Antivaccine nonsense Autism Complementary and alternative medicine Medicine Quackery

More anti-vaccine nonsense from an old friend on (where else?) The Huffington Post

Here we go again.

You may have noticed that I’ve been laying off that repository of quackery, autism pseudoscience, and anti-vaccine nonsense, The Huffington Post. I assure you, it’s not because things have gotten much better there. Oh, sure, occasionally someone will try to post something resembling science and rationality, but it’s impossible for so few to overcome so much history and so much woo. Indeed, even when someone tries, he can’t help but be sucked into the morass of pseudoscience that is HuffPo. For example, Dr. Harvey Karp (the same guy who went toe-to-toe with Dr. Jay Gordon–more on him later–on The Doctors and humiliated him) recently wrote what was for the most part a decent post taking on the myth that vaccines cause autism. Unfortunately, he couldn’t resist prefacing his post with this:

If a foreign government were suspected of doing something that caused brain problems to 1/166 American children our nation would immediately and vigorously respond…and even go to war! Well, our children are under a mysterious assault that is causing 1/166 to develop autism. And, we must band together and immediately and vigorously make the correction of this problem a true national priority.

This is the sort of risibly hyperbolic warlike rhetoric that would not be out of place on the happy home for autism quackery, Age of Autism or even on the home page of Generation Rescue. The reason is that such rhetoric clearly implies that Dr. Karp accepts the “autism epidemic” fear mongering at face value. Think about it: What could be this “mysterious assault” that’s supposedly making so many of our children autistic? It couldn’t possibly be, as, for the most part, what the scientific consensus currently believes it is, could it? It couldn’t possibly be a combination of increased awareness and diagnostic substitution, which is what most of the evidence thus far supports as the cause for the huge increase in incidence of autism over the last 20 years or so. Indeed, prominent autism researcher Simon Baron-Cohen put it very well in an e-mail to Age of Autism (although I have no idea why he is bothering to try to set the cranks there straight):

I think many children in the old days were overlooked and that we are getting much closer to the true rate in the population these days. In that sense, the fact that more cases are being diagnosed could be seen as an achievement, that we are getting much better at identifying such children. If some note of alarm was needed, perhaps it should be over all those individuals who were missed in the old days, and who are now being better recognized.

Which leads Dr. Karp to opine:

In this 3-part blog, I’d like to discuss in detail the reasons why shots are very safe – and super important – and to present some fresh ideas about a more likely cause of autism: an invisible soup of toxins we’re exposed to every day…endocrine disrupting chemicals (EDCs).

Gee, I wonder if that’s what Mark and David Geier were thinking when they came up with their Lupron protocol. Or maybe he’s making wild extrapolations from Dr. Baron-Cohen’s “extra male” hypothesis regarding the pathogenesis of autism. Either way, combine the apocalyptic rhetoric about an autism epidemic with this bit about “endocrine disrupters,” and it sounds like the whole “oh, no it’s the toxins!!!” gambit, only without the “toxins” coming from vaccines. I really hope that Dr. Karp has some decent evidence to support his “endocrine disrupting chemicals” idea for autism pathogenesis, because I’m not aware of any. Maybe he can educate me, but his rhetoric leaves me worried that, after a good start defending vaccines against the sort of anti-vaccine nonsense that HuffPo is reviled for, he may descend into a different kind of pseudoscience. We’ll see.

Which brings me to an old friend of the blog, Dr. Jay Gordon, and his latest foray into anti-vaccine propaganda is also on–where else?–The Huffington Post. The reason is that Dr. Gordon uses Dr. Karp’s post as a jumping-off point for a post of his very own entitled, appropriately enough, Autism and Toxins. Suffice it to say, it lives down to what we’ve come to expect from Dr. Jay over the last four years.

