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Steve Novella vs. Julian Whitaker on vaccines at FreedomFest

Steve Novella vs. Julian Whitaker on vaccines at FreedomFest

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Posted in: Neuroscience/Mental Health, Politics and Regulation, Vaccines

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454 thoughts on “Steve Novella vs. Julian Whitaker on vaccines at FreedomFest

  1. pmoran says:

    Harriet: “That is not worthy of comment. Keep the wagons circled. I may be back.”
    Translation: “you are being mean to me by parodying my well-intentioned criticism. I’m taking my marbles and going home. I’ll probably return in future threads to repeat the same criticisms.”
    You never did what I asked you to do: give specific examples of Steve’s and David’s statements that you disapprove of and re-write those statements to show what you think they should have said. That is even more important now that David has pointed out some of the equally strong statements on your own website. I am not circling the wagons, I’m just trying to pin you down on exactly what you mean.

    Harriet, whether consciously or not, you are being so disingenuous I could spit.

    At this stage in our lengthy interchanges you do the selective quoting out of context thing, so as to be able to attack things I never would say. You never acknowledge that, let alone apologize for it when the error is pointed out. You simply resume attacks which show no effort on your part to understand what I am really trying to say. This is the third time I have had to endure that. I know what I have to say is difficult, that it often concerns fine nuances, and I am not that good at getting it across. But I expect fair comment, even while knowing full well that opinions will not change in the short term..

    You say ” You seem to be grasping at straws just to find any way to criticize our approach” when I have explicitly stated above that I agree with the way Steve Novella has described his opinions on the vaccine-autism link , and I have never had major cause to differ with you on anything much else. (I don’t know what Steve said in the debate, but have rarely known him to put a foot far wrong when it comes to describing the state of evidence on scientific matters. My opinions differ with his on one or two peripheral matters to do with CAM).

    I have provided enough specific examples of poor science or overstatements for you to go on. By defending those you call into question your own intellectual honesty. That is sad. I want no part of that, but that is what you are doing to yourself when you feebly defend David by saying he was merely echoing what was said by the Gonzales study authors had stated. There was no indication that he did not fully share that opinion and such an approach would be entirely out of character if he was being required to accept a similar CAM claim.

    WRT your parody, I state again: this is not about being kind and ultra-tolerant of CAM. It is about being scrupulous in the interpretation of evidence so that, hopefully, others can get an idea how good, unbiased science works.

    There is, I admit, a bit of consideration for the mind set of CAM sympathisers or waverers, because it is frankly stupid to be initiating dialogue with them without having regard to many ways in which they can be spooked. Ad hominem attacks on well-meaning people, over-reliance upon medical authority and dismissal of reasonable concerns are some of those. Thankfully sticking to sound science guards against most of them.

    If we don’t apply that consistently we deserve the suspicions that have already eroding public trust in us.

    1. Harriet Hall says:

      @pmoran

      “I could spit.” Go ahead and spit. While I retch.
      Now you say you agree with Steven Novella’s approach. May I remind you that you recently said “Steven Novella has shown an overly simplistic understanding of the history of CAM and of the main factors which sustain it.”

      I think it’s time for us both to step back and take a deep breath. I really wish you would write a guest post CLEARLY explaining the exact substance and nuances of your criticisms, with specific constructive suggestions and examples. Lacking that, I think the best way for this discussion to proceed is for you to point out the next time you think any of the statements on our blog posts are objectionable. Please point them out and offer a re-wording that would satisfy your objections.

  2. papertrail says:

    Eww, spitting and retching. LOL.

    “I really wish you would write a guest post CLEARLY explaining the exact substance and nuances of your criticisms, with specific constructive suggestions and examples.”

    I second this, and look forward to reading it.

  3. papertrail says:

    “Ad hominem attacks on well-meaning people, over-reliance upon medical authority and dismissal of reasonable concerns are some of those. Thankfully sticking to sound science guards against most of them.”

    I’m going to bet that Dr.G (and Dr. H) would agree with that statement. The question is, is it a fair to suggest that Dr. Gorski commits this? And, why would you not expect strong backlash for suggesting this? Isn’t this an ad hominem attack?

  4. pmoran says:

    Now you say you agree with Steven Novella’s approach. May I remind you that you recently said “Steven Novella has shown an overly simplistic understanding of the history of CAM and of the main factors which sustain it.”

    Yes, let’s stop this when you cease being deliberately obtuse and using self serving, selective, quotations. I was careful to specify (in what you were responding to) “I that have rarely known him to put a foot far wrong when it comes to describing the state of evidence on scientific matters.

    That does not preclude us having differing opinions on the most important factors leading to the upsurgence of CAM in recent times, although those interpretations are going to be even more prone to bias.

    Mind you, if we are not biased against some aspects of CAM there is something wrong with us. The thing we have to realise is that the impulse to give CAM no quarter, to not only kick in in the teeth but to grind its face in the mud, might be very nearly as powerful a corrupter of even, unbiased, scientifc process as money, or the seeking after fame.

    I have lived through a few examples of that, in which I now admit that I was inclining towards the wrong side and afraid of speaking up in defence of what I knew was right.

    .

  5. pmoran says:

    “Ad hominem attacks on well-meaning people, over-reliance upon medical authority and dismissal of reasonable concerns are some of those. Thankfully sticking to sound science guards against most of them.”

    I’m going to bet that Dr.G (and Dr. H) would agree with that statement. The question is, is it a fair to suggest that Dr. Gorski commits this? And, why would you not expect strong backlash for suggesting this? Isn’t this an ad hominem attack

    Again, if you read the whole context you will see I was describing principles that I try to apply, not making accusations (although I allow I might have elsewhere if disturbed by specific examples).

    The truth is we are all guilty of these things at one time or other, especially when engaged in what we think is more private discussions. We are only human. I am warning against letting them carry over into more public pronouncements, where there is the great risk of reinforcing certain already prevalent steriotypical impressions of us.

    Harriet, thanks for the invitation to write an post on this. I will think on it.

  6. David Gorski says:

    “I that have rarely known him to put a foot far wrong when it comes to describing the state of evidence on scientific matters.

    I’m glad you have such faith in Steve. So do I, otherwise I wouldn’t continue to serve as the editor of the blog he founded. I also note that at the debate he said that, with respect to vaccines and autism, science has moved on. He agrees with me. So I assume that the vaccine-autism issue is one area where you don’t think Steve is right? He also stated rather bluntly that the graphs Dr. Whitaker used were “deceptive.” Yes, that’s the word he used.

    Sorry I’ve been away, but I’ve been swamped at work, and I’ve also intentionally stayed a way for a day or two. Having just read your contributions over the last day or two, I think that was the wise course of action, because I could feel my blood pressure rising with each successive post by you I read and I feared I might say something that I would later regret. So, for now, I’ll keep my comment brief and maybe come back later for more extensive comments.

    In the meantime, I third Harriet’s and paper trail’s call for you to write a guest post clearly explaining the exact substance and nuances of your criticisms, with specific constructive suggestions and examples. As editor of SBM. What I’ve seen in this thread from you is mush. I still have trouble figuring out just what it is you’re trying to say.

  7. David Gorski says:

    Again, if you read the whole context you will see I was describing principles that I try to apply, not making accusations (although I allow I might have elsewhere if disturbed by specific examples).

    Nonsense. As confused as your arguments have been, your intent with respect to Harriet and myself has been quite plain in this thread.

  8. libby says:

    Dr. Whitaker, according to the LA Times, is a consultant for supplement firms that he advertises on his website. On the other hand conventional doctors receive billions from pharmaceutical companies to peddle their wares.

    I’m not sure I see that much difference.

  9. lilady says:

    Why don’t you show us the difference between vaccines which actually prevent disease…and the supplements he peddles on his website…in lieu of vaccines, Libby?

  10. Chris says:

    libby:

    On the other hand conventional doctors receive billions from pharmaceutical companies to peddle their wares.

    Citation needed.

  11. David Gorski says:

    The whole point is that you can make a solid, and more obviously non-prejudged, case with proper scientific argument. You don’t need to go beyond what the quality of the data permits, thus risking that our very argument will destroy our credibility in some minds.

    With respect to the vaccine-autism link, that is exactly what I try to do, and, as a result of my efforts, I conclude on a scientific basis that there is not a whiff of a hint of a correlation between vaccines and autism. I’ve challenged you repeatedly to prove my assessment wrong if you can, and all I get in return is handwaving about “proper scientific argument” (what the heck to you even mean by that?) and complaints about tone. You can’t produce even a single paper or a coherent commentary on the existing literature that challenges my assessment. In brief, you cannot back up your accusation that I have somehow failed to make a solid scientific case, despite repeated requests that you do so.

    Is it really any surprise that I don’t take your criticism of my assessment of the science and epidemiology on this particular issue seriously anymore? I did initially, but no longer. You’ve given me no reason to, and, 100+ comments into this thread, I see no sign that you ever will.

