WilliamLawrenceUtridge says:

      But I think that continuing to make certain we’re vaccinating children in the safest way possible is worthy of scientific investigation rather than your persistent disdain and ridicule.

      First, science can’t “make certain”, there is no certainty in science. Second, isn’t there rather extensive research into the components of vaccines? It’s not like we’e just taking extract of garbage juice and throwing that into the vaccines along with whatever happens to be lying around. Each component is rationally chosen and evaluated by a group of genuine experts, experts who have dedicated their lives and careers to a specific tiny niche of the science vaccination.

      Unlike, say, you – a pediatrician who has specialized rather broadly.

      Why do you mistrust these experts? Why do you think the anecdotal evidence presented by parents is superior to the extensive knowledge base built up over years of scientific research? And why do you continue to support the vaccine-autism link, or if you don’t support such a link – why don’t you speak, openly and clearly, against it? Become the Mark Lynas of the antivaccination movement – publicly admit that you were wrong, and go on record that after years of erroneous claims, giving antivaccination proponents tacit support and zero challenges to the accuracy of their claims and the status of the science, publicly support the importance and need for universal vaccination?

      Would you miss your celebrity status among the crunchy granola elite?

    6. Matt says:

      “On the other hand, mighty courageous that you have a little corner of the Internet where you actually use your own name.”

      You mean, like, in addition to PubMed?

      We don’t all have our YouTube videos of speeches we gave at the Green Our Vaccines rally to rely upon for our internet presence.

    7. Stephen H says:

      What is “perserverate”?

      More importantly, you seem to think that science should continue to test even once something is settled. Should we keep throwing apples in the air to see if they come down? Maybe we should continue to measure the circumference of circles, and compare it to the diameter?

      Disdain and ridicule rest with those who continue to insist on the moon being made of green cheese, or who think that the Earth is flat despite evidence to the contrary. Those who continue to insist that vaccines cause autism, despite all evidence to the contrary, have earned their own disdain and ridicule. Unfortunately, they also manage to persuade some of the gullible to their “ideas”, and in doing that *should* be considered criminally liable for child neglect.

      Jay, I was diagnosed several years ago with Asperger’s. It’s a form of autism. Did I get it from vaccines? No – I got it from my parents, who very clearly have their own places on the autism spectrum. Any suggestion that vaccines have anything to do with the way I think is an insult to them and me.

      1. Jay Gordon says:

        Autism Spectrum Disorders have a genetic component and an environmental component.

        There are many likely triggers to that genetic predisposition. Could our current vaccination protocol be one if those triggers for susceptible babies? Yes, it could be.

        1. windriven says:

          “There are many likely triggers to that genetic predisposition. Could our current vaccination protocol be one if those triggers for susceptible babies? Yes, it could be.”

          Or it could be the phase of the moon at the time of conception. Or it could be whether or not the mother consumes sea urchin sushi during the first trimester. In other words, this is all idle speculation. Where is the proof? Where is even the basic plausibility?

        2. Stephen H says:

          Jay, please provide the basis for your claim that autism spectrum disorders have an environmental factor. Presumably you have some proof, in the results of a properly conducted study by a disinterested scientific team?

      2. Jay Gordon says:

        @Harriet Hall

        “Mark Crislip has said “In my experience” are the 3 most dangerous words in medicine. It seems you have not learned that lesson. What hubris! To think your personal opinions trump the evidence and consensus of the entire science-based medicine community.”

        Mark Crislip is wrong. That’s all.

        My personal experience is worth considering as is yours as is David’s. Nothing is “trumped” and RCTs are more valuable than anecdotes. But to dismiss experience is really the height of hubris.

        1. BillyJoe says:

          Yes and all those practitioners who trusted their personal experience with bloodletting as a cure all for sorts of diseases may a valuable contribution as well.

          1. Jay Gordon says:

            There is a middle ground. Vaccinate slower and later and improve the manufacturing and testing processes.

            Be judicious in taking family histories as you would with administration of any other medication.

            Let general anesthesia literature and precautions be your guide. Note the latest controversies in pediatric anesthesia in particular.

            Citing old quotes of mine is fun and useful only if you assume that intelligent people can’t be educated and reach different conclusions over five or ten years. But, keep having fun with it and perhaps talk to some of my high school classmates to hear how ignorant I sounded decades ago.

            Ignoring experienced clinicians like Dr. Gorski or myself and relying only on published data will often lead to false conclusions. Published research is contradicted by newer reseach within years a high percentage of the time.

          2. David Gorski says:

            Citing old quotes of mine is fun and useful only if you assume that intelligent people can’t be educated and reach different conclusions over five or ten years.

            OK, Dr. Jay. You seem to be inferring that you’ve been educated and have now reached different conclusions. Great! Let’s see whether you still agree with you from between 3 and 8 years ago or so, starting with this statement:

            Mercury in vaccines causes autism and other brain injury. The IOM twisted the facts to suit the CDC and the vaccine industry.

            Do you now disavow this statement, yes or no?

            What about this one:

            I think that the public health benefits to vaccinating are grossly overstated. I think that if we spent as much time telling people to breastfeed or to quit eating cheese and ice cream, we’d save more lives than we save with the polio vaccine.

            Do you now disavow this statement, yes or no?

            How about this one:

            Diet and supplements and other alternatives to doing nothing can lead to recovery from autism. Period.

            Do you now disavow this statement, yes or no?

            Then there’s this statement:

            Last but far from least, we have to support and reinforce the intelligent and fiercely held hope these parents of children with autism have. Doctors have to acknowledge and help research the therapies that lead to recovery from autism, recovery brought on by therapies long ignored by the AAP and others. Dairy-free, gluten-free, sugar-free diets have succeeded far too many times for any doctor to claim that they’re not “evidence-based.”

            Do you now disavow this statement, yes or no?

            And what about this one:

            I have been in practice thirty years and watched thousands of children get shots, not get shots, develop autism or remain developmentally “neurotypical.” I have no proof that vaccines cause autism and would be very excited to have my large group of extremely healthy mostly unvaccinated children studied someday. It would be disingenuous to imply that non-vaccination might not lead to an increased incidence in vaccine-preventable illness. It would be equally disingenuous to state that this possibility poses a great threat to America’s children. The risks of vaccinating the way we do now exceeds the benefits of this vaccine program. “Scientists” who suggest that experienced doctors ignore their eyes and ears are wrong.

            Do you now disavow this statement, yes or no?

            Or what about what you said about the MMR vaccine:

            Now, in terms of public health, I don’t want to be the guy who said, “Boy, this vaccine stinks.” It doesn’t stink. It works very, very well. The reason we don’t have measles in America is because the vaccine works great. But sit down, please. Let’s talk about the fact that your cousin and your other cousin both have autism. Or that your son has some questionable neurological issues, he seems to be speaking or walking a little later. I don’t want to mess with him.

            Do you now disavow this statement, yes or no?

            Or this gem:

            I base everything I do on my reading of CDC and World Health Organization statistics about disease incidence in the United States and elsewhere. I base everything I do on having spent the past thirty years in pediatric practice watching tens of thousands of children get vaccines, not get vaccines and the differences I see.

            Vaccines change children.

            Most experts would argue that the changes are unequivocally good. My experience and three decades of observation and study tell me otherwise. Vaccines are neither all good–as this biased, miserable PBS treacle would have you believe–nor all bad as the strident anti-vaccine camp argues.

            Do you disavow this statement, yes or no?

            Finally, what about this one:

            The way vaccines are manufactured and administered right now in 2010 makes vaccines and their ingredients part of the group of toxins which have led to a huge increase in childhood diseases including autism.

            Do you disavow this statement, yes or no?

            Come on, Dr. Jay. i’m willing to believe you ‘ve changed, but you can’t have it both ways. Before I’ll believe you have been educated, I need to know that you’ve renounced previous antivaccine statements you’ve made. (And, make no mistake, those statements were antivaccine.) You seem to want to keep portraying yourself as reasonable and science-based without giving up or otherwise renouncing past statements and beliefs that are most definitely neither reasonable nor science-based.

        2. windriven says:

          “Mark Crislip is wrong. That’s all.

          My personal experience is worth considering as is yours as is David’s. Nothing is “trumped” and RCTs are more valuable than anecdotes. But to dismiss experience is really the height of hubris.”

          I would argue that you have entirely missed Dr. Crislip’s point and Dr. Hall’s in raising it. Crislip is not saying that experience doesn’t matter – it is part of why we spend the time and energy that we do bringing physicians through residency programs.

          Dr. Crislip’s point is that ‘in my experience’ invites confirmation bias and, in any event, does not trump the result of careful scientific evaluation.

          If you are a competent physician your experience will be invaluable in reaching a rapid and accurate diagnosis. But when it comes to treatment, scientifically evaluated regimens – in point of fact the experiences of many of your colleagues, carefully vetted through the filter of the scientific method – trumps your far more limited experience every time.

        3. David Gorski says:

          Mark Crislip is wrong. That’s all.

          My personal experience is worth considering as is yours as is David’s. Nothing is “trumped” and RCTs are more valuable than anecdotes. But to dismiss experience is really the height of hubris.

          No, Dr. Jay. Mark Crislip is quite correct, and you’re excellent evidence supporting his position. In fact, your position is the one that’s the height of hubris in that you think your oh-so-awesome 30 years of clinical experience trumps large RCTs—or should even be considered to be in the same order of magnitude of validity as large RCTs. You pooh-pooh and haughtily dismiss the notion that you can be easily mislead by personal experience. In contrast, I accept that I am human and am just as prone to the same cognitive problems to which all humans are prone that lead them to confuse correlation with causation and draw incorrect inferences from observation of their own limited perspective. I accept, in other words, that I need science and RCTs because personal experience is not enough—or even that good. I accept that I, like all human beings, can be easily misled by personal experience. That’s not hubris. That’s humility.

          I’ve tried many, many times to explain to you, both in e-mail exchanges and on my not-so-super-secret other blog, over the last eight years how individual experience can be profoundly misleading. Despite hours doing that, I’ve failed every time. Truly, you are uneducable on this issue. However, hope springs eternal, and I can’t help but hope that a new environment and new commenters might manage to get through.

          Human beings are profoundly bad at drawing inferences of causation from correlation. The confuse the two all the time. Moreover, memory is imperfect. Yours, mine, all of our memories are highly biased representations of what happened. We all have cognitive tendencies that make our memories support our beliefs when what happened might not. For instance, confirmation bias guarantees that we tend to remember things that confirm our biases and forget things that disconfirm them. Then there’s regression to the mean, which can easily make it appear that an ineffective remedy is effective. The list goes on. This post I wrote a while ago is my attempt to explain this using a different example than vaccines, but it applies perfectly well to vaccines as well:

          http://www.sciencebasedmedicine.org/when-impressive-science-fails-to-impress-patients/

          No, if anyone here is demonstrating hubris, it is not I. It is you. You seem to think that your almighty personal experience is on par with science and clinical trials. It is not.

  2. Dr. Gorski,

    It appears Mr. Gordon’s silence speaks volumes. He appears IMO unable to discern objective facts from subjective opinions. Science is beautiful but she can be a cruel mistress. She shows us what is (the objective) not what we want (the subjective).

  3. Jay Gordon says:

    Qetzel, look no further than narcolepsy, VPD, and case reports about adverse vaccine effects. But these are relatively small issues given that we administer billions of vaccines each year. There is a great need to look at combinations and timing of vaccinations.

    [TONE TROLLING ALERT!] The language and tone of David’s vaccine posts is both disdainful and ridiculing of those of us who stake out a middle ground. That is, we ourselves have received vaccines, give them to our patients, but doubt that the current schedule is optimal for children’s safety.

    Vaccines are “big medicine.” They are not cleared from the body in a matter of hours like antibiotics, pain meds or most other medications. They cause permanent changes in a child’s immune system and most experts would argue those changes are 100% for the better. I don’t agree. I think that some of the changes are not good.

    @odlmanjenkins38 It’s Monday here in the busiest month of the year and I will probably be relatively “silent” today and I hope to answer as much as I can later in the day.

    @David, yes, I believe that there is a group of babies and children who have a genetic predisposition to asthma, allergies, diabetes and autism for whom environmental triggers lead to the conditions’ overt manifestations. As you well know, this is being studied and studied hard in respect to diabetes at the very least. One can also cite the freeway studies, farm worker studies and more.

    As I’ve mentioned many times, my schooling here, at RI and by private emails has caused me to regret many intemperate comments I’ve made and your perseveration in making them sound like bedrock unchanging convictions doesn’t serve the dialogue.

    @Ren I propose no new polio studies. But you know, better than many here, the havoc VPD may wreak in vaccine programs. We have work to do.

    More later.

    Best,

    Jay

    1. David Gorski says:

      [TONE TROLLING ALERT!] The language and tone of David’s vaccine posts is both disdainful and ridiculing of those of us who stake out a middle ground.

      Can anyone name that logical fallacy?

      Oh, never mind. I can’t resist. Dr. Jay, what you are doing is known as the fallacy of moderation, of the middle ground, of the golden mean, or of false balance. This fallacy occurs when two viewpoints that are nowhere near equally supported by science, evidence, data, and reason are treated as roughly equally valid, and then someone like you claims to be more “reasonable” because he “stakes out a middle ground.” In reality, when you “stake out a middle ground,” you are promoting a fallacy that says that the truth must lie somewhere between two extreme positions when in fact sometimes one position is completely wrong and staking out a position between the wrong position and the correct position leads you to being at least partially and often mostly wrong. (The mostly wrong would be you, Dr. Jay.) The antivaccine position (for instance, that promoted by Generation Rescue, Jenny McCarthy, Age of Autism Safe Minds, the National Vaccine Information Center, the Australian Vaccination Network, and other antivaccine groups) is one of those positions that are just plain wrong based on science and evidence. There is no obligation to treat their position as anything other than pseudoscience and quackery, because that’s what it is.

      More reading:

      http://rationalwiki.org/wiki/Balance_fallacy
      https://en.wikipedia.org/wiki/Argument_to_moderation
      http://www.nizkor.org/features/fallacies/middle-ground.html

      The bottom line is that the “middle ground” you stake out is a “middle ground” between science and antivaccine pseudoscience (with a heavy leaning towards pseudoscience), between medicine and antivaccine quackery (with a heavy leaning towards antivaccine quackery), and between reason and unreason. So, yes, I am very disdainful of antivaccine quackery, because it is harmful to children and has no scientific support. Antivaccinationism more than deserves my disdain and that of reasonable science-based human beings everywhere. To the extent that you “stake out a middle ground” between science and pseudoscience that disdain will catch you. The closer to antivaccine pseudoscience you stake out your position, the more you’ll get caught in the side spatter of my disdain.

      @David, yes, I believe that there is a group of babies and children who have a genetic predisposition to asthma, allergies, diabetes and autism for whom environmental triggers lead to the conditions’ overt manifestations. As you well know, this is being studied and studied hard in respect to diabetes at the very least. One can also cite the freeway studies, farm worker studies and more.

      One notes that these studies are generally negative.

    2. windriven says:

      “[W]e ourselves have received vaccines, give them to our patients, but doubt that the current schedule is optimal for children’s safety.”

      Your doubts may be of passing interest at a cocktail party but if you’d like to engage the interest of serious people how about conducting a well designed clinical trial and publishing your results in a peer reviewed journal? The link between vaccines and a variety of pathologies has been studied and studied again – not just in evil BigPharma America, but in a variety of countries around the world. Yet the overwhelming evidence suggests no linkage.

      At what point do judge your – or anyone else’s – doubts about anything to have crossed into the realm of fantasy? Or does this just go on and on like the folks who still believe the 69 moon landing was faked in a TV studio?

    3. qetzal says:

      Jay Gordon:

      Qetzel, look no further than narcolepsy, VPD, and case reports about adverse vaccine effects. But these are relatively small issues given that we administer billions of vaccines each year. There is a great need to look at combinations and timing of vaccinations.

      Narcolepsy, VPD, and other AEs have been, and continue to be investigated. As for combinations and timing, where is the evidence of the “great need” to look at this?

      [TONE TROLLING ALERT!] The language and tone of David’s vaccine posts is both disdainful and ridiculing of those of us who stake out a middle ground. That is, we ourselves have received vaccines, give them to our patients, but doubt that the current schedule is optimal for children’s safety.

      No, the language and tone is ridiculing of those who refuse to accept what the available evidence shows, or who insist that their personal, unsupported doubts are a reason to conduct additional studies that lack scientific basis.

      Vaccines are “big medicine.” They are not cleared from the body in a matter of hours like antibiotics, pain meds or most other medications. They cause permanent changes in a child’s immune system and most experts would argue those changes are 100% for the better. I don’t agree. I think that some of the changes are not good.

      I have never seen any expert claim that vaccine induced effects are 100% for the better. I have seen plenty of experts acknowledge that there are risks, while stating that those risks are vastly outweighed by the demonstrable benefits.

      The fact that you disagree is entirely irrelevant. What matters is the evidence.

    4. Carl says:

      Jay Gordon spoke
      The language and tone of David’s vaccine posts is both disdainful and ridiculing of those of us who stake out a middle ground. That is, we ourselves have received vaccines, give them to our patients, but doubt that the current schedule is optimal for children’s safety.

      I don’t normally like to just drop a quote I heard repeated, but this is about all you are worth…

      “But the man in the middle is the knave who blanks out the truth in order to pretend that no choice or values exist, who is willing to sit out the course of any battle, willing to cash in on the blood of the innocent or to crawl on his belly to the guilty, who dispenses justice by condemning both the robber and the robbed to jail, who solves conflicts by ordering the thinker and the fool to meet each other halfway.”

      1. calliarcale says:

        Carl,

        That’s a nice quote. Here’s another one, from the song “Turn It Up”, from the Alan Parsons album “Try Anything Once”:

        “It’s no good you trying
        To sit on the fence
        And hope that the trouble will pass
        ‘Cause sitting on fences
        Will make you a pain in the ass.”

        I’ve always particularly liked the triple entendre of the last sentence. Literal fence-sitting would indeed make one’s hindquarters sore, and metaphorical fence-sitting will not only cause you grief in the long run, but it will also make other people regard you as something of a nuisance.

        But if you have good balance, fence-sitting lets you do something else. It lets you play the crowd, and that’s something Dr Gordon is very good at. I have noticed that it is only on blogs like this one that he appeals to science and reason and expresses favor for the good that vaccines have done. Elsewhere, he emphasizes the harm they do, because that is what he perceives the crowd there wants to hear. Perhaps he sees himself as a bridge between science and the antivax community, but this could only be a veneer, given his total disinterest in cleaning up the outrageously bad links on his website when it is pointed out to him, months after the last time he said he’d clean it up, where he promptly claims to have only just now noticed.

        In other words, science and facts aren’t really important to him. He’s just interested in working the crowd.

        BTW, on perseveration . . . it’s telling that Dr Gordon would rather dismiss the requests for clarification of his views with an implication that Dr Gorski is merely beating a dead horse than actually end the requests by clarifying. This is why I am convinced Gordon isn’t interested in honest discussion on this topic. He avoids anything that could clarify his position, lest he someday be held to it. Perhaps he should run for public office; he seems eminently qualified.

  4. A worthy subject and needed call to activism.

    But I fear Dr. Gorski may lose readers with his long intros before getting down to brass tacks.

    1. BillyJoe says:

      Just start reading at paragraph three. No problem.

    2. Thank goodness for scrolling! :-)

  5. Andrey Pavlov says:

    Qetzel, look no further than narcolepsy, VPD, and case reports about adverse vaccine effects. But these are relatively small issues given that we administer billions of vaccines each year. There is a great need to look at combinations and timing of vaccinations.

    Exactly the point, Dr. Jay. Nobody rational has ever claimed that vaccines are 100% safe. Even in this very post. But considering the adverse effects are measured against billions of doses worldwide and things like polio, smallpox, HiB (you probably practiced pediatrics in the days of severe HiB epiglottitis, didn’t you? You know, before the vaccine which plummeted the rates of this disease that can kill small children rather rapidly), what more do you need?

    Ah yes:

    That is, we ourselves have received vaccines, give them to our patients, but doubt that the current schedule is optimal for children’s safety.

    On what basis do you say this? Those who are more expert say differently. As do large epidemiological studies. And more importantly, the vaccine schedule does change to reflect the evidence. And it is different in different geographic regions to reflect the prevalence of various diseases! What more could you ask for? The best evidence for one of the best and most significant advances in public health in history is applied to change and update the schedule. Yet you disagree.

    Perhaps you would care to write an alternative vaccine schedule? I mean, if it is clear that the current schedule is sub-optimal then you should know what would make it more optimal, right? Or are you just wanting to change it randomly to something different that you have no idea would be better or worse?

    And that is the point, Dr. Jay. It is not even remotely sufficient to say “it is sub-optimal” and then just leave it at that. Everything is sub-optimal. That is why medical science keeps working. And why, as I said above, the schedule changes to reflect that!

    As Dr. Gorski has pointed out, these are nothing more than anti-vaccine tropes which serve as (very) superficially pleasing talking points that can’t stand up to the minutest of scrutiny.

    And of course, rely on logical fallacy as Dr. Gorski pointed out. He didn’t mention the other one you often employ – the Nirvana fallacy:

    They cause permanent changes in a child’s immune system and most experts would argue those changes are 100% for the better. I don’t agree. I think that some of the changes are not good.

    Nobody says 100% anything. We are scientists, after all. And I absolutely agree that some of those changes are not good. But that is just the start of the question. How bad are they? Is it a net negative? Everything we do in medicine is a risk benefit analysis. And study after study, over and over, has shown that the benefit of vaccination far, far, outweighs the risks. And not only that, that the risks are pretty darned minuscule even in an absolute sense (which is why it takes billions of doses to suss out the negatives in the first place).

    And which is why actual scientists and clinicians are well justified to hand out some disdain and why you have indeed earned it, from myself included.

    But, as Dr. Gorski said, we are all human and experience is a powerful driver. You’ve had more than ample time and should have had more than ample training to have figured it out by now, but one thing that folks like myself – and Dr. Gorski and the rest of SBM – respect more than anything is a willingness to admit when you are wrong. It is never too late.

  6. Jay Gordon says:

    @David The “middle ground” exists and includes those of us who are neither “anti-vaccine” nor in favor of the current manufacturing standards, incomplete safety studies and pseudoscientific administration schedule. Are you really saying there is not middle ground?

    Your calling it a “logical fallacy” doesn’t make it so any more than your calling it a cow would make it a cow. Yes, many studies of environmental impact on the incidence of autism are negative. Some are positive and more need to be done.

    1. windriven says:

      “Are you really saying there is not middle ground?”

      I am. Middle ground can exist where there is room for reasonable people to review the evidence and arrive at different conclusions. Science is littered with these issues. But the supposed link between vaccination and autism isn’t one of them. The preponderance – the vast preponderance – of evidence fails to show a link. There is no evidence on which to base a ‘middle ground’. You must understand that your fears and your doubts and your concerns do not rise to the level of evidence.

    2. David Gorski says:

      There is no “middle ground” between a position that asserts based on no evidence other than testimonials and anecdotes that vaccines cause autism (your position) and the science-based position, that numerous large epidemiological studies have failed to find a link between vaccines and autism or thimerosal and autism.

      I’ll phrase it more generally. There is no reasonable middle ground between a science-based position supported with huge quantities of high quality evidence (vaccines are very safe and effective at preventing serious disease) and a position that is based on pseudoscience and supported only by anecdotes and fantastical “mechanisms” (that vaccines cause autism, SIDS, asthma, diabetes, etc.). Provide some high quality evidence to support your opposition to current manufacturing standards and the current vaccine schedule (and, no, neither your “thirty years of clinical experience” or the numerous anecdotes you find so convincing count) and maybe I’ll accept that there is a “middle ground.” Somehow, unfortunately, you never manage to do that and can never seem to manage to explain on what basis you consider current vaccine safety studies “incomplete.” The best you can come up with is anecdotes and your doubts, which are impervious to science and evidence, except for the occasional minor chipping away at the edges (e.g., on formaldehyde in vaccines).

      And, yes, you are using logical fallacies, in particular the fallacy of the perfect mean. Just because you don’t understand the concept behind that logical fallacy or reject it doesn’t mean that you aren’t using it.

    3. Harriet Hall says:

      Jay Gordon,
      You say the current vaccine schedule is “pseudoscientific.” Isn’t the delayed vaccine schedule you propose far more pseudoscientific? Or rather, simply non-scientific?

      By the way, you never replied to my previous comment that quoted your own words. Do you still stand by what you said? ” “My very strong impression is that children with the fewest vaccines, or no vaccines at all, get sick less frequently and are healthier in general. I truly believe they also develop less autism.””

      1. David Gorski says:

        One also wonders if Dr. Jay stands by these other statements of his:

        Mercury in vaccines causes autism and other brain injury. The IOM twisted the facts to suit the CDC and the vaccine industry.

        Or this:

        I think that the public health benefits to vaccinating are grossly overstated. I think that if we spent as much time telling people to breastfeed or to quit eating cheese and ice cream, we’d save more lives than we save with the polio vaccine.

        Or:

        Diet and supplements and other alternatives to doing nothing can lead to recovery from autism. Period.

        Or:

        Last but far from least, we have to support and reinforce the intelligent and fiercely held hope these parents of children with autism have. Doctors have to acknowledge and help research the therapies that lead to recovery from autism, recovery brought on by therapies long ignored by the AAP and others. Dairy-free, gluten-free, sugar-free diets have succeeded far too many times for any doctor to claim that they’re not “evidence-based.”

        Or:

        I have been in practice thirty years and watched thousands of children get shots, not get shots, develop autism or remain developmentally “neurotypical.” I have no proof that vaccines cause autism and would be very excited to have my large group of extremely healthy mostly unvaccinated children studied someday. It would be disingenuous to imply that non-vaccination might not lead to an increased incidence in vaccine-preventable illness. It would be equally disingenuous to state that this possibility poses a great threat to America’s children. The risks of vaccinating the way we do now exceeds the benefits of this vaccine program. “Scientists” who suggest that experienced doctors ignore their eyes and ears are wrong. Detractors who say that we should ignore parents who are certain that vaccines caused their children’s autism are wrong and often quite mean-spirited.

        Or what you said about the MMR vaccine:

        Now, in terms of public health, I don’t want to be the guy who said, “Boy, this vaccine stinks.” It doesn’t stink. It works very, very well. The reason we don’t have measles in America is because the vaccine works great. But sit down, please. Let’s talk about the fact that your cousin and your other cousin both have autism. Or that your son has some questionable neurological issues, he seems to be speaking or walking a little later. I don’t want to mess with him.

        Or:

        I base everything I do on my reading of CDC and World Health Organization statistics about disease incidence in the United States and elsewhere. I base everything I do on having spent the past thirty years in pediatric practice watching tens of thousands of children get vaccines, not get vaccines and the differences I see.

        Vaccines change children.

        Most experts would argue that the changes are unequivocally good. My experience and three decades of observation and study tell me otherwise. Vaccines are neither all good–as this biased, miserable PBS treacle would have you believe–nor all bad as the strident anti-vaccine camp argues.

        Or:

        The way vaccines are manufactured and administered right now in 2010 makes vaccines and their ingredients part of the group of toxins which have led to a huge increase in childhood diseases including autism.

        Or finally this frightening comment left on a blog:

        I gave a half dozen vaccines today. I gave some reluctantly but respected parents’ wishes to vaccinate.

        Now there’s a scary thought: A pediatrician whom parents have to talk into giving recommended vaccinations. As I pointed out at the time, it sounds as though those parents have more sense and medical understanding than their child’s pediatrician on this issue. Why, if Dr. Jay is not “anti-vaccine” was he “reluctant” to give their child appropriate vaccines?

    4. David Weinberg says:

      I’m a little late to this party, but I’ll jump in anyhow.

      Dr. Jay Gordon, you said:

      “There is a middle ground. Vaccinate slower and later…”

      No, not at all.

      Can we agree on the 3 following statements:

      1. Vaccines have benefits and risks.

      2. There is some schedule of administration which maximizes benefit; even though we might not know what that schedule is.

      3. There is some schedule of administration that minimizes the risk; even though we might not know what that schedule is.

      If we can agree on those 3 propositions, and I hope we can, then the real question becomes: what is the optimal schedule that gives the most favorable risk/benefit ratio?

      Maybe you are right, and we are current schedule is “too many too soon.” Maybe the current schedule is optimal. Maybe we should be vaccinating earlier and more often.

      Your approach is not “middle ground.” In the absence of evidence, and in the face of evidence to the contrary, you have already answered the question.

      Don’t get me wrong, I am not saying we need to spend billions of dollars to compare every single combination and permutation of vaccine administration. I’m just trying to point out the your middle ground position really is a logical fallacy, and is an obstacle to legitimate scientific conversation.

    5. Kindly explain and give a reference for:

      “…pseudoscientific administration schedule…”

  7. Matt says:

    “Qetzel, look no further than narcolepsy, VPD, and case reports about adverse vaccine effects. But these are relatively small issues given that we administer billions of vaccines each year. There is a great need to look at combinations and timing of vaccinations. ”

    Just for my education, what would the influenza/narcolepsy story tell anyone about combinations or timing (especially with infants) of vaccinations? My recollection is these were given to adults, singly.

  8. jre says:

    Dr. Gorski suggests that Dr. Gordon’s argument rests on the fallacy of moderation. Dr. Gordon replies in part:

    The “middle ground” exists and includes those of us who are neither “anti-vaccine” nor in favor of the current manufacturing standards, incomplete safety studies and pseudoscientific administration schedule.

