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If You Think Doctors Don’t Do Prevention, Think Again

Prevention has long been a priority of conventional medicine

Prevention has long been a priority of conventional medicine

One of the common criticisms we hear from alternative and integrative medicine proponents is that doctors don’t do anything to prevent illnesses and have no interest in prevention. They claim that doctors are only trained to hand out pills to treat existing illnesses. Sometimes they even accuse them of deliberately covering up cures and wanting to perpetuate illnesses like cancer so they can make more money by treating patients. Nothing could be more absurd. Every reputable doctor would rather prevent illnesses than treat them. In his book Heart 411, cardiologist Steven Nissen even said he would be glad to see his specialty become obsolete: “Don’t worry about us; we will gladly hang up our scalpel and stethoscope if we can find a better way to lead you to a heart-healthy life.”

Doctors own prevention. They invented it, from vaccines to clean water to preventive screening tests. Mainstream medicine was responsible for the greatest preventive achievement in history: the smallpox vaccine campaign succeeded in preventing anyone from ever getting smallpox again. I defy you to comb through historical records and find any doctor who ever said “Let’s stop vaccinating for smallpox so we can make more money treating its victims.”

Prevention is one of the six fundamental principles of naturopathy. Alternative practitioners pride themselves on prevention, but they don’t actually do a very good job of it. In fact, there is evidence that their patients are less likely to get immunizations and some of the standard preventive screening tests recommended by the USPSTF. Instead of rigorously implementing evidence-based preventive strategies, they tend to offer other speculative, untested recommendations.
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Posted in: Naturopathy, Public Health, Vaccines

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Dealing with vaccine hesitancy and refusal

How do we deal with parents who would rather their babies face diseases than vaccines?

How do we deal with parents who would rather their babies face diseases than vaccines?

As long as there have been vaccinations, there has been an antivaccine movement, and as long as there has been an antivaccine movement, there have been parents who refuse to vaccinate. In a past that encompasses the childhood of my parents, polio was paralyzing and killing children in large numbers in yearly epidemics, the fear of which led to the closure of public pools every summer. In such an environment, the new polio vaccine introduced by Jonas Salk in the mid-1950s wasn’t a hard sell. In fact, satisfying the initial demand for it was the problem, not parents refusing to vaccinate their children. Since then, more and more vaccines have been developed to protect more and more children from more and more diseases, to the point where the incidences of most vaccine-preventable diseases is so low that, unlike 60 years ago, most parents today have never seen a case or even known other parents whose child suffered from a case. Even as recently as the 1980s, Haemophilus influenza type B was a dread disease that could cause meningitis, pneumonia, sepsis, and death. Since the introduction of the the Hib vaccine a mere quarter century ago, Hib has been virtually eliminated. Most pediatricians in residency now have never seen a case.

As much of a cliché as it is to say so, unfortunately vaccination has been a victim of its own success, at least in developed countries. Parents no longer fear the diseases childhood vaccines protect against, which makes it easy for antivaccine activists to provide what I like to call “misinformed consent,” by spreading misinformation that vastly exaggerates the risk of vaccines compared to the benefit of vaccinating. Parents who believe the misinformation conclude, based on a warped view of the risk-benefit ratio of vaccines, that not vaccinating is safer. Add to the mix fear mongering against the MMR based on Andrew Wakefield and his dubious 1998 case series that popularized the then-recent idea that vaccines cause autism, and it’s no wonder that parents decide that not vaccinating is safer than vaccinating. If you believe the misinformation, it’s not an entirely unreasonable conclusion. Then add to that the easy availability of “personal belief exemptions” to school vaccine mandates in many states, which include anything from religious exemptions to parents just signing a form that says they are “personally opposed” to vaccination, and it isn’t a huge surprise that vaccine uptake has fallen in some areas to the point where outbreaks can occur. It was happening in California and my own state of Michigan. (more…)

