Dec 29 2008
For those of us who have dedicated ourselves to promoting science-based medicine, one of the most frustrating impediments to our message is the media. Time and time again, I’ve complained about how the media takes unscientific health claims, particularly when it comes to vaccines, and gives a credulous hearing to them. Sometimes, it’s a filmmaker with a distinct ideological axe to grind who is not making even the pretense of trying to be objective. Sometimes it’s a reporter with a clear bias favoring the antivaccine movement parroting the most idiotic of unscientific lies. Other times, it’s celebrities who think their “education” from Google University trumps science, clinical trials, and epidemiology, often given aid and comfort by sympathetic physicians. Add to that others inclined to support pseudoscience against science-based medicine, such as Don Imus, Larry King, and others, and is it any wonder that the media seems like one huge cesspit of woo?
However, more often, it’s none of these things. As much as they infuriate me, I believe that most reporters in the media do really want to get it right. However, they are hobbled by three things. First, many, if not most, of them have little training in science or the scientific method and are not particularly valued by their employers. For example, witness how CNN shut down their science division. Second, the only medical or science stories that seem to be valued are one of three types. The first type is the new breakthrough, the cool new discovery that might result in a new treatment or cure. Of course, this type doesn’t distinguish between science-based and non-science-based “breakthroughs.” They are both treated equally, which is why “alternative medicine” stories are so popular. The second type is the human interest story, which is inherently interesting to readers, listeners, or viewers because, well, it’s full of human interest. This sort of story involves the child fighting against long odds to get a needed transplant, for example, especially if the insurance company is refusing to pay for it. The third type, unfortunately, often coopts the second type and, to a lesser extent, the first type. I’m referring to the “medical controversy” story. Unfortunately, the “controversy” is usually more of a manufactroversy. In other words, it’s a fake controversy. No scientific controversy exists, but ideologues desperately try to make it appear as though a real scientific controversy exists. Non-medical examples include creationism versus evolution and the “9/11 Truth” movement versus history. Medical examples include the so-called “complementary and alternative medicine” movement versus science-based medicine and, of course, the anti-vaccine movement.
But the thing that most prevents the scientifically accurate evaluation by the media of unscientific health claims has to be the “tell both sides” culture of “balance” demanded by journalists. Telling both sides is, of course, very important when one side is not obviously correct compared to the other. Examples of such a situation include virtually any political controversy, where there almost always are two (and usually more) sides to an issue. In contrast, in science and medicine, there are not always two sides to an issue. (Again, think of creationism versus evolution.) In science and medicine, there is often a side supported so overwhelmingly by evidence, experimentation, and observation that the “other side” does not warrant being told, as it has already been considered and rejected by science. An excellent example of this is homeopathy. Another excellent example of this is the antivaccine movement, and, unfortunately, a prime example of “telling both sides” of the “vaccine debate” reared its ugly head a couple of weeks ago. Worse, it reared its ugly head on a show that ostensibly claims to be medically accurate, so much so that it features four doctors as its hosts.
I’m referring to a TV show called The Doctors. If the episode segment I’m about to discuss, which aired on December 11, is any indication, these are Doctors that anyone seeking scientifically sound information about medicine should run, not walk, away from.
As evidence, I present a segment on autism featuring an old “friend” of the SBM blog. The fact that he was featured on a television show ostensibly designed to discuss medicine and make it accessible to a general audience tells me that not only the producers but the physicians who do the show are utterly without a clue. No, it wasn’t Jenny McCarthy, but it was almost as bad. Before I begin the discussion, although I’ll be discussing all you need to know to understand just how irresponsibly awful this segment was, it would help if you looked at the segment in full.
Here’s segment one:
Here’s segment two:
This is “balance,” apparently.
An abbreviated transcript of the show can be found here. It’s truly disturbing reading, just as parts of this segment are truly disturbing viewing. In fact, this segment shows everything that’s wrong about reporting about medicine in the media. You’d think that having a bunch of physicians doing the show would to some extent inoculate it from such nonsense.
You’d think wrong.