    For those keeping score, that is known as the fallacy of “begging the question.”

    Unless you have some specific objection to the current manufacturing standards, or evidence that existing safety studies are incomplete, or a compelling case that the administration schedule recommended by ACIP is pseudoscientific, you don’t get to casually insert those claims into your argument. Not in polite company, anyway.

    And another thing … (I know it’s unwise to post when riled, but whaddya gonna do?)
    There have, consarn it all, been studies of vaccinated vs. unvaccinated populations. Among the best of these have been in Poland, where the history of public health measures led to distinct cohorts with different vaccination histories. And guess what? Vaccinated children are, if anything, slightly better off by any neurodevelopmental measure than the unvaccinated, If Dr. Jay Gordon has some actual studies to support his position, let’s hear about them.

  9. Stephen H says:

    That was a fun survey. While I don’t live in the US, I said that my representative was Michelle Bachmann. Then I said that I’d asked her to tag another study onto the bill, into relative IQs of parents who refuse to vaccinate their children vs. parents who have a clue. Finally, since they asked about whether someone in my family is “vaccine injured” I discussed needle stick injury.

    Seriously – “vaccine injured”?

  10. I swear that reading anti-vaccinationist sites are like visiting Bizarro-World. The following is a quote from the same article from SafeMinds via AoA

    “Without this basic data, no one can say with certainty whether or not the current vaccination schedule is associated with a greater risk of autism and other chronic health outcomes”

    Viewed in isolation it.sounds like they have true equipoise but reading any other article on the page makes it clear that what they actually think is that “Yes there is harm. Yes we are certain”. In which case it wold seem more consistent to attack SafeMinds rather than promote them.

    Not to mention that SafeMinds are making statements that are kind of weird. They appear to be using the term “certain” in a very specific way. As if no data collected so far can contribute to the question “Do vaccinations cause autism?”. Which sounds a lot like a “Poisoning the well” fallacy.

  11. Dr. Jay has it largely correct on the doublethink wherein there can be no middle ground. When the question of vaccines is involved, the ‘skeptical’ community suddenly forgets the primary axiom of the scientific model: You can only learn what you analyze. Study the MMR? You learn about the MMR. Study polio vaccine? You lean about the polio vaccine. Study thimerosal? Guess what you learn about? If you want to learn about the effects of the process of stimulating the immune system in early life, of *vaccination*, you can’t get there by studying the MMR, or the polio vaccine, or thimerosal and assuming all things are equal.

    You can’t have a consensus that is based on *data*, and in the same breath, go on to tell us that gathering the *data* is impossible due to ethical concerns and/or the crazy decision making processes of people that comprise the unvaccinated. You can have either one or the other. What we have is a consensus based on a *lack* of data and an inability to suppose a mechanism of action to altered outcomes.

    You can admit as much while also admitting that vaccines work, prevalence figures for autism incorporate tons of diagnostic shuffling, herd immunity is real, and the Safe Minds bill is drafted idiotically and has no chance to go anywhere. None of these things are incompatible.

    Our system is *great* at detecting immediate reactions, but awful at detecting subtle, long term changes, or making the most basic attempt at discriminating between a state of immune challenge and a state without immune challenge.

    Here is the fact sheet for a combo vaccine, Pediarix.

    http://www.drugs.com/pro/pediarix.html

    Look at table 1.

    Percentage of Infants With Solicited Local Reactions or General Adverse Events Within 4 Days of Vaccinationa at 2, 4, and 6 Months of Age With Pediarix Administered Concomitantly With Hib Conjugate Vaccine and 7-valent Pneumococcal Conjugate Vaccine (PCV7) or With Separate Concomitant Administration of INFANRIX, ENGERIX-B, IPV, Hib Conjugate Vaccine, and PCV7 (Modified Intent To Treat Cohort)

    That is wonderful data if we want to know if children have different levels of fever after twenty minutes between pediarix/hib/pcv7 versus getting infararix/engerix-b/ipv/hib/pcv7. Superb stuff.

    If our need to understand outcomes exceeds four days after vaccination however, how do these studies help us? Is a follow up all the way out to eight days post vaccination really that helpful? So while the FDA does require the tracking of a lot of things, that doesn’t mean we are necessarily tracking the *right* things,

    The consensus was that birth by C-Section was no big deal for decades, with a consequent skyrocketing of use. I bet eight days afterwards, this analysis was largely correct, and in fact, in some instances, saved a lot of children. Unfortunately, when we dialed our filters out a little bit, it turns out, children born by C-Section do have different outcomes, we just weren’t smart enough to *look* for it. The idea that changes to microbiota could affect an infant deep long after birth was totally foreign to us at that time, but nature paid our ignorance no mind. If we had waited for evidence that C-sections could cause altered outcomes in order to look for it, this relationship would still be invisible to us; it was because we identified a biologically plausible mechanism by which change could be achieved, then went looking to see if it was occurring.

    The consensus was that giving infants tylenol was fine for decades, until we realized that there were biologically plausible mechanisms by which we might be having effects we hadn’t anticipated, and thus *hadn’t looked for*. Now, tylenol is *not* recommended for infants, after forty years or it being recommended, often times, in anticipation of vaccination.

    The animal models are unambiguous regarding the ability of an early life immune challenge to alter development in ways that were unknown to us when we began increasing our vaccine schedule. Our existing research is blind to this, as they fail to compare a challenged state with an unchallenged state, just a challenged state with a slightly different challenged state.

    We are operating on the *assumption* that the process of vaccination has only benefits except in a tiny minority of cases. This very well may be the case, but it is still an assumption.

    I wonder if anyone has pondered the paradox of the complexities of drug development and the fact that every TV advertisement for a pharmaceutical lists as many potential side effects as actual effects alongside the placebo free studies in the vaccination realm. This isn’t a slam on pharma, the space they inhabit is unimaginably complex, and there aren’t any buttons to press that fix fibromyalgia, just buttons to press that do *lots* of things, one of which happens to be what the drug was designed for. What a relief it must be to know that vaccination doesn’t have the same biological complexity to deal with.

    It is because this discussion is founded on that type of assumptions Dr. Gorski doesn’t slam Dr. Gordon with a couple of *actual studies* that evaluate vaccinated and unvaccinated cohorts, but instead threatens to go quote digging to impinge his reliability. Yes, I am sure that possibility bothers Dr. Gordon greatly.

    What great fun it is to dig up quotes by Dr. Jay that are easily dismissed with data or point out that experience has limitations that must be controlled for by analysis and pretend all is right. If only we now just could get the natural world to be governed by those same rules, then we could have certainty that our assumptions match reality.

    1. windriven says:

      @pD

      “the ‘skeptical’ community suddenly forgets the primary axiom of the scientific model: You can only learn what you analyze.”

      Are you somehow suggesting that links between vaccination and [choose your morbidity] haven’t been studied? Did you read Dr. Gordon’s comment above?

      “There are many likely triggers to that genetic predisposition. Could our current vaccination protocol be one if those triggers for susceptible babies? Yes, it could be.”

      That isn’t scientific. It isn’t an examination. It isn’t an analysis. It is pure wild speculation. Where is the science there?

      This issue has been discussed ad nauseum in these pages. It has been studied deeply if not absolutely exhaustively in the scientific community. That said I doubt there is anyone in the scientific community who wouldn’t be open to compelling new information linking the current vaccination protocol with some pathology. So go find it. Are you telling me that all these jabbering activists can’t put together the intellectual and financial capital to fund a properly organized study?

      Or is the real issue that it is easier to rabble rouse in the hope of getting other people to fund what amounts to a fishing expedition in a pond where no one has found any fish? If you or Dr. Gordon or anyone else wants to prove that the granddaddy catfish lives in that pond, no one here or anywhere else is stopping you.

    2. It’s hard to see of PD has an actual point as buried as it is within needless text.

      “You only learn what you analyze” isn’t an axiom of any sort and I’ve yet to see those precise words in any science text or primer. However I do understand the intent to a point and at absolute best it’s a rule-of-thumb. It is essentially the same as saying that no information is generalizable (because if you can’t possibly learn “X” from “not X” then you can equally argue that a study run on 20 people is only going to be valid for those 20 people).

      One does need to be careful about generalizing. ( <- That one sentence is essentially three paragraphs of PD's horrible writing). Interesting fact the same criticism can, of course be leveled at PD's argument. Yes, people thought A in the past and new evidence caused them to think "not A" however was the evidence in every case of equal weight? On what clinical evidence were C-Sections considered to be equivalent to standard birth and what is the strength of effect based on the outcomes in question?

  12. joe imbriano says:

    Lets look at the elephant in the room and not the red herring in the pond

    http://www.thecausesofautism.com

    1. jre says:

      I particularly liked the part about how our bodies are like foil-wrapped burgers in a giant microwave oven.

      1. David Gorski says:

        Indeed. I laughed particularly hard at that part. Actually, the whole post is a laugh riot from a scientific standpoint. Thanks, Joe.

  13. WilliamLawrenceUtridge says:

    Dr. Jay, I see why you garner so little respect in scientific circles.

    My personal experience is worth considering as is yours as is David’s. Nothing is “trumped” and RCTs are more valuable than anecdotes. But to dismiss experience is really the height of hubris

    That’s trivially true, in the sense that your experience is worth considering as a form of hypothesis-generation. Your experience is just like every other human’s experience – filtered through lenses of confirmation bias, Dunning-Kurger, anchoring, self-serving memory and the unwillingness to change your mind. It is for these reasons that science insists upon controls like rigor, replicability, high-quality records, statistical verification, theoretical and empirical coherence and related sundry. You may say “in my experience, X is associated with Y”, but that doesn’t mean your experience is correct, or not merely the result of selective memory. It doesn’t grant you the right to proclaim the results of actual scientific investigation wrong. It doesn’t permit you the luxury of declaring results contrary to your experience to be invalid, particularly when multiple results converge on the same answer. Your arrogant proclamation reeks of hubris and your ongoing defence of the vaccine-autism connection reeks further of the unwillingness to utter, or type, the words “I was wrong”. I’m certain you find it to be emotionally (and financially) rewarding to pander to the concerns of so many parents who stream into your practice to validate their idée fixe. I’m certain it reinforces your belief that here is something to the connection. I’m equally certain that this is at least part of the reason why you feel so justified in proclaiming there to be a link – but that doesn’t make you right. It might just make your practice an anecdote-generating machine, a self-fulfilling prophecy of erroneous beliefs. Your status as someone who publicly and loudly believes that their expertise is equal to that of the CDC vaccine boards, your public pandering to fears about vaccines, essentially guarantees that you will find, you will embody, the kinds of selective, systematic confounds that are so important to control against. And you don’t seem to see it, wrapped as you are in the mantle of self-righteous compassion, cosseted by antivaccination celebrities, and praised by sycophantic parents who finally found someone to pander to them.

    Autism may be totally unrelated to vaccination, and the results gathered to date certainly suggest this is the case.

    Three “pander”s in one comment, I need a better thesaurus.

    1. David Gorski says:

      That’s trivially true, in the sense that your experience is worth considering as a form of hypothesis-generation. Your experience is just like every other human’s experience – filtered through lenses of confirmation bias, Dunning-Kurger, anchoring, self-serving memory and the unwillingness to change your mind. It is for these reasons that science insists upon controls like rigor, replicability, high-quality records, statistical verification, theoretical and empirical coherence and related sundry.

      Nicely put. Personal experience is, in reality, the lowest form of medical evidence. It’s OK for hypothesis generation. Well, it’s not even that good for that; you need to couple that personal experience with some hard data, as in rigorously recorded case histories, to generate a hypothesis compelling enough to be worth testing in more rigorous trials. The problem is, Dr. Jay doesn’t accept this. He thinks his experience is a close approximation to reality. As I said, I’ve been trying to explain all of this to Dr. Jay since around 2005 or so. It never seems to sink in.

  14. WilliamLawrenceUtridge says:

    There are many likely triggers to that genetic predisposition. Could our current vaccination protocol be one if those triggers for susceptible babies? Yes, it could be.

    There is a great need to look at combinations and timing of vaccinations.

    Why? Why vaccines above all else? Why continue insisting it is vaccines, it must be vaccines, vaccines must be a component, when repeated, indeed exhaustive research efforts have failed to validate such a comment?

    Vaccines give minute doses of every single component involved. Some vaccines are down to as few as 7 antigens per injection. The adjuvants are tiny, miniscule, amounts, and often washed out by the background levels that children are exposed to on a daily basis – witness mercury in fish, formaldehyde produced by the body, aluminum found in pretty much all foods. Nearly everything injected into the body is diluted into the blood in short order after vaccination. And further – the infections vaccines prevent cause massively higher doses of the antigen than vaccination does, making the vaccine safer than the disease anyway. Against all this prior probability suggesting vaccination is unlikely to cause autism, all you have are a series of anecdotes from parents primed to believe it is the vaccine, which is pretty much the shoddiest evidence one can ask for beyond what Wakefield provided – outright, naked, greed-motivated lying. There are an unlimited number of hypothetical environmental triggers for autism. Even if a small portion of the population were uniquely susceptible on some genetic basis to the environmental impact of some portion of vaccines – we would still see evidence of that in the form of a consistent signal in the noise. We don’t see such a signal. You can’t compare the vaccine-narcolepsy with a potential vaccine-autism link because such a link has been identified; while both might have similar prior probabilities, upon extensive empirical research we have identified a coherent link for one – but not for the other. Your willingness to claim narcolepsy as evidence against autism actually undercuts your case because the former has been proven while the latter has not – despite years of effort, thousands of subjects and dozens of publications. So perhaps admit that vaccines might not be the cause of autism, rather than moving the goalpost to “susceptible babies”.

    Autism could be caused by television, precipitation, churchgoing, sneezing, apples, sunlight, campfires, loud noises, absence of loud noises, and so on. So why persist in focussing on and insisting that it is this, one thing? The genetic component to autism is what, between 0.7 and 0.9? So why insist that the remaining 0.1-0.3 is due to vaccines? Why would it not be due to a dozen, or a hundred different things, but not vaccines?

    1. David Gorski says:

      My favorite example to use is Internet usage. The “autism epidemic” corresponds very nicely to the beginning of the consumer Internet revolution that began in the early to mid-1990s. So why don’t antivaccinationists consider that perhaps Internet usage causes autism? The correlation is at least as strong—stronger even. Recently Boing-Boing posted a chart showing a very tight correlation between organic food sales and autism diagnoses. So why isn’t it organic food causing autism? The reason, of course, is that first and foremost it’s about the vaccines. It’s always been about the vaccines. It always will be about the vaccines. The reason is that people who think vaccines cause autism against all evidence to the contrary are virtually always antivaccine.

      1. Matt says:

        I once graphed autism papers vs. the administrative prevalence of autism in California. It used to be a great fit. I haven’t checked in a few years.

        When I spoke with one epidemiologist about this, she told me that the intro to one of the big autism books had a similar graph in the introduction.

        Are we going to say that autism papers cause autism?

        The real question is what is the true autism prevalence by year. We can graph data that sorta-kinda are related to the actual fraction of the population who are autistic, which is what people like to do (special ed data, California autism data, etc.). It doesn’t really tell us much.

        As Dr. Gorski says, it’s always about the vaccines. It turns out that the Amish have a much higher prevalence of developmental disability. Like 5 times higher for one community. I bet when some people hear that they will say, “See, they are more susceptible to vaccines!”

  15. Speaking to my patients who were alive prior to the introduction of the polio vaccine and subsequently acquired polio find the anti-vaccine crowd very interesting indeed. They find their position one of luxury as they (my patients) were not afforded the option to get vaccinated and came down with the disease. This is something Mr. Gordon appears to be lacking in information from what I can see in his posts. Mr. Gordon’s anecdotal experiences, opinion based upon these experiences, are just a small N “study” which has no validity, reliability or predictive power. Mr. Gordon’s credulity speaks volumes to his apparent inability to understand the mountainous volume of credible scientific research that builds upon prior research. It appears (based upon his posts) in my clinical opinion Mr. Gordon either lacks the capacity of critical thought or is using denial, externalization, or a reaction formation to deal with the cognitive dissonance he is experiencing (as the evidence appears to go contrary to his opinion/position).

    I am humble enough to admit my perception is molded by my experience and emotional status at the time data is presented or a thought crosses my mind. And when my humility is not up to the task, science knocks me off my pedestal back to reality. I embrace the nature of my deception engine of a brain. I recognize that only through training my critical thinking skills can I hope to stand a change of success. I accept that testimonials are not a valid source of evidence. I understand that the number of people believing something does not validate the position (examples such as the earth being flat, being the center of the universe) “argumentum ad populum.” I accept that extraordinary claims require extraordinary evidence. I accept that the simplest explanation with the least amount of assumptions for a particular observation is the best. I accept and embrace that through evolution our brains have been formed to think the way they do but as science has advanced our knowledge, our brains style of comprehension have not. I accept that when people feel they are the least susceptible to deception is when they are the most susceptible. I accept that in science consensus is not simply people all agreeing something is as they say but that the preponderance of evidence supports the position. I accept that I have been proved wrong (and will be again) about my opinions based upon the preponderance of valid, reliable evidence. I accept that science is not a blank slate. That is builds upon new understanding, new discoveries as new technologies become available. I strongly believe that the plausibility of a proposed study should be validated before any research monies are provided (especially for funds coming from the public; I’m talking to you NCCAM!). I accept that human thinking wants closure and does not like gaps in logic, nor does it like the answer “we do not know.”

    Dara Ó Briain said it best “Science knows it doesn’t know everything; otherwise, it’d stop. But just because science doesn’t know everything doesn’t mean you can fill in the gaps with whatever fairy tale most appeals to you.” The position those who believe a conspiracy exists with ASD and vaccines use the same logic North Carolina is using regarding outlawing Sharia Law because it forces (in their opinion) a religion they do not agree with on their behaviors/laws while trying to outlaw abortion based upon their own religious beliefs (irony meter just exploded!). They are trying to do this btw by attaching abortion restrictions onto an anti-sharia law bill (HB 695). NC already attached abortion restrictions into a new motorcycle safety bill (SB 353). I kid you not. But I digress.

    In conclusion, our brains are deception engines, anecdotal/word of mouth/personal experience/argumentum ad populum ≠ evidence, we have to work at being critical thinkers, and credulity is not good. Oh and by the way, another great article Dr. Gorski!

  16. Andrey Pavlov says:

    Dr. Jay… my experience says otherwise. So does Dr. Gorski’s. And Dr. Clay Jones. And Dr. Paul Offit’s.

    How do we settle our difference of experiences?

    For me, I’d like to turn to science and well conducted studies. Particularly since I know how experience can be shaped by myriad things other than reality.

    And that is the problem – and why “in my experience” is indeed a dangerous thing to rely on. Use it for pattern recognition and to help make faster decisions (or in the absence of data)? Absolutely. Rely on more than actual data? Never.

    You really should learn about how incredibly faulty human memory is, how powerful motivated reasoning can be, how confirmation bias works, and all the ways our brains trick us. If you already do know these things well then you really do deserve our disdain for holding out to your precious experience in the light of vastly superior information.

  17. pmoran2013 says:

    It doesn’t matter whether there looks to be a middle ground to us or not. Or to Jay Gordon, or to those with more extreme views than his . What matters is how it all looks to millions of Mums and Dads who are inclined, whenever there is uncertainty, to avoid actions that might precipitate harm. . They may well then dig their heels in and regard it as an imposition when attempts are made to force even an intangible risk upon them.

    Why would there be this uncertainty? Well, I suspect it derives from a combination of factors–

    1. — a less than absolute trust in medicine and its science for many. Doctors are so convinced of the great benefits of vaccinations, that it is not reasonable to expect them to vigorously defend them even at the cost of significant risk to some individuals. In fact, we do so explicitly in relation to some risks, simply not those brought to our attention through the concerns of others and, it may seem to many, any which might pose a serious threat to vaccine programs.

    We have also shown that we can be wrong. We can miss significant risks despite much-vaunted clinical studies: Some very sound advice for us here — http://www.drjohnm.org/2013/07/changing-the-culture-of-american-medicine-start-by-removing-hubris/

    2. — that on the “evidence” available to the man in the street and regularly reinforced by sections of the media there seems to be a little ground for concern. I am not talking of the testimonial evidence, which will play its part, but the perception that the incidence of some illnesses has increased substantially in recent decades and that there are very few eligible explanations.

    3. — and other suspicions? The previous demand of the so-called “anti-vax” movement for quality, prospective, RCTs of vaccinated versus vaccinated indicates a degree of scientific sophistication, also sincerity in their concern (the studies could prove them wrong).

    But it might also reflect suspicion of some inconsistency in our approach to the evidence. Everyone knows that we would not accept anything less than well-planned and well-performed RCTs as proof of any “alternative” claim, yet we seem happy to accept lesser levels of evidence, along with conjectures about plausibility, when dealing with questions of vaccine safety.

    This is despite our usual inclination of being more sensitive to risk than benefits when considering the safety of treatments. For example systems for managing reports of adverse drug reactions (VAERS in the US) often issue cautions, and medical bodies also issue guidelines, on the basis of purely anecdotal evidence.

    So if nothing else we should try and understand the little nagging things that are going on in the minds of our public, even if they are unable to articulate them in terms that we can understand.

    4. So, it probably does not help our cause that when concerns are aired are they are quite likely to be met with impatience and bluster, rather than with (yet another) hopefully dispassionate but simple account of the available evidence, or where to find it. The target population is being added to all the time, so the job of justifying vaccines will be a never-ending one.

    1. David Gorski says:

      We have also shown that we can be wrong. We can miss significant risks despite much-vaunted clinical studies: Some very sound advice for us here — http://www.drjohnm.org/2013/07/changing-the-culture-of-american-medicine-start-by-removing-hubris/

      I, of course, covered that post, as you might have noticed if you had read the comments of that post. In any case, I view this study differently. It’s not hubris. It’s medicine correcting itself, something quacks and antivaccinationists virtually never do:

      http://www.sciencebasedmedicine.org/the-difference-between-science-based-medicine-and-cam/

      Lest you think I don’t like Dr. John, I do. My mother loves his blog. So how could I not, even if I think he didn’t quite get it right on this study?

      But it might also reflect suspicion of some inconsistency in our approach to the evidence. Everyone knows that we would not accept anything less than well-planned and well-performed RCTs as proof of any “alternative” claim, yet we seem happy to accept lesser levels of evidence, along with conjectures about plausibility, when dealing with questions of vaccine safety.

      Uh, no. Massive straw man alert! There is no inconsistency. The same rules apply to “conventional” medicine such as vaccines and CAM, even if you apparently don’t understand why and how that’s true. Here’s the difference. It is not ethical to do RCTs on a “vaxed versus unvaxed” population because it fails the test of clinical equipoise. (You do know what clinical equipoise is, don’t you?) As I pointed out in the link, all clinical trials have a tension between the most rigorous design possible and clinical equipoise; i.e., ethics. That’s why you can’t do an RCT of “vaxed versus unvaxed,” although you can do an RCT of individual new vaccines, and vaccine manufacturers do just that to obtain FDA approval.

      As for CAM, mechanism is very, very critical to determining if an RCT is ethical. If there is not sufficient preclinical evidence to justify a clinical trial, it is not ethical to subject patients to the potential risks of such a trial. If the proposed mechanism of a clinical trial is so fantastical and so violates the laws of physics (i.e., reiki) that, barring massive new evidence overturning the laws of physics as currently understood, such a therapy is provisionally viewed as having an impossible mechanism. It can’t work. So doing an RCT is unethical.

      So, it probably does not help our cause that when concerns are aired are they are quite likely to be met with impatience and bluster, rather than with (yet another) hopefully dispassionate but simple account of the available evidence, or where to find it. The target population is being added to all the time, so the job of justifying vaccines will be a never-ending one.

      Oh, fer cryin’ out loud. Give me a break. What do you think that pro-SBM pro-vaccine advocates have been doing for years, if not decades? We use a wide array of different techniques, ranging from the staid, boring one that you just advocated to humor to bluster to everything else in between. There are many ways to skin a cat, and we try to use them all. Yet somehow you focus only on tone trolling.

      1. pmoran2013 says:

        “Yet somehow you focus only on tone trolling.”

        David, I stand by what I have said, including concerning the risk of us being seen to be inconsistent.

        Ethical considerations can justify not performing certain kinds of study, but they don’t elevate the strength of weaker data beyond that afforded it in other contexts. We should also, if anything, bias the science against exposing healthy individuals to important risks. This is not a matter that can be blissfully dismissed until the null hypothesis is well and truly disproved, as per usual scientific norms. .

        For the record, I believe current evidence is strong enough to justify a “steady as she goes” policy on vaccination. But it is not so strong that those who would like more direct evidence of vaccine safety in certain respects should be the subject of too much derision and denigration. This is an instance where the onus is very much upon us to produce the goods. Let’s be doing so.

        And language does matter. Look at the headline to this piece of yours. What dark, twisted agenda are the “anti-vaxers” trying to advance with their resort to “the law”.? Why is seeking further study not simply attributable to ongoing genuine concern for public welfare? Is it not evidence of growth that they now understand the ethical problems in prospective studies?

        You have chosen to adopt an extremely adversarial approach, when public health programs like vaccination surely require cooperation and trust. Perhaps your approach is merely serving to increase suspicion (what is he so scared of?).

        I am confident that what most people want is to be absolutely sure that we have looked at the questions seriously and without prejudice and that the benefits far outweigh risks, even possibly at an individual level, not only through the induction of herd immunity.

        Can we not prove that, if we set our minds to it? An unvaccinated person is at risk of very serious adult illnesses like measles for the rest of their lives while such diseases persist anywhere in the world. When did we ever get to point that out while in our habitual reactive mode to the messages of anti-vax extremism? (Which raises the important question of waning immunity.)

        1. David Gorski says:

          Ethical considerations can justify not performing certain kinds of study, but they don’t elevate the strength of weaker data beyond that afforded it in other contexts. We should also, if anything, bias the science against exposing healthy individuals to important risks. This is not a matter that can be blissfully dismissed until the null hypothesis is well and truly disproved, as per usual scientific norms. .

          Man, you sure are good at constructing elaborate straw men. No one said that ethics elevate the strength of weaker data. Here’s the thing. You obviously haven’t read some of my previous posts about “methodolatry,” also known as the “obscene worship as the randomized clinical trial as the only valid method of clinical investigation.” You’d also know that I’ve pointed out that well-designed epidemiological studies with sufficient power can detect associations quite well.

          Let’s just put it this way. Antivaccinationists will accuse us of double standards whatever we do, just as they will accuse us of being pharma shills whatever we do. There’s nothing we can do about it except to be consistent and not to take pharma money. And we are consistent, your “perception” otherwise notwithstanding

          And language does matter. Look at the headline to this piece of yours. What dark, twisted agenda are the “anti-vaxers” trying to advance with their resort to “the law”.? Why is seeking further study not simply attributable to ongoing genuine concern for public welfare? Is it not evidence of growth that they now understand the ethical problems in prospective studies?

          I’m sorry, but I laughed when I read your last sentence. So naive. So completely wrong.

          No, Peter. That antivaxers now have a vague idea of the ethical problems with doing RCTs of vaccines is not evidence of growth, as they do not accept that these ethical problems are real. They merely pay lip service to them because they know scientists won’t do such studies that are so unethica. (No, don’t try to deny or contradict, I could provide you with many links in which antivaxers say just that and dismiss concerns that such RCTs are unethical. I saw one just the other day.) They then try to use what they know to propose scientifically worthless studies that “acknowledge” the ethics, sometimes with hilariously off-base results. All it means is that they are becoming more sophisticated in constructing their pseudoscientific arguments, not that they have learned anything that they really need to learn.

        2. Andrey Pavlov says:

          Have you seriously not read anything that anti-vaxxers write nor any of the myriad writing about it here and at NeuroLogica? Your concerns are only valid in your own vacuum where such things haven’t been discussed ad nauseum and demonstrated to clearly not be the motivating rationale in such proposed bills, studies, etc.

          I find it forever curious and maddening that you seem to love living in your own little bubble world, focusing on the narrowest subset of a topic and acting like that generalizes to practical reality. But, just like your slippery double-speak about acupuncture, I should know better than to waste my time trying to engage you.

          Just thought I’d let you know I’m flummoxed that you bring the same argumentation to the table for vaccines as your do for acupuncture. Of course, I suppose that makes some sense considering you once chastised me as being inconsistent when I speak differently to an internet audience on a general topic than my patient in my consultation room.

          1. David Gorski says:

            Yeah, it’s hard not to conclude that Peter is just blissfully oblivious to the real world and how antivaccinationists actually function. In his ideal world, antivaccinationists’ concerns are real, they’ll come around if we are just reasonable enough with them, and, above all, we must never, ever be perceived as nasty even though the “nicest” among us (like Steve Novella) are routinely attacked by antivaccinationists. Indeed, it was Steve, not I, who had the “honor” of being Photoshopped into a Thanksgiving dinner scene as a baby-eating cannibal on the antivaccine crank blog Age of Autism for his efforts. (I’m still envious of him for that.)

            In other words, Peter just doesn’t know what he’s talking about here.

    2. calliarcale says:

      1) Yes, this is definitely there, and there are people deliberately feeding that. I submit that this is a large part of the problem. Exploitation by those who know that a good FUD* campaign is a great way of drumming up business. We all know about the heavy hitters like Wakefield, but it goes much further. Alternative medicine providers whose livelihood is not threatened by vaccines may nevertheless contribute to this distrust by sowing unearned doubt towards anything in conventional medicine. In Nigeria, imams and tribal leaders wanting to increase their control over their flock sowed doubt about Western-provided vaccines. Not because they had an alternative or were antivaccine, but because fear of the West would increase loyalty to them. And it worked. It also increased polio rates, of course.

