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More Nonsense from Dr. Jay Gordon

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.

He concludes:

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.

Posted in: Public Health, Vaccines

Leave a Comment (42) ↓

42 thoughts on “More Nonsense from Dr. Jay Gordon

  1. hokieian says:

    Wow. Some of his logic makes you wonder if he even understands basic immunology.

  2. _Arthur says:

    “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.”

    That would be medical rubbish.
    My undersanding is that Tamiflu is a chemical which slows down the effects of a viral infection. It would have no direct impact on immunity/antibodies. You still get the flu, but it is less severe.

    But, hey, Jay is the doctor, not me.

  3. Lawrence C. says:

    What is it that attracts the celebrity set to the “unconventional” in medicine? Curiosity? Ignorance? A desire to be “provocative” so as to heighten one’s media profile?

    One can forgive actors that often haven’t a high school education from promoting junk remedies. But Jay Gordon is a powerful, one-man argument for the California Medical Board to revise its licensing criteria and procedures. One can imagine this sort of “anti-vax” stuff coming from people who don’t understand the science of vaccines but from a licensed physician and we are told a faculty member at UCLA Medical? What exactly is he teaching?

    Boggles the mind, all of it.

  4. Todd W. says:

    Kinda makes you wonder if Dr. Gordon reports cases of influenza to state medical authorities.

  5. Ed Whitney says:

    Is there any kind of quack nonsense to which Sharon Stone is susceptible and for which she seeks validation from an MD? Please advise ASAP. If you don’t happen to know, Elizabeth Hurley would be an acceptable substitute.

  6. Peter Lipson says:

    This kind of thinking and public writing warrants censure from the state medical society. It shows a terrible ignorance of basic biological science. I have grave doubts as to whether he would ever be able to pass his boards were he required to.

    This is gross incompetence. I’m sure his patients love him and would never sue him, but he’s wide open for a law suit for failing to adhere to basic standard of care.

    He is the definition of a quack: someone who trusts is own judgment so much that he ignores the collective knowledge of his profession.

  7. Dr Benway says:

    I suspect Dr. Gordon is pandering to the biases of his patients. Likewise, patients with certain biases seek him out. And given the erosion of scientific standards at our medical schools, there are sufficient bright lights (Ornish, Oz, Weil, Eisenberg, etc., etc.) to lend the appearance of legitimacy to Dr. Gordon’s poorly reasoned arguments.

    What are those biases?
    - An interest in novel or exotic experience –a core value among the entertainment industry
    - A confirmation of narcissistic mind-over-matter feelings
    - A sense of belonging to a privileged group capable of seeing through the lies of the powerful
    - A need for privacy
    - An interest in regular marijuana use without getting hassled

    In short: the biases of a young adolescent.

  8. Dr Benway says:

    My last comment might be in moderation.

    I do wonder why Dr. Gordon exposes his contrary views on the Internet. It seems a risky thing to do. Has he no worry about his AAP standing? If not, what does this imply about the AAP? Perhaps the alties have invaded that organization as they have the IOM and our top med schools.

    Gordon visits Orac’s site but never really engages in reasoned argument. He simply pops in to say, “Vaccines are poison. My, aren’t you guys ill mannered. Even so, ya noes I luvs ya Dave!”

    Perhaps he’s working on a book. If so, any significant buzz about him will raise crowd interest in his name and what he has to say. Ergo, more books sold.

  9. Todd W. says:

    Y’know, I took a look at Jay’s full article, and I have to say, I’m a bit confused. He says he’s not going to give the H1N1 vaccine, and then he talks about Tamiflu as if it were the vaccine, when it isn’t. Color me crazy, but does Dr. Gordon actually think that Tamiflu is the H1N1 vaccine???

  10. Todd W. says:

    Taking another, closer look at that open letter:

    I haven’t used the “flu swab” to test anybody, but I’m sure that many if not most of these sick people had Swine Flu.

    So, even though influenza is a reportable illness, he has not tested people. Further, he assumes that they had the H1N1 flu without any confirmation.

    The consequences of not acquiring immunity this time around, however, could be really terrible and far outweigh a mass prevention program.

    He advocates against immunization.

    Here’s my rationale for not using Tamiflu

    He admits he will not use an antiviral drug as a means of lessening the impact of infection.