  12. lilady says:

    @ Dr. Gorski:

    I first proposed that Dr. Moran submit an article to this blog about the “vaccine-autism link” last week…to *show us* how we can dispel parental concerns about the *deleterious effects* of vaccines, in a *proper manner*….without *resorting to* your phrase of “hint of a whiff” linking any vaccine, any preservative or adjuvant, in any childhood vaccine, or, the spacing of those vaccines…with autism. Has P Moran submitted an article to you or Dr. Novella as a guest blogger?

    Dr. Moran raised the specter of post-immunization febrile seizures “perhaps” being associated with a diagnosis of autism or other developmental disabilities. I provided Dr. Moran with the link to the NIH website about post-vaccination febrile seizures…which he dismissed as being “mildly reassuring”. I then provided P Moran with two links to Dravet Syndrome which has been diagnosed as being the pre-existing genetic disorder in children and whose parents “claimed” (and were compensated for), vaccine injuries.

    Why oh, have you *claimed* “hint of a whiff”(?)…now I’m *stuck with* “no scintilla and no iota of proof that vaccines have ever been linked with a diagnosis of autism…or any other developmental disability”. (TM) :-)

  13. pmoran says:

    The whole point is that you can make a solid, and more obviously non-prejudged, case with proper scientific argument. You don’t need to go beyond what the quality of the data permits, thus risking that our very argument will destroy our credibility in some minds.”

    With respect to the vaccine-autism link, that is exactly what I try to do, and, as a result of my efforts, I conclude on a scientific basis that there is not a whiff of a hint of a correlation between vaccines and autism. I’ve challenged you repeatedly to prove my assessment wrong if you can, and all I get in return is handwaving about “proper scientific argument” (what the heck to you even mean by that?) and complaints about tone.

    Well, here we go again. The above statement concerned your misrepresentation of the implications of the Gonzales study, where I was quite explicit regarding why you (and the authors) were making an unjustifiable conclusion.

    With vaccines your conclusions are not likely to be far wrong. We merely don’t have quite the evidence that you claimed: “Multiple large, well-designed epidemiological studies comprising, taken together, many hundreds of thousands of children — ” and it is not wise to put yourself in the position of being challenged to produce it.

    I am also disturbed at how difficult it is to find the complete argument against a causal association between vaccines and autism anywhere. There is a lot of proclamation and declamation, along with debunkings of specific theories, but little which directly targets the sources of public concern.

  14. @libby, wow, billions? Where’s my check from big pharma?

  15. libby says:

    @ Chris:

    So happy you asked for a citation on bribes doctors receive from the pharmaceutical industry. The meta-analysis is from JAMA (The Journal of the American Medical Association).

    http://jama.jamanetwork.com/article.aspx?articleid=192314

    The bribes in the US alone total about $10 1/2 billion per year. The funniest stat from the study, a real belly laugher, is a poll taken from one of the studies:

    “One study found that 85% of medical students believe it is improper for politicians to accept a gift, whereas only 46% found it improper for themselves to accept a gift of similar value from a pharmaceutical company.”

    Setting aside criminal ones, you would have to perform quite a extensive search to find a non-medical group that bore a set of ethics equal to the appallingly low level found within the medical field.

    1. Harriet Hall says:

      libby,

      If you’re going to cite a study, you might want to read it first. That study said nothing about bribes. It said “More than $11 billion is spent each year by pharmaceutical companies in promotion and marketing.”

    2. Harriet Hall says:

      “you would have to perform quite a extensive search to find a non-medical group that bore a set of ethics equal to the appallingly low level found within the medical field.”

      Wrong. Or at least inconsistent with public perceptions. It took me 2 seconds on Google to find that no non-medical group is as ethical as doctors: In a Gallup poll the only groups rated as more ethical than doctors were nurses and pharmacists.
      http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx

  16. weing says:

    “Setting aside criminal ones, you would have to perform quite a extensive search to find a non-medical group that bore a set of ethics equal to the appallingly low level found within the medical field.”

    And you have done just such a search? What are your results?

  17. @libby.

    You’re right. After over a decade of post college education and years of subsequent training, I’m willing to compromise my medical license for a meal catered by a local Mexican restaurant and a couple of clicky-top pens.

    (Do yourself a favor and look up the difference between a bribe and a gift.)

  18. libby says:

    @ SkepticalHealth:

    It was the AMA that made the correlation between political bribery and medical gifting.

    Please think before you write. You will find it less embarrassing.

  19. Chris says:

    libby, that cite is over ten years old. I did not see anything that showed physicians themselves received “billions.” It actually said “More than $11 billion is spent each year by pharmaceutical companies in promotion and marketing, $5 billion of which goes to sales representatives.” I doubt the sales representatives give all of the cash to doctors, I am pretty sure they use part for their own salaries.

    Plus some states have pharmaceutical gift bans.

    So, really, it has nothing to do with Dr. “random graph generator” Whittaker selling supplements and other silly stuff (Healthy Swinger?).

  20. daedalus2u says:

    PM, Dr Gorski’s statement about autism and vaccines was not a refutation of a connection. It was a statement about a lack of evidence that there is a connection. In saying there is “not a whiff of a hint” of a connection, he is absolutely 100% correct. There is no datum (note singular form) that there is a connection between vaccines and autism.

    This really is the state of the scientific evidence behind the claimed connection between autism and vaccines, there is no data that there is a connection.

    If you have some data that refutes that, I would be happy to see that data too, but so far as I know, there isn’t any. So far as the autism research community knows, there isn’t any.

    There are lots of theoretical considerations as to why a connection would be highly implausible, foremost being the fact that neuroanatomy differences observed in autism occur before vaccines are given. A vaccine at 12 months, can’t change neuroanatomy that is fixed in the first trimester in utero.

    The absence of a connection between vaccines and autism can never be proven, but that is a statement about the nature of proof, not about a connection between vaccines and autism.

    Similarly, there is not a “whiff of a hint” that the Gonzales protocol cures pancreatic cancer. Yes, lesser statements can be made about the Gonzales protocol, namely it has not been proven that the Gonzales protocol does not cure pancreatic cancer in some cases. If you are a quack pushing the Gonzales protocol, you would say the latter, “it has not been proven to not work”, if you are an ethical clinician using best practices you would focus on “there is no evidence that it does work”. Both statements are true.

    There are not any lesser statements about the Gonzales protocol that are true and which also compel an ethical clinician to use the Gonzales protocol for treatment of pancreatic cancer, or even to do more trials.

    The Gonzales protocol has very low prior plausibility based only on physiological considerations. Now that there is data that patients using it fare very poorly, the likelihood that it will be successful in future trials is even less. The likelihood is so low that it is unethical to use it on humans in the absence of new non-human data suggesting it would work.

  21. libby says:

    @ Chris:

    Read the study and not 1 or 2 sentences. In that way you won’t waste everyone’s time.

  22. weing says:

    Still waiting for the results of your search showing that your ethics are better than physicians. Or do you intend to waste our time by throwing us the crap you pulled out of your behind?

  23. Chris says:

    libby, well, this is also this sentence: “It has been estimated that $8000 to $13,000 is spent per year on each physician.”

    Now, click on the links on my comment, and read Dr. Hall’s comment.

    Yes, we know there are issues with gifts and prescribing, which is why there are now laws banning that practice. So what does it have to do with Dr. Whitaker’s failings in epidemiology, graphics and his business of selling supplements and other silly stuff?

  24. lilady says:

    @ libby: What were you saying about Dr. Whitaker and his hawking of supplements…in lieu of vaccines?

  25. libby says:

    Harriet Hall:

    I’m well aware of the sentence you are quoting. That is why I didn’t use it. There are over 1 million doctors in the US. On average, each one receives between 8 to 13 thousand dollars a year in bribes from pharmaceutical companies. Some of course none, others much more. Do the math.

    Just for your information, Gallup is societal perception not reality. It’s utter confusion to use a Gallop poll to judge real ethical behaviour (or lack of it in this case). If doctors were in fact ethical they would self-regulate bribery out of the industry. What most doctors in fact do is deny it exists, or rename it as a gift – a very common mechanism of propaganda, the misuse and abuse of language.

    A gift and a bribe operate very differently. To misuse the term gift, as most doctors do, especially on this radically conservative site, is misleading and deceitful. Pharma companies give ‘gifts’ to doctors with the reasonable expectation of something beneficial in return, such as overuse of their products creating greater profit for the company. That is exactly how a bribe works. You can call it a gift if you like, or corn flakes if you prefer that. But whatever you want to label it, it is still in fact a bribe, and it is shameful behaviour.

  26. Chris says:

    lilady, I thought it was interesting that Dr. Whitaker sells household products!

    Now, when I had trouble pain in my legs/feet (so long ago I forgot what it is called, but it is very common), my doctor did not sell me anything. He told me to get inserts for my shoes to give me better arch supports. While he did mention a specific shoe store, I think it is because he shops there and not from a representative visiting him with shoe and insert samples.