      Your points 2 & 3 are great examples of *how* this works. The almost mindless quest for “balance” in the media feeds into it, often unintentionally, by elevating public perception of unreasonable doubts. There are actually many eligible explanations, but those who profit (financially or in other ways) off of antivaccinationism or even alt med in general will tend to minimize those as it doesn’t suit their narrative. And it is not true that we wouldn’t accept other forms of evidence than an RCT for proof of an alternative claim, nor is it true that we are less rigorous when evaluating vaccines. But because of an effective (and not entirely intentional) FUD campaign, that isn’t how much of the public sees it.

      Yes, we should try and understand these things, but as far as #4 goes, if we meet ridiculous claims with just dispassionate accounts, we will be playing right into the hands of the antivaxxers, because that’s just the sort of thing that they can minimize with a little FUD. FUD’s very hard to fight. I don’t think dispassionate accounts are the way to do it. I think empowering people to be critical thinkers is the way to do it, while calling out those who actively seek to mislead. After all, wouldn’t you be outraged if you knew someone was misleading you? Of course you would, and you have a right to know if someone’s doing that to you.

      * Fear, Uncertainty, Doubt, a marketing and propaganda tactic which drives consumers towards your product by driving them away from your competitors; the great thing is it works even if your product is inferior and you have no actual evidence that the competitors’ products are in any way defective; just get people wondering and that will be enough.

  18. @windriven –

    Are you somehow suggesting that links between vaccination and [choose your morbidity] haven’t been studied? Did you read Dr. Gordon’s comment above?

    I choose autism as a morbidity, then.

    Imagine you have a population that drinks Mountain Dew, Five Hour Energy, expresso, Jolt, and Rock Star energy drinks. Now compare that population that drinks Mountain Dew, Five Hour Energy, expresso, Jolt, but does not drink Rock Star and see if the groups are different for [choose your morbidity]. When we perform our comparison, does this tell us about what happens when people take energy drinks, or does it tell us what happens when people drink one less energy drink? Now, replace Rock Star with MMR, Mountain Dew with DTaP, Five Hour Energy with Hib, expresso with Hep-B, and Jolt with pneumoccocal vaccines. That is what our data looks like, no matter how many times it has been glossed over on this site.

    That isn’t scientific. It isn’t an examination. It isn’t an analysis. It is pure wild speculation. Where is the science there?

    I don’t have to defend statements made by Dr. Gordon in order to point out the problems with our existing suite of research and the selective skepticism applied here when the topic is vaccination.

    It has been studied deeply if not absolutely exhaustively in the scientific community.

    If this the case, why does Dr. Gorski spend time discussing the problematic nature of decision making processes of the unvaccinated that introduce bias, or the ethical considerations regarding a RCT? If, on the other hand, you have a *citation* that has overcome these problems, you should provide it to Dr. Gorski, who I am sure would love to have *actual data* to present to Dr. Gordon. You’d think that after a few hundred posts on ‘anti-vaxxers’ he would know about these studies by now, but you never know.

    Are you telling me that all these jabbering activists can’t put together the intellectual and financial capital to fund a properly organized study?

    They don’t seem to be capable of doing much competently, as evidenced by the problems with the bill as presented by Dr. Gorski. In any case, their incompetence does nothing to elevate the robustness of our data, it just makes them not competent.

    1. windriven says:

      @pD

      “I choose autism as a morbidity, then.”

      Vaccine. 2012 Jun 13;30 is one of the more recent. I’m not going to do your homework for you though. A visit to Pubmed or, for that matter, a search in these pages will give you abundant evidence that MMR and autism have been studied but no causal effect found.

      “[Those loudly arguing a causal link between MMR and autism] don’t seem to be capable of doing much competently, as evidenced by the problems with the bill as presented by Dr. Gorski. In any case, their incompetence does nothing to elevate the robustness of our data, it just makes them not competent.”

      Well help me out here. Let’s assume for just a moment that there might be a smoking gun yet to be found buried in all this data, that MMR vaccination as currently delivered can be somehow linked to x cases of autism for every y million vaccinations**. What would you have us do about it? Study it over and over until we get the result that you want? Stop immunizing against diseases that plagued children a century ago and still cause significant morbidity and occasionally mortality in communities with low vax rates?

      What we have is people’s fears on the one hand and a scientific consensus on the other. Beyond conducting research that is methodologically more sound than that done heretofore*, where is there to go? If anti-vax advocates are unwilling to fund such research and if mainstream researchers do not find compelling data that demands such research, we find ourselves at the end of the road.

      *I am not suggesting that there are serious methodological flaws in the research conducted to date. That is well beyond my competence to assess.

      **Let’s use a reductio ad absurdum to explore this. Let’s assume that some unique genetic quirk results in 1 case of autism per 100 million vaccinations. Let’s say we even have a genetic test that can identify this quirk. Do we perform this test at whatever its cost, false positives and negatives, on every child slated for MMR to possibly prevent this single case? Think about recent changes in protocol for mammography and PSA.

      1. Vaccine. 2012 Jun 13;30 is one of the more recent.

        You will note that table 1 indicates that only DTP and BCG was evaluated alongside the MMR. What is the sample size of infants who got less than the fully recommended Japanese schedule minus the MMR? I’ll bet it is less than 10 individuals.

        Do you find it of interest that they *also* failed to find zero relationships between any *other* factor and ASD?

        For all of the prenatal, perinatal and neonatal factors, there were no significant differences between cases and controls.

        No association to maternal diabetes, or obesity, or maternal asthma. Nothing about being born pre-natally, or low birth weight. Nothing about syndromic forms of autism. Nothing about low APGAR scores. That is an amazing subgroup!

        A visit to Pubmed or, for that matter, a search in these pages will give you abundant evidence that MMR and autism have been studied but no causal effect found.

        You confuse ‘the MMR’ with ‘vaccination’. There is a difference you know. The rest of your post suffers from this same problem. You should peruse the CDC recommended vaccine schedule to take a look at the vaccines *other* than the MMR that are given. Of course, if you have been relying on this blog to give you information about vaccination and autism studies, it is reasonable to expect for you to think this is a valid comparison.

    2. “Imagine you have a population that drinks Mountain Dew, Five Hour Energy, expresso, Jolt, and Rock Star energy drinks. Now compare that population that drinks Mountain Dew, Five Hour Energy, expresso, Jolt, but does not drink Rock Star and see if the groups are different for [choose your morbidity]. When we perform our comparison, does this tell us about what happens when people take energy drinks, or does it tell us what happens when people drink one less energy drink?”

      Man are you bad at writing, and framing a statistical problem. So we have five vectors for taking in a number of ingredients three might be considered of interest Caffeine, Taurine, B12. We choose an outcome…say MI, control for known biases and do a regression on each one and find out something about the likelihood that these intakes and their dose response relationship.

      Perhaps you meant to look at these as five distinct factors? Since you’re trying to model vaccines you might model each one as distinct. I don’t know really what you’re on about so it’s hard to say how to properly model this so you can talk about whatever bee is in your bonnet.

      1. Man are you bad at writing, and framing a statistical problem.

        First, horrible, but now I’m just ‘bad’. At least I’m getting better!

        So we have five vectors for taking in a number of ingredients three might be considered of interest Caffeine, Taurine, B12. . We choose an outcome…say MI, control for known biases and do a regression on each one and find out something about the likelihood that these intakes and their dose response relationship.

        The issue is, all of those vectors have a largely similar effect; likewise, with vaccination, all of them share a common effect of stimulating the innate immune system. That’s why they work.

        It isn’t about the ingredients, it is about the pathways that get stimulated, and these are common among vaccines of all types. There are individual differences of course depending on pathogen recognition classification and other factors, but for broad purposes, I think (?) we can agree all vaccines work by stimulating the innate immune system, which is the first step to generating immunological memory.

        Now, with your excellent writing skills and ability to frame statistical problems, maybe you could explain to a simple drone how to detangle the effect of stimulating the immune system, or *not* stimulating the immune system without including a population that didn’t get vaccinated?

        Which vaccines do *not* stimulate an innate immune response?

        Perhaps you meant to look at these as five distinct factors? Since you’re trying to model vaccines you might model each one as distinct. I don’t know really what you’re on about so it’s hard to say how to properly model this so you can talk about whatever bee is in your bonnet.,

        If the mechanism of action is stimulation of the immune system during early life, then we need to analyze the process of stimulating the immune system in early life. If the relevant literature towards this indicates the existence of time dependent effects, then we must model for this as well. For a review of the literature in this regard you can try PMID: 22982535 or 21045175.

  19. pmoran2013 says:

    “Let’s just put it this way. Antivaccinationists will accuse us of double standards whatever we do, just as they will accuse us of being pharma shills whatever we do. There’s nothing we can do about it except to be consistent and not to take pharma money. And we are consistent, your “perception” otherwise notwithstanding”

    It’s not MY “perception”. Did I not make that clear? I have simply laid out some of the reasons why at this point in medical history it is to be expected that there will be some abreaction and anxiety concerning “all those vaccines”.

    Attacking what Callicale calls “ridiculous claims” may be fun, easier, and a source of pleasurable frisson for both speaker and listener, but it may also be peripheral to the main game, even a waste of time if our message, demeanour and language is not (also?) tuned to these other influences.

    The public knows that extremists and kooks are attracted to any cause so that a brief dismissal of the silly claims with a minimum of ad hominem or psychiatric analysis of the claimants, as per Harriet’s recent post on HPV vaccines is probably all they should merit. Giving ridiculous claims too much of an airing may well be counterproductive, making them look as though they are worthy of detailed rebuttal.

    1. Andrey Pavlov says:

      You have zero evidence to support your claims Peter. And plenty to demonstrate that indeed, they are likely unfounded concerns.

      Prime example is the rise of the “New Atheism” and the increased secularization of the world, including the US, and the definitive pushback against the church by my generation and younger. Dawkins, Hitchens, Harris, Coyne, Myers, and many others have been constantly beleaguered by tone trolls like yourself from both sides – including many otherwise atheistic secularists who claim that such “ardent” or “militant” atheism is undoubtedly a turn off and doesn’t promote the cause nor spread the good ideas of secular thought. And yet they keep selling millions, traveling around the world to speak, and the “rise of the nones” continues steadily unabated by such tone trolling. And believe me, the religious have at least as much vested in their pseudoscience as do the sCAMsters and anti-vaxxers.

      The beauty of it is that other means of spreading the same word are not stifled and you have the much kinder and gentler spirits like Dan Barker and Jerry DeWitt still able to appeal to their audience.

      So once again, your chief complaint is that you don’t like the particular style here. Well, then don’t read it. Many who are turned off by Dawkins have found that Barker speaks much more to them. People turned off by Gorski have others to read.

      But this incessant tone trolling and annoyance that a blog of which you are not a part doesn’t run and write the way you like it is getting pretty old. I’m certain Dr. Gorski et al value the input and the comments… but we’ve heard them already. Point noted, rebutted, and agreed to disagree on.

      (sorry if I am speaking for you too much Dr. Gorski feel free to disagree)

  20. pmoran2013 says:

    “You have zero evidence to support your claims Peter.”

    What claims, Andrey? That societal anxieties about vaccines may not be being addressed very smartly? As evidence that this may be so, I tender the fact that vaccination rates are declining in my country to potentially worrying levels.

    “And plenty to demonstrate that indeed, they are likely unfounded concerns.”

    Public concerns are only “likely” to be unfounded? I have stated outright above that I support the present vaccine program. If you think, too, that that is merely “likely” to be valid then you may be closer to my view than that of Dr Gorski, who talks as though there are no grounds for anyone to have doubts and expresses great exasperation whenever they do.

    Andrey, your response was sloppy and patronising to someone who has been defending vaccines since you were in short pants. But you are young, at least in medicine.

    If I can be so presumptuous as to return your well-meant(?) advice, be wary of that sense of utter righteousness that being “on the side of science” can inspire. It is one of the things that can repel those we wish to take heed of our advice.

    Good science is cautious and I think the public has its own good reasons to insist upon that from us in this matter.

    1. Andrey Pavlov says:

      Yes, I’ll agree it was somewhat sloppily written as it was done in haste.

      However, not so sloppy as to justify your complete misunderstanding of what I wrote, especially in context of the comment I was replying to.

      What you have zero evidence of it that our tack here doesn’t work or is counterproductive. That should have been abundantly clear from my example of the New Atheist movement comparing Hitchens and DeWitt. You even manage to correctly address my first sentence, but then somehow think my very next sentence in the same short paragraph completely changes focus! Why on earth would I go from talking about your concerns about our tone here and then in the very next sentence, which clearly expounds on the first, go to talking about the general public concerns of vaccines?

      So I won’t even address your second paragraph since it is completely off topic.

      As evidence that this may be so, I tender the fact that vaccination rates are declining in my country to potentially worrying levels.

      You proffer something which at best can only be an association and not even a temporal one at that? That’s a pretty poor offering. Perhaps you don’t realize how many steps are missing and how many confounders there are in the assertion that “nasty tones (as I define them) are either leading to decreased vaccination uptake or failing to increase vaccination uptake.” Enough steps and confounders that it would be worth writing extensively about. Which has been done and well documented right here. So I tender that as clear evidence that you are incorrect in your assertion.

      If I can be so presumptuous as to return your well-meant(?) advice, be wary of that sense of utter righteousness that being “on the side of science” can inspire. It is one of the things that can repel those we wish to take heed of our advice.

      Thanks for the advice. I’m well aware of it and stick to my tack because it suits me, I’m good at it, and it works. Maybe not for you and certainly not for everyone. But for a plenty large enough audience. And in my own reading and understanding and interactions I’ve found that the majority of those who would be put off were unreachable to begin with (which is a big point you are missing – many people are simply unreachable, regardless of whether they are approached by nasty ol’ me or sweet and kind Peter Moran).

      But the real point of my post stands:

      Your only true commentary is that of tone troll. You don’t like the tone and think it does more harm than good. Noted. Everyone here has noted that over and over because that is all you have to say on the topic. And have not managed to really change any minds. And yet, somehow, SBM keeps growing in popularity and the editors here get invited to do TV interviews, and are publishing books, and expanding into other media. Clearly, the hallmarks of failure due to our nasty tone.

  21. pmoran2013 says:

    Since once again I am to be dismissed as a “tone troll”, in yet another round of juvenile name-calling, I feel I am entitled to an equally demeaning term for detractors (while freely admitting that my own poor attempts at conveying subtle and slightly novel ideas may be a problem).

    I am inclined towards “the SBM chorus”. It hints at the matters that occasionally stir me up: excessive preaching (and preening?) to the choir rather than thoughtful dialogue with the more needful, off-centre, unnecessarily divisive perceptions regarding the motives and concerns of others, retaining their currency through the frequent rehearsal, and their general cosiness, rather than any close correspondence to reality or to any sound purpose. Then there is the tendency to tribal defensiveness, a reflex circling of the wagons whenever there seems a threat to accepted wisdoms or to otherwise admirable persons. .

    I know these are normal human tendencies that we mostly let pass. I do ask myself if it is my mind that has simply become a little warped with age. All I can think of right now is that I may be unusually sensitive to anything that smacks of hubris, for I think this trait of my generation of doctors and medical scientists has contributed to some of the problems we now face. It is not likely to be part of the solution.

    Andrey, I tacitly accepted that you may be right that many different approaches are desirable.

    What I cannot abide is ones that will almost certainly be unhelpful, like the subtexts within Dr Gorski’s headline and elsewhere. Anyone not firmly entrenched in “the SBM chorus”, and therefore already oblivious to the fragile nature of some of its tribal constructs ( i.e. the “straw men” so mercilessly attacked in others), will have questions like these bubbling away in their minds : ” Who are you talking to, when, first up, you imply that persons wanting more reassurance about vaccine safety have some other, unworthy, agenda? Will this not be a startling presumption to a person actually seeking such reassurance from this site? How will it establish rapport, reassuring that here is the place where all the evidence will be looked at without fear or favour? ” And worse, “If this is a symptom of propagandist intent, how can we go on to trust any studies you might refer to? ”

    I know it is difficult for those present to see what I am getting at. Another example of the same tendency is when Steve Novella regularly implies an underhand agenda behind efforts to have integrative medicine established in academia and hospitals. I am sure that a lot of CAM practitioners’ eyes light up at the prospect of greater prestige and income but they also, mostly, do believe that they have something to offer. They would be stupid to pursue such a course if they didn’t. We on SBM may be sure that their beliefs are mostly due to illusion, or offering an unaffordable level of luxury, non-specific patient nurture, but it is obvious enough to outsiders that we have a somewhat warped perception and they may be right to wonder how trustworthy we are in other respects.

    (There is a comparable mixture of motives when the medical profession insists upon “fee-for-service” income arrangements in the interests of being able to provide better patient care. )

    1. Jay Gordon says:

      I wrote a long literate post and it did not make it through. I’ll stick with the small (semi-literate) post below and hope . . .

      @pmoran2013

      Like Bill O’Reilly, Agnes Moorehead, Gretchen Carlson, Steve Doocy (“Fox and Friends) Melissa McCarthy and others, David Gorski plays a role designed to generate traffic and controversy.

      By golly, he knows what he’s doing and has helped these two sites into heavily hit places.

      He’s a “curmudgeon!” A fierce critical “scientist!”

      I’ll bet he’s really a well-educated highly intelligent doctor with excellent writing skills. A smart man who loves his family and his dogs.

      He plays the part of a “rabble-rousing, woo-bashing extremist” better than any “scientist” on the Internet. I have never been lucky enough to see him present at skeptic conferences, but I’ll guess that he performs the same role with equal talent and aplomb.

      Can you actually imagine him acting this way in real life with his colleagues?? I can’t.

      Yes, you can quote mine plenty of foolish and out-dated things I’ve said (“don’t vaccinate, just stop eating cheese” “it’s formaldehyde!” and much, much more) but all that means is that there are days I should stay away from keyboard and opinions which need factual correction by the team here. I actually dismantled most of my website because it couldn’t stand up to the scientific scrutiny of a few RI/SBM people I respect.

      If I were a better actor or a better writer, I could posture, bluster, curse and write screeds but I really just say here what I’d say to people face to face. It’s the only thing that works for me.

      I come here and to RI because among all the tone trolling, bashing and other unpleasantness there’s a helluva lot of real science. Bias and occasional lack of logic, but lots of good stuff, too.

      I’m an easy target. Enjoy.

      Jay

      1. David Gorski says:

        Gee, likening me to Bill O’Reilly? Really, Dr. Jay, if I didn’t know better, I’d think you’re trying to get a rise out of me. :-)

        Of course, this quote by you is silly:

        Can you actually imagine him acting this way in real life with his colleagues?? I can’t.

        No, and why would I?

        Dr. Jay appears unable to comprehend that different situations and different media require different methods and styles of communications. (Actually, Dr. Moran appears unable to comprehend this as well.) Either that, or Dr. Jay is being obtuse. No doubt he envisions me ranting against vaccines and quackery to patients, which I of course do not do. Wow, Dr. Jay! You got me there! I don’t actually rant about cancer quackery to patients who bring up, say, Dr. Burzynski or the Gerson protocol to me, even though I do get quite “insolent” about them right here on this very blog. Good going, Dr. Jay.

        Similarly, I wouldn’t be the skeptical blogging powerhouse that I am today if I wrote the way I speak with patients. To Dr. Jay (and, I suspect, Dr. Moran as well), this is evidence that it’s all an “act.” However, I also note that I wouldn’t get anything published in the scientific literature if I tried to write my manuscripts for the peer-reviewed literature the same way I write my blog posts. It’s different styles for different venues, nothing more.

        Yes, you can quote mine plenty of foolish and out-dated things I’ve said (“don’t vaccinate, just stop eating cheese” “it’s formaldehyde!” and much, much more) but all that means is that there are days I should stay away from keyboard and opinions which need factual correction by the team here. I actually dismantled most of my website because it couldn’t stand up to the scientific scrutiny of a few RI/SBM people I respect.

        This is appears to be Dr. Jay disavowing his previous positions without actually disavowing his previous positions.

        1. windriven says:

          Dr. Gordon:

          “[Gorski] plays the part of a “rabble-rousing, woo-bashing extremist” better than any “scientist” on the Internet.”

          ” I actually dismantled most of my website because it couldn’t stand up to the scientific scrutiny of a few RI/SBM people I respect.”

          Dr. Gorski:

          “This is appears to be Dr. Jay disavowing his previous positions without actually disavowing his previous positions.”

          I took his comments slightly differently. In my view Gordon is tacitly admitting doing what he accuses you of doing: writing inflammatory prose that doesn’t withstand the light of day. Therefore he has had to ‘dismantle most of [his] website. Curiously enough, you haven’t had to dismantle yours.

          Words matter. Some people live to eat theirs. Others, not so much. Good work, David.

          1. David Gorski says:

            You could be right, but, having dealt with Dr. Jay since 2005, I think I know his behavior pretty well. I think he realizes that many of those quotes I cited are ridiculous and scientifically unsupportable, but he can’t directly disavow them because it would risk damaging his popularity among the affluent southern California vaccine-averse parents of his patients and the antivaccine groups who publicize him and invite him to speaking engagements. I rather suspect that the above is the closest we’ll ever see Dr. Jay come to directly admitting that certain vaccine ingredients he attacked before are not dangerous and that vaccines don’t cause autism.

    2. windriven says:

      Peter, I hope you will take Dr. Gorski up on his offer (below). I disagree with a good deal of what I see as your making excuses for sCAMsters. But your concerns that we may alienate some who are trying to find their way to the truth do resonate with me. I am not quite sure how to reconcile the two thoughts and I’m sure there are many readers here with similar dissonances. A careful elucidation of your position might help a lot of us to develop a more nuanced approach.

      ” I am sure that a lot of CAM practitioners’ eyes light up at the prospect of greater prestige and income but they also, mostly, do believe that they have something to offer. ”

      You see, this is one of the things I choke on. That some sCAMsters believe that what they do helps is immaterial; they add expense to health care and their delusions sometimes makes things worse. Moreover, their embrace by physicians, hospitals and medical schools sends a corrosive and very dangerous message. I am sure that I am among the fringe here but in my opinion medical professionals who promote things like homeopathy and reiki are perpetrating fraud and malpractice and should have their licenses suspended. This is not an issue of academic freedom. Physician licensure is an issue of quality control.

    3. lilady says:

      Dr. Moran: If you don’t want to be “dismissed as a tone troll”…then stop your tone trolling behaviors.

      We had this conversation a year ago, when you and I were engaged in a discussion of the techniques we use to reassure parents who have valid concerns about vaccines. I and other posters stated then, that those bloggers on those notorious anti-vaccine websites and their followers are beyond reaching. They, in fact, are dedicated to the destruction of our preventive health public health system and they will stop at nothing, to accomplish their aim of scaring parents away from vaccinating their children.

      http://www.sciencebasedmedicine.org/battling-antivaccinationists-at-freedomfest/

      So, we doctors and nurses in public health who actually speak to parents about their concerns, joined by tens of thousands of pediatricians and family practice doctors endeavor to provide accurate and current information about each childhood vaccine, the efficacy of vaccines, the importance of timely and complete immunizations and the safety of vaccines…including the fact that every study that has been completed and published in reliable science and medical journals, has failed to find any link between vaccines and the onset of ASDs…or any other disorder.

      We also provide accurate information through face-to-face and telephone contact and in the form of parent-friendly printed material about the common side effects; pain at the injection site, mild/moderate fevers and occasional febrile seizures…in addition to the exceeding rare (on the order of 1:1000,000 per dose) serious adverse event. During my tenure at a County health department, I spent hours on the phone speaking with dozens of parents each week.

      Last year you brought up a “hypothetical parent” with a “hypothetical infant” who had experienced a febrile seizure following a vaccination. When the “hypothetical parent” approached you and voiced concerns about lasting neurological impairments related to that febrile seizure, rather than state “I look into febrile seizures” or “I don’t know, but I’ll ask a neurology colleague”, you, unbelievably stated that you couldn’t/wouldn’t reassure the parent that a febrile seizure is benign and has no impact on a child’s neurological development.

      When I commented that febrile seizures, which may be frightening for a parent to observe, are benign, you got quite dismissive of me. I asked you for a link to a study that proved me wrong and you declined to provide that study.

      During our online discussion last year (open the link I provided, and scroll down), you proceeding to discuss Dr. Gorski’s blogging “tone, method, phraseology” and declared it to be uncivil and a turn-off to parents, whereupon I and other posters informed you that you simply are unaware of the activities of these anti-vaccine groups and that we are not trying to reach out to them, not trying to reach a happy middle ground with them and…certainly not trying to build bridges to reach across the long standing, ever deepening chasm that exists between them and us.

      You still believe that you are the arbiter of good taste, civility and how the bloggers blog on Science Based Medicine. You aren’t. Harriet Hall and I both suggested that you submit an article on vaccines and the anti-vaccine movement, to be considered for a guest blogger spot. You haven’t.

      Speaking for myself, until and unless you put yourself “out there” as a guest blogger or start posting about vaccines and the serious, sometimes deadly, diseases they prevent, I will consider your activities as a form of tone trolling.

      1. pmoran2013 says:

        Lilady, I had a quick look at the previous discussion, in which you said –

        “they will stop at nothing until they destroy our public health system.”

        This reflects the kind of over-the-top demonization that I am suggesting may be counterproductive. It can make us look silly.

        At that time, also, I was trying to point out that where people have reasonable concerns, such as that a treatment that was able to cause febrile convulsions might be suspected of sometimes capable of precipitating other neurological damage, they should be acknowledged as reasonable, and dealt with directly without impatience or exasperation.

        Not knowing me from a bar of soap, which you still don’t, perhaps largely through my own incompetent communication skills, you chose to take me as fiercely advocating such a theory myself and challenged me to present evidence for it. You also presented some studies suggesting that febrile convulsions are normally benign. which of course, any doctor already knows. That probably also applies to those caused by vaccines. So hopefully that will be enough for most of those thinking along those lines.

        I am not sure what else to say to you that I have not already said above..

        You also challenge me to present a piece that clarifies my personal approach to vaccines issues. I can probably do that in a few words. It would begin with this: “I can understand why some might have concerns about vaccines — ” and it might go on to list the matters that I referred to in my first post above.

        It would go on in the same temperate vein. We don’t win trust with paranoia. We might win it with dignity, with understated confidence in our positions, with careful consideration of what is in other minds, not what is buzzing around in our own.

      2. pmoran2013 says:

        So it’s not possible to adopt a “hard line” on vaccines without using a deceptive and lumpen, and thus unethical and unscientific characterisation of the opposition”?

        What even is a “hard line”? Do you mean one that tends to overstates the strength of our evidence? Will not the tiniest hint of that not spook further the kind of people we most hope to influence?

        The fact is that these matters have never been given much thought. have they? It has always been more satisfying, indeed self-indulgent, to let our righteous indignation at anti-vax extremists allow them to feature in the centre stage of our deliberations rather than marginalising them to their rightful place as a somewhat kooky side-show.

        That is the way the more reasonable elements see them already. Meanwhile the source of THEIR uneasiness remains, unaddressed, if not inflamed further by the seeming disregard of what seems to them to be quite legitimate concerns. .

        Please think about these matters, and if nothing else try and eschew the more egregious examples of attributing underhand and presumably evil intent where there is none, even when just hinted at by the choice of language.

        If the above is tone trolling, then so be it. I will wear the label proudly..
        .

        1. Andrey Pavlov says:

          So it’s not possible to adopt a “hard line” on vaccines without using a deceptive and lumpen, and thus unethical and unscientific characterisation of the opposition”?

          Style choice. And not at all unscientific nor mischaracterizing of the opposition. Unless you’d actually like to argue that point, which you haven’t.

          What even is a “hard line”? Do you mean one that tends to overstates the strength of our evidence?

          Once again, a point you merely state without any support. Demonstrate that we are overstepping the strength of evidence on vaccines. Merely stating it does not make it so. Though you often conveniently make the implicit assumption so you can go on tone trolling.

          Obviously, I would disagree with you that the strength of the evidence is overstated. In fact, when it comes to vaccines, there is little else in the medical world so strongly supported.

          The fact is that these matters have never been given much thought. have they?

          Oh no, Dr. Moran. After your tone trolling for ages, I can assure you everyone here has indeed given it much thought. It has just been decided that you are off base. Don’t confuse our disagreement with your thoughts as not having thought about them.

          Meanwhile the source of THEIR uneasiness remains, unaddressed, if not inflamed further by the seeming disregard of what seems to them to be quite legitimate concerns

          And once again, we are not addressing them. You are lumping together everyone who has ever had a question about vaccines with the nutters that are the actual target and assuming them to be the same audience. As I’ve said before – that audience is being vied for by the nutters as well. Sitting in silence doesn’t help us win the audience – it gives free reign for the nutters to do so.

          Please think about these matters, and if nothing else try and eschew the more egregious examples of attributing underhand and presumably evil intent where there is none, even when just hinted at by the choice of language.

          And here is where your fundamental premise is wrong. So instead of patronizing us trying to whinge for the umpteenth billion time that we “aren’t listening to you” why not try and actually read the thesis of Dr. Gorski et al’s work and realize that indeed, when it comes to the anti-vax folks, the ones who are the actual and explicit subject of these writings, they are full of evil intent to get rid of vaccines at all costs and regardless of any evidence. Until you realize that is the people who we are speaking of, then the rest of your argument completely fails since it hinges on this premise. One which you have, as I have said before, gotten wrong.