    I also won’t be giving the flu shot to the kids and parents in my practice unless there are extraordinary risk factors.

    He admits he will not be giving the vaccine, going against the standard of care and AAP/CDC recommendations.

    there are very few illnesses common enough or enough ethics committees willing enough to do the right tests. That is, give 1000 people the real vaccine and 1000 placebo shots, expose all of them to the disease and see who gets sick.

    He advocates performing clinical trials in violation of the Declaration of Helsinki ethical guidelines.

    So, clearly, based on this letter, he is operating outside the medical standard of care. Perhaps a complaint should be lodged with the California State Medical Board.

    Implying that this is a dangerous new shot is not scientifically or statistically correct and represents hyperbole and even dishonesty on the part of the so-called “anti-vaccine” camp.

    Wait, didn’t he just imply that the H1N1 vaccine is a dangerous new shot? My irony meter just blew.

  11. wales says:

    I took a look at this open letter to see what all the excitement was about. I see a physician doing exactly what the CDC is doing in terms of laboratory confirmation: CDC recommends lab confirmation in only limited situations and assumes that any flu before the official flu season begins is H1N1 (this open letter is 6 weeks old). Not very controversial. I have friends who have recently seen their docs with flu symptoms and were told by them it was probably H1N1, as the CDC is assuming.

    Regarding Tamiflu, my interpretation is that not using Tamiflu when the virus is as mild as it has been perhaps prevents the virus from becoming resistant to antivirals, keeping the antivirals as back up if needed for a more virulent form of virus later in the season or next year. Also not so controversial.

    Wow he is violating the AAP and CDC influenza vaccination guidelines by not forcing all of his patients to get vaccinated. He is acting as 50%+ of health care workers do. Yawn. This warrants censure from the state medical society? Get serious.

  12. Peter Lipson says:

    wales, you are mostly right.

    There is no need to test most people, and there is no need for tamiflu in most people.

    There would be even less need to think it out if we got more folks vaccinated.

  13. overshoot says:

    Does he prescribe only drugs that have been tested in millions – i.e. none?

    And refuses to administer at least on that has been tested on millions: the Salk polio vaccine. The Francis Field Trial was a prospective, randomized, double-blind trial with millions of subjects and which even tracked the “refusers” who did not take either the vaccine or the placebo.

    Still not good enough for our Dr. Jay, though — he trusts his extensive clinical experience, which doesn’t agree with the trial results.

  14. overshoot says:

    They all felt miserable, and they are all feeling just fine now.

    Over the last 50+ years, I’ve known a lot of smokers. In the post-WWII period most adults smoked, after all. However, I’ve never known one of them to develop lung cancer.

    In fact, of my immediate family there’s a clear pattern: the smokers live longer than the non-smokers. My non-smoking father died 25 years ago; my smoking mother is still alive. Of her non-smoking siblings only one is still alive. On my father’s side the pattern is similar.

    I therefore conclude, based on the same reasoning that Dr. Jay uses, that smoking is healthier than not smoking.

  15. Lawrence C. says:

    “I suspect Dr. Gordon is pandering to the biases of his patients. Likewise, patients with certain biases seek him out…

    What are those biases?
    - An interest in novel or exotic experience –a core value among the entertainment industry
    - A confirmation of narcissistic mind-over-matter feelings
    - A sense of belonging to a privileged group capable of seeing through the lies of the powerful
    - A need for privacy
    - An interest in regular marijuana use without getting hassled

    In short: the biases of a young adolescent.”

    That does explain it, doesn’t it? Instead of going to see a doctor for the purpose of seeing a professional who actually does know something more than you do, one goes to see one’s in-the-know pal who will reinforce those biases (while making a nice living).

    In lieu of censure in California, perhaps the MedBoard could simply “award” a new credential, the NS, for Narcissistic Solipsist.

  16. JayGordonMDFAAP says:

    The H1N1 vaccine guidelines are clear and I’m following them.

    Steve, this is a disappointing piece of blogging using the word “bullshit” in place of reasonable argument.

    You’re a little short on science, too. And your facts are off.

    Other than that . . .

    I give vaccines every day.

    I gave a flu shot or two today to people who requested them and had no contraindications to receiving them.

