Archive for Public Health

9 Reasons to Completely Ignore Joseph Mercola

Some of our more astute readers may have noticed that we are paying influenza slightly more attention than other topics of late.  That’s because this situation is new, rapidly changing, and covers more areas of science and medicine than one can easily count.  It’s also a subject about which the general public and media are keenly interested.  This is an outstanding learning and teaching opportunity for us as a professional community.  Unfortunately, it is also fertile ground for confusion, fear, and misinformation, and a playground for those who would exploit such things. is a horrible chimera of tabloid journalism, late-night infomercials, and amateur pre-scientific medicine, and is the primary web presence of Joseph Mercola.  Unfortunately, it is also one of the more popular alternative medicine sites on the web and as such is uncommonly efficient at spreading misinformation.  I am not a fan, and have addressed his dross in the past.

Joseph Mercola has recently posted an excerpt from an individual he evidently holds in high regard, Bill Sardi.  Bill published “18 reasons why you should not vaccinate your children against the flu this season.”  Mercola chose his nine favorites (one would assume the nine best reasons), and re-posted it on  There are so many mistakes, so much misinformation in so little space, it’s almost a work of art.  You know, like that crappy art that you might expect to find on the wall at an hourly motel.  Without further delay, let’s examine Mercola and Sardi’s nine best reasons for you not to vaccinate your children against influenza this season: (more…)

Posted in: Public Health, Science and Medicine, Vaccines

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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.


Posted in: Public Health, Vaccines

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H1N1 Update

I know we have been focusing on the vaccine issue extensively, but this is crunch time and the anti-vaccine forces are relentless. We are now facing a regular seasonal flu spiked with the H1N1 pandemic. Our best weapon against morbidity and mortality caused by the flu is information, and yet the public is being barraged with misinformation designed to encourage poor choices and thereby result in maximal morbidity and mortality.

I confess I was never impressed with FDR’s famous quip, “All we have to fear is fear itself,” – I think there is plenty else to fear. But his sentiment is very appropriate to the current situation – fear mongering around the seasonal flu and H1N1 vaccines is what we have most to fear.

And of course, as is almost always the case, accurate information is complex and requires a nuanced understanding. This creates uncertainty, which is easy to exploit to manufacture unreasonable fear.

The anti-vaccine fear mongers are playing every card in the deck. They are arguing (falsely) that H1N1 is not severe enough to warrant getting the vaccine, that the vaccine does not work anyway, and that there are unacceptable or unknown risks to the vaccine. In the most extreme cases, bizarre conspiracy theories are brought to bear, but I will not discuss these here as anyone compelled by such fantasies is likely beyond the reach of any information I could provide.


Posted in: Public Health, Vaccines

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Monkey business in autism research, part II

Over the last couple of months, I’ve noticed something about the anti-vaccine movement. Specifically, I’ve noticed that the mavens of pseudoscience that make up the movement seem to have turned their sights with a vengeance on the Hepatitis B vaccine. The reason for this new tactic, I believe, is fairly obvious. The fact that the Hep B vaccine is administered shortly after birth seems somehow to enrage the anti-vaccine movement more than just about any other vaccine. Moreover, given that, aside from maternal-child transmission when the mother is infected, hepatitis B is usually only contracted through either bloodborne contact (the sharing of needles, the administration of contaminated blood) or sexual activity, it’s very easy for anti-vaccinationists to make a superficially plausible-sounding argument that it’s not a necessary vaccine, even though there are reasonable rationales for giving it to infants. The image of sticking a needle into a newborn infant trumps that, though, at least for the anti-vaccine movement. Another possibility, suggested by Steve Novella just yesterday, is that, with the collapse under a overwhelmingly huge pile of evidence of the idea that the mercury-containing preservative thimerosal that used to be used in childhood vaccines until 2001, caused an “epidemic” of autism and the failure of the “too many too soon” slogan to convince anyone who is not already an anti-vaccinationist, the movement needed a new bogeyman to blame for autism. The hepatitis B vaccine, which was added to the pediatric vaccination schedule in the 1990s, around the right time to confuse correlation with causation when it comes to the increase in autism diagnoses (just like thimerosal) was a perfect next target, given that it’s administered shortly after birth.