    Oh, and when my back gets funky and I had hiker’s knee, he prescribed exercises (ones that require no equipment). I doubt had a representative visiting his office offering gifts to promote leg lifts!

  27. Chris says:

    libby:

    Pharma companies give ‘gifts’ to doctors with the reasonable expectation of something beneficial in return, such as overuse of their products creating greater profit for the company.

    Even in states where it is expressly outlawed? And how does that excuse Dr. Whittaker’s use of a ridiculous graph and his selling of pots and pans?

  28. Chris says:

    Oooh, more silly stuff. Look, the 6.2 oz packages of prepacked food boxes are now half price, for $12 instead of $24!

    That is hilarious, and very expensive.

  29. Harriet Hall says:

    @libby,

    “There are over 1 million doctors in the US. On average, each one receives between 8 to 13 thousand dollars a year in bribes from pharmaceutical companies.”

    No. The pharmaceutical industry spends an amount of money on promotion and marketing that corresponds to 8-13 thousand per doctor. That doesn’t mean they are giving the money directly to doctors. They are trying to influence them with advertising, not bribe them.

  30. weing says:

    “A gift and a bribe operate very differently.” Oh yes. A gift is something you get from someone. A bribe is something you give to someone.

  31. Harriet Hall says:

    @libby,

    “Gallup is societal perception not reality”

    Yes, I acknowledged that. I said “Wrong. Or at least inconsistent with public perceptions.”

    You claim that the reality is different from the perception. Maybe. I’d be more than happy to look at any study that reflects reality rather than perception. It’s up to you to find evidence to support your assertion.

    If what you say is true, it would mean that the public perception is entirely wrong. Isn’t it possible that it’s your perception that’s in error? Without evidence, how can we judge whose perception is right?

  32. libby says:

    Harriet Hall:

    Wrong. The meta-analysis is about ‘gifting’, not advertising.

  33. libby says:

    HH:

    Public perception and reality are quite different. Many people believe there’s a Magical Man sitting in a cloud watching his creation, the universe. The only thing you can extrapolate from that is that societal perceptions are irrelevant in a discussion about reality. They are however important to sociological studies.

    Are you saying that doctors never receive gifts from pharma companies?

  34. libby says:

    HH:

    Wrong again. You’re batting 1000. Here is what JAMA says:

    “It has been estimated that $8000 to $13,000 is spent per year on each physician. The attitudes about this expensive interaction are divided and contradictory. One study found that 85% of medical students believe it is improper for politicians to accept a gift, whereas only 46% found it improper for themselves to accept a gift of similar value from a pharmaceutical company.”

    JAMA calls it an “expensive interaction”, and then goes on to discuss the perception of bribery (or to use its euphemism, gifting) among medical students.

    The quote is talking specifically about gifting of doctors, not advertising.

  35. Chris says:

    And, really, what does this have to do with Dr. Whittaker’s total incompetence he showed at the debate, especially with the major fail in regards to that idiotic innumerate graph? Or his failure with the English language by claiming annual measles deaths equals incidence (from Dr. Novella’s telling on his podcast).

    Libby, is this just a ploy to derail this thread as a way of downplaying Dr. Whittaker’s total lack of math skills, vocabulary problems and integrity? (those “Gourmet on the Go” are much cheaper elsewhere)

  36. libby says:

    HH:

    You almost slipped this one by me.

    “Wrong. Or at least inconsistent with public perceptions.” (My statement that Gallop concerns itself with perception, not reality)

    So tell me, how could I be wrong about the facts based on my inconsistency with public perception?

    That’s a ludicrous statement, with more holes in it than a colander.

  37. lilady says:

    Chris, libby is just trying to derail this thread…not too successfully, I might add.

    Libby, aside from your mudslinging, have you any scientific information to justify Dr. Whitaker’s hawking of supplements on his website…in lieu of vaccines?

  38. libby says:

    @ Chris:

    Take a moment and think. Whitacker has been criticized by a legitimate source (LA Times). sciencebasedmediciine.org is not a legitimate source because it operates as a pseudo-debunking tool against the perceived enemies of conventional medicine. There is very little objectivity here.

    Having said that, I was simply making a correlation between the conflict of interest within Whitacker’s ranks, his cozy connection of selling supplements from companies he is vested in, and the conflict of interest among conventional doctors who accept bribes to steer patients towards certain, often more expensive, drugs.

    Both scenarios are a conflict of interest. Doctors shouldn’t be exposing themselves to drug reps bearing bribes, if they had integrity. They should be appalled by the notion. According to JAMA, 54% of medical students find bribery within medicine perfectly fine. The cycle is simply going to continue until there are enough doctors with integrity that say enough is enough. The prospect of that happening anytime soon doesn’t look good.

    You can support this egregious structure if you like. That’s your choice. But those who are informed of what really goes on within standard medicine are usually not so forgiving.

  39. libby says:

    lilady:

    Why would you ask me to justify Whitaker’s actions when the only thing I’ve said about him is negative?

    Sorry but your level of comprehension is far too low.

  40. Chris says:

    Libby:

    Take a moment and think. Whitacker has been criticized by a legitimate source (LA Times).

    Linky please?

    So you are comparing the doctors who write for SBM with a guy that sells overpriced supplements, processed food, pots and pans? I wonder with him not realizing the basic arithmetic errors in that cartoon graph if he could pass the medical boards exams.

    And that JAMA article is still twelve years old, and done before several states legislated against those practices. So it is non-argument.

  41. lilady says:

    @ libby:

    “Why would you ask me to justify Whitaker’s actions when the only thing I’ve said about him is negative?”

    Why didn’t you go to Whitaker’s blog and post some cogent arguments about his crappy science and his undermining of public health initiatives to protect vulnerable children and adults, from serious, sometimes deadly, vaccine-preventable diseases?

    http://www.drwhitaker.com/new-legislation-seriously-misleads-parents-about-vaccine-safety/

    libby: Excuse me. Your level of comprehension is way too low. The subject of this thread is Dr. Whitaker’s debate with Dr. Steve Novella…not about your working out your animosity toward the medical profession.

  42. weing says:

    “you would have to perform quite a extensive search to find a non-medical group that bore a set of ethics equal to the appallingly low level found within the medical field.”

    Still waiting for evidence for this claim.

  43. Harriet Hall says:

    @libby,

    “Are you saying that doctors never receive gifts from pharma companies?”

    Of course not. I’m saying that the article you cited did not mean that pharma companies are giving an average of $8000 to $13000 bribes or gifts to individual doctors. You read something into it that is not there. The 8-13 is the total amount they spend on all promotion and marketing divided by the number of doctors. That includes some for drug reps, some for gifts to individual doctors, but a great deal more for expensive advertising in medical journals, television, and elsewhere. The article discussed total expenditures and then discussed the separate issue of accepting gifts. You conflated two different subjects.

    “So tell me, how could I be wrong about the facts based on my inconsistency with public perception?”

    You misunderstood what I said. I didn’t say you could be wrong based on inconsistency with public perception. I meant that if public perception can be wrong, your private perception might be wrong too. If you are right, the public is wrong. If the public is right, you are wrong. To tell which of you is right, we need evidence. Where is your evidence?

  44. libby says:

    @ Chris:

    “So you are comparing the doctors who write for SBM with a guy that sells overpriced supplements, processed food, pots and pans?”

    That’s right. Both engage in conflict of interest.

  45. lilady says:

    Still working out your animus directed at doctors, eh libby?

    At the risk of sounding redundant, this thread is about the crappy science of Dr. Whitaker and his debate with Dr. Novella.

    It seems that you have some issues with the medical profession. Get some professional help…you need it.

  46. libby says:

    HH:

    So really what you trying to say by blurring the facts is that doctors receive much less in bribes than I am suggesting.

    So let’s assume that you are right. You’re not but let’s assume for the sake of argument. The amount of bribery is considerably less within conventional medicine than I am saying it is.

    So YOU are now left with the logical dilemma of supporting a business structure that promotes conflict of interest based on the amount of bribery, not on the act of bribery itself.

    That’s like saying that a mass murderer who has killed 7,000 people is more ethical and has more integrity than one who has killed 7,000,000.

    The fact is, the act of accepting bribes from drug companies is highly immoral and lacks integrity, whether it’s $1, $1000, $10,000, or more.

  47. BillyJoe says:

    SkepticalHealth,

    “You’re right. After over a decade of post college education and years of subsequent training, I’m willing to compromise my medical license for a meal catered by a local Mexican restaurant and a couple of clicky-top pens.”

    There are many studies (haven’t got the time find and link to them right now) that show that doctors are influenced in their prescribing habits by pharmaceutical companies (let’s face it, they are not going to spend ten billion dollars a year for no return). Yet every single doctor (okay perhaps not every one) thinks that they personally cannot be influenced. And if you think you cannot be influenced, you are a prime subject for that influence. If you have lunch with a pharmaceutical company representative, you are being influenced. If you don’t acknowledge that, you are even more likely to be influenced.

  48. Harriet Hall says:

    @libby,

    “So YOU are now left with the logical dilemma of supporting a business structure that promotes conflict of interest based on the amount of bribery, not on the act of bribery itself.”