    A small minority of the families in my practice might be higher profile because I work in Los Angeles but the vast majority are just wonderful, intelligent loving parents who appreciate how hard I work as a partner in keeping them healthy. And they are healthy.

    And you’re wrong about vaccines versus getting an illness: Many vaccines appear to confer shorter and less reliable immunity than the diseases. This is certainly not a request to bring back polio; I’ll take the disease any day. But the data really might support much more judicious use of the varicella vaccine and the majority of countries in the world agree and have not added this vaccine to their schedules.

    Tamiflu’s going to stop working when we really need it if we prescribe it too often for this H1N1.

    I know I’m an easy target and I’m happy to take your opprobrium but I also disappointed to see that, rather than scientific discourse, you accept incivility in it’s stead.

    And Todd, nice to see you here. By the way, we’re not supposed to test for nor report cases of Swine Flu. You seem to know your way around these sites. Is there a science web site where there’s actual discussion in place of name calling and insults? Please let me know.

    Best,

    Jay

  17. Peter Lipson says:

    Jay, your complaints re incivility are irrelevant. They do not add or subtract from an argument.

    I did correct readers about testing and about tamiflu.

    Your ideas regarding “natural immunity” and “disease-acquired immunity” are non-sensical from an individual, public health, and scientific standpoint, and bringing up VZV is a simplistic attempt to hand-wave and distract from your stand on influenza, which is a very different disease.

    It’s sad, really.

  18. Todd W. says:

    @Jay Gordon

    I stand corrected re: testing and Tamiflu, per Dr. Lipson’s post. That said, you’re rather quick with claiming insults and name calling, yet I fail to see where I have insulted you or called you a name.

  19. keleton says:

    Sheesh. I learned more about immunology in a 200 level physiology class than Dr. Gordon is applying here. It’s too bad I know SO MANY people that follow him. I don’t disagree with most of his parenting advice (or that of the Sears clan) but perhaps they should all be parenting counselors instead of doctors. They just don’t apply science to their medical opinions.

  20. marilynmann says:

    Nice post.

    To be fair, it does appear that exposure to some flu viruses confers at least partial immunity to others, even though the strains are not identical. For instance, the elderly do not seem to be getting sick from H1N1 flu at the same rate as younger people, presumably because they have been exposed to similar flu viruses in the past. However, it does not follow at all that we should avoid the H1N1 vaccine for that reason. First, we have no idea if this future high mortality pandemic is actually going to happen. Second, as you point out, ALL the benefits and risks must be considered, and the immediate risk of serious illness and death trumps some future event that may not even occur. Third, flu vaccines are not as effective as some other vaccines, and many people don’t get vaccinated, so a substantial number of people are going to come down with swine flu even with the vaccine. Fourth, human life being finite, when and if this catastrophic pandemic occurs many of us will no longer be around. Fifth, we will hopefully be improving our methods of dealing with influenza in the future with better vaccines and better medicines, so that if another pandemic happens we will be able to deal with it.

    I don’t really know that much about influenza, so feel free to correct me if any of the above does not make sense.

    BTW, aren’t some of these people simultaneously arguing that flu vaccines don’t work, or that there isn’t good evidence that they work, and that the flu vaccination campaign will keep people from acquiring “lifelong immunity”? Aren’t those arguments somewhat incompatible?

    “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 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.”

    I agree with the gist of this, but I have some minor quibbles. In the case of new drugs, there are often older drugs already on the market that can be used for the same indication. These older drugs, having already been using in millions of people, are more likely to have a more well-known safety profile. So in some cases, it makes sense to avoid a new drug altogether until it has been on the market for a few years and more information on benefits and risks is available. So, avoiding a new drug does not ALWAYS mean prescribing nothing at all. It might mean prescribing an older (and often cheaper) drug.

    With the flu vaccine, a new vaccine must be produced every year so as to match the flu viruses that are circulating that year as closely as possible. So prescribing an “old” flu vaccine is not an option, because such a vaccine would not be effective. However, I totally agree that to label each year’s flu vaccine as “experimental” as if flu vaccines had just been developed, instead of having been around for decades, is overly scary and misleading. Actually, I think the word “experimental” to the average layperson implies something that is totally untested. Flu vaccines do go through a testing process every year in order to gain FDA approval. It remains possible, if unlikely, that one year’s vaccine, including the H1N1 vaccine, might have a higher rate of adverse events than we normally see with flu vaccines. As you say, adverse events are being monitored. Flu vaccines have been shown to be very safe over many years. I have already had the seasonal vaccine and I plan to get the H1N1 vaccine when it is available.