Indeed, just the other day, the anti-vaccine crank groups the National Vaccine Information Center (NVIC), Talk About Curing Autism (TACA), and the anti-vaccine crank blog Age of Autism posted a call for the elimination of hepatitis B vaccination for newborns:

Washington, DC – National Vaccine Information Center and Talk About Curing Autism are calling on President Obama to order the immediate suspension of the Centers for Disease Control and Prevention recommendation of the birth dose of the Hepatitis B vaccine after two recent studies linking the Hepatitis B vaccine to functional brain damage in U.S. male newborns and infant primates.  In a related development today, the United States Department of Health and Human Services, including the Health Resources and Services Administration and Centers for Disease Control and Prevention,  announced that 1 in every 91 children are now diagnosed with an autism spectrum disorder as reported in the November 2009 issue of Pediatrics. Previous data released by the CDC indicated a prevalence of 1 in every 150 children affected by the disorder.

Note how AoA not-so-subtly interposed the latest information about autism prevalence with its call to eliminate the birth dose of the hepatitis B vaccine. Very clever. By doing so, it linked the two in readers’ minds, as if one had something to do with the other. There’s no good scientific evidence that the hepatitis B vaccine has anything to do with the “autism epidemic.” Meanwhile, David Kirby is up to his usual nonsense, and the resident anti-vaccine propagandist at CBS News, Sharyl Attkisson, who has been known to feed Age of Autism information on at least one occasion in the past, served up this credulous, noncritical interview with Andrew Wakefield:

The quantity of misinformation in that single six minute video is far beyond the scope of this article. Were I to start dissecting it, I would not have time to do what the purpose of this article was intended to do: To deal with the study Wakefield is hawking. That’s why I leave the dissection of this pièce de résistance of disingenuousness and misinformation as an exercise for SBM readers–after reading the rest of this post, of course. Trust me, it will help you.

At the heart of this latest propaganda onslaught by the anti-vaccine movement are two studies, one a restrospective study in humans and the other a study in monkeys, both of which the anti-vaccine movement is promoting as slam dunk evidence that the hepatitis B vaccine is causing all sorts of horrific problems. Taking both of them on in one post is too much, even for my logorrheic tendencies. So I’ll deal first with Wakefield’s monkey study and then, either later this week or sometime next week, hopefully discuss the human study.

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

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Head-In-The-Sand Consumer Affairs

Editor’s Note: Please be aware that Ben is deployed in Iraq right now. What that means is that his Internet access is somewhat sporadic. He will show up from time to time to answer comments, however.

– To err is human, but to persist
diabolical –

Lucius Annaeus Seneca (c. 4 BC – 65 AD)

The California (CA) Department of Consumer Affairs (DCA) has an informational booklet on Acupuncture and Asian Medicine that besides depicting many New Age fantasies about prescientific medicine, also makes the unfounded claim that based on a 1997 consensus panel, the NIH formally “endorses” the use of acupuncture for a set of specific conditions, and that there is “clear evidence” that it is effective for some of them. This booklet is available at:

Wondering about this “clear evidence,”  I wrote a letter a few months ago to the National Center for Complementary and Alternative Medicine (NCCAM) and asked for a clarification.

Their candid response explicitly stated that the CA booklet “misstates the purpose of the 1997 consensus panel on acupuncture.” The NCCAM also added that as a “Federal research agency, the NIH does not endorse any product, service or treatment, nor are NIH consensus documents statements of policy.”

