I was originally going to write about Dr. Oz’s show yesterday, entitled What Causes Autism? But then I started watching and realized that I just didn’t have the constitutional fortitude to sit through the whole thing. Sorry to let you down, but there are some blogging tasks that I just can’t handle, at least on some days, particularly Dr. Oz’s faux outrage at one point. Last night was just one of those days. I was too tired and just not in the mood. Maybe I’ll do it later. In the meantime, I’m going to do something that I don’t do very often, namely use a new post to answer a comment. The reason I choose to do so is because I think that comment reveals such a fundamental misunderstanding of science so profound that I think it’s worth commenting on.
Remember our old friend Dr. Jay Gordon, pediatrician to the stars’ children, in particular Evan, Jenny McCarthy’s child? I’ve butted heads on this blog with “Dr. Jay” on and off since 2005. The reason, as regular readers of this blog know, is because Dr. Jay is an apologist for the anti-vaccine movement. Worse, he has allowed himself to be co-opted time and time again by anti-vaccine activists. In particular, he’s one of the handful of go-to pediatricians that reporters can count upon to spread fear, uncertainty, and doubt (FUD) about vaccines, thus providing them with juicy anti-vaccine quotes. And spread FUD he does, with gusto. Over the years, both here and by e-mail, I’ve had exchanges with Dr. Jay in which he repeatedly asserts that his 30+ years of “clinical experience” that have led him to think that vaccines cause regressive autism trumps the numerous epidemiological studies that have not only failed to find the link but failed spectacularly, to the point where we can conclude that vaccines almost certainly have nothing to do with autism. Over time, I (and you, my dear readers) have tried and tried again to educate Dr. Jay, to no avail. No matter how many times we try to explain the concepts of confirmation bias and that correlation does not necessarily imply causation, it all seems to fall on deaf ears.
Yesterday, it was falling on deaf ears yet again. Dr. Jay’s been sparring with some of my readers in the comments of a post from two days ago in which I had some fun dismantling a self-congratulatory anti-vaccine rant by Dr. Suzanne Humphries. In the course of this sparring, he’s been laying down a lot of the classic Dr. Jay nonsense that we’ve come to know and love over the past six years. Then, 201 comments in, I saw this:
No, I do not contribute a lot of “science” to these discussions as you define that word because we disagree about the definition. Science is not a monolithic entity consisting only of double blind randomized control research. It can also consist of the aggregated wisdom and experience of researchers, doctors and others. I add what I can and listen closely to your responses. The time I’ve spent at RI has changed the way I look at vaccines, autism, epidemiology and science in general. It may not be noticeable to some of you but it’s true nonetheless. I’m going to let you in on a secret while throwing you more red meat: You could learn as much from me as I learn from you.
What, I wonder, could I possibly learn from Dr. Jay? How to toss aside science in favor of crunchy, touchy-feely reliance on “personal clinical experience”? Perhaps? How to cater to rich Hollywood stars whose arrogance of ignorance lead them to come to conclude that the University of Google will teach them all they need to know about vaccines to the point that the value of their opinions regarding the risk-benefit ratio of vaccines are equal to that of the conclusions of scientists and physicians who have dedicated their entire careers to studying vaccines and/or autism? Come to think of it, Dr. Jay seems to think that his “personal clinical experience” trumps the conclusions of scientists and physicians who have dedicated their entire careers to studying vaccines and/or autism!
Besides, Dr. Jay’s attacking a straw man version of science commonly used by those who favor the pseudoscience of alternative medicine and/or anti-vaccine beliefs, namely that medical science is only double-blind randomized clinical trials (RCTs). True, RCTs are considered the highest form of clinical evidence, but science is far more than RCTs. Science includes the entire spectrum, all the way from investigations of biochemical reactions, to animal studies, to clinical trials of varying degrees of rigor, to huge epidemiological studies. When coming to conclusions, scientists try to synthesize all of that evidence, particularly the more recent, highest quality evidence together systematically. Science is also not a word, as Humpty Dumpty would put it, that “means just what I choose it to mean–neither more nor less.” Or what Dr. Jay chooses it to mean. Science actually has a definition, and, while philosophers of science might disagree on many of the details, there is broad agreement that science is a method that seeks to develop principles and theories about how nature works that are reproducible, informative, and predictive. It is not, as Dr. Jay asserts, the “aggregated wisdom and experience of researchers, doctors, and others.”