    Wait just a minute! I have never said I support any kind of bribery. For the record, I do not support any kind of gifts to doctors from pharmaceutical companies. Period. Before I retired, I made it a point to avoid any interactions with drug reps. I think there are major problems with the business structure. But your blanket condemnation of doctors and pharmaceuticals is unreasonable.

  49. Chris says:

    Libby, where is that LA Times link? And can you explain that strange plot where everyone becomes autistic, but girls all get there a few years later?

  50. We all seem to be missing a big point. These pharmaceutical companies are developing life saving drugs, and they need to make doctors aware of it somehow. If a pharm rep wants a slice of my time to tell me bout their new drug, then they have to bring us lunch and then I’ll listen to them. In no way does that imply that I will use their drug, either exclusively or at all. But, hey, now I am aware of this drug, and I’ve had the opportunity to ask about it and get a decent amount of (likely biased) information on it. Should I have a patient that fails therapy with other drugs, or who wants that specific drug for whatever reason, I am now better informed to counsel them and prescribe it. I don’t know how the tradition of catering a lunch got started, but it’s pretty standard fair now.

    To be honest, if catering lunches was ever “outlawed”, I bet there’d be a pretty big drop in doctors learning about and utilizing new drugs. Not every doctor reads journals and other information sources. We all know how slow medicine is to adopt change, just imagine if we cut out the way that the majority of docs learn about new drugs. (Sad as that may be.)

    Way back in medical school I did an extended rotation in orthopedics, and the surgeon, who specialized in backs, had his sales rep come in with him any time he used his products. The sales rep also catered breakfast with donuts from the local great donut place. The sales rep was very sharp, and knew his product as well as possible. He provided an invaluable service for the ortho who sometimes had questions about different ways the product could be utilized.

    Personally, I’ve had mixed experiences with sales reps. Some are the “pretty face, dumb as dirt” girls, and yes, I can be as brash with them as I am on the internet. I recently wrote here about one who was pushing a new steroid taper pack, and she didn’t know the difference betwen mineralcorticoid and glucocorticoid. That was an uncomfortable presentation.

    Let’s not forget that without pharmaceutical companies we’d all be chewing willow bark and rubbing dirt and maggots on our wounds.

    @BillyJoe, but is that a bad thing? Lets say I have a patient that needs two anti-hypertensive medications. For whatever reason, they are having trouble remembering to take them both because of the dosing regimen, and as a result of this their blood pressure is out of control which puts them at increased risk for heart disease, stroke, and therefore death. To increase their compliance with medications, I can prescribe a drug Lotrel, which combines two anti-hypertensives into a single pill. It’s much more expensive (ridiculously so – I’ve often wondered why I can’t just glue the two pills together! Kidding), but it increases compliance with medication, thereby giving a better outcome for the patient. So I learned about this drug through a pharmaceutical sales rep who came and catered lunch. Yes, their giving me information influenced my prescribing habits. I now have a better chance of controlling my patient’s hypertension and therefore saving his life. Explain to me how this is a bad thing.

    I whole heartedly agree with you: they are not going to spend the money without people using their drugs. This is why they keep coming out with better drugs. We need better drugs, because a lot of the ones we have aren’t fantastic. Many docs use the crappiest statin because it has the least side effects. Or we have trouble managing diabetes because between a patient who doesn’t care about themselves, and a complicated insulin regimen, we can’t keep their sugars under control. So, yes, pharmaceutical companies, please innovate. They are a necessary evil.

  51. weing says:

    @Chris,

    “Libby, where is that LA Times link? And can you explain that strange plot where everyone becomes autistic, but girls all get there a few years later?”

    I don’t think she is able to do that. You see. What I can gather from her ramblings, is that she was irrevocably potentially damaged by the potential side effects of Zomax sometime in the early 1980s. She has been in this sorry state ever since.

  52. Harriet Hall says:

    ” Not every doctor reads journals and other information sources.”

    They should. An older study (don’t have reference) found that the number of journals read was the factor most strongly associated with practicing good medicine.

    With the multiplicity of other routes of obtaining information (mailings, journals, internet, medical meetings, etc.) I don’t see any need for catered lunches.

    Combination pills improve compliance? Don’t be too sure: http://www.thepharmacyconnection.com/cardiology/2011/07/13/do-combination-medications-increase-patient-compliance/

  53. I whole heartedly agree with what “should” happen, versus what actually happens. Our most technically skilled cardiologist (the one that everyone refers to for a cath) doesn’t know the generic names for the drugs he writes. But he can get a cath in any coronary artery, and our cardiologists happily send their complicated patients to him for cath. Let’s face it, a lot of docs simply aren’t that interested in the latest and greatest science. Nybgrus has commented frequently on his observations of his colleagues.

    With all due respect, Dr. Hall, I don’t believe you every practiced privately. You and I clashed on this before, because I believe you never had to deal with certain patient populations. I don’t mean that in any negative fashion whatsoever. I don’t know if I know of a single private practice group that doesn’t have catered lunches by pharmaceutical sales companies. I think it’s a perfectly fine way for them to approach doctors and inform them about their product. Plus it can help break up an otherwise boring, uneventful, or bad day. That isn’t unethical, bribing, or in any way wrong. If you don’t like it, fine, but that doesn’t convey anything negative to the fact that it is a regular occurrance. And hey, even if all docs kept up with the latest and greatest, you have to admit that you’d learn more from a lunch when a specific drug or therapy is discussed vs. a lunch where you sit and talk with a colleague about their kids, or their new house or car.

    That is an interesting, if amateurly written, link, but somewhat irrelevant. I never suggested putting everyone on a combination pill, I stated that if the patient was having difficulties with compliance it may help, and you know that would be on a case by case basis.

    (It’s funny the things we all find to disagree on when we are set in our own opinions.)

  54. *I may have exagerated when I said he doesn’t know the generic names of the drugs he writes, but he isn’t intimately familiar with the generic names.

  55. pmoran says:

    . .
    Daedalus2: PM, Dr Gorski’s statement about autism and vaccines was not a refutation of a connection.
    It was a statement about a lack of evidence that there is a connection. In saying there is “not a whiff of a hint” of a connection, he is absolutely 100% correct. There is no datum (note singular form) that there is a connection between vaccines and autism.

    Dr Gorski himself says ” In any case, there is a correlation, at least in the US, between the number of vaccines and autism prevalence — ” That along with the claims of some mothers that autism symptoms were triggered by vaccines are the grounds is understandable grounds for public concern.

    How we deal with that is a legitimate subject for discussion especially in an era when there has been an undermining of some of the authority of medical science, through evidence of corruption at the edges of medical practice and within scientific studies, and a lot of new information has emerged showing how bias can feed into scientific research. The public has every right to assume bias on our part in favor of vaccines.

    So we need to be very, very careful To say “there is no datum” may be a valid scientific end-point after considering many avenues of evidence in detail, but it is not an adequate argument in itself in the context. It will look to be overly dismissive of public concern and an argument from authority for many.

    We also cannot get away with “Multiple large, well-designed epidemiological studies comprising, taken together, many hundreds of thousand of children that fail to find a whiff of a hint of a wisp of a correlation between vaccination and autism prevalence or onset.” and then refuse to produce examples when asked. I was asked for my proof, when all that I am claiming is that sections of the public are worried and need a clear explanation of why we are not..

    We also don’t usually act quite this way when there is the possibility of important risk. Observe how we try to get chiropractors to understand this in relation to stroke from neck manipulation — even if they think the evidence is not conclusive, they should be taking some precautions, since that treatment is rarely, if ever, the only available option.

    You have the wrong end of the stick altogether on the Gonzales thing. It was Dr Gorski’s claim regarding the benefits of chemotherapy that was the problem there, because there was no valid control on which to base that question.

  56. libby says:

    Thanks weing:

    I can’t tell you how much mileage I get from your attacks.

    “I went to a well known medical site that supports only conventional medicine. Fair enough, but when I brought up the controversial subject of the gifting of doctors by the pharmaceutical industry it turned out the doctors were not only reluctant to talk about it, although one did admit it was wrong, one other doctor went so far as to label me brain damaged. It really does show you the inherent insecurity and appalling behaviour within the medical system when they have to resort to such childish and inappropriate behaviour.”

    Again weing, thank you.

    Cheers.

  57. libby says:

    @ Chris:

    Roan, Shari (24 January 2000). “Changing Their Role; By mixing celebrity and cyberspace, some high- profile doctors are redefining the way medicine is practiced and promoted.”. Los Angeles Times.

    Not sure why you needed the reference since it presented Whitaker in a negative light. I guess it’s just one of your collection of knee-jerk reactions when you have nothing to say and nothing to add to the debate.

  58. weing says:

    “you would have to perform quite a extensive search to find a non-medical group that bore a set of ethics equal to the appallingly low level found within the medical field.”