This show falls into the same trap that reporters fall into when discussing any form of manufactroversy about dubious science or even rank pseudoscience, be it creationism, antivaccination myths, and “alternative medicine” quackery. It occurs to me that this segment from The Doctors is no different than putting Ben Stein on stage next to an evolutionary biologist. It’s no different than putting Jenny McCarthy on stage next to Paul Offit. It’s no different than–well–putting Dr. Jay Gordon on stage next to a science-based physician, in this case Dr. Harvey Karp.
Of course, The Doctors, being television, features some nauseatingly photogenic young doctors, such as Dr. Travis Stork (who should be told that wearing scrubs outside of the E.R. or O.R. in order to shout “I’m a doctor, dammit!” to the world leads only to contempt and laughter from his fellow physicians–especially surgeons like me–and that his frat boy manner doesn’t exactly inspire confidence) and Dr. Lisa Masterson (who really is an obstetrician), joined by an older but nearly equally telegenic doctor named Dr. Drew Ordon, a plastic surgeon and apparently the elder statesman of The Doctors. These guys are supposed to be the Dr. Phils of medicine, I guess.
One thing I hadn’t been aware of is that Dr. Jim Sears is also a regular on The Doctors (who, by the way, is equally photogenic and telegenic). Dr. Sears’ brother Robert, who is also a pediatrician, just happens to be the author of a book making the rounds among the antivaccine crowd entitled The Vaccine Book. From what I can tell about it, the Sears brothers are in essence Dr. Jay Gordon lite. Like Dr. Gordon, they don’t trust the standard vaccine schedule either, so much so that Robert has developed his very own “alternative schedule,” with which Dr. Jim Sears apparently agrees. Unlike Dr. Gordon’s “alternative schedule,” however, Dr. Sears’ schedule appears to involve actually giving vaccines. I know, I know, it’s hard to believe, but he does apparently give vaccines. However, he does have a lot of “doubts” about how vaccines are given.
Remember, Dr. Gordon has openly said and written on many occasions that he “doesn’t give a lot vaccines” and that he reluctantly gave vaccines. Indeed, he seems to have implicitly admitted that he tries to talk parents out of giving vaccines and acquiesces and “respects the parents’ wishes to vaccinate” only apparently if they are persistent. In that area, the Drs. Sears are somewhat–although only somewhat–more credible when they claim they are not “anti-vaccine,” although they both end up parroting antivaccine canards while intoning that they “do not support not vaccinating.”
Come to think of it, at this point I can’t resist imparting a little of my experience dealing with antivaccine activists to you, my readers, here. A good rule of thumb is that, any time you hear someone saying either “I’m not antivaccine” or “I don’t advocate not vaccinating,” you can be pretty darned sure that antivaccine canards will follow immediately afterward. Consider that a pearl that will serve you well in the future.
End of lesson. Now let’s get back to The Doctors.
One area where Dr. Sears seems to be in complete agreement with Dr. Gordon is that vaccines can cause autism in “sensitive” or “susceptible” children. He also gives a whole lot of vague advice on dietary methods to “boost your child’s immune system,” the favorite haven of boosters of unscientific medical modalities. Here’s a flavor:
Minimize other chemical exposures. The small amounts of chemicals in vaccines are unavoidable. But there are other areas of life where we can control this exposure, and that is in the foods we feed our kids. Serve organic foods as much as possible, beginning with baby foods. A little baby’s growing brain and developing immune system are very susceptible to chemical influences. Eating organic fruits, veggies, grains, and meats is a good way to help insure a healthier brain and body.
This is dangerously close to the “toxin” gambit. In actuality, the “chemicals” in vaccines are tiny in amount, with no evidence that they cause any toxicity, and, as hard as it is for antivaccine activists to believe, that even includes the mercury in the thimerosal preservative that used to be included in vaccines. It’s also unclear just what Dr. Sears means by “chemicals.” After all, everything is made up of chemicals, including–yes–those organic foods that Dr. Sears recommends as so superior without any real evidence that they are. Moreover, no one would argue against a healthy diet including vegetables, grains, and fruits, but it’s not necessary to use just organic foods in order to have a healthy diet. It sure is more expensive, though.