          1. David Gorski says:

            Style choice. And not at all unscientific nor mischaracterizing of the opposition. Unless you’d actually like to argue that point, which you haven’t.

            Yes, I would very much like to see Peter make that argument. Thus far, he has merely argued by assertion. He has not provided one whit of evidence to show that I have in any way been unscientific or mischaracterized the opposition. Seriously, Peter. Put up or shut up. Prove it. You can’t, and I could easily provide scads of evidence to show you that I am not being unscientific, nor am I “mischaracterizing” the opposition. I wouldn’t even have to break a sweat or spend too much time on it, because I’ve done it all before many times over the last eight years.

            Not that you would pay attention. I rather suspect you’d simply blithely wave away the evidence dismissively because you “know” I’m a big meanie who is Doing It Wrong.

        2. Andrey Pavlov says:

          Andrey, I don’t believe it is “hopelessly naïve”: to point out that by tuning one’s approach to the mouthings of antivax extremists you are relinquishing to them the centre stage in the vaccine debate, and more control over it than they deserve

          That is indeed a fair point. One that would be valid if it were correct to assume that ignoring them would leave them to wither and die, or at least become so fringe as to be rendered essentially neuter. The reality of it is that this is not the case. They are consistently and constantly trying to improve and spread their message, get bills passed, influence the minds of famous and influential people, and ultimately use scare tactics and propaganda to sway the audience you are referring to (the one we aren’t actually writing about) away from vaccines. In case you missed it they even tried to get ads put onto airlines and in NY city’s Times Square.

          So yes, on face I agree with you. And indeed I think there exists the possibility we could be wrong here. But the preponderance of evidence and history demonstrate to us that looking the other way merely lets them gain ground.

          Meanwhile, those with more reasonable concerns may be being neglected

          By SBM? Yes, perhaps. You seem to hint at realizing that they are indeed not the target audience of these posts. Yet your writing and thinking is continually sloppy enough to seamlessly switch between the two concepts in order to continue with your tone trollery.

          But that audience is not the niche that SBM is going for. So once again, you are left with nothing but a whinge that the site does not do what you want it to do. Fine. Then don’t read it.

          But that is how the plurality of voices works. Paul Offitt writes editorials in the NYT. The local pediatrician advises parents. The CDC puts out dry yet sanguine statements of pure fact with no editorializing. We point out how nutty the nutters are and why nobody should listen to them or give them the time of day.

          I am also held to be naïve when crediting many or most CAM practitioners with firm belief in what they do. Has it escaped people’s notice that the history of medicine consists almost entirely of false but honest convictions of treatment efficacy, even within our own ranks, and even quite regularly in very recent times?

          Dr. Moran, my example of me bloodletting my patients comes to mind. And really, any practice in medicine that is not supported by evidence. We come down just as hard on our own and in fact condemn them even more because they should know better (such as Dr. Oz! have you not noticed how hard we come down on him?). I spend most of my in person time not arguing about CAM with colleagues, but arguing why administering blood to my patient is not evidence based and makes no sense. Yes, this particular blog focuses more on CAM than accepted medical practices that are false (though indeed, it does focus on that as well!). But once again, your complaint is what the site isn’t not that what it is is actually bad. Trust me, I can speak for myself but I think others would agree, that I have just as much (if not more) disdain for fellow physicians who practice sloppy and lazy medicine and do not abandon practices which have been shown to be bad and harmful. In fact, my own focus of research has been quality assurance and comparative effectiveness because of that interest!

          Mine is not an extraordinary contention. This is why it is unfair, deceptive and inconsistent with the standards of good science to act as though CAM practitioners are, virtually by definition, acting in bad faith.

          And here is yet another example of your seamless blending of ideas to keep blathering on. This post – and this discussion – is about anti-vax nutters. Not CAM. Yet it is convenient to paint it all with one brush to continue your indiscriminate tone trolling. Normally I would let such a thing slide, but it is indeed your standard modus operandi in these debates – to seamlessly switch your language and target from one thing to another without realizing or acknowledging the important distinction, all to maintain your high horse. I’ve called you out on this numerous times in great detail and it gets quite tiresome. But maybe one day you’ll listen. But first you’ll have to get over your old school surgeon ways and realize that even the saltiest of dogs can learn something from the pups from time to time.

          So I’ll close by saying that indeed, it matters not whether you are acting in good faith or not. That is the distinction between manslaughter and 1st degree murder, not between murder and no crime at all.

    4. Andrey Pavlov says:

      It seems to me that lilady, windriven, and Dr. Gorski himself have acquitted themselves pretty well as to why it is reasonable for you to be called a tone troll and why indeed it is reasonable to have much less tolerance of our well intentioned colleagues, but I can’t help addressing a few points directly.

      Firstly, an ad hominem in only a logical fallacy if it is used to distract from the argument. My claim is that tone trolling is your argument – not that your tone is poor and therefore your otherwise sound argument is bad. It is not an insult to say so – it is pointing out a fact; you don’t like the tone here. That is, by definition, a tone troll (well, the troll status is earned by consistently and incessantly commenting about tone, which you do).

      Of course, you’ve even been offered an option – to put up or shut up. Write a guest post! Instead of bloviating endlessly about how mean and nasty we are and why that is so, so bad… write a post about the topic, researched and referenced, and do it the “right” way. I’ll add, BTW, that most of Dr. Gorski’s posts do clearly state that he can understand concerns but that the anti-vax crowd is not espousing genuine concern. You realize that is his thesis in these posts, right? Not that it is unreasonable to have any concerns about vaccines at all, but that the anti-vax movement which includes the likes of Jenny McCarthy and the bills that are being pushed forward are not about genuine concern but about finding a way to dispose of vaccination altogether!

      This is precisely why Dr. Gorski states you are hopelessly naive on the topic. Pile after pile of evidence demonstrates his thesis and your only response is that he is too nasty. First disprove his thesis, if you disagree with it. Demonstrate that the groups and people he is discussing are actually rational, reasonable folks with merely a genuine and legitimate concern about vaccines who are simply misguided by emotion and thus not looking at the scientific evidence wholly and/or appropriately. Then you may indeed have a point. Dr. Gorski in no way targets those individuals and indeed has written many times how he sympathizes with them and realizes that such people are prone to misinformation by these anti-vax nutters who spread misinformation and propaganda. You’ve not only missed the boat but haven’t even arrived at the dock! It’s almost as if you haven’t even been reading the litany of posts on the topic demonstrating his thesis and his target.

      Will some of those folks with the genuine concern be put off and further driven into the arms of the nutters? No doubt. However, it is the opinion of Dr. Gorski – and one that I share – that it would be worse to be dispassionate and dry and that there is a need to actually dismantle these organizations and shame them into silence. The thing you don’t seem to understand is that people do not respond to dispassionate silence. This is why in “debates” between creationists and evolutionary scientists the creationists consistently seem to “win.” How can that be if they literally have zero evidence to support them? Because they are passionate and appeal to emotions and get a rise out of the audience. They have confidence in their speech and conviction in their conclusions. In a public dialogue, it is more important to seem certain than to actually be right.

      Let me repeat that since it is very important to the dialogue at hand.

      It is more important to seem right than to actually be right.

      Which is why science struggles. We understand that we should be cautious and always tentative. People don’t like that. They want certainty and definitive answers. Which is why CAM keeps gaining traction, why religion is still around, and why conspiracy theorists abound. Having a wishy washy post full of niceties and hedging does nothing except demonstrate to those already so inclined that clearly we don’t have the answer and “more research is needed.” That gives wiggle room for the butters to jump in and say “Aha! See! Even ‘the scientists’ don’t know for sure! Do you want your kid getting something we don’t know for sure? And look at how many [bad] studies show that maybe there is serious harm from it? And how about that autism?!”

      But of course, you’ll poo poo that because I am but a lowly medical student and so naive to medicine. Despite the fact that I have likely spent much more time engaged in conversation with those of a serious ideological bent and found, consistently, that it doesn’t matter the ideology the response and tack is always the same. My own undergraduate field of evolutionary biology is probably the only one with more vociferous denialism than vaccines. And I live in The South, by the way, where people kindly ask me “What did you do as an undergrad?” and when I respond “Evolutionary biology and medical anthropology” they kindly put their hand on my shoulder and say they are sorry for me, for being mislead my whole life. The similarities between CAM, religion, and political ideology are profound and deep. Only the topic changes. Which is why I am pretty confident that – at least as things stand today, not back when I was in short pants – such kindly wishy washy approaches are not the way to go. Will they be negative to our cause? Of course not. But they’ll barely register on the positive side of things. And if I am going to put in my time writing – same as Dr. Gorski – why would we waste our time being wishy washy?

      But as I also said, a chorus of many tacks is always better than a single one. So rather than continuing the tone trolling put your money where your mouth is, take all that effort writing comments, and start writing some guest posts!

      In other words, I am flat out saying you are wrong about your understanding of the approach and more importantly of Dr. Gorski’s fundamental thesis. Your premise is wrong and therefore all the subsequent logical steps derived from it are also wrong.

      Another example of the same tendency is when Steve Novella regularly implies an underhand agenda behind efforts to have integrative medicine established in academia and hospitals.

      Once again, that is the thesis. And one that is pretty damned well supported, including from my own personal anecdotes and those of my classmates and colleagues. The fact that you disagree with it demonstrates your naiveté rather than our wrongness.

      <blockquote.I am sure that a lot of CAM practitioners’ eyes light up at the prospect of greater prestige and income but they also, mostly, do believe that they have something to offer.

      Yes, there are true believers mislead by the leaders of CAM. I am also sure that the young missionaries who go to Africa and tell the starving people there to not use condoms and hand them a Bible instead of food also have their eyes light up with how much they are helping. And I am sure that the homeopath’s without borders that went to Haiti and gave out homeopathic cholera vaccines also had their eyes light up with how much they were helping.

      Can you imagine if I, as a medical doctor, started bleeding my patients because I genuinely believed it helped them? Would you look at how my eyes lit up thinking I was helping my patient and then be so kind to me as to dismiss it as my own genuine kindness? After you told me I was wrong, ever so kindly and gently, saying “Hey Andrey, have you thought that maybe bleeding your patients doesn’t actually help them? It seems to me that there is some evidence to the contrary. Perhaps you’d like to discuss it sometime?” and I responded, “No Peter, you are wrong. Just look at how much better my patients are! They tell me how much better they feel and I can just see their improvement. In fact, you should try it yourself! And we should teach it to other medical students. No, no, not as primary therapy, but as an adjunct, you know complimentary to “conventional” medicine.” Then what? Continue to bask in the twinkle of my eye as I falsely believe I am helping my patient? Perhaps you would like to maintain gentle civility and let a few more of my patients die or get harmed by my actions until I finally came around and realized the blunder I have made?

      Please.

      They would be stupid to pursue such a course if they didn’t.

      And now you are fundamentally wrong about the motivations for people’s actions. But this post has become long enough and you probably aren’t going to pay attention or listen anyways, so I feel less motivated to school you on how simplistically naive and uninformed your thoughts on what motivates and generates behaviors and beliefs in people actually is. But I can assure you that in many cases people will continue to do things that they know are wrong for myriad reasons other than avarice, greed, and psychopathy.

      There is a comparable mixture of motives when the medical profession insists upon “fee-for-service” income arrangements in the interests of being able to provide better patient care

      Oh, I agree here. And believe me am I unpopular amongst my colleagues when I broach that topic. But I also don’t shy away from it.

      1. windriven says:

        Nicely said, Andrey. I guess it comes down to what it always comes down to when an issue is debated but a resolution not universally adopted. Battle lines are drawn, sides are chosen and nuance can fall through the cracks. Sometimes the well-meaning find themselves on the wrong side of the line when the firing starts.

        I don’t know how we avoid that without diluting the message. As you aptly pointed out the sCAM leadership is neither nuanced nor benign. They have long since proven themselves immune to the arguments of logic, science and reason. So they draw heavy fire.

        I love the more collegial approach that Dr. Moran advocates. But I am unconvinced that we can adopt that approach in this struggle. The time for that seems long past. And I don’t think it is the science side that made it so.

  22. David Gorski says:

    Who are you talking to, when, first up, you imply that persons wanting more reassurance about vaccine safety have some other, unworthy, agenda?

    OK, this really, really, really demonstrates that you don’t know what the hell you’re talking about with respect to the antivaccine movement. As I have explained to you ad nauseam more times than I can remember, parents who “want reassurance about vaccines” are not what I’m talking about here. It is painfully obvious that you have never spent any significant time looking at what militant antivaccinationists, who are the people about whom I am talking, actually say and write. What they say and write is that vaccines definitely cause autism, SIDS, asthma, and a panoply of other health issues, that vaccines do not work, that they are evil. (I am not exaggerating.) Some of them say that vaccines are a plot to make people infertile; others state that there is nothing that will persuade them that vaccines are safe and effective. It’s not as though I haven’t provided copious examples over the years, both here and elsewhere. These people don’t want “reassurance” about vaccines. They want to get rid of them. That is their agenda.

    And, no, the proposed study is not designed to provide reassurance that vaccines are safe. They don’t want reassurance that vaccines are safe. They want reassurance that their fear of vaccines is justified, or, failing that, an equivocal study that keeps the issue alive. Useful idiots in Congress like Carolyn Maloney and Bill Posey are doing just that.

    Seriously, Peter. You really, really are naive on this issue, so naive as to be clueless.

    However, I repeat an offer that I have made several times but that you have never accepted. I will make it this time in the context of vaccines. Please, educate us with your vast wisdom. Write a guest post for SBM. Tell us exactly how it should be done. How do we combat the antivaccine movement using your “kinder, gentler” techniques? Give us specific tactics. Show us where we’re wrong. Show us the evidence. Only the hard core read the comments; so only a relatively small percentage of our readership are seeing your wisdom here. Write a guest post, and you’ll get thousands of people reading it. Here’s your big chance to show us how it’s done!

  23. lilady says:

    Test post.

  24. pmoran2013 says:

    David, you know full well through our mutual experiences on misc;health.alternative that I am quite au fait with anti-vax extremes.

    You KNOW I am not as naïve as you say, but you have an approach to defend, one that in effect tends to lump all those involved in the vaccine debate into an undifferentiated mass of unreasonableness if not malevolence, ignoring a probably dominant mass of people who simply don’t want to expose their healthy children to even potential risk for what to them may look to be uncertain personal gains.

    Hence your need to judge Jay Gordon and others by the silliest things they have ever said, so they fit into your “antivax” profile. Not good, this, if the silliness actually derives from the scientifically unsophisticated casting around for something on which to hang the vague uneasiness that I referred to in an earlier post, and which is then, through not being recognized, permitted to simmer on and on. Like CAM, antivax sentiment has little to do with science, but a lot to do with trust.

    Never mind that some of those caught up in your net, far from being “antivax” have fully vaccinated their children, but later come to worry that they may have harmed them thereby. They deserve whatever reassurance we can offer, so long as they are not being too obviously driven by litigation..

    Never mind too that those pushing for the present legislation are a far cry from the extreme. In the good old days and probably with varying degrees of conviction today, vaccines were held to not only to be totally ineffective, in which case of course there is no point at all in testing them for safety, they were also held to actually cause the very diseases they were intended to prevent! (Yes, I know such things still happen in darkest Africa, but really —– !)

    I have not at any point supported the performance of the suggested study. If it met certain standards it probably would support vaccine safety and help settle some nerves. It is arrogance to assume that our employers (the public) can never dictate what scientific studies are performed, but we have the right to expect our expert advice to be heeded in any decision making.

    Jay Gordon makes the point that you attract attention, and therefore help “the cause”. I am sympathetic to that, also to the fact that many “anti-vaxers” are not worthy of much respect, but must ask how deceptive, demonizing, characterizations of relatively moderate opponents fits in with the ethical and scientific standards that we otherwise place great store upon. My opinions obviously don’t carry much weight, but I would like this particular site to exemplify dispassionate and honest scientific inquiry.

    I have said my piece but should briefly answer others who have kindly read what I have said and responded.

    1. David Gorski says:

      David, you know full well through our mutual experiences on misc;health.alternative that I am quite au fait with anti-vax extremes

      Not “am,” Peter, “were,” and I’m not even sure about the “were.” Even then you were always mostly about the cancer quackery, and more power to you for it back then! Believe it or not, I emulated you. However, I don’t recall you engaging much with antivaccinationists, nor do I recall you taking much of an interest in their websites. Things have changed over the decade or so since our Usenet days, and the antivaccine groups gave gotten louder, nastier, and more pseudoscientific. No, Peter. You are out of touch with the antivaccine movement as it exists today. That much is quite obvious.

      Your days on Usenet do bring up something for me. Back then, you were almost as—shall we say?—militant about alternative medicine as I am now, at least when it came to cancer quackery. In fact, you appear still to be fairly militant about cancer quackery, albeit a bit more “polite” than I am. When I write about Burzynski, the Gerson protocol, and other blatant cancer quackery, you’re all over it. Ditto homeopathy, when someone like Nancy Malik shows up. You don’t seem overly concerned about possibly offending the poor, confused patients or parents in those cases. But antivaccine? Suddenly you’re all about not offending, as you have become with forms of CAM you view as harmless. Antivaccine quackery is not harmless, however. It’s very harmful. So one wonders about the difference in your approaches with respect to cancer quackery and homeopathy compared to, say, acupuncture and antivaccine pseudoscience.

      And, of course, one notes that you are certainly not above insulting the “SBM chorus” as mindless, dogmatic, and just plain mean, lacking the amazingly powerful empathy that you have in abundance.

      Before I forget, though: I’m asking again. Will you write that guest post that Harriet suggested last time and that I’m suggesting this time? Teach us how it’s done! Obviously our meanness and nastiness cry out for your empathetic wisdom. Who knows? Maybe we aren’t as dogmatic as you think and you can teach us something. But not if you don’t write that post.

  25. pmoran2013 says:

    Windriven: “That some sCAMsters believe that what they do helps is immaterial;”

    It depends upon the question. It is, I agree, not sufficient for most purposes.

    However, If it is obvious to the public and to our politicians that the practitioners are sincere, our not so subtle implications that they are merely trying to pull a fast one on everyone (“sCAMsters”) creates unwanted dissonance. It is not needed, when we can make a good case that there are probably, almost invariably, better uses of resources.

    It is probably another naivety of mine, but I also favour dialogue with misled health care “colleagues”. I badly want them to understand the limitations of what they do. Accusing them of fraud? No.

    1. windriven says:

      Peter, I do hope you’ll take Dr. Gorski up on his offer of a guest post. Your argument for collegiality resonates with me. But I do not believe it to be a winning strategy at this point. Frankly, I feel as if we’ve already all but lost the war and the most striking evidence of this is the integration of sCAM into hospitals and medical schools. This is, for me, deeply frightening. It is bad science. It is bad medicine. It is bad public policy. I can see absolutely no upside to the current state of affairs and damned little prospect of turning things around.

      These are the ilk that likened Steven Novella to a baby eater. So if David draws a Snidely Whiplash mustache on Jay Gordon’s family portrait I have a hard time getting worked up about it. But I’m open to be convinced.

  26. Andrey Pavlov says:

    Thank you for the kind words windriven.

    I do wish to clarify though that I also like Dr. Moran’s approach. I merely argue that it is not sufficient. And in fact, a plurality of approaches is indeed the best possible way. The more “strident” approach with less equivocating and quibbling niceties not only matches the approach of the sCAMsters and anti-vaxxers but serves to draw more attention. When our point of view is supported by those of a more gentle demeanor it strengthens both positions.

    As an example, surgery is quite well established in the art and form of the M&M conference (mortality and morbidity) wherein they examine errors in patient care and how to improve it. However, in my albeit limited experience they tend to be rather harsh and the residents presenting are often quite anxious and it can be indeed quite an anxiety provoking and harsh experience with senior staff often coming across very harshly. In other words, the epitome of what Dr. Moran dislikes. On the other hand the medicine service at my institution (and in general) is very new to the M&M process and their personalities are different. My experience has been that this leads to everyone being much too nice to each other and ultimately wasting more time than need be all in the effort to potentially spare someone’s feelings with constant caveats and equivocations. I think a middle ground is most productive.

    In other words, call a spade a spade and don’t quibble about it, yet be judicious in where one lays blame. We can all take many roles in many situations (something Dr. Moran doesn’t seem to grasp as a legitimate possibility) and it is important to work as a team, exploiting the talents of others.

    But one thing is certain – without drawing a hard line in the sand, nothing will be accomplished except volumes of never ending discussion whilst pseudoscience and sCAMs continue to proliferate like a cancer of bad thought.

    1. pmoran2013 says:

      Andrey, I don’t believe it is “hopelessly naïve”: to point out that by tuning one’s approach to the mouthings of antivax extremists you are relinquishing to them the centre stage in the vaccine debate, and more control over it than they deserve. They belong in a kooky sideshow, worthy of mention perhaps, preferably anonymously and only in passing, and dismissed with the fewest words possible. If people want anything more they can ask for it, but even most vaccine safety advocates already know to steer clear of extremists.

      In contrast, Dr Gorski has chosen to engage in verbal wars with people like Jake Crosby on this august, science-oriented site.. Who is being naïve?.

      Meanwhile, those with more reasonable concerns may be being neglected.

      I am also held to be naïve when crediting many or most CAM practitioners with firm belief in what they do. Has it escaped people’s notice that the history of medicine consists almost entirely of false but honest convictions of treatment efficacy, even within our own ranks, and even quite regularly in very recent times?

      This is the only reason why we have had to design an extraordinarily intricate and expensive system of clinical studies and even with those we can be sometimes misled.

      Mine is not an extraordinary contention. This is why it is unfair, deceptive and inconsistent with the standards of good science to act as though CAM practitioners are, virtually by definition, acting in bad faith.

      I agree with some of what you say.

      1. Andrey Pavlov says:

        So it’s not possible to adopt a “hard line” on vaccines without using a deceptive and lumpen, and thus unethical and unscientific characterisation of the opposition”?

        Style choice. And not at all unscientific nor mischaracterizing of the opposition. Unless you’d actually like to argue that point, which you haven’t.

        What even is a “hard line”? Do you mean one that tends to overstates the strength of our evidence?

        Once again, a point you merely state without any support. Demonstrate that we are overstepping the strength of evidence on vaccines. Merely stating it does not make it so. Though you often conveniently make the implicit assumption so you can go on tone trolling.

        Obviously, I would disagree with you that the strength of the evidence is overstated. In fact, when it comes to vaccines, there is little else in the medical world so strongly supported.

        The fact is that these matters have never been given much thought. have they?

        Oh no, Dr. Moran. After your tone trolling for ages, I can assure you everyone here has indeed given it much thought. It has just been decided that you are off base. Don’t confuse our disagreement with your thoughts as not having thought about them.

        Meanwhile the source of THEIR uneasiness remains, unaddressed, if not inflamed further by the seeming disregard of what seems to them to be quite legitimate concerns

        And once again, we are not addressing them. You are lumping together everyone who has ever had a question about vaccines with the nutters that are the actual target and assuming them to be the same audience. As I’ve said before – that audience is being vied for by the nutters as well. Sitting in silence doesn’t help us win the audience – it gives free reign for the nutters to do so.

        Please think about these matters, and if nothing else try and eschew the more egregious examples of attributing underhand and presumably evil intent where there is none, even when just hinted at by the choice of language.

        And here is where your fundamental premise is wrong. So instead of patronizing us trying to whinge for the umpteenth billion time that we “aren’t listening to you” why not try and actually read the thesis of Dr. Gorski et al’s work and realize that indeed, when it comes to the anti-vax folks, the ones who are the actual and explicit subject of these writings, they are full of evil intent to get rid of vaccines at all costs and regardless of any evidence. Until you realize that is the people who we are speaking of, then the rest of your argument completely fails since it hinges on this premise. One which you have, as I have said before, gotten wrong.

        1. David Gorski says:

          Peter seems to labor under the impression that I have not “thought about these matters” and that I do not “think about these matters.” I have. I have and do, a lot. He simply doesn’t like that I have not come to the same conclusion that he has and can’t believe that I haven’t.

          Whatever the reason Peter does it, telling the world that I “have not thought about these matters” allows him to dismiss me as not having the same deep understanding, empathy, and wisdom that he does.

          You’re quite correct. Being “polite” the way Peter wants us to be polite gives free reign to the hard core antivaccine fringe to frighten parents with tales of evil toxins that will “steal” their “true” child by making them autistic and to ply parents of autistic children with quack nostrums (i.e., “autism biomed”) to “recover” their “real” child from the demon autism. If Peter thinks I’m exaggerating, I’d be happy to introduce him to the antivaccine discussion forums and “autism biomed” forums.

          1. Andrey Pavlov says:

            I absolutely agree Dr. Gorski. Of course, Dr. Moran may view this as “circling the wagons” and tribalism, but the reality is that this stems from my own extensive conversations with him on various topics.

            He definitely seems to think that he has a much deeper empathy and more nuanced understanding of the matter that merely escapes us, but the reality is that he equivocates distinct populations, audiences, and ideas (seemingly) without realizing it in order to continue with his point – which, I may add, is a conclusion he has made and continually works hard to keep supporting that conclusion.

            He seems to ascribe to the school of thought that one must never make people uncomfortable or offend anyone, ever. It would certainly be nice if we could operate like that, but it doesn’t work that way in the real world. Something he should realize considering that the times I do get under his skin he retorts with the old-school authoritativeness of the hierarchy of medicine in which he is the seasoned attending and I am the mere medical student who was in diapers when he was doing this work back in the day.

            But the very fact that we – and particularly you – spend so much time engaging him in the comments should in and of itself dispel the ridiculous notion that we haven’t considered his viewpoints and comments. It’s just that they always boil down to “stop being such a big meanie because big meanies push away the people we should be helping.” Two points which are not substantiated.

          2. pmoran2013 says:

            David, your mischaracterisation of me as simply complaining about people being mean suggests that you have not given the least serious thought to what I am saying. Also the desire to discredit by other means than honest debate. Similarly Andrey is being unresponsive, either dodging the point or bluntly contradicting what I say, and I think my case is stronger than that.

            Do you stand by your apparent position that “anti-vax” activity and concerns stem from rather uniformly extremist minds and should be treated as such? .
            If so, I suggest that this is demonstrably wrong from an examination of the views being put about, and even commonly expressed in the comments here. Not only that, it irritates the hell out of less rabid “vaccine safety” elements, the ones that we might have some hope of influencing with more direct, dignified, and transparently honest recounting of the evidence relevant to their anxieties. That happens about once in a blue moon on SBM. If there are other sites that do that let’s make sure that we at minimum direct people to those whenever vaccine safety come up. (We could probably also use a vaccination specialist.)

            One of your ploys is to wonder what has gone so terribly wrong with me rather than consider what I say. May I suggest that what you don’t sufficiently appreciate is that what you read on extremist sites and discussion groups is accidently well-designed to confirm your bias towards “it’s all one” and (probably also) “everything would be OK if it weren’t for “them”" . It took me many years of talking to people and listening in on their discussions to realize that single issue discussion groups tend to become dominated by a vocal extreme (as, to a lesser extent, applies in the comments here, if a modest collection of moderately off-key perceptions on key matters can be regarded as an “extreme”.).

            It happens that there is always a quiet, listening-majority. They have more moderate, or less rigid opinions. They won’t speak up because they are less sure of their ground and expecting to be howled down by the core clique if they dare to. I allow that in consequence everyone tends to gravitate towards, or learns to be tolerant, of extremist attitudes, whether in reality fully embracing them or not. That happens on SBM, too, when people cannot see the flaws in common tropes, or choose to overlook them in order to be companiable, or, as apparently applies in the case of vaccines, for the sake of supposedly higher causes .

            Yet it is the waverers, these less rabid individuals, and the ultra-protective Mums of the general population, in other words the opposite extreme of “antivaxism” that we surely should have uppermost in our minds when talking about vaccines, in my humble but carefully considered opinion. That is where we need to prevail and have most chance of doing so. You commonly state that you have no hope of changing the minds of the extremists, so WhyTF are you spending so much of your time reacting to them? It is not clear whether doing so will have a positive or negative effect on those who might be persuaded by a different approach. At least consider the option of doing both. That would be good and you would do it well, if somewhat verbosely.

            I am also becoming more inclined to respond to the “put up or shut up” ploy, if you are sure you want this friction aired in more public ways. i don’t mean to be disruptive. I want to stimulate thought.

            BTW Quackwatch, was/is an example of how a hard line can be adopted on many matters with a minimum of snark, ad hominem, straw men or other dubious debating ploys. Dr Barrett has always tried to stick stuck strictly to the factual.

            1. Andrey Pavlov says:

              It happens that there is always a quiet, listening-majority. They have more moderate, or less rigid opinions.

              You say this as if I personally and Dr. Gorski as well haven’t explicitly said so as well. This is not news to us, but in fact something we are quite aware of.

              The difference seems to be that you think if we quiet ourselves in regards to the extreme, that magically that quiet listening majority will suddenly stop listening to the extremists and start hearing our silence for positive effect.

              Yet it is the waverers, these less rabid individuals, and the ultra-protective Mums of the general population, in other words the opposite extreme of “antivaxism” that we surely should have uppermost in our minds when talking about vaccines, in my humble but carefully considered opinion.

              Once again, your argument becomes “You should blog about what I want you to blog about.”

