This is one of those posts inspired by an exchange on Twitter. In brief, the exchange led me to a 14-year-old post that—or so it rapidly became apparent to me—desperately needed updating in light of the COVID-19 pandemic and the bumper crop of COVID-19 “contrarians” (a.k.a., antivax cranks, quacks, and grifters).
Here’s the exchange, which suggested a way to come at the answer:
Which led me to respond:
And it’s true. That old post is one that I’m particularly proud of. At the same time, I realize that it’s spectacularly out of date, given what has happened since COVID-19 hit the world nearly three years ago, hence my thought that I really do need to update it. So, after having thought about it for a day, I decided that I had to try to do it, even if I take the risk that the update is inferior to the original. Also, Dr. Jonathan Howard published an excellent post a week and a half ago about another possible reason why doctors gradually become “contrarians”, a state that has led too many of them to descend into worse than contrarianism, such as openly peddling antivax conspiracy theories. That reason is audience capture, and I will elaborate on it near the end of my post. Moreover, even nearly three years into the pandemic, my colleagues keep expressing surprise that there are so many physicians who’ve turned into cranks with respect to COVID-19 and COVID-19 vaccines, I’d like to discuss why they shouldn’t be so surprised and the factors that lead to this seeming transformation.
Physician social media influencers who’ve embraced COVID-19 contrarianism and antivax
How is my desire to update a previous post about why physicians become cranks and antivaxxers related to what I had originally planned on writing about? It turns out that a few days before the exchange above, I noticed this Tweet by Dr. Drew Pinsky, which as of my writing now is still his pinned Tweet nearly two weeks after his interview with antivaccine leader Robert F. Kennedy, Jr. (RFK Jr.):
That’s right, radio and TV personality who’s now a podcaster, Dr. Drew, hosted longtime antivax activist and leader turned general purpose COVID-19 antimasker, anti-“lockdowner”, and antivaxxer, Robert F. Kennedy, Jr., on his podcast to promote the new “documentary film” adaptation of his conspiracy theory extravaganza book, The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health, first published nearly a year ago. Seeing the Tweet about my old post just a few days after having seen Dr. Drew throw away all pretense of not at least pandering to antivaxxers—if not going antivax himself—after having been seemingly semi-reasonable in years past only told me that I really did need to discuss how so many physicians who were once seemingly reasonable turned into outright COVID-19 minimizers, antimaskers, and antivaxxers in such a short period of time. (I had originally planned on reviewing the movie, but decided that a review could wait, as I’ve downloaded a copy for when the free access to it in effect now expires, thanks to a reader who managed to bypass the countermeasures designed to prevent download of the video file.) Rather, Dr. Drew had unwittingly given me an “in” to introduce my post.
Before I go on, it is important to emphasize that there is absolutely no doubt that, despite his self-righteous assertion that he is “fiercely pro-vaccine” (ironically enough, on The Dr. Oz Show), RFK Jr. is an antivax activist and has been since before 2005, when I first deconstructed an article published in both Rolling Stone and Salon.com (to the eternal shame of both publications). His article, “Deadly Immunity“, posited a conspiracy theory to “cover up” evidence that mercury in the thimerosal preservative used until around 20 years ago in some childhood vaccines had caused the “autism epidemic”. In other words, there is no arguing that RFK Jr. is not a diehard antivaccine activist or that he has built an empire fearmongering about vaccines. Having such a person on one’s show is evidence of either utter naïveté about “telling both sides” with a grifting conspiracy theorist, sympathy to antivax views, a willingness to promote antivax views to profit, or being an antivaxxer oneself. (Take your pick.) Interestingly, early in the pandemic in 2020, Dr. Drew minimized the pandemic but then apologized for it by year’s end when he caught COVID-19. Of course, it didn’t take him long to start backsliding, as by April 2021 he was railing against vaccine passports as assaults on freedom. Now, nearly two years later, he’s way worse than he ever was in promoting COVID-19 minimization and antivax views, as evidenced by his willingness to host an antivax conspiracy theorist like RFK Jr. on his show.
A week before RFK Jr. was on Dr. Drew’s show, guess who else was on his show?
