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Knowledge Versus Expertise: The View From Consumer Land

“The internet, in democratizing knowledge, has led a lot of people to believe that it is also possible to democratize expertise.”

- SBM Commenter, yeahsurewhatever

I’ve spent the last few years of my life in Internet “Consumer Land,” doing what I can to bring accurate health information directly to patients. Of course, I have been surprised by the push-back, and the demand for misinformation. When I first left full time clinical work, it never occurred to me that people would prefer to read falsehoods when provided a clear choice between truth and error. I guess I was pretty naïve.

Journalist Lesley Stahl provided me with some helpful insights during a recent conference. She explained that the Internet has catalyzed a new method of information transfer – speed trumps accuracy, the line between pundits and journalists is blurred, and anyone who can get to a microphone can become an “expert.” Gone are the days of careful sourcing and fact-checking. And gone is the public trust in “mainstream media.”

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Posted in: General, Health Fraud, Humor, Public Health, Science and Medicine, Science and the Media

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Dr. Jay Gordon and me: Random encounters with an apologist for the antivaccine movement

27452983Although he doesn’t detest me nearly as much as antivaccine honcho and founder of Generation Rescue J. B. Handley does, Santa Monica celebrity pediatrician Dr. Jay Gordon doesn’t like me very much at all.

Actually, I’m not sure whether that’s entirely true or not, but Dr. Gordon sure doesn’t like it when I criticize him for his antivaccine rhetoric. He affects an oh-so-wounded posture and self-righteously assures me that he is not “anti-vaccine” and that it is “beneath me” to use such rhetoric against him. Whether such rhetoric is “beneath me” or not, however, I’ve never quite understood why Dr. Gordon gets so upset at when I describe him as “anti-vaccine.” After all, his words are frequently apologetics for the anti-vaccine movement, and his actions frequently give it aid and comfort. After all, he is Jenny McCarthy‘s son Evan’s pediatrician, and as a result of that connection he has been giving speeches to antivaccine rallies, such as the “Green Our Vaccines” rally in Washington, D.C. in June. (He is the man in the sunglasses behind Jim Carrey in the picture at the top of this post by me.) After all, he has been palling around with luminaries of the antivaccine movement, such as Jenny McCarthy and her boyfriend Jim Carrey, the aforementioned J. B. Handley, Robert F. Kennedy, Jr., Boyd Haley, and numerous others at events like the “Green Our Vaccines” rally.

But, above all, over the last three or four years, Dr. Gordon has become the go-to pediatrician that the media seemingly always wants to interview when a vaccine “skeptic” with an MD after his name is required to provide the “balance” that journalists worship above all else, even when that “balance” gives undue credence to pseudoscientific nonsense. He clearly relishes that role, too, most infamously on his appearance with Jenny McCarthy on Larry King Live!, in which McCarthy shouted down pro-vaccine physicians and yelled “Bullshit!” (as if she who yells the loudest and is the most foul-mouthed wins the debate) and as evidenced by his appearances on certain antivaccination mailing lists, from which messages are occasionally forwarded to me.

What else am I supposed to think, except that Dr. Jay is at the very least an apologist for the antivaccine fringe, if not a card-carrying member himself?

Unfortunately, Dr. Gordon strikes me as being mostly a nice guy. I say “unfortunately” because it would be much easier to be as harsh on him as his promotion of antivaccine pseudoscience deserves if he were not. He also clearly believes that he is right based on the evidence. Based on science and clinical evidence, he most definitely is not. Recently, I had decided more or less to lay off him for a while, so as to avoid the wounded cries that invariably accompany valid charges that he is an apologist for the antivaccine fringe. Also, I felt kind of bad beating up on him so regularly and thought that perhaps a respite was in order. Then I found out that Dr. Gordon wrote the foreword to Jenny McCarthy’s new antivaccine and pro-autism quackery book, Mother Warriors: A Nation of Parents Healing Autism Against All Odds. Then, one of my readers actually took the time to transcribe Dr. Gordon’s foreword and e-mail it to me.

I read it, and I was appalled.
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Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

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Calories, Thermodynamics, and Weight

When arguing against a specific scientific claim it is always desirable to be able to say that the claim violates an established law of science. Creationists attempt this with their argument that evolution violates the second law of thermodynamics (it doesn’t). The temptation is that such arguments are short and pithy, they seem conclusive, and they avoid the need to wade through a dense and complex set of scientific evidence and theories.