              Dr. Gorski blogs about the extremists – the large and vocal voice that pushes agendas – not the overly protective mums who could use a PSA. At first Dr. Gorski was too mean because (in your opinion) this was a PSA for the mums. Now you’ve changed tack again and decided that it isn’t but it should be.

              So either we are too mean or we aren’t writing about what you want to write about.

              You commonly state that you have no hope of changing the minds of the extremists, so WhyTF are you spending so much of your time reacting to them?

              Because they try and pass ridiculous bills through our government! They cannot be convinced, Dr. Moran, but they are not benign! As lilady pointed out some of them are working to get Masters degrees in Public Health! Dr. Gorski doesn’t just blog about every random utterance of the anti-vaxxers, he blogs when some specific a relevant thing comes up. Whether it be bills in congress, or when a child is murdered as a result of autism qauckery, an entire post exactly about being mean and lacking compassion, when a new study comes out addressing the very questions of the anti-vaxxers, and even about the “overly concerned mum” who thinks she gave her child autism.

              But as a side benefit, as I have said many times about my own writings on various topics (including a lot on evolution), the benefit is not to directly convince your true-believer opponent. That happens very, very rarely. The benefit is exactly for that middle ground to see the argument back and forth and be able to make the decision themselves. Could a few more people be convinced if there was less snark? Probably. Would a few less people be convinced if there wasn’t snark? Maybe. Is it up to Dr. Gorski to write how he wishes on his own blog? Or is it the role of Dr. Moran to tone and concern troll him endlessly because he doesn’t like how Dr. Gorski writes?

              As was said before, your comments have been noted and you simply don’t like that Dr. Gorski doesn’t agree with your conclusion. You are also under the false impression that your comments are anything more substantive than tone and concern trolling.

              It is not clear whether doing so will have a positive or negative effect on those who might be persuaded by a different approach.

              A bit of actual insight and honesty. Something we have been saying for a while, but I have been leaning towards the opposite conclusion from you and gave my reasons why.

              At least consider the option of doing both. That would be good and you would do it well, if somewhat verbosely.

              That is entirely up to Dr. Gorski. There is no requirement of him – legal, professional, ethical, or otherwise – to balance himself out to anyone’s satisfaction. It is not necessarily so easy to write in a different tone, you know.

              I am also becoming more inclined to respond to the “put up or shut up” ploy, if you are sure you want this friction aired in more public ways. i

              I don’t believe the point was to have you write a post about how mean Dr. Gorski is, but to write one on the same topic that meets your satisfaction as an example for us to learn from. Or, to balance out Dr. Gorski’s meanness, if you like.

              BTW Quackwatch, was/is an example of how a hard line can be adopted on many matters with a minimum of snark, ad hominem, straw men or other dubious debating ploys. Dr Barrett has always tried to stick stuck strictly to the factual.

              And it is linked on the SBM site and oft referenced in posts by many of the authors. SBM is not Quackwatch, nor need it be. The fact that Quackwatch exists is exactly my point from a few posts back about people who don’t like Dr. Gorski and his snark can go elsewhere.

              Or they can sit here and prattle endlessly about how mean he is and how much more SBM should be like Quackwatch.

              (Oh, and you don’t think it is mean to call the site Quackwatch? I’m sure that the practitioners of the quackeries it calls out would be offended to be called quacks since I don’t doubt that they practice with good intent, smiling at all the people they genuinely believe they are helping)

          3. David Gorski says:

            David, your mischaracterisation of me as simply complaining about people being mean suggests that you have not given the least serious thought to what I am saying. Also the desire to discredit by other means than honest debate.

            That is, of course, a straw man of what I have said, but it’s a convenient one. That’s a fairly small part of my complaint with you, but it suits you to elevate it to the top and make it the focus of everything I’ve said. Of course, you conveniently ignores all the other things I’ve said and documented about your clear lack of understanding of the antivaccine movement as it exists now, your own stridency that your own way is the only way such that you can’t help but incessantly lecture and badger those of us who disagree, your utter inability to support your position with evidence, and many other things I’ve pointed out. Clearly, it is you who haven’t given particularly serious thought to these issues.

            Do you stand by your apparent position that “anti-vax” activity and concerns stem from rather uniformly extremist minds and should be treated as such?

            Another straw man. Please point out where I have ever said that antivax activities stem from “uniformly extremist minds and should be treated as such”? I haven’t. Peter, you aren’t impressing me here.

            If so, I suggest that this is demonstrably wrong from an examination of the views being put about, and even commonly expressed in the comments here. Not only that, it irritates the hell out of less rabid “vaccine safety” elements, the ones that we might have some hope of influencing with more direct, dignified, and transparently honest recounting of the evidence relevant to their anxieties.

            I could recount examples where pointing out that something a parent was saying was straight off of an antivaccine website, but in your world, apparently that never works. Here’s the thing. You can’t demonstrate to me that your way works better, and I’ve never said we shouldn’t try multiple strategies. Quite the opposite! It is you who are saying that your way is the best way and damned those “militant” quackbusters! Except, of course, you used to be one, at least with respect to cancer quackery.

            One of your ploys is to wonder what has gone so terribly wrong with me rather than consider what I say. May I suggest that what you don’t sufficiently appreciate is that what you read on extremist sites and discussion groups is accidently well-designed to confirm your bias towards “it’s all one” and (probably also) “everything would be OK if it weren’t for “them”” . It took me many years of talking to people and listening in on their discussions to realize that single issue discussion groups tend to become dominated by a vocal extreme (as, to a lesser extent, applies in the comments here, if a modest collection of moderately off-key perceptions on key matters can be regarded as an “extreme”.).

            Do you think I’m unaware of this tendency? Seriously? You really must think even less of me than I think you do. Here’s the point you’re missing. It is these extremist, radical voices who are the leaders of the antivaccine movement and their most valued “troops.” It is they who form groups like Generation Rescue, The Canary Party, SafeMinds, The Thinking Moms’ Revolution, and the like, and go out to do everything within their power to spread the message that vaccines are dangerous and thereby plant the seeds of all the fears that are out there among the more reasonable parents. Have you ever heard of the Overton window? Look it up. It works on public opinion with respect to vaccines as well. It’s simple politics and human interaction. The extremists push the Overton window on vaccines further and further towards the antivaccine side, as extremists try to do in order to influence political debate. Remember, I’m talking politics here, not science. On the science, they lost long ago, but they hope to recover through influencing public opinion.

            You also seem blissfully unaware that these extremists are exactly the ones who hang out incessantly on Facebook and in “mommy” discussion groups, always ready to offer advice and opinion with respect to vaccines and try to persuade other moms with antivaccine views.

            It happens that there is always a quiet, listening-majority. They have more moderate, or less rigid opinions. They won’t speak up because they are less sure of their ground and expecting to be howled down by the core clique if they dare to. I allow that in consequence everyone tends to gravitate towards, or learns to be tolerant, of extremist attitudes, whether in reality fully embracing them or not.

            Jumping Jesus on a pogo stick, it’s not as though I haven’t said this time and time and time and time again right here on this very blog! Do you even actually read what I write, except when it provides you with an excuse to attack me

            I am also becoming more inclined to respond to the “put up or shut up” ploy, if you are sure you want this friction aired in more public ways. i don’t mean to be disruptive. I want to stimulate thought.

            SBM is all about disruption, or hadn’t you realized that? While we won’t publish something that’s obviously pro-quackery, almost anything goes when it comes to SBM. So, please, just do it. You might be surprised by the reaction.

            BTW Quackwatch, was/is an example of how a hard line can be adopted on many matters with a minimum of snark, ad hominem, straw men or other dubious debating ploys. Dr Barrett has always tried to stick stuck strictly to the factual.

            Quackwatch has a fair amount of references to “quackery,” and its very name is insulting—intentionally so. I’ve even discussed this with other supporters of SBM, namely whether “Quackwatch” is really the best name for such a site or not, because it’s too off-putting to the “moderate middle” who like a bit of CAM. It amuses me that in this you are more “strident” than I am.

          4. David Gorski says:

            Or is it the role of Dr. Moran to tone and concern troll him endlessly because he doesn’t like how Dr. Gorski writes?

            That does appear to be his role, unless he takes Harriet and me up on our offer. He might be surprised by the reaction of SBM readers. In the meantime, I’ve gotten used to Peter’s tone trolling, and it only occasionally annoys me the way it used to do. I guess this thread is one of those times. :-)

            The only thing that confuses me is why he persists. It should be clear to him that after at least three years of trying to convince me he has failed. It should also be equally clear that he’s highly unlikely to succeed now after so many failures to convince me. For my part, I’ve accepted that I’m not going to convince Peter and only tend to respond to what I perceive as his most egregious statements against me. Normally, when something like that happens, two reasonable people will just agree to disagree, something I would be fine with. Yet Peter doesn’t give up. That bespeaks a zealotry or stubbornness that is unusual. After all, I don’t try to persuade him that he should give up being nice and adopt my more “militant” tone. I live and let live. I don’t go picking fights with Peter; he goes picking fights with me over “tone.” Sometimes I respond. Sometimes I don’t. Same as it ever was, at least for the past three or four years…

            1. Andrey Pavlov says:

              Yeah, I’ve noticed that as well. Which is a point I’ve tried to make on this thread and he has blithely ignored. I mean, I even flat out said it – we get that he thinks we are mean and strident here. We disagree with the characterization, but more to the point we disagree that this warrants a change. And then he brings nothing new to the table except to admonish us that science is never certain and we shouldn’t be so starkly black and white. And so the endless cycle goes.

      2. Jay Gordon says:

        @windriven “These are the ilk that likened Steven Novella to a baby eater. So if David draws a Snidely Whiplash mustache on Jay Gordon’s family portrait I have a hard time getting worked up about it. But I’m open to be convinced.”

        I have no knowledge of Dr. Novella’s eating habits but I’d hope he’s an intelligent vegetarian. I would love to see a well done photo shopped Snively mustache on my photo.

        Most complementary medical practitioners practice in good faith and with good intent. Among them, and us “allopathic”–I hate that epithet!–doctors, there are probably more than a few who do the opposite.

        There are anti-vaccine extremists who are not worth reading and there are vaccine-side-effect deniers also not in touch with reality or VAERS. In between, believe it or not, sit you and I! (Will you shower to get that taint off?)

        1. David Gorski says:

          There are anti-vaccine extremists who are not worth reading

          Name one or two of them. I dare you.

          and there are vaccine-side-effect deniers also not in touch with reality or VAERS.

          Oh, really? Define “vaccine side-effect deniers” and name one or two.

        2. WilliamLawrenceUtridge says:

          Most bloodletters practiced with good intent as well, that doesn’t mean they cured their patients. There are right and wrong answers within medicine and we should use science to inform and decide, not assertions by patients that “mercury gave my baby autism”.

          Most proponents of vaccinations I am familiar with do not deny side effects. They correctly point out that there is little science to support serious side effects, and that despite decades of testing there is no good evidence to consider “autism” as a side effect.

          Your “fallacy of the golden mean” is showing again – you are pretending that there are two sides to the autism-vaccination debate. That may have been the case 30, 40 or 50 years ago, but after so much research, essentially none of which showed that vaccines are linked to autism despite incredibly high numbers (which would allow signal to rise out of the noise, even if it were tiny), the best results we have show no link (not quite true, one study suggested vaccines might protect against autism). At some point we should stop wasting the time and money, and at some point you should stop supporting your patients fears about vaccines and autism.

          1. pmoran2013 says:

            WLU: “Most bloodletters practiced with good intent as well, that doesn’t mean they cured their patients. There are right and wrong answers within medicine and we should use science to inform and decide, not assertions by patients that “mercury gave my baby autism”.”

            Exactly MY point. I have never said otherwise. But science covers ALL of reality, including the antivax phenomenon, and it tries to work out the best way to deal with practical problems. . Good science would not try to discredit anticipatable public anxieties (from the factors I have listed, and once first aroused by anything at all), by associating them with the unreasonableness and malevolence of antivax extremists. That is what I am protesting about.

            “Most proponents of vaccinatioam familiar with do not deny side effects. They correctly point out that there is little science to support serious side effects, and that despite decades of testing there is no good evidence to consider “autism” as a side effect.”

            Exactly also. “– no good evidence — .” conveys an openness to review of the matter if the evidence base shifts. Dr Novella’s statements convey the same. It is a far cry from Dr Gorski’s habitual outrage that any should even dare to even question the point once the Dr Gorskis of medical science have spoken. That might help reassure some of those who already want to trust us, but it may well spook further those who are not yet so sure. .

            WlU “Your “fallacy of the golden mean” is showing again – you are pretending that there are two sides to the autism-vaccination debate. That may have been the case 30, 40 or 50 years ago, but after so much research, essentially none of which showed that vaccines are linked to autism despite incredibly high numbers (which would allow signal to rise out of the noise, even if it were tiny), the best results we have show no link (not quite true, one study suggested vaccines might protect against autism). At some point we should stop wasting the time and money, and at some point you should stop supporting your patients fears about vaccines and autism.”

            In this you misrepresent my position, which exactly corresponds to your “no good evidence” statement. But look, never mind what is going on in my mind. Can no one see that I am trying to explain what we have to attend to in the minds of others, not those of the incorrigible fools and nutters, but mothers who want to be sure they can trust us with their children? IOW, let’s be having the science, and less self-indulgent rhetoric.

          2. David Gorski says:

            Exactly also. “– no good evidence — .” conveys an openness to review of the matter if the evidence base shifts. Dr Novella’s statements convey the same. It is a far cry from Dr Gorski’s habitual outrage that any should even dare to even question the point once the Dr Gorskis of medical science have spoken. That might help reassure some of those who already want to trust us, but it may well spook further those who are not yet so sure.

            Uh, no, Peter. All I’m asking you is to show me the evidence. If you do, and I find it compelling, I might change my mind. Somehow you never seem to do so. If we then have to rely on anecdote and experience in the absence of evidence, I would contend that mine is as valid as yours, perhaps more so given that it’s more recent.

  27. lilady says:

    @ Dr. Moran: I suggest you reread the link I provided up thread and the content of our last dialogue about Dr. Gorski’s blogging style. I provided you with several articles about febrile seizures, which you couldn’t/wouldn’t use to offer reassurances to your “hypothetical parent” about lasting neurological effects if a child has a febrile seizure following a vaccination. You, at that time, were very dismissive about my comments…yet you refused to pony up links to any case studies of children who had lasting neurological sequelae associated with a febrile seizure, following a recent immunization

    Long before there was an internet and when you were a young doctor who had not yet become a strong proponent of fighting CAM associated with cancer treatments, I was “out there” advocating for developmentally disabled children and adults.

    I retired as a public health nurse clinician-epidemiologist 8 years ago and have spoken at public meetings about vaccine safety and discussed vaccine safety issues with thousands of parents who have valid concerns about vaccines…in addition to my other activities of investigating individual cases, clusters and outbreaks of V-P-Ds on behalf of my employer, a large County health department (catchment area 1.2 million population). I’ve worked in the seven satellite clinics within that County health department and administered tens of thousands of vaccines to children and adults.

    Now, a smart doctor (or nurse), learns to read and learn from discussions that take place on science blogs, where their knowledge about a specific subject is nil. You haven’t learned that basic lesson about science blogs. To make up for your utter lack of knowledge about the activities of the anti-vaccine, anti-science groups who want to scare parents away from vaccines and undermine our public health system, you have embarked on a crusade to critique Dr. Gorski’s style, phraseology and tone. You are concern trolling and tone trolling and are indignant that your have been called out repeatedly for those behaviors.

    You stated…

    “In contrast, Dr Gorski has chosen to engage in verbal wars with people like Jake Crosby on this august, science-oriented site.. Who is being naïve?.”

    When was the last time Crosby commented on the SBM blog? IIRC, Crosby made a comment on the RI blog ~ one year ago…then quickly retreated when his ill-informed comment about Kanner’s regressive autism, was swiftly demolished.

    Have you seen Crosby’s posts on Age of Autism? Can you point me to any of his articles that are NOT sliming, libelous “hit jobs”? Can you point me to any of his posts on Age of Autism, that indicate he has basic knowledge about published research studies? You do know, don’t you, that Jake is enrolled in a MPH-Epidemiology & Statistics Program at George Washington University and has not graduated this year with his class?

    http://www.ageofautism.com/jake-crosby/

    Dr Gorski, unfortunately, announced on his other blog, that he would be attending and speaking at a skeptics meeting in Washington DC. It was too late for the “SBM Chorus” to attend, but Jake who attends school there, was “lurking” on the blog. It gave him the opportunity to personally stalk Dr. Gorski and blog about it.

    I strongly doubt that you are aware of the many scurrilous libelous articles that have been written about Dr. Paul Offit, by Crosby and these other irrational, dangerous bloggers. Dr. Offit has received threats on his life, in the mail and via telephone and has, at times, been escorted into public meetings with the protection of armed guards, because of these threats.

    A few months back, a short blurb appeared on the SBM blog, which announced Dr. Offit’s public seminar to be conducted at the Cold Spring Harbor Laboratory on June 8th for him to discuss alt/CAM medical treatments. With the knowledge of Jake’s lurking on blogs and his past history of targeting and stalking Dr. Offit at public meetings, I made arrangements to attend that seminar. I was ready to be a witness to the stalking and harassing of Dr. Offit by his personal stalker. If you were located in the area of Cold Spring Harbor Laboratory, would you have stood by my side to observe and report on this young man, who is, IMO, a dangerous anti-vaccine fanatic? I doubt it.

    1. pmoran2013 says:

      Lilady, That I know of Jake Crosby has never posted on this site but my recollection is that Dr Gorski devoted a post to talking about him at the time of the events you mention..

      IRRC I wrote privately to Dr Gorski at the time suggesting that he was giving him more media space than he deserved.

      I did so because, contrary to what you have chosen to believe, I was fully aware of Jake’s sad attempts at coming to grips with the science relevant to vaccines. Or is that you are suggesting that his personal attacks on Dr Gorski should be returned in kind? Even if were thought to be a good thing to take the attacks of such a person seriously , this might not be the best place for that, although i can sympathize with Dr Gorski’s impulse to respond somewhere..

      I am not sure otherwise what you want me to say. I apologize if I have not treated you with enough respect.

      1. David Gorski says:

        IRRC I wrote privately to Dr Gorski at the time suggesting that he was giving him more media space than he deserved.

        You did no such thing, as far as I remember.

        I did so because, contrary to what you have chosen to believe, I was fully aware of Jake’s sad attempts at coming to grips with the science relevant to vaccines. Or is that you are suggesting that his personal attacks on Dr Gorski should be returned in kind? Even if were thought to be a good thing to take the attacks of such a person seriously , this might not be the best place for that, although i can sympathize with Dr Gorski’s impulse to respond somewhere..

        You clearly have no knowledge of the history of my trying to guide Jake to a better path using the “kinder, gentler” methods you espouse back when I first became aware of him. It didn’t work. Big surprise there.

        1. pmoran2013 says:

          Here is an extract from the email that David has forgotten. It suggests that, contrary to his assertion, i was well acquainted with his dialogue with Jake Crosby. (dated 20th Oct 2010)

          “You don’t deserve this from Jake, David, although perhaps your disclaimer should have included something about the indirect association. (with the drug company == PJM)

          The tragedy is that thousands of words have now been expended on this barely-an-issue, with probably no end in sight to that any time soon, without a single bit of evidence in relation to an imputed autism-vaccine link being put forward. This is what I dislike about all kinds of discredit-the-man debate, no matter what it is based upon.

          Jake has even been able drawn attention to mercury in vaccines and a now well-refuted interpretation of Wakefield’s findings as though these were now well-accepted problems.”

  28. Jay Gordon says:

    At Hollywood Bowl seeing Willie Nelson. Posting here instead of Facebook, OK?
    Wish you all were here!

  29. Jay Gordon says:

    @Carl Waaaay up near the top with the avatar of a saltine … You know you’re quoting Ayn Rand, right??

    Wowie, Carl.

    And, Dave, I double dare you!

    1. windriven says:

      Re Carl and Ayn Rand: and your point? Rand had some incisive insights. So did Marx. The subtle mind is able to recognize the pearls and discard the dross.

      Come to think of it that is a valuable metaphor for the subject at hand. Science operates in exactly this way, examining a torrent of ideas and discarding all but the ones with value.

      1. Andrey Pavlov says:

        But it is so much easier to make a point using guilt by association rather than actual critical thought and insight

  30. Jay Gordon says:

    David Gorski
    August 10, 2013
    There are anti-vaccine extremists who are not worth reading

    Name one or two of them. I dare you.

    and there are vaccine-side-effect deniers also not in touch with reality or VAERS.

    Oh, really? Define “vaccine side-effect deniers” and name one or two

    I do not want to do that, David. I have no desire to offend the former group and the names in the latter group would be people here whose opinions I value when they talk about other subjects.

    Even the RI/SBM posters with the most strident
    anti-antivax opinions are well worth reading at other times.

    1. David Gorski says:

      I do not want to do that, David. I have no desire to offend the former group and the names in the latter group would be people here whose opinions I value when they talk about other subjects.

      And there we have it. That’s all I was trying to get out of you: An admission that you stay silent in the face of dangerous quackery and pseudoscience because you’re afraid of offending your bread and butter, the antivaccinationist and autism biomeddlers. Horror of horrors, he might even no longer be able to hang out with antivax Hollywood celebrities anymore if he were to criticize antivaccine viewpoints.

      You do realize, don’t you, that this doesn’t make you look very good. Either you believe in antivaccine quackery, and that’s why you won’t call out various antivaccinationists, or you no longer do but are afraid to risk offending them, likely because your livelihood as pediatrician to the stars’ children might be jeopardized. Or somewhere in between. Either way, it’s not great.

      Even the RI/SBM posters with the most strident
      anti-antivax opinions are well worth reading at other times.

      We’re made of sterner stuff than apparently your friends at Generation Rescue. We can take it. But, hey, throw me a bone. Define “vaccine injury denial” for me. Come on, Dr. Jay. It’s for me. :-)

    2. Todd W. says:

      Jay,

      You stay silent because you don’t want to offend? Here you are. You have an opportunity to say something, to help those people you view as “extremists” to take a moment for introspection and self-examination. If you say something, then, yes, they might be offended, but there’s also the possibility that they will think about what they are saying and temper their views.

      But I think the more important opportunity here is that if someone is spouting extreme, pseudo-scientific nonsense that has the potential to harm others, you have an obligation to say something, particularly as a health care professional. If you remain silent when it is pointed out to you, then you are, at best, condoning them and at worst lending tacit approval to what they say.

    3. David Gorski says:

      I do not want to do that, David. I have no desire to offend the former group and the names in the latter group would be people here whose opinions I value when they talk about other subjects.

      So does that mean you’d rather be saying things like this?

      Authorities Friday confirmed one case of the measles in Ventura County and some doctors are urging parents to have their children vaccinated against the potentially deadly disease.

      Dr. Paul Russell, acting Ventura County Public Health Officer, told CBS2′s Amy Johnson that there are four other possible cases of the measles along with the confirmed case.

      “There is a teenager who was exposed to another person with measles who had never been immunized against measles,” the doctor said. “Children need to be immunized.”

      But not all parents are following the doctor’s advice.

      Joel Shapiro, who has a four-month-old daughter, says he’s decided not to give his daughter the MMR vaccination until she turns four.

      His pediatrician, Dr. Jay Gordon, agrees with his decision.

      “I’m not just a proponent of letting parents choose. I’m a proponent of revising the current vaccine schedule. I think that we give too many vaccines to children too early in life. I think that we group vaccines together without being 100 percent certain of the safety of those groups, those combinations,” the doctor said.

      For those of you not familiar with southern California geography, Ventura County is the next county north on the coast of California from the L.A. area and Santa Monica, where Dr. Jay practices. The county seat, Ventura, is only around 45 or 50 miles from Santa Monica. So here we have a pediatrician supporting a parent not vaccinating his child even though there is a measles outbreak nearby in the next county. One also notes that Dr. Jay said this less than a month ago. I didn’t notice this particular article at the time it was published, but it’s hard to imagine a pediatrician being more irresponsible than that.

      1. lilady says:

        The comments from Dr. Gordon and the father of his four-month-old patient that I read on that CBS article were so bizarre, that I posted several comments. I first commented that a four-month-old infant is not eligible for a measles vaccine even if the child had face-to-face contact with the Ventura measles case. The infant should receive a IM gamma globulin shot. Knowing of Dr. Gordon’s history against the MMR vaccine (and every other childhood immunization), I also inquired if the infant had older siblings who were deliberately unimmunized against measles, but Dr. Gordon who is loathe to reply to me, did not reply.

        IIRC, I then asked if a CBS reporter could contact Dr. Gordon directly for clarification about his statement…and why Dr. Gordon found it necessary to have a parent of one of his patients speak with the reporter. I don’t believe that Dr. Gordon was ever contacted…or if he was…somehow the reporter did not add Dr. Gordon’s comments to the article.

  31. Science Mom says:

    @David The “middle ground” exists and includes those of us who are neither “anti-vaccine” nor in favor of the current manufacturing standards, incomplete safety studies and pseudoscientific administration schedule. Are you really saying there is not middle ground?

    As has been pointed out to you Dr. Jay, this is a logical fallacy. Let me use another application of your “middle ground” fallacy to demonstrate the absurdity. Should “middle grounders” adopt a vesica piscis as the most likely shape of the Earth in the argument between flat-earthers and rational people? Or how about our world’s governments being controlled by shape-shifting reptilian overlords? Is the middle ground position therefore only some of our world’s governments or would it be that the shape-shifting overlords are something other than reptilians?

    So yes Dr. Jay, we are saying that this issue has no middle ground because it is as absurd as my examples. You have constructed so many strawmen regarding a pro-vaccine position that it is no wonder you fancy yourself “taking the middle ground” and that such a position even logically exists. I for example am rather outspoken regarding the problems with flu vaccine effectiveness and policy; no one here accuses me of being an anti-vaxxer. It’s merely an extension of a pro-vaxx position. Safety and efficacy of vaccines are not perfect and we support valid studies and criticisms of these topics. Something you will never see from anti-vaxxers.

    This little dookie dropped by Dr. Jay dovetails in nicely with his previous quote:

    I do not want to do that, David. I have no desire to offend the former group and the names in the latter group would be people here whose opinions I value when they talk about other subjects.

    Even the RI/SBM posters with the most strident anti-antivax opinions are well worth reading at other times.

    This merely serves as an example of how untenable your position is. There is no reason why you can’t serve up some examples for your claim. But Dr. Gorski has the right of it…you don’t want to offend your bread and butter. Naming some examples would place you on one and only one fictitious side and you are too cowardly and too concerned with pandering to your base to do that.

  32. romanianteacher says:

    Can’t me make a large RCT on puppies or other beautiful,harmless creatures?
    Although,just between us,I think that seeing that in some countries is full of idiots that don’t vaccinate their children,soon enough they’ll have the proof of their folly.The sad, oh so sad proof.I have dear friends whom I cannot reach ,and it amazes me how they are so lazy that can’t learn some elementary rules about discovering the truth,but how I said,unfortunately the truth will come crushing in, and it won’t free them it will make them hopeless.

  33. pmoran2013 says:

    I have had great difficulty posting, and have not been able to respond to some matters outstanding —

    Firstly, If I reacted to every straw man of David’s, and other sly ways of dismissing me as an annoying, uncomprehending aberrance we would be here forever. Just one, perhaps. David finds straw men everywhere when it suits him. Equally unfair ones of own are either invisible to him or somehow justified in his own mind . .

    For example when I said :-

    “David, your mischaracterisation of me as simply complaining about people being mean suggests that you have not given the least serious thought to what I am saying. Also the desire to discredit by other means than honest debate.”

    He responded –

    “That is, of course, a straw man of what I have said, but it’s a convenient one –.”

    I am certain that David has on occasions used those exact words. He has certainly within the present thread said “Being “polite” the way Peter wants us to be polite –” in when trying to cement the support of others. What else does describing me as a tone troll convey? I think this kind of thing, especially the dismissive name-calling is unworthy of a science-based discussion group, no matter who you are talking to.

    To summarize our positions, David now seems to accept that we are required to deal with a less homogenous collection of “antivax” minds than shows up in his writings and those of others. The most obvious divide is, of course, between those who claim to more or less support vaccination but are not sure that they are as safe as we say, and those who for a variety of much harder to understand reasons oppose them altogether.

    Yet nearly everyone here still defends lumping them all together. You and Lilady certainly allege that they all want the same thing, that is, vaccines off the face of the earth. I contend that this is a very risky approach, if, as is very likely, the more moderate elements are mostly what they claim to be. They will switch off from us with reinforced suspicions concerning the integrity and soundness of medical opinion. You should not need to ask me for evidence that this is so, or that a different approach would work better, it is a reasonable speculation that this obviously annoying “straw man” (AKA deceptive mischaracterization) will be unhelpful to any purpose. .

    You say that a variety of approaches probably have their uses. I agree. i have simply argued that special care might be needed when dealing with the rabid extremes, as Andrey also allows to some extent, but I don’t take the fact that others support something as reassurance that it must be right, as you seem to.

    What special care? We don’t want the extremists to either dominate debate or create access for them to a wider audience. Is it a good idea to be inflaming their passions further? I don’t know the answer to some questions, but I am fairly sure that the righteous indignation that these persons understandably arouse in us is not a trustworthy guide to how to carry on our side of any debate. It can lead to risible hyperbole and paranoia, as well as injudicious, probably counterproductive use of ad hominem (such as that mentioned above, and that those expressing anxiety about vaccines have an underhand agenda, rather than genuine need for reassurance).