Yes, he had Dr. Vinay Prasad, the oncologist turned COVID-19 minimizer and antivaxxer parroting antivax tropes that were old when I started blogging, just repurposed for COVID-19 vaccines and children, and Dr. Kelly Victory, an ER doctor who by the first summer of the pandemic had become a veritable cornucopia of COVID-19 misinformation and only got worse from there. In August, Dr. Drew even had Alex Berenson on his show. You might remember that Berenson was once dubbed—and accurately so, at least at the time given that others have come to vie for the title—the “pandemic’s wrongest man“.
In fact, just take a look at the last several weeks of his Ask Dr. Drew podcast. For example, in his most recent Ask Dr. Drew, Dr. Drew has Edward Dowd, a “former Wall Street analyst and BlackRock portfolio manager” that Dr. Drew credulously touts as a “numbers guy”—in other words, someone with zero relevant expertise in epidemiology, pharmacovigilance, infectious disease, vaccines, or any other discipline that would allow him to come to any scientifically plausible conclusions based on the datasets he examined but possessed of lots of hubris and Dunning-Kruger—claiming that there has been an epidemic of sudden deaths in 2021 and 2022; i.e., since the COVID-19 vaccines rolled out. Together with Dr. Kelly Victory, he discusses “Sudden Adult Death Syndrome” (SADS). I was way ahead of him on this, having thoroughly discussed why “SADS” is nothing new and vaccines have nothing to do with it.
Then I looked at the list of most recent episodes of Ask Dr. Drew:
As you can see, Dr. Victory has been on the show multiple times since mid-September and seems to be a go-to guest, along with COVID-19 minimizers and antivaxxers like Harvey Risch, Dr. Jay Bhattacharya, and, of course, RFK Jr. He promotes antivax conspiracy theories and lies, such as:
- The awful study by anonymous scientists for the Florida Department of Health that Dr. Joseph Ladapo tried to represent as showing that the vaccines are more dangerous than the disease in men under 40;
- The distortions around the old news that the Pfizer mRNA-based vaccine trial “never tested the ability of the vaccine to prevent transmission”, disinformation that I discussed in detail last week;
- Misguided attacks against California law AB 2098 as some sort of horrific affront to free speech;
- Anti-mask propaganda;
- Fear mongering about the nanoparticles used in mRNA vaccines, a topic that once led me to dub lipid nanoparticles in mRNA vaccines the “new mercury to antivaxxers“;
- Mass delusional psychosis, the discredited idea promoted by Dr. Robert Malone and Dr. Mark McDonald that the pandemic caused an epidemic of “delusion” that qualified as a “psychosis”.
Indeed, I can’t help but be amused by a September 8 episode of Ask Dr. Drew in which Dr. Drew asked the question, “Is Dr. Drew Anti-Vaccine?” Even though I haven’t listened to more than a few minutes of these particular episodes, judging from the topics and guests on his show over the last few months, I’m hard-pressed not to answer—and most emphatically—”yes” to this question. I mean, just look at his list of topics going back to August! By and large, his guests have been a veritable laundry list of COVID-19 deniers and antivaxxers.
Before I move on to discussing why so many physicians seemingly turned into cranks after COVID-19, let me just mention that it isn’t my intention to pick on just Dr. Drew—although he richly deserves to be picked on and his audience is dozens of time that of this blog and many times greater than that of my other blog. He just happens to be unlucky enough to have been the physician social media influencer who happened to catch my attention the most recently. Here at SBM we’ve written about so very many others, including Dr. Zubin Damania (a.k.a. ZDoggMD), an E.R. physician and long-time social media influencer who went from being a skeptic I used to cite, particularly his funny YouTube videos mocking antivaxxers, to a font of COVID-19 minimization and even antivax disinformation regarding COVID-19 vaccines and children himself; the aforementioned Dr. Vinay Prasad, an oncologist with a large Twitter following before the pandemic who had previously made reasonable criticisms of medical reversals and the oncology drug approval process but turned to COVID-19 misinformation fairly early in the pandemic, even once likening public health nonpharmaceutical interventions to incipient fascism; and so many more who can be found on Substack, which has become the new wretched hive of scum and quackery for COVID-19. Then there are some who are not so much social media influencers but have become the go-to physicians for Fox News and other outlets promoting COVID-19 disinformation, such as Dr. Marty Makary, a surgical oncologist who most recently appeared on Tucker Carlson’s show to attack the CDC Advisory Committee on Immunization Practices (ACIP) when it was considering adding COVID-19 vaccines to the childhood immunization schedule, and Dr. John Ioannidis, arguably the most highly published living scientist and a former hero of mine who has been reduced to promoting awful “science” that incompetently and deceptively used a satirical publication index to attack critics of Great Barrington Declaration-style “let ‘er rip” pandemic policies intended to reach “natural herd immunity.”