  21. cheglabratjoe says:

    As I pointed out on Steve’s previous entry, it’s amazing to me that the SBM folks are being slammed for their “tone” when they call a spade a spade.

    Dr Gordon, even if you were correct about vaccines somehow providing inferior immunity, your “point” would still be BS. Some protection are the cost of a sore arm is better than obtaining “natural” immunity at the cost of getting (and possibly spreading) the actual disease.

    And what of your own tone? What exactly is civil and non-insulting about falsely accusing people of being big pharma shills, as you are wont to do?

  22. daedalus2u says:

    It should also be pointed out that every case of flu that is prevented is one (actually many millions) of fewer chances for that flu to mutate into something worse. Especially when multiple strains are circulating simulataneously.

  23. superdave says:

    Dr. Gordon, how can you justify preferring people to get immunity by getting a disease rather than being vaccinated?

    Do you think the risks of getting the flu are worse than the risks of the vaccines?

  24. Lawrence C. says:

    People often reveal more of themselves when they write than directly about the subject they’re writing about.

    It is interesting that “JayGordonMDFAAP” happily if unwittingly admits that the criticism directed to him in the blog post is indeed “opprobrium” as the root of that word does mean “against disgraceful acts.” The usual definition today means “harsh criticism or censure” or “the public disgrace arising from someone’s shameful conduct.” (Oxford American Dictionary)

    Of course it could mean any number of things, such as stretching one’s vocabulary past its normal limits, Freudian-slip, or simple thesaurus-grazing. But it is interesting nonetheless.

  25. magra178 says:

    he’s promoting his patients to get sick with a potentially fatal illness; if our pediatrician did that I’d walk out and report him or her.

  26. Danio says:

    Jay Gordon said:

    Many vaccines appear to confer shorter and less reliable immunity than the diseases. This is certainly not a request to bring back polio; I’ll take the disease any day.

    (my emphasis)

    ORLY? So you and Jenny McCarthy are in agreement on that point then? Or was that yet another Freudian slip on your part?

  27. JayGordonMDFAAP says:

    Typos, Freudian slips and a vocabulary stretched.

    I prefer the polio vaccine to the disease.

    Keleton, thanks for the kind words about my pediatric practice. You seem to know me, my neighborhood and people who visit my office. Kindly elaborate for these nice people about the malpractice actions, Medical Board complaints or the dissatisfaction of the tens of thousands of patients in my care over the past thirty years.

    Oh! Zero of those first two and very, very little of the third? I work my tail off, practice meticulously careful medicine but differ with you and most of the people here about vaccines.

    Not enough for the absurd focus on me.

    Jay

  28. Dr Benway says:

    Back in the day, we had these attendings that could only admit to the teaching service. This was on account of their being madder than a box of frogs. And yet their patients often were quite devoted to them.

    One old geezer used to want to put everyone on Cipro for some reason.

    Ah, memories.

  29. superdave says:

    Dr Gordon, you really have not addressed anything but the more facile points, and your personal complaint record is irrelevant. If your point is that you want people to have immunity to this virus, why does it make more sense to leave to chance that they even get it an that they have no complications, than to make sure they get a vaccine? The risk to reward ratio just does not justify this. What do you think about “flu Parties”? Based on your writings, you sound like you would be for them. Do you think they are a good idea?

  30. wales says:

    Actually I would say that the personal complaint record is the only relevant thing here. With SBMers crying quack and gross incompetence, the pertinent evidence is the health of his patients.

    The SBM posse is ridin’ hard, giddyup lynch mob!

  31. cheglabratjoe says:

    Poor, persecuted wales! How do you manage to make it through a day commenting here?

    Do you want someone to spell it out for you? Fine: Todd W was over-the-top, and has been corrected. I, for one, wish he hadn’t said all that, because it gave you and Dr Gordon something to complain about rather than actually address the points raised.