Before I dive in, though, I do feel a bit reticent about being too harsh on Dr. Jay. Don’t get me wrong; I no longer buy his protestations that he is not “anti-vaccine.” I accept that Dr. Jay believes he is not antivaccine, but his words so routinely belie his denials that I’ve come to believe that he really is deluding himself. What’s more bothersome is that Dr. Jay is generally a nice guy. He’s also just so pathetic when criticized, putting his head down and his tail between his legs like a puppy who’s being yelled at or smacked. In doing so, he inevitably retreats into his usual armamentarium of logical fallacies, appeals to his “personal clinical experience” and anecdotes, all the while whining about just how horribly mean I and my readers are to him. Unfortunately, he seems utterly incapable of accepting that he really does bring a lot of it on himself. Naturally, Dr. Jay starts out with a nod to the guy who so thoroughly and politely smacked him down on The Doctors before heading into a science-free assertion:

Dr. Harvey Karp has just written an excellent blog beginning to discuss the role environmental toxins play in causing autism. I agree that the huge rise in autism is real, and not just related to better diagnosis or reclassification of mental illness. Autism is most likely caused by a genetic predisposition and an environmental “trigger.”

This is called argument by assertion. Dr. Jay simply asserts that the rise in autism can’t be accounted for by better diagnosis or reclassification of “mental illness,” seemingly failing to understand that autism is not a mental illness per se; it’s a neurodevelopmental disorder. He wants you to believe his assertion, not because he can present any scientific evidence to support it, but rather because…well, he’s Dr. Jay and he said it. In other words, it’s the logical fallacy known as an argument from authority. In any case, there is copious evidence that there is a significant genetic component to autism. There may even be an environmental component. However, there is no good evidence for an environmental “trigger.” Indeed, an environmental “trigger” is, in anti-vaccine-speak, virtually always a code word for vaccines.

And Dr. Jay proves me right by going straight for the conspiracy theory ad hominem attacks:

Studies showing that vaccines and their many constituents do not contribute to this problem are flawed, filled with specious reasoning and, for the most part funded by the pharmaceutical industry. Even articles in reputable medical journals are often written by doctors with an economic interest in continuing the vaccination program’s status quo. This does not invalidate all of these studies but it certainly makes them suspect and a poor foundation for an argument excluding vaccines from the list of environmental influences on the increase in autism in America and elsewhere.

Of course, Dr. Jay is utterly incapable of pointing out a single example of “specious reasoning.’ Certainly, he can’t provide a single valid scientific criticism of any of the studies that hasn’t been written by the anti-vaccine movement for him to regurgitate. Indeed, he does exactly that in saying that the Danish study data are “misused by all and interpreted to suit one’s needs.” Never mind that he is full of crap on this one. I won’t go into details because Steve Novella has already discussed the fallacious attacks on the Danish study. Here’s a hint, too, Dr. Gordon: Citing antivaccine crank websites like Vaccination Liberation Info in support of your arguments doesn’t do much for your reputation. Indeed, have you ever heard of Scopie’s Law? It goes something like this:

In any discussion involving science or medicine, citing as a credible source loses you the argument immediately..and gets you laughed out of the room.

Perhaps I should enshrine Orac’s law:

In any discussion involving vaccines, citing Vaccine Liberation Info (or JABS, or Generation Rescue, etc.) as a credible source loses you the argument immediately..and gets you laughed out of the room.

Of course, I suppose I should be grateful that Dr. Gordon hasn’t pulled out the truly idiotic analogy between the vaccine industry and the tobacco industry that he has used in the past. Perhaps he learned something from the slapdowns he received over that one, much as he doesn’t appear to use the “formaldehyde gambit” anymore after receiving a heaping’ helpin’ of much-deserved not-so-Respectful Insolence for it. Too bad he apparently didn’t tell Jim Carrey; it might have spared him from looking about a stupid as stupid can be a couple of months ago.

Still, despite the routine spewing of talking points straight from the anti-vaccine movement, Dr. Gordon continues to insist that he’s “not anti-vaccine.” Indeed, he gets so, so indignant whenever anyone calls him anti-vaccine, as Steve Novella and I have both reluctantly felt compelled to do at various times. No doubt he’ll do the same now. However, he does have an excuse:

The facile dismissal of those of us calling for safer vaccinations and scrutiny of the current vaccine schedule is not scientifically based and polarizes the discussion. Perhaps most importantly, this dismissal is insulting to the thousands of parents and families who aver that their children have been harmed by vaccines. There are extremists choosing to ignore the facts in all vaccine/autism camps. I am not one of them.