Posted in: Politics and Regulation, Public Health, Vaccines

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Reviewing Andrew Wakefield’s VAXXED: Antivaccine propaganda at its most pernicious

VAXXED

I’ve finally seen it. I’ve finally seen Andrew Wakefield and Del Bigtree’s “documentary” VAXXED: From Cover-up to Catastrophe, and I didn’t even have to pay to see it! Now, having watched Wakefield and Bigtree’s “masterpiece,” I can quite confidently say that it’s every bit as accurate and balanced a picture of vaccine benefits and risks as Eric Merola’s two movies about the quack Stanislaw Burzynski and his Second Opinion: Laetrile at Sloan-Kettering are about cancer and cancer research, The Beautiful Truth is about the Gerson protocol for cancer, Simply Raw: Reversing Diabetes in 30 Days is about diet and diabetes, Expelled! No Intelligence Allowed is about evolution, and The Greater Good is about…vaccines! Of course, based on what I knew of the story, saw of the VAXXED trailer (which deceptively edited together statements by William Thompson), and have discussed about the efforts of Andrew Wakefield, Del Bigtree, and Polly Tommey to use VAXXED as a tool in a publicity campaign to try to spread fear, uncertainty, and doubt (FUD) about vaccines using the “CDC whistleblowerconspiracy theory (about which a primer can be found here), I shouldn’t have been surprised, but I was actually surprised (slightly) at the manipulative depths to which this film sinks.

On the plus side, its production values are better than those Eric Merola’s films (although I, with no experience, could probably make a film with better production values than Merola), but that just makes it somewhat more effective propaganda. In my review and discussion of the movie and its claims, I will discuss the claims made by Bigtree and Wakefield as well as the movie as a movie. Unfortunately, there is so much misinformation in this 91 minute documentary that I will only be able to hit the “high” points without going far, far beyond even a Gorski level of logorrhea in this post. Worse, there is a considerable amount of dishonest framing, in which actual facts and events are presented in a deceptive manner to tell a distorted narrative. Before that, though, let’s meet the key players.
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Posted in: Book & movie reviews, Politics and Regulation, Science and the Media, Vaccines

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How low antivaccine “warriors” will go: Of Facebook harassment reporting algorithm abuse and publicly attacking a 12 year old boy

NOTE: Anyone who has seen several derogatory articles about me on the web and is curious about what the real story is, please read this and this.
Marco Arturo

I was going to write about something else this week, but events over the last several days led me to change my mind. The first was the reaction of a pseudonymous antivaccine “warrior” going by the ‘nym Levi Quackenboss to a viral video posted by a 12-year-old boy named Marco Arturo. The second was my learning that other antivaccine “warriors” had resumed abusing the Facebook reporting algorithm to get pro-science advocates supporting vaccines banned from Facebook for periods up to 30 days and thereby silence them. I wrote about this latter tactic a couple of years ago, when the Australian antivaccine group the Australian Vaccination Network (AVN), or AVN (which was forced to rename itself the Australian Vaccination Skeptics Network in 2014), started abusing Facebook’s algorithm for reporting harassment and abuse in order to get members of the skeptic group Stop the Australian Vaccination Network (SAVN) temporary Facebook bans. It’s a tactic that has continued, with a fresh batch of temporary bans issued by Facebook in response to bogus complaints over the last few days.

I’ve frequently written about how often the preferred tactic of antivaccinationists and others pushing medical pseudoscience is not to answer criticism with evidence, science, and rational argument, but rather to respond with attacks and attempts to intimidate and silence. The reason, of course, is that they do not have any of that to support their beliefs. At some level, I suspect that many of them know it. Be that as it may, those of us who lament how few physicians and scientists, even those sympathetic to scientific skepticism, are willing to publicly speak out and call the quacks to task know that the consequences of doing so are often quite unpleasant: Online attacks, poisoning of one’s Google reputation, attempts to get one banned from Facebook, and, of course, the antivaccinationists’ favorite: Harassment through one’s job by complaining to one’s bosses. To illustrate these hazards, I’ll start with the story of Marco Arturo, before moving on to a more organized effort. (If you read my not-so-super-secret other blog, you’ll have heard of Marco’s story before, but I’ll summarize here as well.) Then I’ll update you on how Facebook continues to allow its reporting algorithms to be abused to silence pro-vaccine voices there. I’ll finish up with examples of what we at SBM have experienced and some thoughts on what can be done. (more…)

Posted in: Computers & Internet, Health Fraud, Vaccines

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Does your antivax doctor have another agenda?