    Dr Gordon, surely you don’t think that comment would pass muster here? You addressed NOTHING, instead patting yourself on the back about how people like your practice. I know people who like their chiropractors; what does that have to do with the validity of their practice?

  32. Todd W. says:

    Going back to my previous post that generated so much response:

    So, even though influenza is a reportable illness, he has not tested people. Further, he assumes that they had the H1N1 flu without any confirmation.

    I was wrong on this point, as pointed out by Dr. Lipson.

    He advocates against immunization.

    This point still stands, based on the letter. Dr. Gordon has pointed out that he has given out the flu vaccine to those who requested it, but the question remains whether he discourages people from getting it if they ask about it. There is also the question of whether he talks about it with patients who do not even bring it up.

    While I admit that the recommendations suggest to focus on those patients who are at risk for complications, I would think it would be responsible to at the very least discuss the issue with patients when they come in for a visit.

    He admits he will not use an antiviral drug as a means of lessening the impact of infection.

    Dr. Gordon has cleared up that he meant he would be averse to using Tamiflu because of the potential to create a drug-resistant strain. That’s fine. That is not how the letter came across to me, but the clarification was appreciated.

    He admits he will not be giving the vaccine, going against the standard of care and AAP/CDC recommendations.

    Again, as others have pointed out, I was a bit over-the-top here. The questions I raised above about discouraging patients from receiving the vaccine or remaining silent about the vaccine if the topic does not arise are, I feel, still legitimate questions and concerns.

    So, clearly, based on this letter, he is operating outside the medical standard of care. Perhaps a complaint should be lodged with the California State Medical Board.

    Again, I was a bit over the top, here, allowing my emotions to outweigh my reason. I apologize for that.

    Wait, didn’t he just imply that the H1N1 vaccine is a dangerous new shot? My irony meter just blew.

    I stand by this, as well. His letter did imply that the H1N1 vaccine is a dangerous new shot.

    As cheglabratjoe pointed out, I have been corrected and appropriately chastised. I hope this post has clarified where I admit I was wrong and serves to correct the record.

  33. wales says:

    cheglabratjoe, i don’t know, how do YOU manage to make it through a day (without) commenting here?

    btw, I am not the one being persecuted.

  34. Peter Lipson says:

    Todd, there are a number of people for whom Tamiflu is specifically recommended, and to refuse to recommend it to these people is dangerous and irresponsible.

    The recommendations for vaccination for certain groups establish an evidence-based standard of care. To practice outside that standard without a clear reason supported by evidence is foolish.

  35. Todd W. says:

    Dr. Lipson, thanks for the clarifications.

    Dr. Gordon, if you’re still reading the comments here, I’m curious about your answers to the questions I raised and to the points Dr. Lipson brought up.

  36. Peter Lipson says:

    DrJay:

    Many vaccines appear to confer shorter and less reliable immunity than the diseases.

    Data please? And also include the safety of having the illness vs. getting the vaccine.

  37. superdave says:

    wales, the complaint record may indicate how satisfied his patients are but that doesn’t mean he is right about this issue.

  38. Julie RM says:

    Thank you for this post, Steven. A couple links for you all, in case anyone is still checking comments.

    First, I posted about this letter on Rational Moms. Since I’m not a doctor, my post is less sophisticated, but after reading this one, I see that we picked the same quotes and used about the same arguments. I made the same error as Todd W. and was corrected by Dr. Jay, who made an appearance in the comments to tell me that I wasn’t being nice. (And I guess I wasn’t. Really Steven is nicer in this post, and for Jay to say there was name calling is just ridiculous. If what you’re saying is bullshit, then it’s not name calling to call it bullshit.) So here’s some blog whoring:

    http://www.rationalmoms.com/2009/09/23/dr-jay-gordons-letter-to-the-masses/

    Second, Dr. Jay’s most recent letter absolutely made my head spin. Take a look, if you dare.

    http://www.drjaygordon.com/development/news/swinefluhighanxiety.asp

  39. The Blind Watchmaker says:

    Individual pediatricians have to deal with patients, patient’s families, patient’s fears and patient’s family’s fears. It would be very easy to appear to be the kind, caring doctor by telling them that it is OK to not have shots. I would have loved to have a pediatrician when I was a kid who would have told my mom that it was ok to not get shots. People would feel very comforted by a pediatrician that explained the “natural way” to fight disease with various herbs and spices (spices?).

