Oct 15 2009
Dr. Jay Gordon is a pediatrician to a particular subculture of pseudoscientific celebrities, such as Jenny McCarthy. He lends his MD cred to this community. He also appears, in my opinion, to be a shameless self-promoter – one of those pop professionals (Dr. Oz, Dr. Phil) who has sold his soul for some easy celebrity.
Regardless of his motivations, he has been spouting arrogant nonsense about vaccines for years, essentially arguing that his clinical gut feeling and anecdotal experience trump the actual science. This is exactly the wrong approach to science-based medicine.
In a recent open letter on his website, he adds to the anti-vax chorus advising not to get the H1N1 (swine flu) vaccine. It’s almost as if this crowd wants to maximize the morbidity and suffering from this somewhat preventable disease. I know this is not literally true, but their ideologically motivated and confused actions will have the same effect.
Gordon starts his letter with, of course, some anecdotal evidence from his practice, admitting that he is seeing many cases of flu-like illness over this summer, but:
They all felt miserable, and they are all feeling just fine now.
The implication here is that H1N1 is not that bad. In an average flu season, 30,000 Americans die from the flu. By all accounts, we are in for at least a very heavy flu season, and H1N1 has been killing more young and otherwise healthy people as well as pregnant women (while the regular flu tends to kill the old and infirm). Again we see Gordon perfectly willing to substitute his own anecdotes for hard data.
In fact, as we learn more about H1N1 we are finding that it has some unique and worrisome properties. An article that is just being released finds that severe cases of H1N1 are at high risk of pulmonary embolism – a potentially fatal complication.
A Canadian study looking at a series of H1N1 cases concludes:
“Our data suggest that severe disease and mortality in the current outbreak is concentrated in relatively healthy adolescents and adults between the ages of 10 and 60 years, a pattern reminiscent of the W-shaped curve [rise and fall in the population mortality rate for the disease, corresponding to age at death] previously seen only during the 1918 H1N1 Spanish pandemic,” the authors write.
Overall the mortality of H1N1 is similar to the seasonal flu, about 1% – but it is behaving differently and has some concerning characteristics.
Gordon then gets into the meat of his article:
Preventing outbreaks of this “novel H1N1″ influenza may be a mistake of huge proportions. Yes, sadly, there will be fatalities among the 6 billion citizens of the planet. Tens of millions of cases of any illness will lead to morbidity and mortality, but this is completely (tragically) unavoidable. The consequences of not acquiring immunity this time around, however, could be really terrible and far outweigh a mass prevention program.
This paragraph is so confused it is hard to know where to begin. First, he is being awfully dismissive of the fatalities that will result from H1N1. The whole point of the vaccination and prevention campaign is to reduce fatalities – especially since more of those fatalities will be otherwise young healthy people (not that we don’t care about older patients, but younger deaths are generally considered to be more tragic).
He claims that these deaths are unavoidable. Hogwash. We can minimize these deaths by an effective vaccination campaign – the very campaign that he and others are hampering. Also, there are other methods to reduce spread of the flu – good hand washing and hygiene, and staying home if you have the flu.
Then he claims that if we don’t get sick this time around, we will not have immunity to fight what is to come. But the whole point of getting vaccinated is to produce immunity without having to suffer the illness. One thing that is clear is that the flu vaccine produces a good antibody response in most people (especially young healthy people, less so in the old and frail).
He goes on:
Here’s my rationale for not using Tamiflu: If (if, if, if) this virus circles the globe as the rather innocent influenza it now appears to be, but mutates and returns as a very virulent form of influenza, it will be quite wonderful and life-saving to have formed antibodies against its 2009 version. These antibodies may be far from 100% protective, but they will help. This is incredibly important but being ignored in the interest of expediency.
But getting the vaccine will also confer protective antibodies. Also, for some people, they may still get the flu even if they have been vaccinated, but the severity will be less – in which case they get the best of both worlds – antibodies from the vaccine, a milder case of the flu, and a further immunity boost from the flu itself.