What’s really annoying about this particular episode of The Doctors is that, mixed in with some accurate information, is a bunch of the infuriating false “balance” that so drives advocates of science-based medicine to distraction with Dr. Gordon’s antivaccine stylings piled on top. The parents (Dan and Lori) featured in the segment have seven children, with another one on the way, and four of their children are autistic. I don’t know about you, but to me that fact alone would strongly suggest a genetic component, but naturally these parents blame vaccines for their children’s autism.
To them, it’s the vaccines once again. To antivaccinationists, it’s always the vaccines, because it’s always all about the vaccines themselves and the concept of vaccination, no matter how much they tell you it isn’t, that it’s a concern about “too many too soon,” or that it’s about any individual ingredient in the vaccine, metal or otherwise. Don’t believe me? Ask parents like Dan and Lori what, specifically it would take to persuade them that vaccines are safe enough that they will vaccinate their baby after it’s born? Their answer will be so vague as to give them an excuse not to vaccinate no matter how safe vaccines are, or the bar will be set so high (100% safety, for example) that no medical intervention can possibly reach it.
Let’s see what Dr. Sears has to say about it:
We do know–over the years we’ve learned–there’s definitely a genetic factor here. There’s something in the genes of your kids that make them a little vulnerable to a trigger, and we still don’t know what that trigger is. It could be some viral infection; it could be something in the environment, a toxin, like a heavy metal–like lead. You guys had lead in the house. There’s other chemicals. Maybe there’s something that happens during the pregnancy. There’s a lot of theories, and I am looking forward to the day that we do know for sure. Until then, we’re kind of at a loss.
It turns out that there actually is an infection that, if it happens during pregnancy, can cause autism in the child: rubella, at least if the mother has no preexisting immunity to it. Whoops! That’s one most excellent reason for universal MMR vaccination to prevent autism. Sorry, Dr. Sears.
I share Dr. Sears desire to see the day when we understand the causes of autism. However, there’s no evidence that heavy metals, be they mercury or lead, cause autism in “susceptible” children or otherwise, Dr. Sears’ assertion notwithstanding. There’s no evidence that there is a genetic predisposition to heavy metal poisoning that leads to autism in response to tiny amounts of exposure to mercury or aluminum in vaccines or in the environment. Dr. Sears’ blather about there being “a lot of theories” is nothing more than another instance of false equivalency. Not all those hypotheses–not theories, by the way–are of equal validity, and certainly the hypothesis that vaccines cause autism, either in general or in susceptible individuals does not have any scientific support worthy of the name. There are a lot of “theories” about the diversity of life or what happened on 9/11, too. That doesn’t mean that creationism is a valid theory, or that 9/11 Truthers have a plausible “alternative” version of what happened on that horrific day.
Then it gets worse. A lot worse. Dr. Stork introduces our old friend Dr. Gordon:
Because there’s so much confusion we’re bringing in some leading experts today. We have Dr. Jay Gordon. He’s a leading pediatrician who believes strongly that vaccines are a major contributing factor in autism. He treats the son of actress Jenny McCarthy, who’s a major advocate for this cause.
“Leading expert”? “Leading pediatrician”? “Believes strongly”? Personally, I don’t give the proverbial rodent’s hind end what Dr. Gordon (or any other scientist or physician) “believes strongly.” When it comes to questions of medicine or science, I care what the evidence and the science say. If a physician or scientist can convince me that what he says is backed up by science and evidence, then I’ll take him seriously. If he can’t (like Dr. Gordon), then I won’t. It really is just that simple. Remember, Dr. Gordon is the physician who values his own personal clinical experience over science and epidemiology, believing that his personal impressions trump everything else. Indeed, in my arguments with him, I get the distinct feeling that he’s insulted by the observation that anecdotal evidence easily leads people–even pediatricians–astray. His hubris knows no bounds in this, as he seems to think that he, alone among humans, can overcome the cognitive quirks and biases that all humans have and that, indeed, the very scientific method was developed to compensate for. And he proves it again here:
Vaccines as they are now formulated can cause autism and other problems.
It never ceases to amaze me how confidently Dr. Gordon can repeat that again and again. Yet, repeat it he does:
And there’s nobody here who disagrees that all childhood medications, including vaccines, should be as safe as they can be. And nobody disagrees with that. Right now they’re not as safe as they can be. I would plead with you: Do not vaccinate your new child. You have a genetic, a familial disposition to children developing autism. All children who get vaccines don’t get autism; all children who are autistic are not autistic because of vaccines. But with a strong family history, honestly, after a second or third child, I think a pediatrician who continues to give vaccines is practicing very bad medicine. Please do not vaccinate this new child.