The list goes on and on; I won’t belabor it here, although I might mention more later and ask again why so many of my colleagues are still shocked that there are so many antivax and crank physicians out there. Spoiler alert: They were always there. It is also not an unreasonable criticism to state that some of these doctors, through their presence on social media—and even old media—had become de facto entertainers or social media influencers who just happened to have MDs. Certainly, that is arguably true for Dr. Drew, Dr. Oz, and ZDoggMD, the last of whom recently shed all pretense of being a clinician and quit to build his media empire full time. However, the same can’t be claimed for Dr. Prasad , who prepandemic was clearly an academic physician who just dabbled in social media. He even said in an interview four years ago:
I guess I would say that, although I tweet about things often, I do not believe I have made any arguments on Twitter that I have not first made in the peer reviewed literature. I have some arguments that I purposely do not make on Twitter, because the paper is under review. I’m actually cognizant of that, although I think Twitter is … let’s be honest, why do I use Twitter?
Number one, I find it fun. I find it fun to use Twitter, it’s enjoyable, it’s interactive, you get to hear from interesting people. I do not use Twitter to debut ideas, I use Twitter to get ideas out that were published in peer reviewed journals.
That doesn’t sound like someone who had become social media influencer first and left his career as an academic physician to be his second concern. Oddly enough, though, a few months later Dr. Prasad quit Twitter around the time he started his podcast, which before the pandemic tended to cover mostly more mundane medical topics related to oncology and clinical trials. Obviously, he came back to Twitter before the pandemic, but he came back under a different handle. Then after the pandemic hit he started two Substacks. After he started going “COVID-19 contrarian,” his paid subscriptions to his Substack grew markedly, and his social media presence ballooned.
Dr. Makary is another example. Although he has a large Twitter following now (~190K), before the pandemic it was nine-fold smaller (a very respectable, but not huge, Twitter following), and he mostly used his Twitter account to promote his books. Since he “went contrarian,” his Twitter following has ballooned, and it now seems he’s on Fox News at least once or twice a week. He’s still a clinical surgeon, though, who operates on complex hepatobiliary cancers; indeed, I kind of dread going back to in-person surgical meetings, as it’s quite possible I could run into him at the Society of Surgical Oncology or the American College of Surgeons meeting next year, or even maybe at a more general cancer meeting like the American Society of Clinical Oncology.
John Ioannidis is a weird one in that he actually routinely brags about having no social media presence. However, it now occurs to me in retrospect that, for all his bragging about not being on Twitter, Instagram, Tik Tok, and other platforms, he does seem quite aware of social media discussions about him, which makes me strongly suspect that he does lurk a lot on Twitter at least. His path to this probably came from his having been almost universally acclaimed for his skeptical takes on the evidence base supporting various medical interventions; he seems genuinely surprised that he hasn’t gotten the same reaction from his COVID-19 takes. Of course, before, most of his takes were not so politically charged.
Let’s move on to the concept of audience capture, which I didn’t consider in my 2008 post.