In the “diet wars” the first law of thermodynamics has been thrown around a lot. Up to now I have been aware of two camps defending their position with thermodynamic arguments. The first (and the one that I find most compelling) is the calorie in vs calorie out camp, that argues that the laws of thermodynamics apply to people too. This means that weight management must be a function of calories in (the total calories consumed by a person) – calories out (the total caloric expenditure, including metabolic processes, waste heat, exercise, and others). Thermodynamics must be obeyed and so if one wishes to lose weight they must burn more calories than they consume.

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Posted in: Public Health

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Autism’s false prophets revealed

appIn the brief time that Science-Based Medicine has existed, I’ve become known as the vaccine blogger of the group. True, Steve Novella sometimes posts about antivaccine pseudoscience and fear-mongering (unlike me, he’s even been directly attacked by David Kirby) and both Mark Crislip and Harriet Hall have each done one post about it, but, at least this far, hands down I’ve done more posts about the misinformation, pseudoscience, and outright quackery spread by antivaccine activists such as J. B. Handley’s Generation Rescue and his recently recruited empty-headed celebrity spokesperson Jenny McCarthy, not to mention a number of others who promote the resurgence of infectious disease by sowing doubts about the safety of the most effective weapon the mind of humans have ever devised against it. Truly, few uses of “alternative” medicine bother me as much as the antivaccine orientation of so much of the movement supporting it, a movement that has also led to all manner of “biomedical” treatments (quackery).

What you might not know is how I developed my interest in this particular area of dangerous pseudoscience. After all, I’m a cancer surgeon and an NIH-funded cancer investigator, not a pediatrician, immunologist, or neurologist. As hard as it is for me to believe, given that it seems today that I’ve always been refuting this nonsense, I only first discovered the antivaccine movement about three and a half years ago. True, I had been a regular on certain Usenet newsgroups for at least four or five years before that and had encountered antivaccinationists there before, but my contact with them online had been sporadic, and they seemed “out there” even in comparison to the usual run-of-the-mill alt-med maven. But then in the spring of 2005 I started to notice in a big way the cadre of pseudoscientists, parents of autistic children, and others who pushed the myth that thimerosal-containing vaccines or vaccines in general cause autism. Oddly enough, it started out with the Huffington Post, of all places. In May 2005, Arianna Huffington started a large group blog, chock full of famous pundits and celebrities writing blog posts. Within three weeks of its formation, I had noticed a very disturbing aspect of the Huffington Post, and that was that it appeared to be providing a major soapbox for antivaccinationists, including a post by Janet Grilo of Cure Autism Now, two posts by that propagandist of antivaccinationists David Kirby (with whom our fearless leader Steve Novella has managed to get into a bit of a tussle), and posts by that Santa Monica pediatrician to the children of the stars, Dr. Jay Gordon, a man who assiduously denies being “antivaccine” but parrots the most blatantly obvious talking points of the antivaccine movement and is currently best known as being the pediatrician for Jenny McCarthy’s son Evan. At the very least, Dr. Gordon is an apologist for the antivaccination movement, and he has become one of the “go-to” guys for the media looking for physicians who are “vaccine skeptics,” making numerous radio and TV appearances to promote his “skepticism.”

The next phase of my “awakening” to just how pervasive antivaccine fearmongering and pseudoscience were came when Robert F. Kennedy, Jr. wrote an incredibly dishonest and deceptive screed that got wide coverage in the summer of 2005. His article, called, charmingly enough, Deadly Immunity was a rehash of all the misinformation about thimerosal in vaccines and autism wrapped up with in a bow of conspiracy-mongering worthy of a 9/11 Truther with a penchant for quote-mining that would make a creationist blush. The article appeared simultaneously on Salon.com (which normally doesn’t publish such nonsense) and Rolling Stone, a magazine that really should stay away from science and stick to covering entertainment and politics. It was followed by a media blitz by RFK Jr. and antivaccine propagandist David Kirby, best known for his credulous treatment of the thimerosal/autism link, Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy, published a few months before RFK, Jr.’s article, and his subsequent activities posting antivaccine nonsense on Huffington Post and, more recently, on the quackery-promoting antivaccine blog Age of Autism.