A witch placing a scorpion into a potSeveral weeks back, I wrote a piece in praise of Michigan’s Fresh Air Camp’s decision to admit only properly vaccinated children. Predictably, there was a bit of a backlash from people who, despite the obvious benefits, oppose vaccinations.

I can’t fault a parent for the decisions they make for their kids. We all work from the gut when it comes to our children, and this can make us see risks incorrectly. But I cannot forgive people who should know better. Medical professionals should all support basic public health such as vaccination, just as they should support healthy eating, physical activity, and clean water. I feel strongly enough about this that I have called for pulling the licenses of doctors who oppose vaccination.

As usual when I write about vaccines, I got plenty of hate mail and disturbing blog comments – no biggie. That’s part of standing up for the truth. What really disturbed me was a local doctor, here in the same community that the camps serve, coming out publicly against the new policy. When a medical professional weighs in on a matter of public health, people listen. (more…)

Posted in: Science and Medicine, Vaccines

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Medical exemptions to vaccine mandates for sale after SB277! Get ’em before they’re gone!

NOTE: Anyone who has seen several derogatory articles about me on the web and is curious about what the real story is, please read this and this.

SB277, which eliminates nonmedical exemptions to school vaccine mandates in California, is a very good law, but it's not perfect. Unfortunately, one provision allows the issuance of medical exemptions based on the say-so of doctors using antivaccine misinformation and pseudoscience.

SB277, which eliminates nonmedical exemptions to school vaccine mandates in California, is a very good law, but it’s not perfect. Unfortunately, one provision allows the issuance of medical exemptions based on the say-so of doctors using antivaccine misinformation and pseudoscience.

I realize that it’s a cliché to say so, but some clichés are true. Time really does fly. It’s hard to believe that a year ago California—and, by proxy, the rest of the country—was in the throes of a major political war over the bill SB277. SB277, you will recall, was a bill introduced into the California Assembly in the wake of the Disneyland Measles outbreak in early 2015 that eliminated non-medical exemptions to school vaccine mandates beginning with the 2016-2017 school year. Ultimately, SB277 passed and was signed into law by Governor Jerry Brown last July. It was an uncommon victory for science and public health, and already appears to be having a positive effect on vaccine uptake in kindergarten children.

Unfortunately but not unexpectedly, to say that the proposal and passage of SB277 into law drove the antivaccine movement into even greater fits of crazy in response is to put it mildly. It became a common trope on antivaccine websites and blogs to see SB277 compared to fascism, in particular the Holocaust. Robert F. Kennedy, Jr. and “Dr. Bob” Sears explicitly compared SB277 to the Holocaust. Truly, the Godwin was strong in the antivaccine movement. One particularly offensive meme that went around at the time consisted of antivaccinationists suggesting that SB277 was a major step in the direction of requiring unvaccinated children to wear a badge or armband to identify themselves, the way that the Nazis required Jews to wear badges or armbands with a yellow Star of David on them. One, Heather Barajas, even went so far as to be photographed with her children wearing such an “unvaccinated” badge and juxtapose that photo with photos of Jews from the Third Reich wearing yellow Stars of David.
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Posted in: Homeopathy, Politics and Regulation, Public Health, Vaccines

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Vaxxed and the Tribeca Film Festival: How Robert De Niro learned the hard way about Andrew Wakefield and the antivaccine movement

Robert De Niro made a massive mistake last week.