Reasons why physicians and scientists become “contrarians”
Rereading my 2008 post on this topic, I believe that its conclusions are still largely accurate, just incomplete now. As mixed as my feelings about evolutionary biologist Richard Dawkins are these days, nonetheless I still think that that a good way to start this part of the discussion is with a probably apocryphal story that he liked to tell. (The first time I heard it was watching his BBC documentary series The Root of All Evil?.) It was about an elderly and esteemed scientist who had supported certain scientific hypothesis for many years. One day a visiting professor from America came to give a talk at Oxford University, in which he presented evidence that conclusively refuted this professor’s favorite hypothesis. As the lecture concluded, all eyes were on the esteemed senior scientist whose favorite hypothesis had just been roundly falsified. According to Dawkins, the old professor strode to the podium, shook the speaker’s hand, thanked him profusely, and said, “I have been wrong these fifteen years” In response, the audience applauded uproariously. Whether this story is apocryphal or not or whether it’s grown with Dawkins’ retelling it over time, I don’t know. It is nonetheless the ideal towards which science strives.
I bring this story up for two reasons. First, it is indeed true that the goal of science is for a scientist to be able to let go of even a most cherished hypothesis if the evidence refutes it, something that human nature leads us to find very, very difficult to do. Indeed, most scientists would probably not have reacted quite the same way that this respected senior scientist did; instead, most probably would have argued with the visiting professor or tried to shoot down his competing hypothesis. Second and more importantly, the vast majority of physicians are not, in fact, scientists. It is not a criticism or insult to state this. Medicine is a different discipline, and clinical medicine requires a different, albeit overlapping, skillset. Medicine is, as I like to say, applied science, and a good clinician does not have to be a research scientist to be competent—or even excellent—at diagnosing and treating patients.
In my original post, I listed several human traits that can lead a scientist or physician astray. This time around, I’m going to stick mainly with physicians and try to synthesize my old post with what I see now, after nearly three years of pandemic and 14 years overall. I admit that this is all anecdotal and based on personal experience, but I suspect that my ideas could provide hypotheses to test in scientific studies. That shortcoming in my speculation aside, the three main characteristics, stated more succinctly and slightly differently, that I listed back then as key to understanding cranks were:
- A pre-existing belief in alternative medicine. This one is fairly self-explanatory, as alternative medicine goes together with antivax pseudoscience, quackery, and conspiracy theories like pizza and beer. Years before the pandemic, I wrote about how a culture of acceptance of alternative medicine in the form of “integrative medicine” could lead to a physician becoming antivaccine. While it’s not surprising that physicians who were antivax before the pandemic only doubled down on their antivax views applied to COVID-19 vaccines, it also shouldn’t be surprising that physicians who before the pandemic had promoted dubious ideas about, for example, diet as a panacea for virtually every health problem turned to antivax conspiracy theories. (Yes, I’m talking about Dr. Asseem Malhotra, but not just him.) In context, it’s not at all surprising that physicians who had just dabbled with antivax ideas or pandered to antivaxxers did a full heel turn after COVID-19 vaccines were released.
- Arrogance that the physician knows better than his medical profession and specialty, which I called the sine qua non of “contrarians” and “brave mavericks”. Among medical cranks in particular, this arrogance manifests itself in the failure to acknowledge just how easily all humans, including them, can confuse correlation with causation, engage in selective memory such as confirmation bias, and are fooled by anecdotes, personal experience, and regression to the mean. I can understand how this can happen. Even among people steeped in the scientific method, it is sometimes hard not to fall prey to these shortcomings in human cognition. It is this tendency that will lead them to liken themselves to Galileo, persecuted scientists who will someday be vindicated. We frequently call this the “arrogance of ignorance“, in which a physician does not realize how much he doesn’t know. Before the pandemic, I would note that this arrogance could lead physicians to dismiss as “sheeple” the physicians who practice science- and evidence-based medicine as lacking the vision that they have, all the while making excuses for not doing rigorous clinical studies that would confirm or disprove the efficacy of their remedies over and above a placebo. Since the pandemic, the same trait appears operative, just applied to disproven cures for COVID-19 like ivermectin, and disbelief that masks and non-pharmaceutical interventions do any good against COVID-19.