Posted in: Acupuncture, Politics and Regulation, Public Health, Science and Medicine

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The price of anti-vaccine fanaticism: Case histories

One of the major themes of SBM has been to combat one flavor of anti-SBM movement that believes, despite all the evidence otherwise, that vaccines cause autism and that autism can be reversed with all sorts of “biomedical” quackery. Many (but by no means all) of these so-called “biomedical” treatments are based on the false view that vaccines somehow caused autism. I and my fellow SBM bloggers have expended huge quantities of verbiage refuting the pseudoscience, misinformation, and outright lies regularly spread by various anti-vaccine groups and two celebrities in particular, namely Jenny McCarthy and her boyfriend Jim Carrey. Most of the time, we discuss these issues in terms of the harm to public health that is done by falling vaccination rates due to the fear engendered by the message of the anti-vaccine movement and the threat of the return of vaccine-preventable diseases that once wreaked havoc among children.

There is another price, however. There is a price that is paid by autistic children themselves and their parents. It is a price paid in money and lost time. It is a price paid in being subjected to treatments that are highly implausible from a scientific standpoint and for which there is no good scientific evidence. It is a price that can result in bankruptcy, suffering, and, yes, even death.

It is a price, I think, that is best demonstrated through a few case studies. This is a situation when anecdotes have their use.

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

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Crank “scientific” conferences: A parody of science-based medicine that can deceive even reputable scientists and institutions

If there’s one thing that purveyors of pseudoscientific medical modalities crave, probably above all else, it’s legitimacy. They want to be taken seriously as Real Scientists. Of course, my usual reaction to this desire is to point out that anyone can be take seriously as a real scientist if he is able to do science and that science actually shows that there is something to his claims. In other words, do his hypotheses make testable predictions, and does testing these predictions fail to falsify his hypotheses? That’s what it takes, but advocates of so-called “complementary and alternative medicine” (CAM) or “integrative medicine” (IM, or, as I like to refer to it: “integrating” quackery with scientific medicine) want their woo to be considered science without actually doing the hard work of science.

There are several strategies that pseudoscientists use to give their beliefs the appearance of science, a patina of “science-y” camouflage, if you will. One, of course, is the cooptation and corruption of the language of science, which has been a frequent topic on this blog, particularly in posts written by Drs. Atwood and Sampson. Another is to produce journals that appear to be science, but are anything but. I’ve discussed one example, the Journal of American Physicians and Surgeons and Medical Acupuncture, but others include Homeopathy, the Journal of Alternative and Complementary Medicine, and Medical Hypotheses, which recently was forced to retract a horrible paper by arch-HIV/AIDS denialist Peter Duesberg. What’s worse is that some of these journals are even published by what are considered major publishers, such as Mary Ann Liebert, Inc., and Elsevier.

There is, however, a third strategy. How do scientists communicate their findings to other scientists, as well as meeting and mingling with other scientists? Why, they hold scientific meetings, of course! These meetings can be small or even as large as the American Association for Cancer Research meeting, which is attended by around 15,000 cancer researchers each year. So, too, do cranks hold meetings. These meetings often have all the trappings of scientific meetings, with plenary sessions, smaller parallel sessions, poster sesssions, and an exhibition hall, complete with exhibits by sponsoring companies. Sometimes these meetings can even appear so much like the real thing that they take in legitimate researchers and legitimate universities. Here, I present two examples of such conferences.

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

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Report a doctor’s dubious practices, go to jail?

Althought I and other SBM bloggers have criticized state medical boards for not doing enough to protect patients from physicians who practice pseudoscientific medicine and quackery, they do nonetheless serve a purpose. Moreover, critical to medical boards doing even the limited amount of enforcement that they do is the ability of health care providers or other citizens to submit anonymous complaints against physicians who are not practicing up to the standard of care or who may be in other ways taking advantage of patients. Unfortunately, the other day I found out via one of the that I frequent of a very disturbing case in Kermit, Texas. Two nurses who were dismayed and disturbed by a physician peddling all manner of herbal supplements reported him to the authorities. Now, they are facing jail:

In a stunning display of good ol’ boy idiocy and abuse of prosecutorial discretion, two West Texas nurses have been fired from their jobs and indicted with a third-degree felony carrying potential penalties of two-to-ten years’ imprisonment and a maximum fine of $10,000. Why? Because they exercised a basic tenet of the nurse’s Code of Ethics — the duty to advocate for the health and safety of their patients.