I’ve alluded to the fact before that I have quite a bit of blogging experience under another guise. Indeed, I’m sure many of the readers here know what that guise is. Suffice it to say that at the time I prefaced a post about RFK, Jr.’s article by saying that Salon.com had “flushed its credibility down the toilet” and referred to the article itself as the “the biggest, steamingest, drippiest turd Salon.com has ever published.” Clearly (and fortunately), I use much less–shall we say?–colorful language on this blog, but I bring this up so that the reader knows where I am coming from. Indeed, since that time in the summer of 2005, I’ve been wondering when scientists, public health officials, and physicians supporting science-based medicine would finally wake up and start to push back against this tide of antivaccine nonsense, which is starting to result in the resurgence of measles and other vaccine-preventable diseases. This year, I’ve seen some hopeful signs, including organizations like Voices for Vaccines and Every Child By Two, as well as other signs of push-back against the antivaccine movement, which, I hate to admit, has been clearly winning the P.R. war. What there hasn’t been yet is a book written from a scientific viewpoint that directly addresses the history of the recent resurgence of the antivaccine movement and refutes the pseudoscience that it promotes.

Until now, that is.
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Posted in: Book & movie reviews, Neuroscience/Mental Health, Politics and Regulation, Public Health, Vaccines

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Bisphenol A in Plastics – Should We Worry?

Bisphenol A (BPA) is a chemical used in the manufacture of hard plastics which can be found in a wide range of products, including baby bottles, plastic utensiles, and plastic food containers. It has been the focus of some controversy over its safety, and the resulting debate reveals much about how the current system deals with such issues.

The concern is that BPA can leech from plastic containers into the food or liquid it contains, and when consumed can have negative health effects. The debate is over how to interpret existing evidence about BPA safety, which gives conflicting results. Essentially it is a debate about how to weight different kinds of evidence, and where safety thresholds should be.

The Science of Toxins

Toxicity is always a function of dose. Anything is toxic at high enough dose, and safe at a low enough dose.  Regulatory agencies concerned with protecting the public health, therefore, typically use scientific evidence to establish doses that are likely to cause toxicity in humans and then set safe levels of exposure significantly below that level to create a buffer of safety. But what kind of evidence is used?

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Posted in: Politics and Regulation, Public Health

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National Health Interview Survey 2007 – CAM Use by Adults

The Center for Disease Control (CDC) conducts an ongoing telephone survey of medical problems and health care utilization – called the National Health Interview Survey (NHIS). They recently released their data from 2007. This is the first year for which they specifically broke out questions assessing the use of so-called complementary and alternative medicine (CAM).

CAM is a political/ideological entity, not a scientific one. It is an artificial category created for the purpose of promoting a diverse set of dubious, untested, or fraudulent health practices. It is an excellent example of the (successful) use of language as a propaganda tool.

The fundamental intellectual flaw of “CAM” as a concept is that it is made to include modalities that are extremely diverse, even mutually contradictory, under one umbrella. Very deliberately modalities which are scientific and mainstream, like the proper use of nutrition, are often included under the CAM umbrella by proponents in order to make it seem like CAM is a bigger phenomenon than it actually is, and as a wedge to open the door for the more pseudoscientific modalities.

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Posted in: Public Health, Science and Medicine

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The worst of times for antivaccine believers: Yet another study fails to show any link between the MMR vaccine and autism

ResearchBlogging.orgTHE BEST OF TIMES

It was the best of times (for antivaccinationists). It was the worst of times (for antivaccinationists). It was the age of wisdom (definitely not for antivaccinationists). It was the age of foolishness (definitely for antivaccinationists). It was the epoch of belief (for antivaccinationists).

Such is the time we live in, my apologies to Charles Dickens, even though he is long dead.

Let’s face it. If we ignore the science, it is, alas, indeed the best of times for antivaccinationists. I’ve lamented the rise of non-science-based fearmongering among the antivaccine brigade before many times. Indeed, I’ve lamented how the influence of ignorant, unscientific dolts like Jenny McCarthy spouting nonsense about vaccines has already resulted in the resurgence of vaccine-preventable diseases such as measles in areas of the U.S. to the point where I’m not along in fearing that the bad old days will soon return, just as Andrew Wakefield’s litigation- and money-driven “studies” suggesting that the MMR was somehow responsible for autism and GI problems linked with autism resulted in the measles going from being conquered in the U.K. 14 years ago to being declared endemic again there, all because of the fear stoked in parents by bad science, paranoia, and anti-vaccine fearmongering.