- Ideology. Although back in the day I used to routinely discuss how there was a stereotype that antivaxxers were hippy dippy granola crunching “liberals” and “progressives”, specifically how that stereotype was misleading because there has always been a strong right-wing contingent among antivaxxers, these days it is undeniable that the most common ideological basis behind COVID-19 misinformation and antivax views has become overwhelmingly right wing, in fact far right wing, with antivax misinformation routinely amplified by the likes of Tucker Carlson and even conservative governors like Florida Gov. Ron DeSantis. Although physicians, as a whole profession, tend to lean slightly Democratic, certain specialties lean heavily conservative/Republican, such as anesthesiology, surgery, ENT, and ophthalmology. (Interestingly, infectious disease doctors were the most liberal of all specialties, with only 23% registered as Republican.) In any event, given how much the antivaccine movement has been captured by the right based on a shared affinity towards resisting “mandates” it should not be surprising that a number of physicians with a pre-existing conservative/libertarian bent would be more likely break bad with respect to the pandemic. (John Ioannidis and Jay Bhattacharya appear to be excellent examples of this phenomenon, along with the physicians who affiliated themselves with the Brownstone Institute, such as its Scientific Director Martin Kulldorff.)
- Ego gratification (particularly from patients) that comes with being a “brave maverick doctor” practicing medicine outside the mainstream. This derives from two things. First, it feels really, really good to successfully help a patient get better. Every physician who treats patients has felt this, and it’s a key reason why young people decide to study to become physicians in the first place – they want to help people. If a physician comes to believe that he’s discovered a treatment that helps patients whom mainstream medicine cannot, that feels even better. (Notable examples from this blog include long-time cancer quack Stanislaw Burzynski, who really thinks he can cure incurable brain cancers and whose patients share that belief, and any number of “autism biomed” quacks who think that they can cure autism.) Also, never underestimate the ego gratification that can come from believing oneself to be superior to one’s colleagues, someone who has some special insight that their colleagues lack. Prepandemic, this ego gratification often led physicians to dismiss as “sheeple” their colleagues who practiced science- and evidence-based medicine as lacking the vision that they had, all the while making excuses for not doing rigorous clinical studies that would confirm or disprove the efficacy of their remedies over and above a placebo or their hypotheses that, for example, vaccines or genetically modified organisms (GMOs) caused autism. It is no coincidence that there exists a political conspiracy group disguised as a professional society, the Association of American Physicians and Surgeons (AAPS), that is basically dedicated to the idea that there exist “maverick doctors” who are not sheep and move ahead of the flock. These mavericks, not coincidentally, include anyone who joins the AAPS, many of whose physicians view evidence-based guidelines as unacceptable constraints on what should be their godlike power to decide upon how to treat patients as they see fit. Also not coincidentally, the AAPS has become a major promoter of COVID-19 misinformation, although it has always been antivax.
As I discussed before, it shouldn’t surprise anyone that there are a disturbingly large number of antivax physicians who are behaving badly over COVID-19 out there, to the point where everything antivax is old again. These physicians were always with us, as anyone in medicine knows; COVID-19 just gave them the excuse to unmask themselves.
But what about audience capture?
“Audience capture” or just “capture”?
I’ll finish up by elaborating on what Dr. Howard wrote about on Friday. Specifically, this passage echoed my own experience years before Dr. Howard (mainly because I’m a lot older than he is and thus discovered the antivaccine movement before he did):
Over the ensuing decade, I observed something interesting about the anti-vaccine movement. When I first encountered it, anti-vaccine influencers could gain attention by claiming vaccines caused autism. That was once cool and edgy. After a few years, however, this bogus claim was merely the price of entry into Anti-Vaxx World. Since there was nothing to be gained by merely saying vaccines caused autism, in order to gain attention, anti-vaccine influencers like Dr. Brogan were forced to blame vaccines for all manners of maladies, such as the “epidemic” of SIDS (even though SIDS rates have decreased markedly). Other anti-vaccine doctors compared vaccines to rape, and RFK Jr. compared vaccinations to the Holocaust. Attacking pediatricians became commonplace.