And here’s where I plead with Dr. Gordon: Please, please, please, stop advocating malpractice on national television. Yes, I said it, and I’ll say it again: malpractice. In my opinion (and not just my opinion but the overwhelming medical consensus), it is unforgivably irresponsible (and bad medicine, to boot) to advocate not vaccinating children, particularly for such a flimsy reason backed by exactly zero science. Once again, if Dr. Gordon sees this, I want to know–no, I demand to know–upon what scientific evidence he bases this recommendation. I’ve asked him this over and over and over again, so many times that I might as well be blue in the face, metaphorically speaking.
Dr. Gordon can never answer the question. There is no scientific evidence that vaccinating the siblings of autistic children will increase the risk that they, too, will become autistic. On the other hand, there is a lot of evidence that autism has a strong genetic component. It’s possible that there might also be an environmental component, but existing evidence does not support that component being vaccines or heavy metals, the quack industry designed to “detoxify” those heavy metals and “repair vaccine injury” notwithstanding.
No doubt if Dr. Gordon becomes aware of this, he’ll whine again, as he usually does, about how “mean” I am, how “unfair” it is of me to refer to him as being anti-vaccine, and now how vicious I am to call his advice to Dan and Lori malpractice. But such recommendations do arguably constitute malpractice, and there was a time when such complaints might have made me wonder if perhaps I’ve been too strident or if I’ve been too hard on Dr. Gordon. Once. Right now I no longer care, especially after hearing Dr. Gordon’s answer to a followup question by Dr. Stork about what, given what that he’s advised parents with autistic children not to vaccinate any additional children that they might have, he would say to parents without any family history of autism:
To think very hard. To find a doctor you trust. To get yourself very much informed. To look at your family history. Do you have a family history of autism or a strong family history of childhood depression or other illnesses? Autoimmune diseases. The very serious neuroimmunologists are now saying autism is a neuroimmune disorder. I really think that it doesn’t make any sense to give five or six shots to a little baby whose immune system and central nervous system are still a little bit questionable and extremely immature. Wait six months, wait a year. Get counsel, read as much as you can. But the way that vaccines are manufactured can cause autism; the way that they’re administered can cause autism, and they should be much, much safer.
It’s the same “too many too soon” garbage I’ve debunked time and time again here. I do wonder if Dr. Gordon’s learned a bit from his previous encounters, where he was so thoroughly (and deservedly) slapped down for decrying formaldehyde in vaccines, apparently ignorant that formaldehyde is a normal product of human metabolism, that the amount in the human body is larger than in any vaccine, and that we humans are routinely exposed to far more formaldehyde from household products and pollution in cities than from any vaccine. Notice how now he’s being a lot more vague. He’s no longer mentioning any specific “toxins.” Instead he’s subsuming the “toxins” into complaints about the “manufacturing process.” I guess he is educable, but in the wrong way, alas. He also goes right back to spouting the same old conspiracy mongering antivaccine canards when faced with Dr. Karp, who is described as “agreeing with” the studies that find no link between vaccines and autism, as if his opinion of the studies were based on faith rather than a sober consideration of their merits–and thus equivalent to Dr. Gordon’s dismissal of those same studies. (I do particularly like the look on Dr. Gordon’s face when Dr. Karp says that when he claims vaccines cause autism he’s “got to show the data.” Precious. And at around 6:55 on the video. Don’t miss it.) All Dr. Gordon can come up with is:
The studies were not done well. The studies were done, often funded by the manufacturers of the vaccine. I don’t vaccinate against any illnesses that pose anywhere near as much a threat to your family as autism does. I admit that if we stop giving certain vaccines some illnesses might return. I admit that there’s no proof that vaccines cause autism. There’s no proof; there’s evidence. I think that all of the data, all of the studies can be interpreted in a variety of ways. I don’t have any proof that vaccines cause autism; I have a strong suspicion that they contribute. But I’d love to move on from that discussion and talk about what we could do to show that they dont’ cause autism.