Truly, it is the best of times for antivaccinationists, or so it seems from a superficial view.
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Posted in: Clinical Trials, Public Health, Science and the Media, Vaccines

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Attitudes and Public Health

Increasingly there is a cultural trend toward health care freedom and empowerment. This trend is partly a reaction to the paternalism of the past, and reflects an overall change in attitude by the public toward all institutions and authority. Within medicine there has also been a move toward the partnership model of practice – where patients are well-informed full partners in the decision-making process. But this trend has also been fueled by providers who want the public to have the freedom to choose their unconventional treatment, even if it does not meet reasonable standards for evidence or even ethics.

In addition the public must deal with an increasingly free health care market with an expanding array of products, and claims to back them up. The internet has served to facilitate and accelerate this process.

Therefore public education about common health matters is more important than ever. Part of the mission for this blog is to improve public health education, to correct common misconceptions, help put recent research into proper perspective, and to counter false or misleading propaganda or marketing claims. There seems to be an intense need for such correction, and mainstream media and the internet are full of misinformation. News outlets are a mixed-bag, sometimes providing helpful information, but more often emphasizing unusual or dramatic health risks while ignoring far more important but less interesting ones.

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Posted in: Public Health

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Thanks, Jenny McCarthy! Thanks for the measles!

27452983I would like to take this opportunity to echo my co-blogger Steve’s sentiment and thank Jenny McCarthy.

What? You say. Has Gorski completely lost his mind? (Or maybe you used another word besides “mind,” a perhaps not so savory word.) Not really. I just agree with Steve that accomplishment should be recognized, and there’s no doubt that in her year as the new celebrity spokesperson for the antivaccination movement, Jenny McCarthy has pulled off a major coup.

She’s helped reignite a movement that was until her entrance (and especially the entrance of her far more famous boyfriend Jim Carrey, who’s said some things just as breathtakingly dumb as Jenny has) more or less moribund, to the point where it’s now become so effective that measles is coming back far faster than I had thought possible. Between her tireless prosletyzing on Oprah Winfrey’s show that vaccines caused her son’s autism and that “biomedical” quackery can “cure it”; her organizing of a march on Washington, D.C. this summer to push an explicitly antivaccine agenda disguised under the deceptive and disingenuous (but brilliantly Orwellian) slogan “Green Our Vaccines“; her holding celebrity fundraisers (complete with Britney Spears, Hugh Hefner, and Charlie Sheen, yet!); and her fronting WWE events to raise money for Generation Rescue, she’s done it all in a little more than a year. And she’s not resting on her “laurels” (such as they are), either. This September, she will be publishing the followup to her previous book on “healing autism” (with quackery), Mother Warriors: A Nation of Parents Healing Autism Against All Odds. No doubt she will again appear with Oprah to fawning acclaim to make the unfounded assertion that vaccines injured her son to make him autistic and that her favored forms of quackery have successfully “healed him.”

In light of these “accomplishments,” it’s only right that we all give Jenny (and Jim) the “thanks” they deserves for their role in bringing the measles back to the U.S.
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Posted in: Neuroscience/Mental Health, Public Health, Science and the Media, Vaccines

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Amanda Peet is My Hero(1)

“The graveyards are full of (unvaccinated) men.” Charles de Gaulle, modified by the author.

We live longer than anytime in history. Our long lives are due in large part to good nutrition, sanitation, and vaccines.

There have been numerous posts here and elsewhere about the vaccine deniers, primarily focused around the modern myth that vaccines cause autism.

That is not the topic of this post. Instead, I am going to take a brief tour of the childhood vaccines and review the morbidity and mortality caused by vaccine preventable diseases and the efficacy of the vaccines in preventing these diseases. With the brouhaha surrounding vaccines it is beneficial to step back and contemplate the death and misery that the vaccine preventable disease have caused and continue to cause.

In the interests of full disclosure, I am an Infectious Disease doctor. I make a living from treating diagnosing and treating infections. I don’t make dime one if people do not get infected, so I am against any and all vaccines as they cut into my bottom line (2).

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Posted in: Public Health, Science and the Media, Vaccines

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