He then resorts to a tired anti-vax argument:
Getting many viral illnesses confers lifetime immunity, and very few vaccines do.
This is just bullshit. There is no inherent advantage to getting the illness over getting the vaccine, and vaccines have the huge advantage of producing antibodies without the risk of an illness. It is pure nonsense and a violation of the basic principles of risk vs benefit to recommend getting sick to produce immunity when there are alternatives.
Also, his logic is not valid. If the H1N1 comes around for another pass you won’t need lifetime protection – just about one year’s worth. Who cares if you will have antibodies 50 years from now. By then, whatever flu virus is going around will be a different strain anyway. Talking about lifetime immunity to the flu is profoundly naive of the nature of influenza.
Then he makes his anti-vaccine stand:
I also won’t be giving the flu shot to the kids and parents in my practice unless there are extraordinary risk factors. I anticipate giving none at all this year. I doubt that there will be any really large problems with the vaccine, but I also doubt any really large benefits. As I said, I think that this year’s version of this particular H1N1 is as “mild” as it will ever be and that getting sick with it this year will be good rather than bad. The chances that a new “flu shot” will be overwhelmingly effective are small.
That’s right – he won’t be giving anyone the vaccine – but he insists he is not anti-vaccine. He mentions risk factors – but again this is ignorant of the facts of H1N1, which kills people without risk factors. You cannot treat this like the seasonal flu, where it is reasonable to focus on those at risk from dying and the people who are exposed to them. With H1N1 being young and healthy, or being pregnant, is a risk factor.
This approach also ignores the fact that the benefit of the flu vaccine is probably greatest for the other guy – the person who never gets exposed to the virus because you had immunity from the vaccine. Gordon and others are doing their best to make sure we don’t come near herd immunity for H1N1.
But he has not yet reached his quota of nonsense:
I consider this, and most seasonal and novel influenza A vaccines, as “experimental” vaccines; they’ve only been tested on thousands of people for a period of weeks and then they’ll be given to hundreds of millions of people. Not really the greatest science when we’re in that much of a hurry.
What Dr. Gordon just described is true of every drug on the market – they are tested in thousands and then marketed to millions. Does he have an alternative? Does he prescribe only drugs that have been tested in millions – i.e. none? This is why there are phase IV post-marketing studies of all drugs, and vaccines are tracked more carefully than other drugs on the market. We actively look for complications of vaccines and drugs after they are on the market, so that rare side effects or adverse events can be tracked. It is absurd to dismiss the flu vaccine as experimental. It is a proven technology, used for decades, and carefully studied and tracked.
It sure isn’t “sexy” to suggest handwashing, good nutrition, hydration, extra sleep and so on. It’s not conventional to suggest astragalus, echinacea, elderberry and vitamin C. Adequate vitamin D levels are crucial, too.
He makes it sound like he is taking the high ground by advocating for hand washing. Get in the back of the line, Gordon, the WHO, CDC, and every doctor I know have been recommending this for flu prevention since H1N1 reared its head. Then he launches into a typical list of unproven herbs (echinacea does not work) and vitamins. He falsely claims that the H1N1 vaccine is experimental, then recommends a treatment that we actually know doesn’t work – but I guess that’s OK, because it’s “unconventional.” Vitamin C and D are fine – there is evidence that during the winter months many people may be Vitamin D insufficient (not really deficient). So taking some extra vitamin D is reasonable. But there is no evidence to suggest that you can rely upon this measure to prevent getting the flu or that it will decrease morbidity and mortality from the flu (again we see the double standard for evidence).
In my opinion, Dr. Gordon is simply anti-vaccine. His arguments are confused and factually challenged. But he has a glitzy website and he treats celebrities.
If you want to read a well-reasoned article about why you should get the flu vaccine, here is an excellent post from Effect Measure.
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