    You came to this site with that claim. I asked for scientific evidence supporting it. You can’t seem to provide it. Now your feelings are hurt and consider this an attack. Aww. I’m just trying to reconcile the glowing opinion I have of myself with the appalling things that you think about me.

  59. libby says:

    @ SkepticalHealth

    You state: “You’re right. After over a decade of post college education and years of subsequent training, I’m willing to compromise my medical license for a meal catered by a local Mexican restaurant and a couple of clicky-top pens.
    (Do yourself a favor and look up the difference between a bribe and a gift.)”

    I’m not sure I see the relevance of your post. There is nothing illegal, and apparently within the medical system, nothing immoral or unethical, for receiving bribes (or gifts if you prefer) from pharmaceutical companies. So I don’t see how you would be compromising your medical license in doing so. On the other hand I would support the move to strip licenses from doctors for receiving such bribes.

    As for your preference for “gift” over “bribe”, there is some overlap but generally gifts are not associated with an inducement to behaviour. When you give a wedding gift for instance, there is no expectation that the gift will alter the behaviour of the newlyweds. When a drug company ‘gifts’ a doctor, they are using the ‘gift’ for the sole purpose of influencing behaviour. Perhaps it doesn’t work in all cases, and drug companies are savvy enough to avoid spending money on uncooperative doctors.

    Secondly, gifts are not generally refused. There are a few doctors on this site who admit to refusing ‘gifts’ from drug companies. It is reasonable to assume that they are aware of the expectations attached to them. This should make it clear that these inducements are not gifts and that the use of the word gift in this situation is a euphemism for tainted behaviour. Bribe, although somewhat harsh, bears the implication of wrongdoing associated with such behaviour, and therefore better expresses the act.

    The use of euphemisms within American society is quite an interesting topic, but off topic for this board.

  60. BillyJoe says:

    SkepticalHealth,

    Frankly, I’m surprised you think it is a good idea that doctors get their information about a drug from the source that also sells that drug (I’ll bet the Merck rep never told you about the increased risk of heart attacks of Vioxx). And that you think it is okay to accept a free lunch while they educate/indoctrinate you about their drug. That situation is so obviously loaded with both conscious and unconscious influence, I think it should hardly need to be pointed out. It is no excuse that every doctor in America does it (argumentum ad populum?). I agree that pharmaceutical companies have produced a large range of useful products, but I disagree that your enthusiasm should extend to the sales departments of these companies.

  61. Sometimes the posts and beliefs by people here are just so incredibly naive and unrealistic. Especially when it comes from non-medical personal who are nothing more than Google researchers. I guess you all turn off the TV when a commercial comes out, because you don’t want to be influenced to buy the wrong computer or car, and you only keep your eyes on the road directly in front of you when you drive, because you don’t want to be influenced to stop at the wrong gas station or restaurant due to billboards, and when you read magazines you have someone look through it first to rip out all the advertisements for you.

    If I sit through a $10 lunch by a sales rep and learn something, that’s great. It isn’t “indoctrinating” me. I’m in no way held to some agreement that I’m going to prescribe this drug or use this service. But at least I have been exposed to the drug and am aware of it in case that it is ever needed. I’m increasing my knowledge and awareness of the applications of a particular drug, and at the same time I have access to ask someone who is very familiar with the drug lots of questions (that I’m sure they answer in a biased manner.) Next time you read about a new therapy in a magazine, go ahead and ask the magazine a question and see if it answers back to you.

    Some of you are acting as if everything “big pharma” is advertising is bad, or that we already have every medication we will ever need. It’s just very naive. I dislike sales people of almost every profession, including pharmaceuticals, but they are not all bad, and pharmaceutical companies providing lunches while they take up your valuable time to tell you about a new drug or therapy is not that big of a deal, and doesn’t sit there and “indoctrinate” and “corrupt” doctors into being shills for big pharma.

    @libby, I’m not interesting in anything you have to say. After that idiot rustichealthy, I’m done arguing with anti-medicine know-nothings. You are free to be as ignorant and ridiculous as you want. I saw you wrote a few paragraphs to me, I’m sorry, I didn’t bother to read it.

  62. lilady says:

    @ P Moran: The fact that this post has been somewhat derailed by a crank poster, fit right into your agenda to take another swipe at Dr. Gorski’s “tone”, eh?

    “How we deal with that is a legitimate subject for discussion especially in an era when there has been an undermining of some of the authority of medical science, through evidence of corruption at the edges of medical practice and within scientific studies, and a lot of new information has emerged showing how bias can feed into scientific research. The public has every right to assume bias on our part in favor of vaccines.”

    Shame on you for this renewed attack on Dr. Gorski. I said before and I’ll state it again, you are tone trolling and concern trolling. At this point, I really think you need to develop some introspective insight into your behavior. IMO, you are jealous that Dr. Gorski has become one of the foremost science bloggers on the internet, including his blogs on cancer research. Time to fold your tent now, we know your game.

    BTW, I’m still waiting for any research for your statement…

    “Harriet, I doubt if vaccines cause autism, although I do have to wonder, as a non-neurologist, whether severe febrile convulsions after some vaccines could be a triggering or exacerbating factor in the susceptible (Dr Novella?).”

  63. lilady says:

    @ libby: You’ve worked and overworked your derailing topic of your perceived COIs within medicine, to death.

    Have you nothing to add to the topic of this thread which is Dr. Julian Whitaker’s pseudoscience…or are you just getting your jollies?

    You say that you condemn what Whitaker’s writes on his blog. So why not pick any vaccine topic from his blog that you find particularly disingenuous, or the charts he used during the debate with Dr. Novella, to analyze and debunk?

    It would *prove* to us that you are not deliberately derailing this thread.

  64. BillyJoe says:

    SkepticalHealth,

    I don’t get it. You spend maybe half an hour of your valuable time having lunch with a pharmaceutical representative to get biased information about a drug they sell and they want you to prescribe in order to justify the time, money and man-hours it takes to convince you to do so, when you can probably spend less than half that time getting independent advice through your medical journal about that same drug. As I say, I don’t get it.

  65. BillyJoe says:

    SkepticalHealth:

    “I guess you all turn off the TV when a commercial comes out..and you only keep your eyes on the road directly in front of you…because you don’t want to be influenced [by] billboards, and when you read magazines you have someone look through it first to rip out all the advertisements for you.”

    Yes I do. Don’t you? Don’t you ‘switch off’ when the advertisements come on while you’re watching TV, ignore billboards when you’re driving, and read past the advertisements when you’re reading a magazine? I mean, why would you pay any attention to misinformation, half truths and lies, except maybe occasionally for self-amusement.

  66. Harriet Hall says:

    I used to think that food and gifts from pharmaceutical companies were OK and that I was not influenced by them. In fact, I could never even remember which company sold which drug. But then I read studies showing evidence that doctors are influenced. Even if I didn’t associate the company with the drug, I was learning brand recognition and selectively getting samples to try. So I changed my mind and now agree with Dr. Crislip: no gifts, no food. I get my information from other sources. If I see an ad for a new drug in a medical journal, I can read the details and consult PubMed. If doctors waited until an unbiased source like The Medical Letter evaluated new drugs, they might be slower to adopt new drugs, but that might be a good thing.

  67. weing says:

    @BillyJoe,

    “Don’t you ‘switch off’ when the advertisements come on while you’re watching TV, ignore billboards when you’re driving, and read past the advertisements when you’re reading a magazine?”

    I do pay attention. I try to figure how they are trying to manipulate me. Have you ever considered that the advertisers are aware of your ‘switching off’?

    http://www.sciencedaily.com/releases/2010/02/100224134145.htm

  68. Harriet Hall says:

    @pmoran,

    Put up or shut up. When you criticize Dr. Gorski’s words, offer a re-writing. Show us what you think he should have said.

  69. Harriet Hall says:

    @SkepticalHealth,

    “With all due respect, Dr. Hall, I don’t believe you every practiced privately.”

    Maybe the fact that I was never in a private group that regularly attended drug luncheons means that I can view the practice more objectively as an outsider.

  70. pmoran says:

    @pmoran,

    Put up or shut up. When you criticize Dr. Gorski’s words, offer a re-writing. Show us what you think he should have said.

    I have given two examples of what he should NOT have said, one because it is clearly not sustainable by the study he was referring to according to the standards that we hold to on SBM and ruthlessly condemn in others, other because it committed him to produce data that he subsequently could/would not produce. You all then hid behind a scientific convention (“you claim that you prove it”) that has no obviously useful place within vaccine debate.

    I have already explained as best I can why this kind of carelessness is inappropriate for a group that prides itself on being strictly science-based, and one which also wishes to have influence in the defence of vaccines and other matters. If you think otherwise, you explain yourself. You look at the original context of everything I have said and explain it all away.

    I am not in the least phased by this last tactic of yours, which is an attempt to find some way of finally coming out on top in an otherwise unwinnable argument. I am thinking about a formal post on the subject, but am not sure how I can express things much clearer, so as to have people actually thinking about the matters I raise.