Asking that cars be manufactured with more attention to safety and that driving is best when done safely does not make one “anti-car” or anti-driving. Asking for safer vaccinations and more judicious use of those we have does not make me or anyone else “anti-vaccine.”

First off, the call for “safer” vaccines is a sham. Maybe Dr. Gordon believes it, though. So let’s test it. Dr. Gordon, if you read this, I hereby challenge you to answer some simple questions:

  • You say you want safer vaccines. OK then, please, define for us exactly what you would define as “safe enough.” Be very specific. What rate of complications for which vaccines would be “safe enough”? What rates of various infectious diseases against which these vaccines protect would be acceptable in order to balance the risk-beneifit ratios. Please justify your conclusions with reasoning and citations of appropriate peer-reviewed scientific papers.
  • You castigate vaccines for having “toxins.” You’ve apparently backed off on formaldehyde, accepting that it’s a normal byproduct of human metabolism and that a baby makes more formaldehyde in a single day than is contained in the entire vaccine schedule. However, what “toxins” would you remove? Be specific, and provide evidence that these “toxins” actually cause harm.
  • What specific evidence would it take for you to accept that vaccines are safe relative to the risk of disease and to start recommending that your patients vaccinate other than “reluctantly.”

I’ve yet to see you answer these questions. All I’ve seen is your dodging them and dancing around them, engaging in evidence-free rants and the copious use of the pharma shill gambit. Here’s a hint, Dr. Jay: Even if everything you said were true, it would be the science that matters more than anything else. Funding sources matter; they should make us a bit more skeptical. But in the end it’s the experimental design, data, statistical methodology, and data analysis that matter more.

As for that lame gambit about its not being “anti-car” to call for safer automobiles, well, that’s not what anti-vaccine advocates like yourself do. In fact, if a “car safety advocate” said that she would not use a car, ever (as Jenny McCarthy said she wouldn’t vaccinate again, ever, if she were to have another child); spreads misinformation and pseudoscience about cars, all designed to make them seem enormously more dangerous than they really are; can’t provide anything but bad studies and bad science to back up her viewpoint; and, no matter what, always blamed the car for virtually every problem, well, then, yes, I’d say such a “car safety advocate” was anti-car.

See the analogy to the anti-vaccine movement, for which you’ve become an apologist, if not a card-carrying member?

Finally, I like the way Dr. Gordon plays the poor abused mother card, as though questioning anti-vaccine propaganda is being “insulting” to mothers. I’ll repeat yet again that correlation does not necessarily equal causation, and the plural of “anecdote” is not “data.” Once again, we humans are very prone to seeing patterns, whether there is a pattern or not. It’s not “insulting” to point this out. Indeed, we scientists understand that we are just as prone to these cognitive quirks and shortcomings as anyone else. That’s why we don’t trust testimonials and anecdotes, except as hypothesis generating tools, and that’s why the scientific method is so important. It’s a way of preventing our biases, cognitive shortcomings, and tendency to confuse correlation with causation from leading us astray. Indeed, Dr. Karp put it fairly well:

In fact, one of the scariest characteristics of autism is that it can suddenly afflict a child who seems developmentally normal. But, is it possible that this sudden problem right after shots is just a coincidence? Absolutely, yes! Every day, serious and amazing things occur, purely by chance. Think of it this way, in a large country like the US, a one-in-a-million coincidence happens 300 times a day.

Approximately 24,000 children are diagnosed with autism every year and in about 1/3 of those cases (8000/year…150/w) normally developing kids show abrupt deterioration (so called “regressive” autism). Regression usually appears between a child’s 1st and 3rd birthdays, a period during which they get shots 4 separate times. Do the calculations and you quickly realize that, every year, over 600 children will spiral into autism during the four 1-week periods that follow these 4 shot visits… just by pure, utter, random chance.

Such a high chance of coincidence means that a parent who hears about 4-5 toddlers (or even 4-500 toddlers) who worsen after shots may easily be fooled into assuming that the cause of the autism was the shots…but they would be jumping to a totally false conclusion.