Robert De Niro made a massive mistake last week. Fortunately, he started to make up for it.

One of the disadvantages of only doing one blog post a week here at Science-Based Medicine is that sometimes stuff happens at too fast a pace for me. If something happens on Tuesday, by the time Sunday rolls around and it’s time for me to do my weekly post, it’s often old news, too old to bother with. That’s why it’s a good thing that I have my not-so-super-secret other blog, where I can keep up with such events. On the other hand, the advantage of a once-a-week posting schedule is that there are times I can look back at a story that evolved over the last week and, instead of blogging about it in daily chunks, I can put together a post that tells the whole story and puts it in context. Something like that happened last week. The beauty of it is that I played a major role in bringing the story to public consciousness, followed the story as it evolved, and now can provide a fairly complete recounting. Or so I hope.

First, however, let’s take advantage of another good thing about waiting to blog about a story, namely getting to see the reactions of quacks to what happened. No one can do it better than everybody’s favorite all around quack, crank, and all-purpose conspiracy theorist Mike Adams, who greeted me yesterday morning with this headline: VAXXED film pulled from Robert De Niro’s Tribeca Film Festival following totalitarian censorship demands from pharma-linked vaccine pushers and media science trolls. What on earth is Adams talking about, you might wonder? In case you haven’t been following the news, here’s a link to the New York Times story on the same incident: “Robert De Niro Pulls Anti-Vaccine Documentary From Tribeca Film Festival.” Basically, the 2016 Tribeca Film Festival selected an antivaccine documentary directed by Andrew Wakefield for screening and then thought better of it after a major uproar and a whole boatload of bad press.

I’ll deal with Adams’ post a bit later because it’s so hilariously nutty but also because it is basically the propaganda line that antivaccinationists are putting on this PR debacle brought about by Andrew Wakefield and Robert De Niro. (I never thought I’d use those two names in the same sentence.) Let’s go back a week and see what I mean. (more…)

Posted in: Book & movie reviews, Science and the Media, Vaccines

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American Journal of Public Health article touts “potential public health benefits” of homeopathy

Homeopathy: It's just water.

Homeopathy: It’s just water.

An article in the April, 2016 issue of the American Journal of Public Health caught my eye: “Homeopathy Use by US Adults: Results of a National Survey.” I was pleased to see that homeopathy use is actually quite low. The 2012 National Health Survey found that only 2.1% of U.S. adults used homeopathy in the last 12 months, although that was a 15% increase over 2007. Users were mostly young, white, well-educated women, the typical CAM consumer.

Even fewer saw a homeopathic practitioner (only 19% of all users), although those who did perceived a greater benefit from homeopathic remedies. This difference, speculate the authors, could be due to several factors, one of which is

a more individualized and effective homeopathic prescription by the provider.

What? Are the authors suggesting that the series of off-the-wall questions asked by homeopaths leads to a prescription of an “effective” homeopathic remedy?

They certainly seem to be. Who are these authors, anyway?

They are Michelle L. Dossett, MD, PhD, MPH, Roger B. Davis, ScD, Ted J. Kaptchuk, and Gloria Y. Yeh, MD, MPH. All are, or were, with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center. All are also connected with Harvard and work, in various ways, in “integrative medicine” research. The article was funded, in part, by the National Center for Complementary and Integrative Health, and in part by Harvard. (more…)

Posted in: Clinical Trials, Homeopathy, Medical Academia, Public Health, Vaccines

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The claim that Gardasil causes premature ovarian failure: Ideology, not science

It's amazing how, to antivaccine activists, it just so happens that a vaccine that targets a sexually transmitted virus must also destroy a girl's ovaries.

It’s amazing how, to antivaccine activists, it just so happens that a vaccine that targets a sexually transmitted virus must also destroy a girl’s ovaries. It must be a coincidence, right?