    Also ideas sink in regardless. People will be thinking more carefully about what they say, as the result of the foregoing.

    .

  71. Harriet Hall says:

    @pmoran,

    “I am not in the least phased by this last tactic of yours”

    It is not a tactic. It is an honest attempt to understand what you mean. You have made it abundantly clear what you think we “should not” say. I understand that. What I still don’t understand is what you think we “should” say. I am simply asking you to give us an example of what David “should” have said about vaccines and autism that would satisfy all your objections and communicate the science clearly to worried parents to assuage their fears without any risk of alienating them, without any risk of their misunderstanding or thinking we are overstating the case.

    What would you tell patients who ask “Do vaccines cause autism?” If you don’t come up with a re-writing that would satisfy you, I will be forced to assume that you can’t. I suspect you will find that it is fiendishly difficult if not impossible to do what you are asking us to do. A blog post is too small to provide the education in science that is required to really understand the issues.

  72. libby says:

    “@libby, I’m not interesting in anything you have to say. After that idiot rustichealthy, I’m done arguing with anti-medicine know-nothings. You are free to be as ignorant and ridiculous as you want. I saw you wrote a few paragraphs to me, I’m sorry, I didn’t bother to read it.”

    And I give a damn because………….

  73. mousethatroared says:

    HeHe – SkepticalHealth versus Libby – it’s like two deaf people arguing in a pitch dark room.

  74. Harriet, I’m going to open up my mind to you. I happily accept that being provided Mexican food by a pharmaceutical sales rep may influence my decision somewhere down the road in prescribing a medication. Perhaps if I don’t know enough to decide between two medications, and I’ve heard good stuff (from a biased sales rep), I may be inclined to go one way instead of the other, or perhaps a patient will have failed the usual suspects and I’ll try some other drug that I learned about during a meal instead of an advertisement in a magazine.

    So, enlighten me, please show me the data that demonstrates that patients of doctors who are influenced by sales reps giving them dinners have worse outcomes than those the patients of doctors who only read journals for the latest information, and refuse all pharmaceutical interactions.

  75. Harriet Hall says:

    I don’t know of any evidence that patient outcomes are worse for doctors who get their information from drug reps, but I don’t think we have to wait for such studies before we change our habits.

    There is clear evidence that they change their prescribing patterns, even when they believe they have not been influenced. And there are anecdotes where they have been persuaded to order an expensive new drug instead of an older one that works just as well, and where they have increased prescriptions for a drug well beyond the standard of care, and where they have come to believe false information from drug reps that contradicts the evidence from the medical literature.

    Some of these anecdotes are included in this thoughtful article by a medical ethicist: http://www.scu.edu/ethics/publications/submitted/morreim/prescribing.html

    Reining in costs is a concern. Another concern is jumping on the bandwagon early on and prescribing new drugs that are later found by post-marketing surveillance to be harmful and are removed from the market.

    I would argue that with this much evidence of influence, it would be wise to limit the influence as a preventive measure rather than waiting until we have clear evidence of poor patient outcomes.

  76. David Gorski says:

    I have given two examples of what he should NOT have said, one because it is clearly not sustainable by the study he was referring to according to the standards that we hold to on SBM and ruthlessly condemn in others, other because it committed him to produce data that he subsequently could/would not produce.

    Peter, now you’ve gone into the realm of being disingenuous. You know darned well that I provided a link to several studies right here on SBM, I will also point out yet again that you airily dismissed them without apparently even having read them. Dr. Offit provides similar lists of studies and puts it this way in an article:

    Since then, a number of other studies have compared the incidence of autism among children who received the MMR vaccine and those who didn’t, and they have concluded that autism isn’t more common in vaccinated children. Numerous reputable scientific studies involving hundreds of thousands of children have found no link between the MMR vaccine and autism.

    Most experts think that autism may be at least partly genetic, and point out that there’s no plausible way for a vaccine to trigger it. After all, there’s no known connection between autism and measles, mumps, or rubella. It doesn’t make sense that a vaccine would cause a condition that the disease itself doesn’t cause, since a vaccine is essentially a symptomless infection.

    Or perhaps the State of California should be chastised for saying this:

    MYTH #2: Vaccines cause autism.

    FACT: The clear consensus in the scientific community is that there is no association between vaccination and autism. Research shows autism rates are the same in vaccinated and unvaccinated children. Twenty-three studies have tested hundreds of thousands of children and found no link between autism and vaccines. The American Medical Association, American Academy of Pediatrics, the Institute of Medicine, and World Health Organization have all maintained that there is no connection between vaccines and autism.

    Peter, if you are going to criticize me for saying there isn’t a “whiff of a hint” of a link between vaccines and autism, to be intellectually honest you’d better criticize Paul Offit, the State of California, the AMA, the American Academy of Pediatrics, the Institute of Medicine, and the WHO as well. Yes, that is a bit of an appeal to authority, but it’s not done to show that my scientific assessment is correct (the totality of existing scientific and clinical evidence do a fine enough job of that), but rather to suggest to you that what you have a bug up your butt about is not so much the statement, but rather me. If you really want me to, I can dump a pile of studies on you—even send you the PDFs if you have no access to them—but you need to give me a reason to think that you might actually bother to look at them, given that you didn’t bother to look at the studies listed in the link I provided you days and days ago.

  77. David Gorski says:

    What would you tell patients who ask “Do vaccines cause autism?” If you don’t come up with a re-writing that would satisfy you, I will be forced to assume that you can’t. I suspect you will find that it is fiendishly difficult if not impossible to do what you are asking us to do. A blog post is too small to provide the education in science that is required to really understand the issues.

    I second Harriet’s question. Let’s say a friend of the family with a new baby has heard the claims that vaccines cause autism. Knowing your status as a retired surgeon, she wants to know what your medical opinion is. Let’s say she asks you, “Do you believe that vaccines cause autism?”

    How do you answer? I’ve answered this question many, many times; so I know how I would answer it, but do you? Given your dancing around Harriet’s question, I’m becoming less and less confident that the answer would boil down to a strong “no.”

  78. lilady says:

    And, another State, and other groups (including the Canadian National Advisory Committee on Immunization), which declare there is no “scientific evidence linking vaccination and autism”.

    http://www.health.ny.gov/prevention/immunization/vaccine_safety/truth_about_autism.htm

    The Truth About Autism

    Despite claims of harm, years of research from more than seven countries all support that vaccines have been proven to be safe, with no link to developmental disorders, including autism. This has also been confirmed in the United States federal court. More than 600 pages of reports on multiple test cases were reviewed and showed no scientific evidence linking vaccination and autism. This also is supported by the New York State Department of Health, along with the American Academy of Pediatrics, the Centers for Disease Control and Prevention, American Medical Association, American Academy of Family Physicians, the Children’s Hospital of Philadelphia, the Canadian National Advisory Committee on Immunization, the Department of Health of the United Kingdom and many other reliable organizations around the world. If you’re interested in learning more, read “Clear Answers and Smart Advice About Your Baby’s Shots (immunize.org)” and “Evidence Shows Vaccines Unrelated to Autism.”

  79. lilady says:

    Here’s another publication from the Australian government for health care providers…to dispel the myths about vaccines causing autism:

    http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/1FC63A2886238E6CCA2575BD001C80DC/$File/myths-13-35.pdf

  80. David Gorski says:

    Dang it, lilady, they’re just way too dogmatic and certain! :-)

  81. lilady says:

    @ Dr. Gorski:

    Somehow, I just *knew* you would appreciate that last link I provided from the Australian government, to guide health care workers to dispel myths about vaccinations causing autism.

    Here’s another scenario for Dr. Moran…Let’s say a friend with an infant is upset because her baby had a febrile seizure after a vaccination. She asks you, “will this seizure cause autism?” What would your reply be, Dr. Moran?

    Would you tell her “I doubt if vaccines cause autism, although I do have to wonder, as a non-neurologist, whether severe febrile convulsions after some vaccines could be a triggering or exacerbating factor in the susceptible.”

  82. David Gorski says:

    Perhaps we could break it down for Peter. I wonder if Peter would object to it if I said the following two things:

    • There is not a whiff of a hint of a link between the MMR vaccine and autism
    • There is not a whiff of a hint of a link between thimerosal in vaccines and autism

    Both of these are pretty much bulletproof, as far as statements of scientific findings go.

  83. lilady says:

    Tsk, Tsk Dr. Gorski, perhaps you are being a bit too strident. :-)

    I know how I would answer…and have answered… a young parent who has questions about vaccines causing autism…or a post-vaccination febrile seizure causing autism. And, it wouldn’t be “mildly reassuring”….

    “There is no scintilla and no iota of proof that vaccines have ever been linked with a diagnosis of autism…or any other developmental disability”. :-)

  84. David Gorski says:

    How about there is not a scintilla of an iota of a whiff of a hint of scientifically reliable evidence that vaccines have ever caused a case of autism?