    “They deserve whatever they get from us” seems to be the main argument of a number of those responding to me. I understand that kind of emotional reaction, but not that the science-oriented might so easily give way to self-indulgent and reckless sentiment. I have not been advocating undue softness on vaccine questions, I am suggesting that there might be more room for level heads and clearer vision.

    You are right that I have in the past been a party to attitudes and stances that I now suggest need review including how we perceive and talk about “anti-vaxers”. Why? Because I am aware that my own tribal “don’t rock the boat” instincts caused me to suppress little misgivings that I have always had — not that vaccines are not sufficiently safe and effective but about the way we try to convince people of that. I am quite sure that what that boils down is not only winning, but being actually deserving of their trust. That involves treating reasonable concerns with respect and a transparently honest approach to the evidence.

    I understand that another somewhat more tentative contention of mine will be even more difficult for some to embrace. It is that even without the rabid extremists we might be having to address certain matters (some listed in my first post) that make vaccination especially liable to public anxiety. For all we know we might still have been having to face a significant level of antivax sentiment, just as a combination of other matters combined to blow CAM up into a serious public health problem in some respects. Wakefield and a few others may have merely set a match to a fuse.that would sooner or later been ignited by something.

    If true, as I think is likely, this would supports the wisdom of critically reviewing our overall approach and possibly a change of emphasis.

    1. David Gorski says:

      Peter, when I point out that you are using straw men arguments, the sorts of statements you just made are the reason why. For instance, when you said:

      To summarize our positions, David now seems to accept that we are required to deal with a less homogenous collection of “antivax” minds than shows up in his writings and those of others. The most obvious divide is, of course, between those who claim to more or less support vaccination but are not sure that they are as safe as we say, and those who for a variety of much harder to understand reasons oppose them altogether.

      What’s the straw man? Implying that I ever didn’t acknowledge that we have to deal with a “less homogeneous collection of ‘antivax minds.’” I mean, seriously, Peter. Come on. I’ve written about this more times than I can remember, both here and at my not-so-super-secret other blog. I’ve even defined what I mean by “antivaccine” in a rather long post. I’ve also discussed the divide between the radical elements of the anti-vaccine movement compared to the more “reasonable” (or at least reasonable-seeming) elements, compared to parents who simply have doubts. I’ve done it more times than I can remember, both here and at my not-so-super secret other blog.

      And here’s another straw man:

      Yet nearly everyone here still defends lumping them all together. You and Lilady certainly allege that they all want the same thing, that is, vaccines off the face of the earth.

      Nonsense. Neither lilady nor I have allege that they “all want the same thing.” I can’t speak for lilady, but what I “allege” is that the leaders of the antivaccine movement are unrelentingly hostile to vaccines and spread fear, uncertainty and doubt (FUD) about vaccines through pseudoscience and quackery, and I provide copious evidence to demonstrate that.

      And here we go again:

      You are right that I have in the past been a party to attitudes and stances that I now suggest need review including how we perceive and talk about “anti-vaxers”. Why? Because I am aware that my own tribal “don’t rock the boat” instincts caused me to suppress little misgivings that I have always had — not that vaccines are not sufficiently safe and effective but about the way we try to convince people of that. I am quite sure that what that boils down is not only winning, but being actually deserving of their trust. That involves treating reasonable concerns with respect and a transparently honest approach to the evidence.

      The key word here is “reasonable.”

      Look, I’m tired. I (mostly) don’t agree with you. You’ve tried to convince me for three or four years now. I’ve read your arguments, and—whether you believe me or not—considered them carefully. I still don’t agree and have explained where, how, and why I don’t agree more times than I can remember. As I said before, the normal thing to do in such a situation would be for us to simply agree to disagree. I’m fine with that. You appear not to be and persist in attacking, as if you can’t accept that your viewpoint is the minority and you haven’t exactly had much success in making it less of a minority opinion.

      The offer for you to write a post first made by Harriet and just reiterated by me in this very thread remains open. Take us up on it. Or don’t. I don’t much care anymore. Either way, I’m done for a while. An overwhelming need to move on for a while has overtaken me, and sparring with you keeps me from doing that.

  34. pmoran2013 says:

    Oh dear! Don’t judge me by the grammatical errors. I was hardly expecting that post to go through, after the problems with posting I have been having.

  35. pmoran2013 says:

    David: “What’s the straw man? Implying that I ever didn’t acknowledge that we have to deal with a “less homogeneous collection of ‘antivax minds.’””

    Of course not. You did so, after I raised the matter of the varied audience that your writings will reach, and whose needs and reactions should be kept in mind.

    I was reacting to the dismissal of my views as “tone trolling”, even explicitly devoid of substance with “Being “polite” the way Peter wants us to be polite –” .

    I don’t mind you disagreeing with my views, indeed I expect that of you as a natural reaction of most of us to unsought critique. You can even explain why you disagree without casting aspersions on my character.

    1. David Gorski says:

      Peter, let’s review a little history here. Back when you first started complaining about our “tone” on SBM, I bent over backwards to be polite, respectful, and downright nice. I considered your criticisms carefully. I did all that that because of my admiration for your work on cancer quackery. Over time, I realized that I didn’t agree and that, although you sure could produce a lot of verbiage, it never really said much, except for the same things over and over. It also became apparent that you really had no evidence to back up your viewpoint other than your own beliefs and experiences (something you just admitted again in this very thread). So your criticisms became steadily less and less interesting to me and your self-righteousness and obvious sense of superiority over us dogmatic meanies who just like to argue and attack (your view, not so subtly implied) more and more annoying.

      As the months and years dragged by and you kept repeating the same criticisms and even ramping them up, painting us (and especially me) as callous (yes, you did), and portraying us as extremists more interested in arguing and insulting, not to mention oblivious to the nuances that seemingly only you, alone among all the bloggers and commenters here, understand, it got real old real fast. Now, three or four years in, I just don’t have the patience anymore. The only reason I didn’t lose patience with you within a couple of weeks after you started your criticisms is because of my enormous respect for your past work.

      As for casting aspersions, let me remind you that you’re no slouch in that department yourself. I could provide examples, but why bother? It would involve searching the comment archives and would take time that I don’t feel like devoting to the task, because they’re scattered over three or more years worth of comments. Given that I’m done for a while and it’s time to move on, I’m not sure it would be a worthwhile exercise anyway. I could also go on and point out some examples of your inconsistency when it comes to applying your principles of civility (for instance, what about the believers in homeopathy, and how could you possibly approve so much of a website with the name of QuackWatch when it so offends CAM believers and Steve Barrett is even more hated by them than I am?), but, again, why bother? Vitriol aside, maybe I’ll feel like revisiting this endless circular argument in the future (and maybe not), but for now I’m done.

  36. stuastro says:

    Carolyn Maloney has shown herself up in her mindless rant as completely lacking in any basic scientific concepts or scientific knowledge. But then, she is JUST a politician.

  37. lilady says:

    @ Dr. Moran: I don’t wish to engage you any further, but you have make assumptions about my motivations and my methods of engaging parents who have valid concerns about childhood vaccines, by making overly broad statements such as these…

    “The most obvious divide is, of course, between those who claim to more or less support vaccination but are not sure that they are as safe as we say, and those who for a variety of much harder to understand reasons oppose them altogether.
    Yet nearly everyone here still defends lumping them all together. You and Lilady
    certainly allege that they all want the same thing, that is, vaccines off the face of the earth. I contend that this is a very risky approach, if, as is very likely, the more moderate elements are mostly what they claim to be.”

    Care to show me where I have “lumped” parents who have valid concerns about vaccines and the anti-vaccine crank bloggers, together?

    I just finished stating how I provided information to thousands of parents in person and via telephone, when I worked as a public health nurse, which included the common side effects following vaccination (pain, redness at the vaccine site, fussiness, low grade fever), less common side effects such as higher fevers leading to a febrile seizure…and the extremely rare (on the order of 1:1,000,000 per dose administered), serious adverse event.

    You raised a question one year ago, about a (hypothetical) parent who came to you about a febrile seizure following a vaccination and a concern about the seizure leading to autism, and I provided you with links to information published in the United States and in Australia, that found no link whatsoever between a post-vaccination febrile seizure and the onset of autism. You produced no information to prove me wrong and you were rather “dismissive” of my comments.

    If I were you, I would not be so fast to accuse others of attitudes, accuse others of
    incivility and accuse Dr. Gorski and me of “lumping” parents who have valid concerns about vaccines with the crank anti-vaccine bloggers whose sole goal is to spread fear, uncertainty and doubt about vaccines…and their aims of bringing the vaccine program in the United States to a screeching halt.

    I presume you are familiar with J.B. Handley, a wealthy businessman who founded Generation Rescue, who funds the activities of Age of Autism and who has spent hundreds of thousands of dollars for full page advertisements in major media outlets and for the erection of large billboards to undermine public health initiatives to protect infants and young children against serious, sometimes deadly, vaccine-preventable diseases. He is a coarse, vulgar man who “photo shopped” head shot photographs of respected scientists, doctors and journalists at a Thanksgiving table, dining on the carcass of a real infant on a platter. He is the same crank blogger who made this statement on March 17, 2010.

    http://www.ageofautism.com/2010/03/tinderbox-us-vaccine-fears-up-700-in-7-years.html

    Tinderbox: U.S. Fears up 700% in 7 years

    By J.B. Handley

    “With less than a half-dozen full-time activists, annual budgets of six figures or less, and umpteen thousand courageous, undaunted, and selfless volunteer parents, our community, held together with duct tape and bailing wire, is in the early to middle stages of bringing the U.S. vaccine program to its knees….”

    Read on Dr. Moran…to see the rest of Handley’s blog and the vicious remarks made by the posters at AoA.

    I submit to you that you are clueless about the activities of the many science bloggers who post accurate information on the internet about vaccines and the many knowledgeable licensed health care professionals who post on those blogs and on mainstream media sites.

    I know the games you play because they are the same games that your new-found friend plays when he posts on Respectful Insolence, with his pretenses of civility, his lies and his tone trolling.

    I suggested to you last year that you “show us how it is done”, by submitting an article to SBM about CAM or about vaccines. Why not try to write up your opinion of this newly evolving situation out of Australia which severely curtails what chiropractors state about vaccines? It should dovetail nicely into your area of expertise.

    http://www.forbes.com/sites/emilywillingham/2013/08/08/chiropractors-in-australia-barred-from-making-antivax-claims/

    1. pmoran2013 says:

      Lilady, I do know how foolish and/or deluded, and malevolent some antivaxers can be, but I don’t know how to convince you of that.

      And I was surprised to hear you accept that some parents have “valid concerns about vaccines”? When I say anything that even hints at that that I get pounced upon and asked to “produce the evidence” for that assertion! My whole point has been that through an unmerited focus upon the rabid element, a pervasive, simmering undercurrent of uncertainty is not being directly addressed as much or as well as it should.

      Last time I did an Internet search on vaccine safety I found it difficult to find any sites that did so comprehensively, although some did what they did very well. There was plenty about specific points such as MMR and thiomerosal but nothing that I thought dealt adequately with the whole spectrum of difficult matters that I think are nagging away at people and creating fertile ground for the extremists. I felt this was partly because the doctors usually writing this material have an entrenched perspective that makes it difficult to look into the minds of others. Perhaps someone like you would do it better.

      I would be delighted to hear it if there are sites now doing this better. Can you refer me to any?

      I looked (again) at that previous exchange of ours. You got offended that I described your link as “mildly reassuring”. It did not refer specifically to convulsions after vaccines, which may be a small point to us, but would be regarded as a weakness by those who want to be sure.

      Also, expecting these concerns to be totally assuaged by our reference to clinical studies is one OUR naiveties. We forget that we have taught them to be suspicious of clinical studies. We have told them to be wary of bias in the researchers and if anyone is biased towards vaccines it is us. We even go so far as expecting people to trust OUR studies while at the same time using Ionnadis’ assertion that “most published research studies are wrong” to undermine research that we don’t wish to accept. This is an inconsistency that has yet to intrude upon SBM consciousness but that I have been intending to bring up. The resultant distrust in the processes of medical science is one of the “difficult matters” that I alluded to above.

      Which brings me back to my main thesis — that it all comes down to trust. This is such a precious commodity for present purposes that we should not risk losing the least smidgen of it through carelessness, through doing what is most self-satisfying, obvious and well-justified at first sight, but which may perversely only arouse suspicion as to the integrity and soundness of our position.

  38. pmoran2013 says:

    I unreservedly retract the “aspersions on my character” comment and was already planning to do so. David has never done that. That was a mind explosion.

    I would like to comment on the frequent accusations of “straw man” on these pages. It has become almost a reflex response to real or implied criticism.

    It annoyingly and sometimes insultingly implies the use a deliberate underhand debating ploy, when in many cases it will be nothing of the kind.

    The misrepresentation may be due to a simple misunderstanding, which can be equally simply addressed. It can be a matter of opinion, when “straw man” is called on the basis of some remote and rare exception to the supposed misrepresentation. The “misrepresentation” may be also reasonable inference from the tone (yes “tone”), language choice, and subtexts in the material being responded to, and what is not said as much as what is said.

    I think all this should be considered before trotting out what can be an equally facile way of trying to come out on top in debate.

  39. lilady says:

    “Lilady, I do know how foolish and/or deluded, and malevolent some antivaxers can be, but I don’t know how to convince you of that.”

    You could have fooled me Dr. Moran; your comments here state otherwise.

    “And I was surprised to hear you accept that some parents have “valid concerns about vaccines”? When I say anything that even hints at that that I get pounced upon and asked to “produce the evidence” for that assertion! My whole point has been that through an unmerited focus upon the rabid element, a pervasive, simmering undercurrent of uncertainty is not being directly addressed as much or as well as it should.”

    Surprised to hear that, you say? I’m calling you out on your massive misrepresentation of my statements and with my position. We don’t have to respond to the overwhelming majority of parents who have children diagnosed with ASDs, because they accept their special needs children, have the ability to understand the protective value of vaccines and don’t troll the comments sections of science blogs.

    “Last time I did an Internet search on vaccine safety I found it difficult to find any sites that did so comprehensively, although some did what they did very well. There was plenty about specific points such as MMR and thiomerosal but nothing that I thought dealt adequately with the whole spectrum of difficult matters that I think are nagging away at people and creating fertile ground for the extremists. I felt this was partly because the doctors usually writing this material have an entrenched perspective that makes it difficult to look into the minds of others. Perhaps someone like you would do it better.”

    You didn’t try very hard to locate those sites, did you? There are ample sites that Dr. Gorski and every other blogger on ScienceBasedMedicine.org have provided.

    “Last time I did an Internet search on vaccine safety I found it difficult to find any sites that did so comprehensively, although some did what they did very well. There was plenty about specific points such as MMR and thiomerosal but nothing that I thought dealt adequately with the whole spectrum of difficult matters that I think are nagging away at people and creating fertile ground for the extremists. I felt this was partly because the doctors usually writing this material have an entrenched perspective that makes it difficult to look into the minds of others. Perhaps someone like you would do it better.

    I would be delighted to hear it if there are sites now doing this better. Can you refer me to any?”

    Sure. A compilation of just a few of the many studies completed in recent years about vaccine safety, published specifically for parents and others, who have valid concerns about vaccine safety records (AAP Journal Pediatrics, Updated April, 2013)

    http://www2.aap.org/immunization/families/faq/vaccinestudies.pdf

    “Also, expecting these concerns to be totally assuaged by our reference to clinical studies is one OUR naiveties. We forget that we have taught them to be suspicious of clinical studies. We have told them to be wary of bias in the researchers and if anyone is biased towards vaccines it is us. We even go so far as expecting people to trust OUR studies while at the same time using Ionnadis’ assertion that “most published research studies are wrong” to undermine research that we don’t wish to accept. This is an inconsistency that has yet to intrude upon SBM consciousness but that I have been intending to bring up. The resultant distrust in the processes of medical science is one of the “difficult matters” that I alluded to above.”

    Who has taught who to be wary? You and I both know that the crank anti-vaccine bloggers and their followers do not have the ability or the desire to understand the nuances of Ionnadis’ assertions. Your remarks here are diversionary and a smoke screen to mitigate the massive Straw Men that you have been erecting.

    “Which brings me back to my main thesis — that it all comes down to trust. This is such a precious commodity for present purposes that we should not risk losing the least smidgen of it through carelessness, through doing what is most self-satisfying, obvious and well-justified at first sight, but which may perversely only arouse suspicion as to the integrity and soundness of our position.”

    That is your fallback position…to placate, to seek “a middle ground” to seek to “build bridges” to reach out to these anti-vaccine, anti-science bloggers… not mine. I don’t want to cede an inch when it comes to these evil, irascible and irrational people. As long as I am able, I will continue to educate parents who have valid concerns about vaccines and parents who are “fence-sitters”.

    I don’t want to see another innocent autistic child be subjected to painful, invasive and dangerous *biomedical treatment/cures* for their autism by credulous and/or abusive parents.

    I don’t want to see the bio-meddlers like Andrew Wakefield and Lisa Goes interfere with treatment of a child in a hospital, thus setting the stage for that parent of a young man to brutally murder her child.

    http://scienceblogs.com/insolence/2013/06/14/autism-biomed-and-murder-of-alex-spourdalakis/

    Nor do I want to see another youngster die of a vaccine-preventable disease,
    because I vacillated, or because I sought the middle ground, or because I sought to build those damn bridges.

    1. pmoran2013 says:

      Lilady: “That is your fallback position…to placate, to seek “a middle ground” to seek to “build bridges” to reach out to these anti-vaccine, anti-science bloggers… not mine. I don’t want to cede an inch when it comes to these evil, irascible and irrational people. As long as I am able, I will continue to educate parents who have valid concerns about vaccines and parents who are “fence-sitters”.”
      Good for you and so will I.
      Your first sentence above is puzzling, since I have several times cautioned against entering into direct dialogue with the extremists at all. Even in the post that you are responding to I emphasized the need to focus more upon the people with what you describe as having “valid concerns.”. I would regard those concerns as having only limited “validity” according to their own perceptions, but they are nevertheless deserving of respectful attention and “bridge-building”..
      Have you forgotten that I have even referred to the risks to permitting the extremists to hold centre stage?. They are cunning and unprincipled enough to twist anything we say, or to seize upon careless talk (hyperbole, paranoia, ad hominem etc) and exploit it to their own advantage.
      So perhaps we are quite beyond understanding each other.
      Thanks for the PDF from the AAP. That is an excellent collection of studies, as a resource for people like us. It is not likely to be readily accessible (either findable or immediately meaningful) to the kind of scientifically unsophisticated people who are most in need of our reassurance.

      1. DT35 says:

        I cannot imagine anything that would destroy my trust in my personal physician faster than the hand-patting, “there, there” accomodationism Dr. Moran urges. I find his apparent belief that the lay public is too weak-minded to hear plainly-stated facts without swooning with emotional distress patronizing in the extreme.

        1. pmoran2013 says:

          DT35, I am aghast that I am being interpreted in that way, but again, perhaps that is my fault.

          Even so, why is it not equally patronising to assume that the public has no mind of its own, and that it is only through the activity of the anti-vax extremists that any might have uneasiness about vaccines? That is the standard sceptical attitude, it seems.

          Is it not also disrespectful to assume that their minds are so simple, so rightfully subservient, that they should automatically respond to our perception of what constitutes “plainly stated facts”. That may work for some, but only for those who already have a serious degree of trust in us and the integrity of any studies we produce.

          I enumerated some of the influences that arouse uncertainty in my first post. To those might be added the reasonable perception that vaccines have grown into quite a substantial medical intervention. If single pills can turn out to eventually have completely unsuspected side effects, how can the medical profession be so sure about the ultimate safety of all these vaccines? (It seems that I must spell out that this is NOT my view, but a reasonable public perception.)

          When people raise such questions do we deal with them with outrage at the questioning of our judgement, and a take-it-or-leave-it presentation of our “facts”, or do we try to understand what is ACTUALLY going on their minds, so that it can be dealt with honestly, directly, and up front?

          The fact is that we cannot have absolute certainty and we should freely admit it. What we do have is enough data to put any risks into a very reassuring perspective. I believe many of the doubters will be more receptive to that approach than overdone, blunt, denials that may seem to them to be in conflict with our past performance regarding the safety of our interventions.. As I have said, that is liable to spook more than it reassures if people already have certain doubts.

          The (mostly) easily discredited theories should be looked upon as manifestations of this nagging undercurrent. Demolishing them does not remove the more fundamental problem.

          1. Andrey Pavlov says:

            DT35, I am aghast that I am being interpreted in that way, but again, perhaps that is my fault.

            It’s your fault but no matter how many people “misinterpret” you, you’ll stick to the same tone trollery.

            Even so, why is it not equally patronising to assume that the public has no mind of its own, and that it is only through the activity of the anti-vax extremists that any might have uneasiness about vaccines?

            Because, Peter, there is a reality established. You don’t just get to equivocate whatever the fuck you want because it suits your argument. You don’t get to continue to come up with “why not if, but, maybe why not be nice, but, isn’t this” gobbeldy gook bullshit because when yet another person – not so tightly affiliated with the SBM “circling of the wagons” crowd – tells you that your platitudes are condescending.

            How about you take the evidence in stride and realize that, indeed, some people are more amenable to sugary sweet niceties and others, like DT35, don’t like being offered simple minded chestnuts and realize that many tacks are indeed warranted and useful? Because you know, demanding constant niceties and utmost Moranian decorum ignores the folks that actually value the unwavering truth of the matter.

            Which means that Dr. Gorski – and anyone else, for that matter – can write however he pleases on his own blog. Address the audience you want. Honestly, I would actually encourage and value that. But sweet jeezy creezy get off your damned hobby horse to try and make other people do what you want instead of doing the work yourself!.

          2. windriven says:

            “Even so, why is it not equally patronising to assume that the public has no mind of its own, and that it is only through the activity of the anti-vax extremists that any might have uneasiness about vaccines? That is the standard sceptical attitude, it seems.”

            From whence springs the public ‘uneasiness about vaccines’ if not the lips and pens of the anti-vaxers? Those of my parents’ and grandparents’ generations may remember wheezing infants gasping for their last breaths, the plague of polio crippling even a president, measles leaving some of its survivors blind, smallpox killing a third of its victims and scarring many of its survivors.

            For them uneasiness was about whether their children would survive to adulthood.

            I think the ‘standard skeptical attitude’ is more accurately summed as: “put up or shut up.” The subject has been investigated; well investigated. The anti-vaxers offer fear, superstition, scary words, but no evidence.

            And no Peter, the public does not have a mind of its own. Most of the public is not well educated in science. They are bathed in the waters of mass media and from them draw their information. Sadly, ‘Berzerk Clown Kills 23 with Fungo Bat’ draws more public interest than ‘Another Study Fails to Find Link Between MMR and Autism’. The anti-vaxers, speaking of mercury and thiomersal and BigPharma are the scientific equivalent of the ‘Berzerk Clown’ headline.

  40. pmoran2013 says:

    Windriven: “I think the ‘standard skeptical attitude’ is more accurately summed as: “put up or shut up.” The subject has been investigated; well investigated. The anti-vaxers offer fear, superstition, scary words, but no evidence.”

    I accept some of your differences of opinion, Windriven. One thing that does bother me is the “put up or shut up”.” attitude that you support as the “standard skeptical attitude”.

    That is appropriate for most kinds of scientific claim, wherein the onus is squarely upon the claimant to produce supporting evidence, and it is other equally well-informed scientists that are needing to be persuaded.

    With vaccines it is different. We doctors are the instigating party. We are encouraging scientifically unsophisticated parents (sometimes via coercion) into subjecting perfectly healthy children to measures that cannot be held to be entirely without risk and which may never be of personal benefit to them. Under these circumstances, and especially when vaccination programs are already under threat, there is no obvious limit to our obligation to show that what we are advising is sufficiently safe, and that there is no cost-effective or safer way of achieving the same ends (e.g. quarantine programs or vaccinating world “hotspots” ), also that they are doing what we claim they do.

    You yourself mention factors that may encourage uneasiness about vaccines at this time, such as the lack of familiarity of the present public with the consequences of some of the diseases concerned . To the public mind the intensity of vaccine schedules might seem to be increasing in inverse proportion to the threat making them ask why? and to once again look askance at “Big Pharm”.. The recent upsurge in CAM is yet another factor, misleading people into the belief that they can protect their own children from undue harm though supposedly “natural” means. Many of those arguing against vaccines put forward that belief.

    So we are now up to 8 or 9 differing influences that come together to create a receptive pot for ‘antivaxers” to stir ( I listed some in my first post and have added others since). All I am suggesting is that perhaps ALL of these matters are deserving of more attention, whereas most sceptical discussion is reactive to the speculative theories of the antivax “intelligentsia”. They themselves probably started off by putting “two and two” of these together and coming up with something that gelled with their other inclinations, such as that of “alternative” practitioners to discredit the mainstream in any way they can.

    1. Andrey Pavlov says:

      That is appropriate for most kinds of scientific claim, wherein the onus is squarely upon the claimant to produce supporting evidence, and it is other equally well-informed scientists that are needing to be persuaded.

      With vaccines it is different.

      That is an absolutely ridiculous argument. This is, in fact, the argument that is proffered by creationists and other anti-evolution apologists. But furthermore, it can be applied to every single medical intervention in use. You haven’t defined a special population – you’ve merely shifted the entire concept on its head.

      It doesn’t matter what the intervention is, if there is a concern (I’ll concede, whether scientific or a large enough public concern) then we study it and determine if there is any validity to it. We’ve done that. The question is settled. Decades of research of the most rigorous kind demonstrate the incredible safety profile and huge benefits of vaccination.

      We doctors are the instigating party.

      In all sciences, the scientists are the “instigating party.” The evolutionary scientists are the “instigating party” for evolutionary theory. So perhaps we should bend over backwards to try and settle an already settled question. What a ridiculous idea.

      subjecting perfectly healthy children to measures that cannot be held to be entirely without risk and which may never be of personal benefit to them.

      Nothing is ever entirely without risk. And your statement right there is exactly the talking point of the anti-vax extreme. And you should know better. If you start framing it from the perspective of “not 100% safe” and “may never personally benefit” then what is the point? Herd immunity is a pretty important point about vaccines, which is why the argument can not be framed from the perspective of personal benefit in such a narrow sense. And, of course, you know that but insist on playing some ridiculous Devil’s advocate as if those arguments made any sense in the actual scientific discourse of the topic.

      Under these circumstances, and especially when vaccination programs are already under threat, there is no obvious limit to our obligation to show that what we are advising is sufficiently safe, and that there is no cost-effective or safer way of achieving the same ends

      Yeah… and? That is precisely what we are doing. Demonstrating over and over again how ludicrous the arguments of the anti-vax contingent are. How the data doesn’t show what they claim it does. How mountains of really good data show exactly the opposite. So what are you actually trying to say here?

      Oh yes, back to the “we should always say it kindly, dotingly”, and as DT35 pointed out, condescendingly. See how your argument always circles back to “I don’t like how this site and Dr. Gorski write about it and everyone who ever writes about vaccines should write the way I want them to“? There are plenty of other sources that are quite dispassionate, kind, etc. Your demand is that every source be that way. Well, not only is that not reasonable, not within your purview, and immaterial to any actual argument it is quite reasonably concluded to be spurious. Different tacks are important as I have pointed out ad nauseum. And as DT35 demonstrated in a brilliantly placed anecdote for us.

      But what your argument shouldn’t mean is wasting more resources to settle a question that is already settled. We do not need more data to demonstrate with ever increasing fidelity that autism and vaccines are not linked. We do not need 7 sigma certainty on this topic. And even moreso, if we had 7 sigma certainty they would clamor for 9 sigma certainty. There has to be a limit Peter. We can’t just spin our wheels trying to be nice and accommodating to every ludicrous request for ever more proof of something that “isn’t 100% without risk.”

      All I am suggesting is that perhaps ALL of these matters are deserving of more attention, whereas most sceptical discussion is reactive to the speculative theories of the antivax “intelligentsia”.

      And they do. But the unreasonable part of your suggestion is that ALL of these matters are deserving of more attention HERE. The authors here can pick and choose their topics as they see fit. And when your argument is always reduced to “you should write about what I want you to write and how I want you to write” then you should finally just realize that this isn’t your blog and either shut up or contribute yourself. Because you really have nothing more substantive to say than that.

      1. David Gorski says:

        Yeah, I think the thing that most irritates me about Peter is his unwitting arrogance on this particular topic cloaked in what I view to be a faux humility. He thinks his issues are so important that we at SBM must change the way we blog and the topics we blog about to be more in line with the way he thinks we should communicate science and medicine. His apparently having thought long and deeply about these issues seems to make him think that he is a greater authority than us. If we don’t see this and do it his way, he will relentlessly hector us, as he has done for the last three or four years.

        He’s even been repeatedly offered a chance to write a guest blog post and try to make his case right here on this very blog. He hasn’t done it, and I predict that he will never do it. Instead, he seems to want us SBM bloggers to change and do it for him.

      2. pmoran2013 says:

        Andrey, I am glad you accept my basic premise i.e. — ” that perhaps ALL of these matters are deserving of more attention, whereas most sceptical discussion is reactive to the speculative theories of the antivax “intelligentsia”.”