    Parent’s would feel like great parents if they let their kids have cake for dinner. The feedback may make them continue the practice because it is making them happy.

    Fortunately, most parents realize that, in the long run, feeding kids cake for dinner will do more harm than good. It is irresponsible.

    Fortunately, most pediatricians realize that, in the long run, vaccinating their patients despite their protests and despite parent’s fears is the right thing to do.

    A single doctor’s practice is a relatively small group. Their feedback represents anecdotal ‘data’ to that doctor that confirms to the doctor that they are doing ‘good’. Fortunately, for any one pediatrician, serious consequences of not vaccinating patients may not present themselves in an obvious way. At least not right away.

    Confirmation bias is not what should guide medical practice. Just because people like the doctor and give high satisfaction marks on surveys says very little about whether the doctor is making responsible decisions (although if done with empathy, even tough recommendations like giving painful shots to kids should not reduce the patient satisfaction survey results).

    If we all practice this way, the law of large numbers kicks in. Small percentages multiplied by large numbers lead to significant morbidity and mortality. The 0.6 to 1% mortality from H1N1 multiplied by millions of patients gives us tens of thousands of (avoidable) deaths.

  40. Prometheus says:

    On the recommendation of Dr. Novella, I read “Dr. Jay’s” diatribe on influenza. The amount of mis-information is awe-inspiring.

    Yet, “Dr. Jay” has the chutzpah to claim:

    “You’re a little short on science, too. And your facts are off.”

    I’d find this a bit more believable if “Dr. Jay” had cited specific examples. And if he didn’t use this excuse every time his poor understanding of biology is pointed out to him.

    As has been pointed out already, you don’t need lifelong immunity to influenza. This is because influenza has a segmented (eight segments) RNA genome.

    RNA viruses – like influenza – mutate extremely rapidly because RNA polymerases make more errors than (genomic) DNA polymerases. This is why we have “new” strains of influenza every fall – the “old” ones have mutated sufficiently that our immunity to last year’s strain is insufficient to prevent disease in most people.

    In addition, influenza’s segmented genome means that if two different strains infect the same animal (human, pig, horse or waterfowl), they can “mix and match” their segments to generate a completely new strain. When this happens, we usually experience pandemic influenza, because our previous years of influenza immunity are now pretty much worthless.

    “Dr. Jay’s” concern about Tamiflu (oseltamivir) is ironic because resistance to Tamiflu popped up last influenza season, apparently the result of a random mutation (see above) rather than overuse of Tamiflu. Fortunately, the H1N1 “Swine” influenza isolates this year remain sensitive.

    The irony of this is double – first that Tamiflu resistance occured despite the fact that the drug isn’t used very much and, secondly, because the recommendations of “Dr. Jay” – if they were widely followed – would lead to more use of Tamiflu, thus speeding selection for resistant influenza.

    Clearly, “Dr. Jay” doesn’t know nearly enough about basic virology to be posting an “open letter” about influenza. And this isn’t the first time “Dr. Jay” has been dead wrong in his “facts”.

    So, instead of coming here to whine about how he is abused and misunderstood, “Dr. Jay” would be better served by using the information he is given here to correct his “open letter”. The simplest way to correct it, from what I read, would be to press the “delete” key until only his name remains.

    Prometheus

  41. Danio says:

    So, instead of coming here to whine about how he is abused and misunderstood, “Dr. Jay” would be better served by using the information he is given here to correct his “open letter”.

    This would be refreshing indeed. Alas, as evidenced by the newest ‘open letter’ linked to by Julie RM above, Jay is simply digging his heels in even harder, declaring:

    this winter is not different than previous winters. Swine Flu does not pose a realistic risk to your family.

    and advocating Echinacea tea, Astragalus, Elderberry, Probiotics (!), and other ‘immune boosting’ brews. Curiously, he chose not to address the fact that approximately 50% of the Swine flu deaths in the past two weeks have been children/young adults. Just a normal flu season, folks. Nothing to see here. Move along.

    His arrogance of ignorance knows no bounds. It is, frankly, terrifying.

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