    Now that’s strident. :-)

  85. daedalus2u says:

    It is very important for people to distinguish between personal ignorance and a lack of knowledge in the field. There is a good example of this happening right now in AGW denialism, with Richard Muller, a self-proclaimed climate skeptic, now announcing that the scales have fallen from his eyes:

    http://thinkprogress.org/climate/2012/07/28/602151/bombshell-koch-funded-study-finds-global-warming-is-real-on-the-high-end-and-essentially-all-due-to-carbon-pollution/

    He is just where the rest of climate science community was in the 1990′s.

    He based his “skepticism” on his own personal incredulity (because he didn’t personally analyze the data). He did not default to “I don’t know” when confronted with personal ignorance and claims that one does not have the expertise and knowledge to evaluate.

    https://www.nytimes.com/2012/07/30/opinion/the-conversion-of-a-climate-change-skeptic.html?_r=1&pagewanted=all

    He know says that everyone should have been a skeptic until someone (him of course) has put together this compilation of data that confirms what every other climate scientist has been saying for decades.

    That is not correct. Real skeptics default to “I don’t know”. They don’t argue from personal incredulity while being ignorant of the data and reasoning that others are using. Only denialists do that.

  86. pmoran says:

    David: Perhaps we could break it down for Peter. I wonder if Peter would object to it if I said the following two things:
    There is not a whiff of a hint of a link between the MMR vaccine and autism
    There is not a whiff of a hint of a link between thimerosal in vaccines and autism

    Both of these are pretty much bulletproof, as far as statements of scientific findings go.

    Ah, now you are talking sense! They are indeed more accurate statements. Some listeners might wonder about the unneeded vehemence, unusual in scientific commentary, but these statements are supported by stronger evidence than relates to the over-arching question of whether vaccines are connected somehow with autism rates i.e. through some as yet unknown mechanism.

    ( I am not saying that they are, Lilady, or that there is an likelihood that they are. I am in most of what I have said looking at the question in the way a moderately well-informed and concerned parent might. You offered one study that suggests that there is no link between number of vaccines and mental disabilities in general in Danish populations, which allows us to suggest that there is likely to be no significant link, but we could use a lot more data of that type. )

    (And D2, you are right in everything you say, apart from its aptness for the kind of debate we have with vaccine
    safety, where personal, immediate risk is of concern to people who have little hope of ever analyzing all the available data. We have to do that for them, but in a way that is most likely to “take”.)

  87. David Gorski says:

    So, Peter, the implication of your statement above appears to be that you think vaccines other than MMR or something in vaccines other than thimerosal could cause autism. Do you have any evidence to support that apparent view?

  88. lilady says:

    @ P.Moran:

    I replied to Justin, when he *questioned* the providing of the separate H1N1 vaccine, along with the seasonal influenza vaccine, autumn 2009 to pregnant women…and his wrong assumption that two separate flu vaccines *might* increase the risk for autism..

    “Apparently, the concern about the effects of stimulating the immune response by administering the seasonal flu vaccine along with the H1N1 seasonal flu vaccine to pregnant women, is no longer unknown”.

    http://www.nlm.nih.gov/medlineplus/news/fullstory_127090.html

    “A Danish study that included more than 53,000 pregnant women, 13 percent of whom received the H1N1 vaccine, found no increased risk of major birth defects or pregnancy problems.

    “We compared the vaccinated with the unvaccinated pregnancies with respect to a number of adverse events — major birth defects, premature birth and fetal growth problems. None of these adverse events were more common among H1N1-vaccinated pregnancies. We conclude that H1N1-vaccinated pregnancies are not at increased risk of these adverse events,” said Dr. Anders Hviid, a senior investigator at Statens Serum Institut, in Copenhagen.”

    You then offered up this gem:

    “As a non-expert in this field I would first suggest following up the 53,000 women in Lilady’s Danish study to see if there is any hint of increased autism in the offspring of those receiving vaccines during pregnancy. (You need such data, too, Lilady).

    I then replied…

    “P Moran: The H1N1 vaccine was administered to high risk individuals first…including pregnant women….starting October 2009. Those infants born to those Danish women are now at least two years old and some are approaching their third birthdays…..Wouldn’t we *know* by now, if there is an uptick in the number of children being reported as showing signs of autism?” and…

    “The H1N1 strain has been incorporated into every seasonal influenza vaccine since then, starting with the the 2010-2011 influenza vaccine:

    http://www.cdc.gov/flu/about/qa/vaccine-selection.htm

    Your last comment directed at me states…

    “….(I am not saying that they are, Lilady, or that there is an likelihood that they are. I am in most of what I have said looking at the question in the way a moderately well-informed and concerned parent might. You offered one study that suggests that there is no link between number of vaccines and mental disabilities in general in Danish populations, which allows us to suggest that there is likely to be no significant link, but we could use a lot more data of that type. )

    So now, are you in agreement, that the children ages two and approaching 3 years old, born to 53,000 pregnant Danish women who received the two vaccines (H1N1 AND Seasonal Flu vaccines), is an important study, because you state,

    “You offered one study that suggests that there is no link between number of vaccines and mental disabilities in general in Danish populations, which allows us to suggest that there is likely to be no significant link, but we could use a lot more data of that type.”

    What about my original question Dr. Moran, you know, the risk to a child who has a post vaccine febrile seizure, for later being diagnosed with autism. I provided you with a NIH citation, as did “papertrail”. Your attitude was dismissive and you stated that the information that was provided to you was “mildly reassuring”.

    IMHO, you have are out of your league here, Dr. Moran. You are clueless about parental concerns about the safety of vaccines and clueless about parents’ concerns regarding the vaccines-autism link and the post-vaccination febrile seizures-autism link.

    Dr. Gorski and I provided you with links to statements made by a slew of governmental agencies including the WHO, the IOM, the CDC, California, New York State and every possible professional organizations, including the IOM, the AAP, the AAFP…and others…that re-iterate there is no possible link to vaccines causing autism.

    I even provided you with a link to an Australian Department of Health and Aging publication for guidance for health care providers to answer parents questions about vaccine safety and the bogus vaccines-autism link. Did you even peruse it Dr. Moran?

    ‘MMR vaccine causes autism and inflammatory bowel disease (IBD)’

    The Facts

    The MMR vaccine does not cause autism or inflammatory bowel disease (IBD). This theory was proposed by a group of researchers in the United Kingdom in 1998. They suggested that measles virus in the gut caused a
    new syndrome of IBD which resulted in decreased absorption of essential vitamins and nutrients through the
    intestinal tract. It was suggested that this in turn caused developmental disorders such as autism, or worsening of symptoms in children already diagnosed with autism, so-called ‘regressive autism’.

    Although this theory generated a lot of media attention, the few studies on which it is based have many significant weaknesses. Numerous well-conducted studies and expert panel reviews since 1998 have now produced conclusive evidence that there is no link between MMR vaccine and autism or IBD.

    A review by the World Health Organization concluded that current scientific data do not show any causal
    link between the measles virus and autism or IBD. An extensive review published in 2004 by the Institute of
    Medicine, an independent expert body in the United States, also concluded that there is no association between the MMR vaccine and the development of autism. Other reviews by the American Academy of Paediatrics, the British Chief Medical Officer, the UK Medical Research Council, and Canadian experts have also found no link between autism or IBD and measles-containing vaccines. In 2004, 10 of the 13 authors of the
    original 1998 study (published in The Lancet) published a statement retracting the paper’s interpretation,
    stating that the data were insufficient to establish a causal link between MMR vaccine and autism. The Lancet
    subsequently retracted the originalpaper.

    It was also suggested that giving each vaccine component of MMR separately over time would be better than giving MMR as a combination vaccine However, there is no scientific evidence to support this suggestion. In fact, giving each component separately may be harmful because vaccination for each disease would be delayed, leaving the population susceptible to outbreaks of these diseases. National and international expert bodies all recommend that MMR should continue to be used. Only the rubella vaccine is available as a separate vaccine in Australia.”

    At this point, I am ready to state to any parent who asks me about the vaccine-autism link, or, the post-vaccine febrile seizure-autism link that….

    There is not a whiff of a hint of a link between the MMR vaccine and autism

    There is not a whiff of a hint of a link between thimerosal in vaccines and autism

    There is not a scintilla of an iota of a whiff of a hint of scientifically reliable evidence that vaccines have ever caused a case of autism

  89. daedalus2u says:

    The problem with statements such as:

    “There is not a scintilla of an iota of a whiff of a hint of scientifically reliable evidence that vaccines have ever caused a case of autism”

    is that the more superlatives get tacked on, the more the final conclusion is discounted by people who do not understand the data and the logic behind the conclusion. At some point adding more superlatives makes the discounting even higher.

    It is easy for quacks (and even non-quacks) to tack on empty superlatives. We have seen many superlatives attached to medical research, superlatives that have not been born out (so far). Wasn’t the human genome project supposed to find cures for all diseases? When are stem cells going to provide replacement organs? When is the “war on cancer” going to be “won”?

    The problem is that non-experts in the exact specific field are unable to tell if the superlatives are warranted or not, and usually it is non-experts who are making the empty superlative claims.