I say “fairly well” because, if one looks carefully at most cases of “regressive” autism, signs of autism can almost always be identified well before the “regression” occurs. In that context, “seems” is a good word, because parents often miss the subtle early signs of autism. Surely Dr. Karp must know that. He also must know that vaccines are blamed for autism if regression occurs up to a month after vaccination, sometimes even longer, meaning that his estimates are, if anything, quite low. I also have no idea where Dr. Karp got his “one in a million coincidences” happening “300 times a day.” I can only assume he’s simply taking the approximate population of the U.S. (300 million) and dividing by one in a million. However, there’s no reason to assume a “one in a million” occurrence will happen once a day. It’s sloppy reasoning that undermines the rest of his argument. In any case, epidemiological studies have looked assiduously for evidence that children regress into autism in temporal proximity to vaccination at a rate that is greater than what would be expected by random chance alone or that there is a correlation in general between vaccination and autism. They’ve failed to find even a whiff of such an association.

Be that as it may, I realize that Dr. Gordon can’t seem to understand that confusing correlation with causation is incredibly easy even when two events are not causally related, despite its having been explained to him time and time again. He seems to think that he is above it all and that he could never, ever be led astray by his personal experience:

I have been in practice thirty years and watched thousands of children get shots, not get shots, develop autism or remain developmentally “neurotypical.” I have no proof that vaccines cause autism and would be very excited to have my large group of extremely healthy mostly unvaccinated children studied someday. It would be disingenuous to imply that non-vaccination might not lead to an increased incidence in vaccine-preventable illness. It would be equally disingenuous to state that this possibility poses a great threat to America’s children. The risks of vaccinating the way we do now exceeds the benefits of this vaccine program. “Scientists” who suggest that experienced doctors ignore their eyes and ears are wrong. Detractors who say that we should ignore parents who are certain that vaccines caused their children’s autism are wrong and often quite mean-spirited.

That’s right; we’re “mean-spirited” for suggesting that human cognition is fallable.

I suppose it’s also “mean-spirited” to point out that I’ve seldom seen so many bad arguments packed into a single paragraph. While admitting that he has “no proof” that vaccines cause autism and admitting that decreasing vaccination rates could very well lead to outbreaks vaccine-preventable diseases, Dr. Gordon makes the utterly false conclusion that such a possibility would not pose a threat to our children. How on earth he comes to that conclusion, I have no idea, but come to it he does. What about Hemophilus influenza type b? Remember that nasty bug, Dr. Jay? Twenty years ago, it was the scourge of pediatrics, causing invasive disease in 1 in 200 children under the age of 5. Of these, one half to two-thirds developed meningitis, with a mortality rate of 5% and rate of permanent brain damage of 30%. It is a truly nasty bug. Then a vaccine was developed in the late 1980s, and by the late 1990s Hib had virtually disappeared. Indeed, younger pediatricians in practice now have never seen a case of Hib meningitis. Apparently Dr. Jay thinks that it wouldn’t be a big deal if we stopped vaccinating against Hib. Instead, he would willingly subject our children to real risks of outbreaks of vaccine-preventable diseases in order to protect against a hypothetical risk that vaccines cause autism, a hypothetical risk that multiple large, well-designed studies have failed to validate, having failed to find even a hint of a wisp of a correlation between either thimerosal and autism or vaccines and autism.

One of the interesting things that came out of Dr. Jay’s tap dancing, however, is his admission that he apparently doesn’t vaccinate large numbers of his patients (“my large group of extremely healthy mostly unvaccinated children”). I’d be very curious to know what percentage of Dr. Jay’s patient population is unvaccinated and whether it was because he didn’t think they needed to be. Of course, Dr. Jay is lionized in anti-vaccine circles; so he probably attracts parents who don’t want to vaccinate, and, because he shares their vastly inflated, evidence-free view of how “dangerous” vaccines are, he validates their beliefs and doesn’t challenge their fears of vaccines. He, as he himself puts it, “doesn’t give a lot of vaccines” and “vaccinates reluctantly” when parents insist on having their child vaccinated. Characteristically, Dr. Jay also deploys the logical fallacy of an argument from ignorance:

Dr. Karp, if you are going to talk and blog about kitchen cleaners, furniture polish, pesticides and other toxins, how can you possibly ignore the 30-40 injections of potentially risky material we give children in their first 24 months of life? There is absolutely no proof that these shots are as safe the makers say they are and certainly no proof that new combinations of vaccines and hastily created shots are safe enough for our children.