When you’ve been blogging for over 11 years on your own blog and 8 years on a blog like Science-Based Medicine, particularly when what you blog about is skepticism and science-based medicine, with a special emphasis on rationally and scientifically discussing quackery, inevitably you see the same misinformation and lies pop up again and again. Indeed, those of us in the biz not infrequently refer to such stories as “zombie lies,” because no matter how often you think they’ve been killed they always come back. Personally, I like to refer to them as Jason, Michael Myers, or Freddy Krueger lies (or just slasher or monster lies), for basically the same reason. You kill them with facts, evidence, science, and reason, but sooner or later they always come back. Always. That’s why trying to refute them is like playing Whac-A-Mole. This time around, a group called the American College of Pediatrics (ACP) is claiming that Gardasil is causing infertility in girls, a claim that showed up last week on that repository of quackery, NaturalNews.com. Oddly enough, despite the article’s hysterical tone, it wasn’t written by NN’s big macher himself, Mike Adams.

The reason that slasher lies keep coming back is because they never really go away completely. They only look that way because they recede for a while until someone new discovers them or their originators decide the coast is clear and they can repeat them again. There’s one particular slasher lie that keeps coming up about the HPV vaccine, usually Gardasil (mainly because that’s the brand of HPV vaccine most commonly used in the US) but not restricted to Gardasil. Sometimes Cervarix falls prey to the same lies, mainly overseas where it is the predominant version of HPV vaccine used. Given that I was in Boston at the annual meeting of the Society of Surgical Oncology over the weekend and was also busy hanging out with Kimball Atwood and Clay Jones one night, surgical colleagues another night, and the Boston Skeptics on Saturday, it seemed to me to be a good time to revisit this topic, particularly given that it hasn’t been covered on SBM before. If this post looks familiar, it’s because it has appeared before, but it was in a different form. Consider this a beefed up version of the prior post, because even when I recycle material I can’t just recycle it unchanged. I have to tinker, add, and, of course, customize for the blog. It’s what I do.
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Posted in: Public Health, Religion, Vaccines

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Are the recommended childhood vaccine schedules evidence-based?

The vaccine schedule: Safe and efficacious.

The vaccine schedule: Safe and efficacious.

We write about vaccines a lot here at SBM, and for a very good reason. Of all the medical interventions devised by the brains of humans, arguably vaccines have saved more lives and prevented more disability than any other medical treatment. When it comes to infectious disease, vaccination is the ultimate in preventive medicine, at least for diseases for which vaccines can be developed. We also know that when vaccination rates fall, it opens the door for diseases once controlled to come roaring back. We saw this phenomenon with the measles a year ago in the Disneyland measles outbreak. We’ve seen it around the country, with measles outbreaks occurring in areas where a lot of antivaccine and vaccine-averse parents live. Perhaps the most spectacular example occurred in the UK, where prior to Andrew Wakefield’s fraudulent case series in The Lancet that was used to link the MMR vaccine to autism, measles was under control; it came roaring back as MMR uptake plummeted in the wake of the publicity his research engendered. By 2008, ten years after Wakefield’s case series was published, measles was again endemic in the UK. Measles outbreaks flourished. Although MMR uptake is improving again in the UK, there remains a reservoir of unvaccinated children aged 10-16 who can transmit the virus.

Thanks, Andy.

Fortunately, Wakefield has been relegated to sharing the stage with crop circle chasers, New World Order conspiracy theorists, sovereign citizen cranks, and other antivaccine cranks like Sherry Tenpenny. Unfortunately, the damage that he has done lives on and has metastasized all over the developed world. Given the persistence of the antivaccine movement, which fuels concerns about vaccines in parents who are not themselves antivaccine but are predisposed to the antivaccine message because they distrust government and/or big pharma or have a world view that overvalues “naturalness,” I was quite interested in an article that appeared in The BMJ last week. Basically, it asked the question “Is the timing of recommended childhood vaccines evidence based?
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Posted in: Clinical Trials, Epidemiology, Public Health, Vaccines

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