This is basically a “God of the gaps” argument, very much like the disingenuous one that is used by “intelligent design” creationists to argue against evolution. Indeed, Dr. Gordon is doing the antivaccine version of the Gish gallop. Basically, what Dr. Gordon is saying is “We don’t know; the studies are inconclusive; there’s no proof; but I think vaccines cause autism anyway.” Why? I can only surmise that it’s because he’s Dr. Gordon and therefore knows better than all those pointy-headed scientists. Of course, the studies are not inconclusive; they are very strong. All Dr. Gordon has to go on is his belief and his excessive faith in his personal ability to make clinical observations. Certainly he has no science to go on. He even admits it.
Dr. Karp’s slapdown that comes next is the only good part about this segment:
Before you recommend–and I know you recommend immunizations should be delayed six, twelve, or even 24 months before kids get it, you’ve got to have the proof; you’ve got to have science behind you. It’s not just “you have strong beliefs”–I appreciate your beliefs, and beliefs are important to guide research–but we need the research proof before we start jiggling around with something that we absolutely know has helped to prevent millions of cases of disease.”
Predictably, all Dr. Gordon can do is try to change the burden of proof by responding:
It’s not our job to prove that vaccines are dangerous, it’s the researchers’ and manufacturers’ job to prove that they are safe. They haven’t been adequately tested for safety.
Contrary to Dr. Gordon’s fantasy world, vaccines are indeed extensively tested for safety and efficacy. When informed of this over and over and over again, Dr. Gordon can’t seem to do anything more than to stick his fingers in his ears and says, “La-la-la-la, I can’t hear you!” just like a little child.
Meanwhile, Dr. Sears chimes in:
I do not want everybody to stop vaccinating, because then we’re going to see polio come back, and kids are going to start dying of measles again,” he says. “In my office, I try to look at each child individually. I want to get them eventually fully vaccinated, unless they have a lot of risk factors for autism. If your [Dan and Lori's] family was in my practice, there’s no way I would vaccinate your kids, but I would also talk to you about how to minimize your risks of catching those important illnesses. I encourage my patients not to blow off vaccines, but I want to do it as safely as I can…Some of the more controversial ones, we wait until later,” he says.
You know what? I made a mistake, and I now admit it. I called Dr. Sears “Dr. Gordon lite” early in this post. I now change my mind. Dr. Sears is Dr. Gordon. He spouts the same science- and evidence-free nonsense about not vaccinating children with a family history of autism. Once again, I emphasize that there is no evidence that vaccinating children with older siblings with autism increases their risk of being autistic too. The difference is that, unlike Dr. Gordon, Dr. Sears is a regular on a television show that millions of people watch every day. Dr. Gordon’s potential to do damage with his pseudoscientific “advice” pales in comparison with what Dr. Sears can do with his audience of millions each and every weekday.
There’s no doubt that it’s incredibly difficult to make a television show that is not just entertaining but scientifically accurate as well. The problem is that what makes for good television all too often conflicts with what is good science. For one thing, good television often demands conflict, and that’s where the fallacy of “balance” so worshipped by the media comes into play. There have to be two sides. At least, so it is believed by journalists; certainly it’s a convenient “hook.” The problem with this viewpoint should be obvious from my previous discussion. In science and medicine, while there may be two sides to a medical issue (as in the antivaccine movement versus science- and evidence-based medicine), that does not mean that the two sides are equal–or even remotely close to equal. However, simply having scientists explain why vaccines are safe and refute the misinformation being pushed by antivaccine advocates wouldn’t make good TV. Sure, I’d enjoy it, and so, I daresay, would many of my readers, but to the vast majority of the public it would be boooooring. So, as in the two segments above, the two sides are represented as though there is a legitimate scientific controversy when there is not.
Finally, one thing that The Doctors demonstrates beyond a shadow of a doubt is that having physicians involved in the making of a show about medicine and medical controversies is no guarantee that the resulting show will be science-based. Any Doctors that treat Dr. Gordon as a “major expert” in anything other than pandering to the antivaccine movement and have had antivaccine leader Barbara Loe Fisher on their show for any purpose other than to debunk her antivaccine pseudoscience are doctors you should not just run away from but flee from as fast as you can with your arms covering your head.
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