        You corrupted dialogue by cutting out the part of my response to Windriven that puts my “ridiculous” remarks in context, namely “One thing that does bother me is the “put up or shut up”.” attitude that you describe as the “standard skeptical attitude”. ”

        I thought it would be obvious to most why this would be an inappropriate stance on vaccine safety — medically, ethically, and also strategically, and my partial explanation of why still stands. Looking back, I may have overstated the case a little with ” no obvious limit to our obligation” to produce safety evidence (so long as our case IS sound in all respects, we should only have to go so far as is necessary to ensure adequate public cooperation with minimal or no coercion ) but the principle still holds. This is a much more complex risk/benefit situation than those normally considered within medical science.

        In case this is also on your mind, the above would also be an appropriate response to anything I have said, because I have made no claims as to the safety of vaccines other than that there is no good evidence that they are not safe. I am merely offering some carefully thought-through opinions on why our first instincts as to how to best address the problem could be wrong, possibly only making things worse, by, among other things, attributing purely sinister motivations to people with much more complicated reasons for not being quite sure of our trustworthiness.

        Dr Gorski’s allegations of my supposed arrogance and hectoring are not worthy of response.

        1. David Gorski says:

          One notes that calling someone’s statement “unworthy of a response” is a response. :-)

          But, seriously, can we finally just agree to disagree? I’m really tired of this, and I don’t want to keep going around and around with you anymore.

        2. Andrey Pavlov says:

          In the spirit of letting it drop, and considering that we are indeed much closer in mind than the vociferousness of our debate might make an outsider think, I will merely say that we disagree on tack and what works and doesn’t and leave it at that.

  41. Jay Gordon says:

    @David Gorski “But, seriously, can we finally just agree to disagree? I’m really tired of this, and I don’t want to keep going around and around with you anymore.”

    I’d be OK with that, David.

    Jay

    1. David Gorski says:

      Heh. Not bad. Not going to work, though. The difference between my disagreement with Peter and my disagreement with you is that my disagreement with you is easily amenable to presenting data and science, which I do. My disagreement with Peter is more over tactics and questions for which there is no definitive answer. Sorry. Nice try.

  42. pmoran2013 says:

    “But, seriously, can we finally just agree to disagree? I’m really tired of this, and I don’t want to keep going around and around with you anymore.”

    I’ll shake hands with you at any time. We are, after all, on the same side. I do reserve the right to speak my mind.

    1. Harriet Hall says:

      You have spoken your mind many times now, and you have been listened to.
      If you keep repeating the same thing, readers will learn that they can stop reading your posts, as I have.
      The invitation stands to write your own guest article explaining your position in full. If you did that, you wouldn’t have to repeat yourself any more: whenever you objected to a post you could simply provide a link to your article for those who hadn’t yet seen it.

    2. WilliamLawrenceUtridge says:

      Echoing Dr. Hall, repetition doesn’t convince. I just wish the Pete Moran I first became acquainted with, the Pete Moran who so vehemently opposed cancer quackery, the Pete Moran with the incisive, well-written and science-based criticisms would return. I see the occasional glimpse of this Pete Moran when you engage with new commenters who make absurd, or even merely slippery points, and I am heartened he’s not dead. The current Pete Moran, who repeats the need to give way to CAM, to accommodate, to sell out the science to please patients, is an enormous disappointment. And so, so dull.

      1. David Gorski says:

        I miss him, too. About 12-13 years ago, when I was a regular denizen of misc.health.alternative, Peter was one of the skeptics I most wanted to be like. His essays at cancerwatcher.com provided a model for me to emulate. Indeed, his posts on alternative cancer cure testimonials were the inspiration behind one of my very first “epic” posts way back in December 2004. As I said, I miss that Peter. I still see flashes of him when I blog about cancer quackery and homeopathy; so maybe he’s not gone.

    3. David Gorski says:

      Peter:

      Look, there are no hard feelings, at least not from me, but at least let’s give it a rest for a while. I’m sure the opportunity will come to revisit these issues, Why don’t you put your effort for a while into taking Harriet and me up on the offer to have you write a guest post?

  43. pmoran2013 says:

    WLU:”The current Pete Moran, who repeats the need to give way to CAM, to accommodate, to sell out the science to please patients, is an enormous disappointment.”

    One of the reasons these discussions are exhausting is that people misunderstand and/or totally misrepresent what I am trying to say, or what I intend. At least 95% of my posts are supplementary ones, trying to redress misrepresentations — such as that I am “selling out science”. Can you give an example where I have done that?

    I am well prepared to argue out the science behind anything I have ever said at any time, WLU — matters to do with placebo and non-specific influences — why people use CAM and what they get out of it (and what they can’t) — any area at all where you think I may be wrong. (Privately, though for now).

    My positions may differ in small ways from that which the average medical sceptic is comfortable with, and what our esteemed leaders may say, but it remains to be seen who has the more sophisticated and unbiased understanding of some aspects of medicine and its science, and of how to best keep CAM from harming people.

    Time will tell. Valid ideas seem to eventually prevail and I am happy for mine to stand or fall on that basis.

    1. Harriet Hall says:

      Write a guest article and redress all the misrepresentations you want. Explain your sophisticated and unbiased understanding and show us where we went wrong. Please, please, please!!! Write an article and say whatever you want once and for all instead of this constant carping.

  44. pmoran2013 says:

    “I’m sure the opportunity will come to revisit these issues, Why don’t you put your effort for a while into taking Harriet and me up on the offer to have you write a guest post?”

    I’ve thought seriously about it, but expect that in that form, too, people will misunderstand what I am saying. In vaccine matters, too, there is the faintest of lines between wanting to see “reasonable” public anxieties dealt with well and seeming to be raising extra, unnecessary, doubts about vaccines safety.

    If I can be confident in doing better in that format, I will do so.

    1. Andrey Pavlov says:

      I honestly do not want to rekindle another endless back and forth; my only goal here is to provide a piece of thought for you Dr. Moran.

      If, after all these years of making the same comments on “highly thought out and nuanced” thoughts over and over again, you are still met with “others misunderstanding you” over and over again, it may be time to consider that you aren’t being misunderstood but you yourself are not clear on what you are trying to say.

      When I write a piece of prose I can read it a thousand times and it will seem perfectly sound, logical, and clear to me. Then someone else reads it and points out a few gross errors. Occasionally those errors can’t be resolved – I’d had the idea half formed in my head and wrote it out, thinking it so eloquently put together and yet when I really try to flesh it out and get my editor to understand it I realize I can’t and the whole of it must be scrapped.

      What I am getting at is that when you think everyone else is crazy maybe it is you that is crazy (to coin a phrase). And if I have learned one thing from my nearly 4 year sojourn through scientific skepticism it is that the single best tack is to always be willing to assume the error lay with me.

      If you can’t write out your thoughts in a clear manner and are a priori convinced that even then everyone will continue to misunderstand you, people who are typically rather smart individuals and from varying backgrounds, then that may well be an indication to look deeper into the content of your writing rather than the words themselves.

      1. Harriet Hall says:

        I was about to say something similar, but you have said it much better than I would have.

    2. Karl Withakay says:

      If you’re that genuinely fatalistic about your ability to effectively communicate the nuances of your position(s) to the SBM audience, I wonder why you bother commenting at all.

    3. David Gorski says:

      If I can be confident in doing better in that format, I will do so.

      Come on, Peter. No writer is ever perfectly confident that he can get precisely what he means across. Expecting such confidence before writing is a recipe for inaction. You just do the best you can; that’s what I do. I often succeed; sometimes I don’t do so well; fortunately, I seldom completely fail. But even when I do fail, I just get up, brush myself off, and jump into the fray again.

  45. WilliamLawrenceUtridge says:

    One of the reasons these discussions are exhausting is that people misunderstand and/or totally misrepresent what I am trying to say, or what I intend. At least 95% of my posts are supplementary ones, trying to redress misrepresentations — such as that I am “selling out science”. Can you give an example where I have done that?

    Nope, not really. That’s my gestalt impression after reading, and re-reading many of your comments. Now I’ve pretty much mostly given up.

    Please, write a guest post. I read every single post on SBM from top to bottom. Perhaps it will give us an “a-ha” moment and your myriad comments will finally gel into a cohesive understanding for everyone. Rather than being reactive, be proactive in defining and laying out your mental territory. Perhaps you will demonstrate hitherto-unappreciated ways of engaging with CAM and CAM-using patients that I’ve never considered before. Clearly you have this capability, your anti-cancer page clearly shows your ability to write, engage with evidence and emotions, and defend a stance. The only reason I bother to even skim some of your points and not simply ignore you is because of the credit you built up over there.

    But as is, your comments are either completely misunderstood, or completely unconvincing here. I wish it were not so. Write a guest post. Give us a two-fer Thursday.

  46. Andrey Pavlov says:

    Accurate and concise. Very well said.

  47. pmoran2013 says:

    “What I am getting at is that when you think everyone else is crazy maybe it is you that is crazy (to coin a phrase). ”

    That looks suspiciously like the argumentum ad populum that others also seem to be invoking. Dr Gorski needs to have a word with you all. :-)

    No, I am not overly phased by this. I have lived through too many occasions now when we doctors have had to change perceptions/beliefs/direction. We were ALWAYS sure that what we had been doing before was perfectly appropriate.

    Secondly, I am confident that I am right about some of the matters I raise, also that they should be raised. A recent one concerns the motives of CAM practitioners when seeking certain privileges. I would not, in general, support their claims, but for sounder reasons than that it is all part of a giant scam. (yes I know I am being repetitive, but I am about to shut up, unless provoked ).

    Finally, you forget that I know how the sceptical mind works. I know how I myself would once have reacted to anything that looked as though it might hint at being “soft on CAM” in some remote way. I would have rooted around for a reason to dismiss it, too, even perhaps “we can’t possibly take you seriously unless you write a guest post”.

    1. Jay Gordon says:

      You will not win over any CAM practitioners or users with your present methods. It is well worth reaching out to both to see if they will give more consideration to evidence-based medicine.

      Assigning evil motives also doesn’t lead to any meaningful discussion. Very few practitioners of CAM have evil intent.

      I don’t know either the old or the new Peter Moran. Were he interested, I’d be happy to have a private email conversation because I’m intrigued by the subtle shifts he appears to have gone through which I regard as paralleling some changes I’ve also been through. Peter, I don’t know if I’m allowed to post my email here, but David has it if you’d like to talk.

      Jay

      1. David Gorski says:

        You will not win over any CAM practitioners or users with your present methods.

        I already have won over a handful of CAM users over the years. So your “never” proclamation is incorrect. The real question is what’s the relative effectiveness of either approach or whether both work better than one.

        1. Andrey Pavlov says:

          I, for one, see a plethora of evidence that a single approach is nearly always inferior to multiple approaches. I also do not believe it necessary for each individual person to have multiple approaches at once (though certainly styles change over time) but rather think it better to master the approach one is good at and hone it well. Sweet FSM knows I could never write like Dr. Crislip and if I tried it would be an amazing failure. We stick to what we are good at and our strength comes in solidairty with others of similar mind and different style.

        2. Jay Gordon says:

          David, I think that speaking to people in a nicer way creates better communication. I know that might sound simplistic or sarcastic, but I’m serious. I disagree with you often, but I listen better when you don’t speak to me as if I’m an absolute idiot. Or satan incarnate.

          I honestly don’t understand the other way: Your writing is more than a little “winning” for the regulars here but I’d imagine you could influence a tremendous number of parents on the fence about vaccines if you spoke to them (and me) with respect instead of persistent disdain. If your goal is to save lives and defeat anti-vaccine rhetoric and you have the facts and science on your side, why not approach those parents and others with a kinder voice.

          Conduct the conversation knowing that other people may actually see what you term as a “false equivalency” as a viable set of choices and then scientifically disabuse of that notion.

          1. WilliamLawrenceUtridge says:

            Scientifically the choices are not equivalent. The scientific choice is to be vaccinated according to the CDC schedule, and the only objections should be equally scientific (allergies to the vaccine medium, real ones like eggs, or immune issues, again, real ones like cancer). And parents on the fence will be convinced by their doctors, these blogs have a different purpose.

            Dr. Gorski’s bedside manner is doubtless different from his blogside manner.

    2. Andrey Pavlov says:

      Well, then in my lowly med student ignorance and beguiled by my skeptical groupthink I will simply have to trudge onward despite your undoubtedly highly thought out and more nuanced than I can understand advice.

      At least one amongst all us skeptics has finally seen the wisdom of the One True and Correct approach to CAM. Hopefully the rest of us dimwits and inexperienced folk will see the light some day.

      I won’t bother to dissect out the numerous problems with your thoughts and ideas as expressed in your last post; it’s tiresome, pointless, and circular.

      At least you know you are right, so that should certainly comfort you in the wake of my snark.

  48. lilady says:

    Gee Dr. Gordon, I’m wondering why you continually post wrong information about vaccines on your website.

    Two years ago, you were still posting your opinion about Prevnar vaccine, stating (it was) “too new for me to recommend”. Prevnar vaccine was licensed in 2000 and eleven years after it was placed on the CDC and AAP Recommended Childhood Vaccine Schedule, you, in your infinite wisdom, were dissuading parents from getting this vaccine which is protective against deadly invasive S. pneumoniae infections.

    http://www.immunize.org/photos/pneumococcal-photos.asp

    You also stated your opinion about the MMR vaccine (which) you did not recommend to the parents of the young patients in your practice, until age four and you would not recommend the varicella vaccine until age ten, (only if a child had not contracted the “natural” virus).

    When you posted on Dr. Gorski’s friend’s blog, I questioned you about how you deviated from the Standards of Care of the American Academy of Pediatrics regarding complete and timely immunizations for each child, following the AAP and the CDC Recommended Childhood Vaccine Schedule. You eventually took down all your opinions about each vaccine on that Schedule and rather than providing links to the California Department of Public Health website for reliable information about the vaccines and the serious, sometimes deadly, diseases those vaccines prevent, you resorted to posting links to whale.to for parents to peruse. I again commented at you that the pig farmer’s articles about vaccines was not, IMO, a reliable source; five weeks ago you removed all those whale.to articles.

    Recently, a confirmed case of measles was reported in Ventura County and you and the parent of one of your four-month-old patients, commented about the case and the MMR vaccine. Do you recall what your young patient’s father stated?

    http://losangeles.cbslocal.com/2013/07/19/1-confirmed-case-of-measles-in-ventura-county/

    “Joel Shapiro, who has a four-month-old daughter, says he’s decided not to give his daughter the MMR vaccination until she turns four.”

    Now where did Joel Shapiro, get that information from?

    His pediatrician, Dr. Jay Gordon, agrees with his decision.

    “I’m not just a proponent of letting parents choose. I’m a proponent of revising the current vaccine schedule. I think that we give too many vaccines to children too early in life. I think that we group vaccines together without being 100 percent certain of the safety of those groups, those combinations,” the doctor said.

    How many more vaccine safety studies would you need Dr. Gordon, aside from these recently published in the AAP “Pediatrics” journal, for you to change your mind and abide by the AAP Standards of Care for timely and complete vaccinations according to the AAP and CDC Recommended Vaccine Schedule?

    http://www2.aap.org/immunization/families/faq/vaccinestudies.pdf

  49. Jay Gordon says:

    Thank you, lilady, for your lovely post.

    Best,

    Jay

    1. David Gorski says:

      Come on, Dr. Jay. That was lame, even by your standards.

      I’d be interested in knowing the answers.

  50. Jay Gordon says:

    I have a question. Many of you won’t believe this but I trust your opinions about vaccines.

    As you all know, Israelis are now receiving an attenuated oral polio vaccine with 1 and 3. I have a number of families in Israel part time and others traveling to Israel. Assurances are being made that this vaccine poses zero risk to children who have received at least one “killed” vaccine and that makes sense to me. Further assurances are being made that this vaccine poses no risk to anyone.

    I am conversant, as are all of you on VAP and what’s now being called VDP in India and elsewhere and understand the likely need to transition to the IPV from the OPV in developing nations. I also understand that continuing OPV programs in many regions of Asia and Africa is crucial to eradication and should not be interrupted until IPV programs can be put into place.

    Is this OPV being used in Israel the best way to deal with viral strands being found in sewage? They also report that 25-35 people have been found carrying polio virus. Is this likely to be strictly vaccine associated?

    Thanks for your help. Please excuse my cross-posting this but I’d like your advice.

    Jay

    1. Harriet Hall says:

      If you trust our opinions about vaccines, why don’t you trust our opinion that the recommended vaccine schedule be adhered to?

  51. lilady says:

    I see you have cross-posted this comment on the Respectful Insolence blog; I’ve already replied….

    Dr. Jay: The reason for the implementation of one dose of live attenuated for Israeli children who have already received IPV is explained by this Global Alert and Response from the WHO:

    http://www.who.int/csr/don/2013_08_15/en/index.html

    “15 August 2013 – The World Health Organization (WHO) estimates the risk of further international spread of wild poliovirus type 1 (WPV1) from Israel to remain moderate to high. This risk assessment reflects evidence of increasing geographic extent of circulation over a prolonged period of time.

    WPV1 has been detected in 67 sewage samples from 24 sampling sites in Israel, collected from 3 February 2013 to 4 August 2013. Initially restricted to southern Israel, WPV1 has now also been detected in the central district as well. WPV1 has also been isolated in stool samples from 27 healthy children (all under the age of nine years) and one adult, who had been fully immunized for their age as part of ongoing stool sample survey activities. No case of paralytic polio has been reported. In addition to routine acute flaccid paralysis, public health authorities have expanded the surveillance to all age groups and have increased enterovirus surveillance and are screening aseptic meningitis cases for polio.

    A supplementary immunization activity (SIA) with bivalent oral polio vaccine (OPV) started in parts of southern Israel during the week of 5 August 2013, and a nationwide campaign is planned for 18 August 2013 for children up to the age of nine years. The objective of these SIAs with OPV is to boost mucosal immunity levels in cohorts of children naïve to OPV to rapidly interrupt virus circulation.”

    You state…

    “I am conversant, as are all of you on VAP and what’s now being called VDP in India and elsewhere and understand the likely need to transition to the IPV from the OPV in developing nations. I also understand that continuing OPV programs in many regions of Asia and Africa is crucial to eradication and should not be interrupted until IPV programs can be put into place.”

    Would you like to rephrase that statement? India does not now “call” VDP cases or iVDP cases, without testing to confirm that the case is caused by receipt of the polio vaccine. India has been free of endemic polio since January 1, 2011.

    There is no travel advisory to immunize U.S. Citizens traveling to Israel with OPV vaccine, although all children are advised to have completed the Childhood Recommended Vaccine Schedule as recommended by the CDC and the AAP, plus hepatitis A vaccine. Rabies vaccine is recommended for rural travel within Israel and Typhoid vaccine is recommended for travel to the West Bank and the Gaza region.

    http://wwwnc.cdc.gov/travel/destinations/clinician/none/israel

    You can find the Recommended Childhood Vaccine “Catch-Up” Schedule at the CDC website, Dr. Jay, for all your young patients who have never received vaccines or who are incompletely immunized.

  52. Jay Gordon says:

    Harriet–You view these as simple decisions and that identical medical intervention of this kind (vaccines) are correct for every single child. This is my major disagreement with you. Not that “teh ebil shots kil childrun” as some so eloquently accuse.

    There are some incredibly interesting and important discussions which could be held here about the “tipping point” for the OPV to IPV programs in developing nations or assessing duration of protective antibody levels for pertussis vaccinations.

    Or I guess you could spend you time and energy calling me an idiot.

    1. WilliamLawrenceUtridge says:

      Can you name any reason a child should not be vaccinated that isn’t named here?

      And why wouldn’t you simply trust the vaccination, polio and public health experts who are making the recommendations they do for Israel, and in fact the world over? What do you think we can say here that is more convincing than that said by the best experts in the world on these specific diseases?

      I wouldn’t say you are an idiot, you are quite clever in putting up a superficial gloss of reasonableness in your objections to vaccination. I just don’t think you are cleverer than the sum total of experts on vaccination who put together the recommended schedule. Boy, do I ever think you are not cleverer than them.

      You may even have been clever enough to convince yourself that you’re being reasonable and cautious, which again brings me back to the experts. Why do you think them reckless? Why on earth do you think you know something they don’t? On what basis? Your patients?

    2. nybgrus says:

      I don’t think anyone is calling you an idiot Dr. Jay – just someone who doesn’t apply rigorous evidence and values his own experience above actual science (which I suppose is a stupid thing to do, albeit somewhat understandable – you just get less slack because you should know better).

      But what I am seeing in you latest posts here is at least a very double-standard way of applying evidence. Poor people suffering terribly need the vaccines because they help, but us rich white folk with less disease can get away with doing less. And that’s actually not entirely untrue – but it will fail rather quickly as we have seen with the pockets of measles outbreaks here and in the UK.

      The biggest problem – and what Dr. Hall is calling you out on – is that you seem to want to seek sciencetific evidence for one thing but then simply reject the same scientific evidence for your pet buggaboo about the vaccine schedule. You ask for input to understand the polio vaccine, yet seem to think you know better than the evidence regarding the vaccine schedule.

      Of course the vaccine schedule is not absolutely optimal for absolutely every child. But the data show us quite clearly it is quite good and quite safe and effective. But the bigger issue is – on what basis can you possibly decide which child it isn’t optimal for and how to then adjust it? You can’t. Nobody can. Not beyond what we already do. And trying to claim that it is your “experience” guiding you is just a sly way of saying you are making shit up.

      Of course, the less charitable interpretation is that you are feeling a little twang of guilt at being so incredibly wrong all along the way and yet you simply cannot face losing your crowd of celebrity patients and supporters.

      In any case, your commentary is no doubt disengenuous.

    3. Harriet Hall says:

      Then you don’t trust our opinions and shouldn’t say you do.

  53. David Gorski says:

    Oh, come on, Dr. Jay. You’re being disingenuous. You have been asked time and time again to cite the scientific evidence that leads you to question the existing vaccination schedule. Thus far, you’ve failed to deliver. You can’t seem to deliver. Given that, why should we listen to you?

    As for the rest (i.e., your bit about the “tipping point” from OPV to IPV and assessing the duration of pertussis antibodies), all it does is reveal you as not having any evidence. It’s basically a Gish gallup. Why not try something different? Actually explain to us in clear, cogent terms, all backed up with citations from the peer-reviewed scientific literature, why you think the vaccination schedule should be changed and how. Until you do that, I find it very hard to take you seriously.

  54. Jay Gordon says:

    Dr. Gorski, you’re wrong on this one. I have a legitimate question, a request for advice, an honest answer and all you’ve got is venom. You’re a bitter person for some reason. You’re wrong. There’s no reason not to step away from that attitude for a minute and give a civil answer.

    And, by the way, I really would like opinions from anyone who’d care to offer them. This is a real life issue for me right now.

    1. David Gorski says:

      Oh, please, Dr. Jay. I did give you a civil, albeit critical answer. And, no, you have not provided an evidence-based answer.

      1. Jay Gordon says:

        You gave me an uncivil answer.

        Oral polio vaccination is becoming more controversial and I’d like opinions from people who know about this than I do.

        David, you are becoming a caricature of the person I first met some years ago.

        Then, you were a scientist and a good fair critic of my opinions. Now, you’re just playing the role of a curmudgeon on the Internet. It gets old, David.

        You can find citations about the oral polio vaccine debate by the dozen and you know it. It is you who is being disingenuous.

        My dislike for the current vaccine schedule has never been supported by research and medical evidence; It’s my opinion and the discussions have made me think and changed many of my practices.

        A caricature, David. A verbose, peacock-like, nasty shadow of your former self. What happened to you?

        1. WilliamLawrenceUtridge says:

          It’s my opinion that your opinion of the vaccination schedule is only slightly better than that of Jenny McCarthy’s, and materially worse than someone completely uneducated about vaccines who thinks they should just trust their doctor. It’s my opinion that the media should stop pretending you are one of two sides on a debate of issues, and stop treating this manufacturoversy as anything but a public health danger.

          Merely because commentors and editors don’t want to play whack-a-mole and do the heavy lifting for you doesn’t make them curmudgeonly. I would say it merely indicates their respect for your intellectual honesty and willingness to admit your mistakes. You’ve made them by the ton, your continued pretense that somehow you know more than the CDC is harmful, and you should stop. Again, be the Mark Lynas of antivaccination movement. Publicly admit that there is no evidence to support your “alternative” vaccine schedule, and that the risks of vaccination are far, far below the risks of the diseases they prevent. That’ll get you respect here, far more than “you tell me why it’s safe”. For me, it’s safe because the CDC says so – and I’m not going to invest the time and money in all the PhDs I would need to even begin to debate them.

        2. windriven says:

          Dr. Gordon,
          Could you suggest two or three suggestions of citations that you think are thought provoking regarding oral polio vaccination?

          My initial reaction is that oral polio vaccines have been around since I was a child. When I was a child polio was still terrifyingly common. I remember pictures of people in iron lungs. Today a neighbor not much older than I walks with a pronounced limp owing to childhood polio. In the (mumbles number of ensuing years) polio has vanished from my radar screen.

          But I am open to having a compelling argument put it back on my radar screen.

        3. David Gorski says:

          David, you are becoming a caricature of the person I first met some years ago.

          Then, you were a scientist and a good fair critic of my opinions. Now, you’re just playing the role of a curmudgeon on the Internet. It gets old, David.

          Tone trolling? I never saw that coming…not.

          Seriously, though, Dr. Jay. Go back and read some of my old stuff. I’m the guy who referred to RFK, Jr.’s Salon.com article in 2005 as the “the biggest, steamingest, drippiest turd I’ve ever seen it publish, an article so mindnumbingly one-sided and uncritical that in my eyes it utterly destroys nearly all credibility Salon.com has had as a source of reliable news and comment. Honestly, the editors of Salon.com should hang their heads in shame for publishing this paranoid piece of fear-mongering and trumpeting it as ‘investigative reporting.’” (I’m actually rather proud of that passage, eight years later.) I could provide many more, for instance a 2009 post that I entitled “If you hand me some stupid, yes, in fact I am going to hit you over the head with it. Because you absolutely deserve it,” which was mainly a rebuttal of some really dumb antivaccine nonsense being parroted by Vox Day but in which I described Jenny McCarthy thusly, “I’ve often complained about Jenny McCarthy as a sterling example of the ‘arrogance of ignorance.’ Whatever the ignorant hubris that Jenny likes to lay down on a regular basis, however, she is limited by her puny intellect in just how much hubris is generated (although it is that very same puny intellect that allows her to lay down such bursts of enormous stupidity that threaten to fry the brains of anyone with intelligence greater than one standard deviation below average).”

          If anything, I think I’ve mellowed considerably in the last few years, particularly here on SBM where my more…colorful and entertaining…flights of fancy must be restrained, the opinions of you and Peter notwithstanding. Even at my not-so-secret other blog, where the two examples above come from, I’ve actually toned it down considerably since those “glory years.”

      2. Jay Gordon says:

        Lilady–You have called me a liar at least twice in your post above. You are off probation and banned instead. You are not worth one more minute of my time. Good bye.

        No, I did not fabricate the Israel-bound travelers and residents of Israel and yes, the vaccine was available to both hospitals and private practitioners for compassionate use long before it was in universal use.

        I visit polio eradication.org every single day, by the way.

        David, you’re proud of your incivility, rudeness and name calling? Good for you. You have turned into a caricature. You’re the Bill O’Reilly of SBM.

        1. David Gorski says:

          Dr. Jay, Dr. Jay, Dr. Jay…

          I know you’re just trying to get under my skin with the whole Bill O’Reilly tone trolling schtick, but all you’ve succeeded in doing is to disappoint me. Seriously? You don’t really think your obvious diversion into trying to make it more about “tone” than evidence and your dancing around disavowing your past antivaccine statements will succeed, do you?

          Let’s put it this way. You admit you have no data, and when my readers present you with data, you ignore it. Why is it that we should take you seriously again? I’m sorry if this sounds mean to you, but you regularly confuse meanness with not letting you divert the conversation.

        2. lilady says:

          @ Dr. Jay:

          You cross posted a comment/inquiry about children in your practice who travel to Israel and the campaign instituted by Israeli health officials, who, in consultation with the WHO are providing one dose of OPV to young children who have already had IPV. Foolishly I thought your question was sincere because you stated you value the information about vaccines that you have received from posters here…and from posters on Respectful Insolence.

          I was the only one who replied to your comment and I linked to two websites that provided the reason for this public health initiative in Israel and travel advisories issued by the CDC for immunizations for travel to Israel.

          You then posed additional questions (JAQing off), in order to put your ill-informed/not backed by science “opinions” out there. You had the nerve to insult Dr. Gorski on his own blog with the most vile and untrue observations of his “character”.

          Then, and only then did I question if you really had patients who were traveling to Israel and who had concerns about the institution of the one dose IPV vaccine for young Israeli kids.

          “Lilady–You have called me a liar at least twice in your post above. You are off probation and banned instead. You are not worth one more minute of my time. Good bye.”

          So no Dr. Jay. I only called you a liar once in my post above, based on your lies about the availability of varicella that you claimed you administered to children with cancer 15 years before the vaccine was licensed in the United States, in 1995. You already knew that my child did not have cancer. He was immune compromised with leukopenia, megaloblastic anemia with anisocytosis and poikilocytosis (pancytopenia) along with ITP and a platelet adhesion/aggregation disorder with a h/o internal bleeding episodes associated with high fevers.

          You posted your lie repeatedly on Respectful Insolence, in spite of my comments directed at you that testing on healthy volunteers was being done in Japan where the vaccine was developed during that time frame, (circa 1980), when you claimed you were using the vaccine under a “compassionate use protocol for kids with cancer”.