The nurses, in their 50s and both members of the American Nurses Association/Texas Nurses Association, reported concerns about a doctor practicing at Winkler County Memorial Hospital in Kermit. They were unamused by his improperly encouraging patients in the hospital emergency department and in the rural health clinic to buy his own herbal “medicines,” and they thought it improper for him to take hospital supplies to perform a procedure at a patient’s home rather than in the hospital. (The doctor did not succeed, as reportedly he was stopped by the hospital chief of staff.)

How can this be? This is how:

Posted in: Herbs & Supplements, Politics and Regulation, Public Health

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The HPV Vaccine (Gardasil) Safety Revisited

Gardasil (qHPV) was licensed in 2006 as a vaccine against four types of Human Papillomavirus (HPV) and marketed as, “The first vaccine targeted to prevent cancer.”  From its inception it has been one of the more controversial vaccines.  Some religious groups feared that the reduced threat of a sexually transmitted disease would lead to increased sexual promiscuity.  Other groups were concerned about its safety.  Some have questioned whether its high financial cost would make it a cost-effective intervention, while others have questioned the marketing tactics of its manufacturer Merck.

Most of these concerns bear consideration (though I have no time for those who advocate using the threat of disease and death to force conformation to their religious beliefs), and were in large part addressed by David Gorski in a SBM article last year.  If you’ve not read his post, I strongly suggest you do so.  Now that a large post-licensure study on qHPV has been published, it seems a good time to revisit the issue of greatest concern to me as a pediatrician and to most parents, namely qHPV’s safety and efficacy profile.


Posted in: Public Health, Vaccines

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Even with the H1N1 pandemic flu strain going around, you should still be vaccinated against the seasonal flu

Even with the H1N1 pandemic flu going around you should still be vaccinated against the seasonal flu. revere has the details. Read. Enjoy. Be educated.

I guess that means Dr. Doug Bremner must think that revere is an idiot. After all, Bremner tells us that the flu vaccine is all a plot for big pharma to make money, don’t you know? Subtlety and weighing of risk-benefit ratios in a manner that doesn’t turn into an anti-big pharma rant is beyond him, as both Peter Lipson and I discussed (and Peter discussed again) not too long ago.

Fortunately it is not beyond revere to rationally weigh the risks and benefits of being vaccinated:

The truth is this. No one knows what’s going to happen. We’re all guessing. But in my estimation, the risk-benefit calculation for vaccine side-effects and flu is so markedly in favor of the vaccine that I made the decision to get vaccinated and that’s what I’d advise others, too. How confident am I? I’m confident it is the most rational thing to do given what we know.

Exactly. It is quite possible to look at the evidence and science and decide that the risk-benefit ratio is so much in favor of vaccination that it makes sense to be vaccinated. It’s also possible to look at the same literature and be less enthusiastic. You don’t need to appeal to big pharma conspiracy theories, and, in fact, such appeals only muddy the issue unnecessarily.

I’d love to see Bremner try to counter the arguments of a highly respected senior epidemiologist who can calmly discuss the pros and cons of flu vaccines from a scientific and practical standpoint based on evidence. Bremner points to “experts” who say that vaccination against the seasonal flu is a waste of money and time, but here’s one expert I bet that Bremner can’t refute. I won’t hold my breath waiting for him to try, though. It’s so much easier just to say that you’re an idiot if you get vaccinated against the seasonal flu. Obviously, in Bremner’s world, revere must be in the thrall of big pharma and pro-vaccination ideology.

Just like me, I guess.

Posted in: Public Health, Vaccines

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