After all, “experience” and “wisdom” can profoundly mislead. Why have so many people thought for so long that homeopathy “works,” that it is anything more than water? It’s because “personal clinical experience” can make it appear that homeopathy works, thanks to the normal human cognitive shortcomings that lead us to easily confuse correlation with causation and mistake regression to the mean for an effect due to treatment. It’s the same sort of “experience” and “wisdom” that led physicians for centuries, all just as confident as Dr. Jay, to believe that bloodletting could help or even cure a large number of ailments. “Personal clinical experience” is what misleads practitioners into believing that reiki works, even though reiki is nothing more than faith healing that substitutes Eastern mystical beliefs in a “universal energy source” for the Christian god as its basis. “Personal clinical experience” is what led Dr. Jay to mistakenly believe that vaccines cause autism and a large number of other problems.
Dr. Jay also has another fundamental misunderstanding of science:
Medicine changes. HRT, statin therapy, surgical techniques and efficacy and more. Someday we’ll view our current vaccine schedule the way Dr. Halsey and others taught us to view the use of thimerosal as a preservative: Not the safest way to do things.
Translation: They thought me mad–mad, I tell you! But I’ll show them! I’ll show them I was right! They’ll see. They’ll see I wasn’t mad!
Yes, medicine does change. It changes in response to new science, new evidence, new clinical trials. The process is messy, and it often takes longer than one might wish, but change does come in response to new evidence. But that’s the key. Change in medical practice is driven by scientific evidence. What drove changes in the use of HRT? Evidence that HRT could increase the risk of breast cancer and appears not to decrease the risk of heart disease. What has driven changes in statin therapy? Evidence. What has driven changes in surgical technique? Evidence. Well, evidence and technology. Dr. Jay has no evidence to support his anti-vaccine apologia; he simply asserts that, because medicine changes, someday scientists will reject the current vaccine schedule as being unsafe. it’s a prediction made based on nothing more than Dr. Jay’s personal opinion and his fervent wish. Particularly telling is this exchange, in which Dangerous Bacon asks:
Which one of those cited examples (or changes in any other facet of medicine) came about because of anecdotes and Internet-fueled fears in direct opposition to scientific evidence, Jay?
Initially, Bacon, all of them. “Scientific evidence” can fall apart under greater scrutiny.
Dr. Jay’s said some really silly things, but that has to rank right up there. Dr. Jay seems to think that scientific evidence falls apart under “greater scrutiny” from conspiracy mongers on the Internet. This is, of course, utter nonsense. The “scrutiny” that comes from Internet conspiracy mongers tends to be the “scrutiny” that creationists apply to evolution, that anthropogenic global warming denialists apply to AGW, that HIV/AIDS denialists apply to HIV science.
Or the “scrutiny” that anti-vaccine activists apply to vaccine science on the Internet.
But, hey, despite his utter cluelessness with regard to science and science-based medicine, I still feel in a benevolent mood, so I’ll ask Jay (and I know he’ll be reading sooner or later):
- What specific scientific evidence do you have to support your claim that the current vaccine schedule is unsafe?
- What specific scientific evidence do you have to support your claim that vaccines cause autism?
- What specific scientific evidence do you have to support your claim that vaccines cause asthma and all the other problems that you attribute to them?
Inquiring minds want to know!
Actually, it’s truly depressing to see a fellow physician who so misunderstands science, who relies on anecdotes and personal feelings rather than scientific evidence, and who defends dangerous pseudoscience like that of the anti-vaccine movement. I’ve tried for well over five years, but apparently I’ve failed. Some people just aren’t reachable.