          I also informed you that VZIG was the only post exposure prophylaxis available for women exposed during pregnancy to lessen the chance of a child being born with Congenital Varicella Syndrome…and that local health departments (including the County health department where I worked, procured the VZIG from the Red Cross and distributed it). You, finally, after weeks of trying to convince the commenters on RI, finally just “disappeared”…your typical M.O. when you are caught in a lie.

          Yes Dr. Jay. You really messed up here at SBM, by showing the dark side of your personality, that you display so often on R.I.

          1. Jay Gordon says:

            @pmoran2013

            “Dr Gordon, I am no vaccine expert, but I accept that quality anecdotal evidence can carry some weight and I can understand how scientific evidence and scientific opinion on vaccine safety can look ample to some, but less so to others.”

            Yes

            “It may be only a matter of luck and the fact that most other kids are vaccinated if you have not yet seen any come to serious harm.”

            Yes, that is possible. Not likely after all these years and thousands of patients, but still quite possible.

            “So, to me the question boils down to whether your anecdotal evidence, your seat-of-the-pants observations, are of sufficient quality for you to be inducing others to run such risks? You are a doctor and should know how unreliable that kind of observation can be.”

            I agree. I speak quieter than I used to and question more than I used to. I have learned a lot at SBM and RI. Most of the families I take care are not being “talked out of” vaccines by their contact with me. If anything, some of the “zero” families opt in to a limited, delayed schedule. Elsewhere, they might have stayed at zero. I am not trying to pretend that I have lost any of my bias against the current schedule. I am readily admitting that there is not science to support alternative schedules.

            ” I mean, most kids are very healthy whether they have vaccines or not. That is a fact. What then, precisely, is the pattern that you claim to be seeing in your patients, and can you back that up with data from your records?”

            Yes, and that protects even the worst of primary care doctors including pediatricians. No matter what I do, really bad things will rarely happen. I wish I had begun aggregating data long ago about vaccinated versus non-vaccinated children and the incidence of illness or other outcomes. I didn’t. I have considered seeking out an MPH candidate or two to review my charts but that’s not where my energy and time have gone. I make no pretense to having measured these outcomes except using observation colored badly by confirmation bias. Peter, I have never claimed to be able to cite study after study showing how bad vaccines are. I don’t believe that now–if I ever did–and those studies just don’t exist. This morning, I read this abstract http://www.ncbi.nlm.nih.gov/m/pubmed/23050604/?i=5&from=/23141562/related and another about shingles and Varivax. I’m unimpressed, as is everyone here by case reports. I have seen what I’ve seen, admit to lots of bias and come in here to learn. I sure don’t get any points from Dog or change any minds by my appearances and posts!

            “Are you sure that you are sufficiently factoring in your own likely confirmation biases, now that you have a hypothesis to chase down?”

            NO!

            Thank you for the measured tone (tone? yes, tone, David!) of your post.

          2. David Gorski says:

            Elsewhere, they might have stayed at zero. I am not trying to pretend that I have lost any of my bias against the current schedule. I am readily admitting that there is not science to support alternative schedules.

            So you admit that you are practicing neither science- nor evidence-based medicine.

            I wish I had begun aggregating data long ago about vaccinated versus non-vaccinated children and the incidence of illness or other outcomes. I didn’t. I have considered seeking out an MPH candidate or two to review my charts but that’s not where my energy and time have gone. I make no pretense to having measured these outcomes except using observation colored badly by confirmation bias.

            Which brings up the question again: Why should anyone take your pronouncements seriously? I’m not asking this to be “mean,” contrary what you seem to think. The question goes straight to credibility and why anyone should consider your concerns if you can’t provide evidence, even carefully tabulated anecdotal evidence, to back them up? At least you recognize confirmation bias, but I suspect you don’t recognize just how bad yours is. Saying that isn’t being “mean” either. It’s pointing out that it’s very hard for human beings to recognize our cognitive shortcomings that go along with being human. That’s why science and controlled observations are so important in medicine.

          3. David Gorski says:

            BTW, Dr. Jay. You might like my newest post, in which I deconstruct an example of the poor quality evidence that is often presented by antivaccinationists to support their belief that vaccines cause autism. Enjoy!

            http://www.sciencebasedmedicine.org/preventing-autism-not-so-fast-dr-mumper/

    2. Lilady gave you an excellent answer.

      And as WLU pointed out – what else can we possibly say? How would we find out information on the topic? By referencing the expert literature. The whole point of a scientific endeavor is that reasonable people come to the same conclusion presented with the same evidence. We don’t possess knowledge that the experts don’t in order to contradict their assertions. That doesn’t mean they are infallible, but it’s the best we got.

      The difference is that you insert your own “special” knowledge to contradict the evidence whenever and however you see fit. I just don’t see what else you intend to garner from multiple opinions on such a topic.

      (I should add that I did not specifically mention those we already know to be reasonably exempt from vaccination, as WLU did, but your assertions and actions go well beyond that)

    3. WilliamLawrenceUtridge says:

      Ugh, the more I read of Dr. Gordon’s comments, the more absurd they are. If you’re looking for serious answers, go to the CDC. Sweet tapdancing pornstar Christ, why on earth would you come here? At best you could say the contributors here are specialists in the tropes and fallacies of the antivaccination movement, even the best-informed hasn’t done the decade or more work required to be a specialist in the area such that they have the expertise to really contribute to the discussion at the level occurring around the table when the recommended vaccination schedule was decided upon. I don’t think anyone here would have the temerity to claim they could reasonably sit at that table and rise to the occasion.

      I have a legitimate question,

      You should go to the CDC website.

      a request for advice,

      You should go to the CDC website.

      an honest answer

      You should go to the CDC website.

      and all you’ve got is venom.

      After years of you being the official MD spokesdoctor for the antivaccination movement, after years of discussion, after years of debate and drive-by commenting, after dozens of research studies with tens of thousands of subjects and millions of dollars in funding, over more than a decade for MMR alone, what else is there to say? Should we pretend that you care about the science? I mean, you can bang your head against a wall only so many times before you get a headache. Honestly, what do you want anyone here to say?

      You’re a bitter person for some reason.

      See aforementioned headache. You are mistaking “bitter” for “frustrated”. Dr. Gorski gets invective thrown at him by scientific illiterates day after day, gets nonsense e-mails from ignorant twits who can’t muster much beyond the fallacies fed to them by naturopaths and celebrity doctors, e-mails and comments which must above all be boringly repetitive from arrogant little pustules who tried to get him fired, and here you come along – a doctor, who should know better – and you tell him to be nice to you and give you yet another reply to your questions despite the painfully obvious fact that given your years of history of interactions, you have no genuine intention of bothering to change your mind. Really. Why would he react badly? Why would he not pretend that your question is in good faith? I can’t imagine why. You want good faith replies? Publicly disown your stance that vaccines are more dangerous than the diseases they protect against. Be the Mark Lynas of the antivaccination movement. Then you’ll get some of the respect and civility you apparently need so much. Is it because you’re used to fawning from the patients you cater to so solicitously?

      You’re wrong. There’s no reason not to step away from that attitude for a minute and give a civil answer.

      Yes there is. There is every reason to believe it would be a huge waste of time.

      And, by the way, I really would like opinions from anyone who’d care to offer them. This is a real life issue for me right now.

      You should go to the CDC website.

      If you were genuinely sincere about this issue, that’s where you would be, not here tone-trolling Dr. Gorski’s nth reply to you.

  55. lilady says:

    For Dr. Jay, the publicity-seeking pediatrician to the stars, it is all a game. If he isn’t running a Gish gallop on this blog (or on Respectful Insolence), he flings snide remarks at every person who disagrees with him, while hiding behind the ploy of “Just asking questions”.

    Dr. Jay, you readily admit you have no science and no links to published scientific papers to back up your “opinions” about vaccines, the timing of vaccines, the spacing of vaccines, the ingredients in vaccines and the utterly disproven link between vaccines and the onset of autism. So Jay, why should we believe you, when we all have experience with your methods, your *fabrications, your pretenses and opinions about our **”civility”?

    If you had done any research whatsoever about the post-polio eradication end game, you would have been aware that tens of thousands of scientists from around the world are analyzing the global polio eradication campaign data, to determine when we can finally cease using OPV.

    http://www.polioeradication.org/Posteradication/Preparingforposteradication.aspx

    I provided you with accurate answers to the questions you posed about a one-time dose of OPV being recommended and being implemented for Israeli children. I also provided you with the advisories issued by the CDC for travel to Israel, which you couldn’t find fault with.

    At this point I am wondering if those children you claim to have in your practice who are going to Israeli are just another fabrication conjured up in your mind. Should you in fact, actually have patients going to Israeli, you should be showing their parents the “Catch Up” Recommended Childhood Vaccine Schedule and have those who are very far behind on their vaccinations and those who taken your “advice” and never received vaccines, cancel their trip plans.

    BTW Dr. Jay, have you forgotten that your patients are the infants and children you care for…and not their uninformed vaccine-phobic parents that your pander to?

    * Dr. Jay likes to fabricate and tried to convince me that my developmentally disabled child was eligible for varicella vaccine 15 years before it was licensed in the United States. He “claimed” he had access to the vaccine, which was still under development in Japan, under a “compassionate use protocol” for children being treated for cancerous solid tumors. (My son did not have cancer, nor did Dr. Jay have access to the varicella vaccine circa 1980).

    ** The oh so civil, proper and pretentious Dr. Jay has put me “on probation” on the Respectful Insolence blog.

  56. WilliamLawrenceUtridge says:

    Lilady–You have called me a liar at least twice in your post above. You are off probation and banned instead. You are not worth one more minute of my time. Good bye.

    …and this is supposed to do what? Hurt her* feelings? It’s not like you are able to prevent her from responding to your posts. Why bother asking for comments and substance if you’re just going to flounce off when they call you on your nonsense? Why not prove them wrong by demonstrating you aren’t talking nonsense? Are you unable to do so?

    *I don’t know if Lilady is a “her” or not, but with “lady” in the name, I’m taking a shot.

  57. lilady says:

    I’m absolutely crushed that Dr. Jay has banned me on Respectful Insolence//sarcasm.

    I’m wondering what I posted that caused him to do that; one week ago he offered me the opportunity to enjoy a convivial lunch and split a bottle of wine with him…

    m/insolence/2013/08/16/yet-another-antivaccine-meme-rises-from-the-grave-again-no-diane-harper-doesnt-hate-gardasil/

    So, being that I misbehaved and he has rescinded his kind invitation, I posted another comment back at him (out of moderation now and upthread), detailing his lies and his dropping the mask of civility to show us his truly obnoxious personality.

    WUL, you are correct I am a lady. :-)

  58. pmoran2013 says:

    Dr Gordon, I am no vaccine expert, but I accept that quality anecdotal evidence can carry some weight and I can understand how scientific evidence and scientific opinion on vaccine safety can look ample to some, but less so to others. .

    That derives from the fact that medicine has a population-level “public health” perspective, which necessarily inclines it to a more relaxed risk/benefit expectation than might be considered desirable by some parents when being asked to subject their kids to even hypothetical risks. We have studies showing that the public is very averse to actions that pose immediate risk, even if for later benefits. The SBM view is influenced mainly by the former perspective, while you have chosen to champion the interests of the latter. That is not necessarily a bad thing — unless —?..

    The problem as I see it is that you have gone hard enough at the matter to expose kids to risk. It may be only a matter of luck and the fact that most other kids are vaccinated if you have not yet seen any come to serious harm. And those not adequately vaccinated, partly through your efforts, still have the rest of their lives to run, during which they are at even more risk of serious consequences from these “childhood” illnesses if they should be unlucky enough to be exposed to them.

    So, to me the question boils down to whether your anecdotal evidence, your seat-of-the-pants observations, are of sufficient quality for you to be inducing others to run such risks? You are a doctor and should know how unreliable that kind of observation can be.

    So I personally don’t expect you to produce a mass of studies supporting your position, but I do expect you to be able to more clearly describe the kind of observations or other material that arouse your concerns, just as I might ask a cancer quack to explain how they know that their treatment works . I mean, most kids are very healthy whether they have vaccines or not. That is a fact. What then, precisely, is the pattern that you claim to be seeing in your patients, and can you back that up with data from your records? If particular cases have aroused your concern, can you describe them? Are you sure that you are sufficiently factoring in your own likely confirmation biases, now that you have a hypothesis to chase down?

    I understand why you might be wary of doing so in an environment that is as hostile as this to anecdotal evidence (for good reason, in many other settings), but I am not sure what else you can do.

    1. BTW, Peter: If you don’t believe that there are people who are unalterably antivaccine, read this post and, more importantly, the comments after the post:

      http://www.naturalnews.com/041781_vaccinations_murder_charge_parents.html

      Truly frightening.

  59. David Gorski says:

    So I personally don’t expect you to produce a mass of studies supporting your position, but I do expect you to be able to more clearly describe the kind of observations or other material that arouse your concerns, just as I might ask a cancer quack to explain how they know that their treatment works . I mean, most kids are very healthy whether they have vaccines or not. That is a fact. What then, precisely, is the pattern that you claim to be seeing in your patients, and can you back that up with data from your records? If particular cases have aroused your concern, can you describe them? Are you sure that you are sufficiently factoring in your own likely confirmation biases, now that you have a hypothesis to chase down?

    To any out there who might think I’ve been too “mean” to Dr. Jay in this exchange, I would like to point out simply that what Peter has just done is nothing more than ask the sorts of questions I’ve been asking Dr. Jay for eight years. I have yet to get a straight answer, which leaves me (understandably, I think) frustrated and less patient when I see Dr. Jay giving the same sorts of answers I’ve seen him give time and time again over the last eight years. Perhaps Peter will have more success than I have had, but I tend to doubt it. In any case, Dr. Jay and I have had exchanges on my not-so-super-secret other blog and by e-mail. Every time, I’ve tried to get him to provide me with more concrete evidence to support his concerns, even if anecdotal, than his usual citation of his “30 years of clinical experience.”

    I’ve failed every time.

    I’ve tried to explain to him how correlation does not necessarily equal causation and how, as a prominent “pediatrician to the stars’ children” who is known to be very sympathetic to, if not in outright agreement with, the vaccine averse, he has a biased sample of the population with a much larger proportion of parents who believe vaccines harmed their children. So he takes their histories, and he believes that vaccines cause injury and autism, too.

    I’ve failed every time to get him to understand, much less acknowledge, how his biased sample and confirmation bias can lead him astray, as they can with all human beings, including myself. However, Dr. Jay has faith in his clinical experience above all else and pooh-poohs concerns that he can be led astray by personal experience, even though we as human beings are all prone to such problems.

    I’ve pointed out where Dr. Jay’s gone wrong in basic science (for instance, a rant he did a few years ago about formaldehyde in vaccines) and in analogies (for instance, likening vaccine manufacturers to tobacco companies in their level of deceit). I’ve pointed out where Jenny McCarthy gets the science not just wrong, but spectacularly wrong. I’ve pointed out how the vast preponderance of evidence does not support the hypothesis that vaccines cause or contribute to autism.

    I’ve had some minor successes in getting Dr. Jay to realize he made a mistake (e.g., with his formaldehyde rant). However, I’ve failed every time to get him to admit publicly his biggest errors in fact, science, and reasoning and to disassociate himself from the worst elements of the antivaccine movement. The best I’ve managed is to get him to acknowledge (in this very thread) that there are “extreme” antivaccinationists that he “doesn’t listen to” (but only in the context of also mentioning that there are “extreme pro-vaccinationists”). He won’t call out any of the antivaccinationists with whom he has allied himself or whose children he takes care of. Also, Dr. Jay seems to value his self-image as being a very reasonable and even-handed man, which makes him particularly prone to the fallacy of moderation/fallacy of the golden mean.

    Now, don’t get me wrong. I realize that doing so would be difficult. Dr. Jay would likely pay a high price in terms of fame as the pediatrician to the antivaccine stars’ children, particularly if he started trying to persuade them to be vaccinated according to the recommended schedule. He likely wouldn’t be able to hobnob with the famous anymore and would likely get many fewer, if any, invitations to appear on TV and radio. He might even lose patients. It would, however, be the right thing to do, and I hold out hope that one day he might still do it. After all, he keeps coming back to these hostile environs, both here and at my not-so-super-secret other blog. He must have serious doubts about his position. At least that’s the way I look at it.

    1. nybgrus says:

      Peter’s reply is indeed a good one. Except for the fact that it has been attempted ad nauseum with Dr. Jay in the past. Even I personally have given such responses and asked such questions to him (though obviously not as much or as long as you). It seems sadly not-so-strangely naive that after decades of Dr. Jay being in the spotlight, being called out by numerous vaccine science savvy folk, and for chrissake being a fracking pediatrician that now, at this juncture, a kind and gentle “hey, did you maybe happen to think about this particularly logical fallacy you may perchance be happening to possibly be falling vicitm to?” could possibly have any sort of effect? I mean really? Because all of a sudden Jay is going to read Peter’s oh-so-nicely stated observation and give himself the Picard facepalm and see the error of his ways?

      I think it was Einstein that said insanity is doing the same thing over and over and expecting different results.

    2. Jay Gordon says:

      @pmoran2013

      “Dr Gordon, I am no vaccine expert, but I accept that quality anecdotal evidence can carry some weight and I can understand how scientific evidence and scientific opinion on vaccine safety can look ample to some, but less so to others.”

      Yes

      “It may be only a matter of luck and the fact that most other kids are vaccinated if you have not yet seen any come to serious harm.

      Yes, that is possible. Not likely after all these years and thousands of patients, but still quite possible.

      “So, to me the question boils down to whether your anecdotal evidence, your seat-of-the-pants observations, are of sufficient quality for you to be inducing others to run such risks? You are a doctor and should know how unreliable that kind of observation can be.”

      I agree. I speak quieter than I used to and question more than I used to. I have learned a lot at SBM and RI. Most of the families I take care are not being “talked out of” vaccines by their contact with me. If anything, some of the “zero” families opt in to a limited, delayed schedule. Elsewhere, they might have stayed at zero. I am not trying to pretend that I have lost any of my bias against the current schedule. I am readily admitting that there is not science to support alternative schedules.

      ” I mean, most kids are very healthy whether they have vaccines or not. That is a fact. What then, precisely, is the pattern that you claim to be seeing in your patients, and can you back that up with data from your records?”

      Yes, and that protects even the worst of primary care doctors including pediatricians. No matter what I do, really bad things will rarely happen. I wish I had begun aggregating data long ago about vaccinated versus non-vaccinated children and the incidence of illness or other outcomes. I didn’t. I have considered seeking out an MPH candidate or two to review my charts but that’s not where my energy and time have gone. I make no pretense to having measured these outcomes except using observation colored badly by confirmation bias. Peter, I have never claimed to be able to cite study after study showing how bad vaccines are. I don’t believe that now–if I ever did–and those studies just don’t exist. This morning, I read this abstract http://www.ncbi.nlm.nih.gov/m/pubmed/23050604/?i=5&from=/23141562/related and another about shingles and Varivax. I’m unimpressed, as is everyone here by case reports. I have seen what I’ve seen, admit to lots of bias and come in here to learn. I sure don’t get any points from Dog or change any minds by my appearances and posts!

      “Are you sure that you are sufficiently factoring in your own likely confirmation biases, now that you have a hypothesis to chase down?”

      NO!

      Thank you for the measured tone (tone? yes, tone, David!) of your post.

      1. “No matter what I do, really bad things will rarely happen. I wish I had begun aggregating data long ago about vaccinated versus non-vaccinated children and the incidence of illness or other outcomes. I didn’t. I have considered seeking out an MPH candidate or two to review my charts but that’s not where my energy and time have gone.”

        I’m sure you’ve read Prometheus’s post about vax/unvaxed studies. Even if you had kept your records from day one it’s probably not enough to convince you. I’m not trying to be mean I’m just saying that there are so few unvaxed that it’s hard to produce a study of higher-power than anything we’ve already seen. You could enroll 80% of the unvaxed in the US and still not have a very high power study.

        The question you need to ask yourself is “What study of what power would convince you?”. Then you need to decide if this is consistent with other outcomes you accept. If it isn’t then you need to decide if you need to reject other things you accept or accept that which you currently accept.

        1. passionlessdrone says:

          @ Jonathan Graham –

          I’m not trying to be mean I’m just saying that there are so few unvaxed that it’s hard to produce a study of higher-power than anything we’ve already seen. You could enroll 80% of the unvaxed in the US and still not have a very high power study.

          Finally someone with the guts to admit the truth, though I doubt you meant to.

          There just aren’t enough unvaccinated children on which to perform an analysis; that means that all of the fury, the bluster, and the *intentional* replacement of MMR and thimerosal for ‘vaccination’ in these discussions is worth a hill of beans.

          We just do not have a population of sufficient numbers to perform adequate analysis. Even with a population set unimaginable in the context of existing studies (80% of all unvaccinated children!), our study would be weakly powered.

          Does this reality give us any insight into the relative power of our *existing* studies? How do we reconcile this apparent paradox with the notion that a relationship between vaccines and autism has been thoroughly debunked?

          The question you need to ask yourself is “What study of what power would convince you?”

          It would seem, for the SBM community at large, that answer is, ‘not a very powerful one’, utilizing your own criteria above to measure our existing analysis set.

          Then you need to decide if this is consistent with other outcomes you accept.

          I will admit, at least an honest response. It isn’t about how the quality of our analysis, it is about the potential problems of applying a quality analysis. I won’t deny this one reasonable line of argument.

          @windriven – Perhaps you should ‘educate’ Jonathan Graham on how diligently this issue has actually been studied. It’s been discussed here on this board, ‘many times’, I bet he’s just missed the part where a highly powered study was performed. Why not just post a link to the discussion of *that study* (or those studies!) here, on the SBM site, that provides the type of strong, highly powered studies Jonatahan Graham doesn’t seem to think exist.

          1. “Finally someone with the guts to admit the truth, though I doubt you meant to.”

            The society of shadow statisticians will have my head.

            “There just aren’t enough unvaccinated children on which to perform an analysis; that means that all of the fury, the bluster, and the *intentional* replacement of MMR and thimerosal for ‘vaccination’ in these discussions is worth a hill of beans.”

            I really don’t know what you’re on about but you might be missing the context.
            The point of a vaxed/unvaxed population/cohort study is that it could reveal something that currently multi-center epidemiology trials haven’t. That’s the point of the prior persons post…and it probably can’t.

            A case-control study would be better, one that looked at dose-response would be better still. However when constructing those – or any study – you have to ask the question “What power is going to be persuade me?” Is an Alpha of 10% and a Beta of 10% acceptable? If so, do I currently believe that Thimerosol is, in the context of vaccines responsible for Autism? If so, then why aren’t I convinced by larger epidemiology work which answer that particular question with much better power?

            1. Jay Gordon says:

              Amazing. Simply amazing.

  60. lilady says:

    Dr. Moran: I would like to personally thank you for your comments about Dr. Gordon. You and I have a history of some “lively” debates here on SBM and this comment about vaccines, in particular your astute observations about Dr. Gordon’s firm stance on vaccines, is really appreciated.

  61. WilliamLawrenceUtridge says:

    Finally someone with the guts to admit the truth, though I doubt you meant to.

    One truth that we should have the guts to admit is that if we stop vaccinating out of fear of autism, we’ll have a lot more dead kids. Personally, I’m against that.

    Plus, maybe it’s not the vaccines.

  62. Jay Gordon says:

    @Utridge You are correct on both points.

    Many of us would like a better vaccine schedule. As I mentioned above, increased safety and fewer unproven combinations of vaccines and “six vaccine visits” would better serve children and families if for no other reason than it would preserve confidence in the process.

    Personally, I believe vaccines do play a role in triggering a genetic predisposition to autism. But even if they play no role at all, the safety of simultaneous administration of six vaccines at once has never been established. No, no proof of danger has never been established either, but the obligation is to prove safety.

    1. David Gorski says:

      Personally, I believe vaccines do play a role in triggering a genetic predisposition to autism.

      Based on no evidence.

      But even if they play no role at all, the safety of simultaneous administration of six vaccines at once has never been established.

      Not true, as has been explained to you many, many times over the last eight years.

    2. Harriet Hall says:

      If “the obligation is to prove safety,” then it is your responsibility to prove the safety of delaying vaccines. We have no reason to think it is safe, many reasons to think it is risky, and no evidence that your practice results in better outcomes for children.

    3. Chris says:

      “Many of us would like a better vaccine schedule”

      Have you applied for membership to ACIP?

      One parent of a child injured by the OPV, John Salamone, did become a member of ACIP. His work, with actual evidence, is why the USA switched from OPV to IPV.

  63. WilliamLawrenceUtridge says:

    Many of us would like a better vaccine schedule.

    How do you measure “better”? By “better”, do you mean “better pandering to those who think it is “too many, too soon”? Because my standard for a “better” vaccine schedule is one that prevents the greatest amounts of morbidity and mortality among children (and adults).

    As I mentioned above, increased safety and fewer unproven combinations of vaccines and “six vaccine visits” would better serve children and families if for no other reason than it would preserve confidence in the process.

    You know what would help preserve confidence in the process? If you didn’t pretend there was merit to the “too many, too soon” and “green our vaccines” scaremongers. If you publicly came out and stated that you have yet to find any scientific proof of vaccines being in any way connected to autism.

    Personally, I believe vaccines do play a role in triggering a genetic predisposition to autism.

    Physicians before 1800 personally believed that cutting open their patients’ veins and dosing them with powerful emetics and purgatives were effective in treating imbalances of the four humors. If you can’t see that your personal beliefs are little more than a means of generating self-confirming information and that scientific assessments are a far better way of determining relationships, then I don’t know what to say to you. I certainly see why you get little respect here.

    But even if they play no role at all, the safety of simultaneous administration of six vaccines at once has never been established. No, no proof of danger has never been established either, but the obligation is to prove safety.

    You know what’s not safe? Dying of pertussis. Why do you think these tiny doses of vaccines, orders of magnitude lower than what you would be exposed to if you were actually infected with any of these diseases, are unsafe? Jebus, it’s not like they’re put together randomly with a dart board. Each vaccine component is rationally decided upon at a dose that is also rationally selected by a panel of experts in the exact slice of knowledge you would need to have to assess the ingredient for safety and utility. Why on earth would you ever assume your personal hunch is better than that?

    You might have a case if every single vaccinated disease were present in a single shot – but they’re not, they’re separated into the least number of appointments, balanced with the best mixture of doses, based on what experts think.

    Meanwhile, what’s your “modified” schedule based on? How do you know the spacing and timing of your vaccines don’t cause more harm than that experienced by children on the recommended (expert-based, rationalized) schedule? I mean, aside from widening the window within which more children are vulnerable to dangerous diseases. You keep de facto claiming with absurd rank arrogance that your experience is better than that of all the experts the CDC can muster. On what basis? Because your patients are convinced their children are autistic because of vaccines due to a couple hours spent on the Google University echo chamber? Do you not perhaps see the flaws in that?

    And if you don’t, then you really shouldn’t be claiming some sort of special expertise in anything scientific.

  64. Andrey Pavlov says:

    I simply have to point out a couple very poignant examples of your flawed thinking Dr. Jay. Others have already harped on you enough, so I’ll refrain from too much of it, but a couple of points just really stand out as needing to be addressed.

    Many of us would like a better vaccine schedule.

    No, Dr. Jay. Everyone wants a better vaccine schedule. One that optimizes benefits while minimizing harms. One that takes into account changing prevelances and incidences of diseases which they target in the populations that are relevant. One that is updated as evidence and new coverage arises. In other words exactly what is going on right now and what the CDC does.

    What you are talking about is some imaginary concept of “better is better” and using a cleverly hidden (probably even from yourself) tautology as if it were a valid talking point concerning the vaccine schedule. Of course we all want a better vaccine schedule and your comment here – and indeed all of your writings – implies that those of us here for some reason are opposed to a better schedule. Your argument would only hold water IF you had a proposed alternative schedule with evidence to support why it is better. You don’t even have the beginnings of that, just weak and whiny asseverations that it could be better… just so long as it isn’t the CDC or other actually authoritative bodies determining what “better” is.

    As I mentioned above, increased safety and fewer unproven combinations of vaccines and “six vaccine visits”

    Once again, zero evidence to demonstrate any validity to this claim. And plenty of epidemiological data to demonstrate it is wrong. Could there be a danger in “too many too soon?” Sure. Is there good prior plausibility that there is? No. Is there data to demonstrate that there is? No. Could there be harm that is being masked by a confounding benefit in the epidemiological data? Yes. Would that matter? NO! Because if the harm is small enough to be masked by the benefit such that study after study can’t find the harm then guess what? The risk benefit analysis is clear!

    As a physician you should know these things. Which is why you get a particularly harsh treatment around these parts. You deserve it. You aren’t merely ignorant. You are willfully ignorant and using motivated reasoning to slither your way around it. That does not deserve doting kindness and education – it deserves contempt from your peers for sullying our profession. And that is exactly what you are getting.

    You will, however, get our sincere respect if you finally stop equivocating and admit you were wrong, are wrong, and take a firm stance in support of the evidence based and rational use of vaccines.

    No, no proof of danger has never been established either, but the obligation is to prove safety

    But guess what has been established? The amazing BENEFITS of vaccination. So in the face of a clear, well defined, well established, and LARGE benefit with no evidence of harm, the onus is not to continue to try and prove ZERO harm before implementation but to change implementation AFTER harm has been established. And study after study simply can’t establish it.

    Your position is wholly untenable and unbecoming of a physician.

Comments are closed.