    Sometimes even “experts” make empty superlative claims. I was at a talk at MIT, where a senior geneticist was talking about genetic tests for autism and claimed that he thought there would be a prenatal genetic test within 5 years (this was half the time he was quoted in print). This is nonsense, it was nonsense at the time. At the time it was well known that MZ twins were sometimes discordant for autism. If MZ twins are discordant for something, there can’t be a genetic test for it because MZ twins share the same genome. Since then the GWAS have shown that the genetics of autism is extremely complicated with no gene accounting for more than a few percent. What that means is that if autism is “genetic”, that it is due to a very complex interaction of at least 50+ genes. I feel very confident saying that there will never be a genetic test for autism. Even if only 20 genes are important, 20 factorial is 2×10^18, about 10 million times more human genomes than have ever existed. Even if every living human genome is sequenced, there are a billion times more possible combinations in those 20 genes that can be compared to a phenotype.

    On the other hand, sometimes the superlatives are not empty, but are dismissed as if they are, my statements about nitric oxide come to mind. I know they are not empty, and I also know that the people dismissing them don’t know enough about nitric oxide to dismiss them as empty.

  90. lilady says:

    @ daedulus 2U See my posts and Dr. Gorski’s posts from yesterday about “superlatives” :-)

  91. David Gorski says:

    Methinks daedulus doesn’t always recognize exaggeration for dramatic or comic effect when he sees it. :-)

  92. daedalus2u says:

    I do, but when I am not exaggerating people think that I am and discount what I am saying to zero.

    I very much appreciate that there can be gross false exaggeration due to error (homeopathy can cure all disease), false exaggeration due to error, (homeopathy can cure rabies), exaggeration due to ignorance (we will know how to cure disease once we look at the genome), exaggeration for comic effect (only a flesh wound), and a non-exaggeration (restoring a more normal nitric oxide level will improve all disorders).

    I think this is the strongest statement I have yet made about nitric oxide, and I don’t think it is an exaggeration. I am pretty sure that everyone reading it will discount it to essentially zero, without knowing the first things about nitric oxide physiology.

    PM is concerned that parents, ignorant about vaccine safety and worried about autism, are discounting statements about the lack of association between autism and vaccines simply because there are too many superlatives. I feel his pain.

  93. papertrail says:

    Interesting, related to this thread:

    Debunking Vaccination Myths: Strong Risk Negations Can Increase Perceived Vaccination Risks.

    Betsch, Cornelia; Sachse, Katharina

    Health Psychology, Mar 12 , 2012,

    http://psycnet.apa.org/psycinfo/2012-06398-001/

    Paradoxically, messages strongly indicating that there is “no risk” led to a higher perceived vaccination risk than weak negations. This finding extends previous work on the negativity bias, which has shown that information stating the presence of risk decreases risk perceptions, while information negating the existence of risk increases such perceptions. Several moderators were also tested; however, the effect occurred independently of the number of negations, recipient involvement, and attitude. Solely the credibility of the information source interacted with the extremity of risk negation: For credible sources (governmental institutions), strong and weak risk negations lead to similar perceived risk, while for less credible sources (pharmaceutical industries) weak negations lead to less perceived risk than strong negations. Conclusions: Optimal risk negation may profit from moderate rather than extreme formulations as a source’s trustworthiness can vary.

    So, if this study is an accurate reflection of the situation, you can use stronger “negating risk” wording to assure vaccine hesistant parents if you’re perceived as highly credible but you would be more reassuring if you speak less assuredly if your perceived your authority is lower.

  94. pmoran says:

    Lilady:
    IMHO, you have are out of your league here, Dr. Moran. You are clueless about parental concerns about the safety of vaccines and clueless about parents’ concerns regarding the vaccines-autism link and the post-vaccination febrile seizures-autism link.

    I seem to have inadvertently led you to believe that I am mounting a case for a vaccine/autism connection. I apologise for that.

    I had expected you to eventually catch on to the fact that I am actually concerned about how we present our case to certain audiences, especially as a group affecting to support a certain purity and consistency of scientific standards that sometimes enters into dialogue with vaccine safety extremism. That means being aware of gaps or weaknesses in our own evidence, even if the sum of evidence of several different kinds does point to there being no convincing connection.

  95. daedalus2u says:

    papertrail, yes, that was the effect I was trying to describe. That is a very common trait. If someone asserts something with a degree of certainty that you think is inappropriate, it calls into question their competence and the truth of what they are saying.

    This is why I try and focus on people’s data and figure out what the data means for myself. Trying to figure out the truth of something based on the degree of confidence someone has in it is not something I know how to do. I can evaluate data and processes by which data is turned into conclusions, but that can take a long time.

  96. lilady says:

    @ Dr. Moran:

    Right from the beginning of this thread, you raised objections to Dr. Gorski’s style, his phases and his tone.

    Furthermore, you appointed yourself as the arbiter of how Dr. Gorski should describe the debate that he witnessed between Drs Whitaker and Novella as well as the ridiculous charts that Dr. saw Whitaker used during the debate.

    Now, none of us saw the debate, because Dr. Whitaker (wisely), did not put the video up on his blog or his FaceBook page. He did however, receive some flack on his website for the four recent articles he posted about the dangers of childhood vaccines, the *autism* risks associated with vaccines, the passage of California AB 2109…which he and other quacks (such as Dr. Bob Sears) claim to deny parents of the their rights to “opt out” of vaccines and claim personal belief exemptions, the shingles vaccine and the HPV vaccine.

    I chose to post some accurate information with links to reliable websites, on each of these topics, on Dr.Whitaker’s website. Dr. Whitaker, in turn, posted back at me…he’s all fluff and no substance. Is this a bad thing?

    When was the last time a parent consulted you about seizures (febrile, grand mal, absence, psychomotor or Lennox Gastaut types), Dr. Moran? It is a very frightening to see your child having a febrile seizure. I can assure you that when I counsel parents whose child has had a febrile seizure associated with an illness or following an immunization…what I say to them is more than “mildly reassuring”.

    When was the last time you conducted an educational program about vaccines for large groups of parents who have concerns about the vaccines? When was the last time you provided the VISs for each Recommended Childhood Vaccine to these same parents? Have you ever discussed the schedule for administering HBIG and the first hepatitis B vaccine administered to her infant at birth, with a pregnant woman, who is a chronic carrier of the hepatitis B virus?

    I worked in public health investigating individual cases and outbreaks of vaccine-preventable diseases and I worked in seven satellite clinics counseling patients and encouraging them to be tested for HIV and other STDS. I provided the childhood immunizations and the adult immunizations, to patients who received their primary care at these clinics. I set up and participated in special clinics to provide vaccines to contacts during measles outbreaks and during large food-borne hepatitis A outbreaks.

    I have a great wealth of knowledge about vaccines and the diseases they prevent.

    You “suggested” that febrile seizures following immunizations *might* be implicated somehow/or somehow, “trigger” autism. I provided you with the NIH website about febrile seizures and “paper trail” provided you with a link to an article that (should have) put your theory to rest. You’ve had days to research post-vaccine febrile seizures on the internet or by calling your colleagues who are neurologists. Now, are you willing to state that your theory, that has been researched and studied for years, has absolutely no validity?

    How many children with autism or other developmental disabilities…and their parents… have you ever met Dr. Moran. I’ve met hundreds of them. How often have you been in State residentials “schools”, developmental centers and State psychiatric centers or Intermediate Care Facilities or group homes where autistic children and adult with developmental disabilities reside? How often have you put yourself “out there” to assist parents when they seek in-home or out of home respite care for their kids, or do battle with Medicaid, Medicare and private insurance carriers to get therapies for their children? I’ve been doing advocacy in my State for thirty-five years on behalf of developmentally disabled children and adults.

    You didn’t like it one bit when Drs Gorski and Hall, dissected your arguments about the Gerson protocol and made *suggestions* how you could or should have presented your arguments in a different manner, how you drew *conclusions* that some patient might misconstrue…or that you really didn’t nail down the lid of the coffin that is the Gerson protocol and finally bury it. Yet, you felt you were justified by coming to Dr. Gorski’s blog to “just ask a few questions” and to critique his style, his phrases and his tone.

  97. papertrail says:

    Re: the Betsch study that I posted about, too bad they didn’t use actual vaccine hesitant parents as subjects. Instead, they told the subjects to imagine making a vaccine decision. I wonder why they didn’t use the real thing. Still interesting tho.

  98. BillyJoe says:

    As always we should tell the truth and damn the consequences.
    There will always be naysayers, but the truth must surely win out in the end.

  99. fledarmus1 says:

    @Papertrail re: the Betsch study – using actual hesitant parents as subjects would seem to have the same ethical issues as using placebo vaccines. When your goal is as important as increasing vaccination levels, you don’t want to be taking the chance that the message will be lost due to the presentation. Try the presentations out first on people who don’t have children to vaccinate, and hope that the best results on those people will also work on people that do have children to vaccinate.

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