And there is absolutely no proof that there isn’t a celestial teapot circling the sun between the earth and Mars. A better example of argumentum ad ignorantiam I am hard-pressed to remember.

Oh, I’m sorry, I’m just being so very, very mean. Or insolent. Or both. Or whatever. I’m sorry; I just can’t help myself when I encounter so many logical fallacies, abuses of science, and just plain bad arguments in such a short article. In any case, Dr. Gordon is full of crap yet again. Vaccines are continually tested for safety, and each new vaccine is tested against the background of the current vaccine schedule. Perhaps Dr. Jay requires a colon cleanse to remove the accumulated toxins from so much crap. They’re affecting his reasoning ability. Oh, wait. Sorry. Strike that. I’m being mean again. I must try to be nice, just like Dr. Gordon.

That’s because Dr. Gordon is so much nicer than I am. He is never, ever mean as he blithely dismisses all the scientists who have worked on studies that have failed to validate the concept that vaccines cause autism as hopeless pharma shills in the thrall of the filthy lucre poured upon them by vaccine manufacturers and labeling commenters here as being paid by big pharma to post comments refuting anti-vaccine pseudoscience. When he slanders vaccine manufacturers by likening them to tobacco companies pushing a dangerous product through pseudoscience, marketing, and the denial of epidemiology, Dr. Jay’s not being mean. He’s just telling it like it is.

Because only Dr. Jay is allowed to insult others or use harsh arguments in favor of his position. That’s just being a truth teller. When others do it, they’re just plain mean and nasty. Like me.

Dr. Jay finishes with a flourish:

It remains very possible that changing the way we manufacture vaccines and being more selective in our use of them may have huge public health benefits. It would be unscientific and immoral to ignore these more difficult possibilities in favor of the easier answers in Dr. Karp’s post. We can save more children if just think harder

Again, what Dr. Jay is advocating is definitely a “more difficult.” Unfortunately for him, it’s also a “more difficult possibility” with completely unproven benefits, no evidence to suggest that there would be benefits, and a well-known down side of decreasing the rates of vaccination and thus endangering herd immunity. There is no logical or reasonable rationale for taking Dr. Jay’s advice, given that there is no science behind it. At least, Dr. Jay is utterly incapable of articulating a scientific rationale for his position. All he can offer is conspiracy mongering; the pharma shill gambit; logical fallacies such as special pleading, arguments from ignorance, appeals to popularity, and arguments from authority ; and reliance on anecdotal evidence. In other words, Dr. Jay can offer no compelling reasons to support his view. But, then, what do I know? I’m just a big, contemptuous meanie who hates mothers. (For how I’ve dealt with such charges before, Dr. Jay might be amused to read my response to Robert F. Kennedy, Jr., who made in essence the same charge against skeptics who have the temerity to point out that there is no good scientific evidence linking vaccines to autism. It’s one of my more entertaining posts, if I do say so myself.)

But back to my being a big meanie. No doubt Dr. Gordon will soon show up soon all wounded and insulted that I (or others, like Steve Novella, whose post I urge Dr. Jay to read) would ever accuse him of being “anti-vaccine.” Again, I believe him when he says he he is “not anti-vaccine” to the point that I accept that Dr. Jay believes himself not to be anti-vaccine. The problem is, his actions and words belie his denials. He doesn’t vaccinate many of the children in his practice, is proud of his contingent of unvaccinated patients, and pops up frequently in the media castigating vaccines as being riddled with “toxins” and various other evil humors, sometimes even speaking in front of anti-vaccine rallies like last year’s “Green Our Vaccines” rally. It’s still not too late for Dr. Jay, however. As I always say, if you don’t want to be seen as “anti-vaccine,” then stop repeating science- and evidence-free, logical fallacy-ridden talking points that feature prominently on the websites of pseudoscience-boosting and anti-vaccine websites and blogs, such as, Age of Autism, Generation Rescue, or Vaccine Liberation Info. Oh, and learn a bit of science.

Maybe I should have restrained myself from adding that last sentence. I wouldn’t want to be accused of being mean and nasty, now would I?


Hey, fake autism experts—put up, or shut up!

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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