He’s right, too…mostly. In actuality, antivaxxers blamed vaccines for all those things long ago; it’s just that blaming vaccines for SIDS, for example, comparing vaccines to rape, and calling for doctors to be tried and hanged, guillotined, or otherwise executed for their role in promoting vaccination programs (now falling under the rubric of “Nuremberg 2.0“) were considered fringe even among antivaxxers. What Dr. Howard gets right is the increasing radicalization of the antivax movement, to the point where what was once considered fringe—embarrassing, even, to antivaxxers who liked to consider themselves more “reasonable”—is now mainstream, to the point where a popular pundit like Tucker Carlson even approvingly featured RFK Jr. in his Fox News special about how society, GMOs, vaccines, and other things he doesn’t like are going to result in the “end of men”, who apparently need “bromeopathy” and testicular tanning as tools to restore their flagging testosterone levels. But why? I think Dr. Howard was on to something when he wrote about “audience capture”:
I think [audience capture] perfectly describes what I’ve observed before the pandemic with anti-vaxxers like Dr. Brogan and during the pandemic with contrarian doctors, several of whom I once admired as defenders of evidence-based medicine. However, they’ve since become trapped by their followers. After 2.5 years of minimizing COVID and discouraging pediatric vaccination, they’ve cornered themselves into positions they knew to be quackery prior to the pandemic. Echoing Dr. Brogan and anti-vaccine tropes about measles and HPV, they write pro-virus articles titled “The Triumph of Natural Immunity” and argue that it’s “natural and healthy” when children get sick with COVID.
I agree, but with one difference. I define the “audience” that has captured once-reasonable physicians (or at least seemingly reasonable physicians) more broadly than just their social media presence. Think of it this way. Twitter was only founded in 2006 and didn’t really take off for a few years. Facebook hadn’t yet come to dominate social media discourse in 2009. Before I wrote my post, blogs and discussion forums were about it, but audience capture still arguably happened. Although this example does not include physicians, think of it this way. I once wrote about how parents with doubts about vaccines would become radicalized and turn into antivaxxers subjecting their children to all sorts of quacky “autism biomed” to “recover” their autistic children after becoming active in antivax online discussion forums. Doctors are not immune to these sorts of social pressures.
That’s why I define the “audience” of physician influencers as including potentially not just their social media followers, but their patients (if they have any, that is—Drs. Ioannidis and Bhattacharya, for example, do not practice clinical medicine, and Dr. Vinay Prasad appears to have a minimal clinical practice and mostly does research) and followers of any sort. For example, although Dr. Marty Makary does have nearly 190K followers on Twitter, he appears not to have a podcast or a Substack (although he frequently appears on other people’s podcasts). His main fame appears to come from his regular appearances on Fox News and other conservative traditional media outlets to cast doubt on public health interventions and vaccines for COVID-19. Another example is Dr. John Ioannidis, who, as I mentioned before, brags about having no social media presence but who is frequently quoted by the media about the pandemic and now has a hagiographic (and very painful to watch) YouTube “documentary” Out To See that portrays him as the classic “brave maverick doctor” who in early 2020 saw everything that his colleagues did not, was unjustly “persecuted” for it, and now accuses his fellow physicians and scientists of currying political favor—a classic case of projection, if ever I saw one.
As I pointed out on Twitter about the faux profundity in the movie, which, I suppose, I’ll have to watch at some point (I’ve only watched part of it so far), as much as it is likely to nauseate me:
Ioannidis also voices classic eugenicist thinking that has long undergirded antivax sentiment:
And, my favorite:
As I said, some of these quotes from Ioannidis sound like bad facsimiles of Jack Handey’s “Deep Thoughts” applied to medicine.
Why does audience capture do this? I refer to the same article by Gurwinder Bhogal that Dr. Howard did, “The Perils of Audience Capture“, which starts with the example of an influencer named Nicholas Perry, who discovered that “uploading mukbang videos of himself consuming various dishes while talking to the camera, as if having dinner with a friend” got him a lot of attention that his previous videos did not, noting:
These new videos quickly found a sizable audience, but as the audience grew, so did their demands. The comments sections of the videos soon became filled with people challenging Perry to eat as much as he physically could. Eager to please, he began to set himself torturous eating challenges, each bigger than the last. His audience applauded, but always demanded more. Soon, he was filming himself eating entire menus of fast food restaurants in one sitting. In some respects, all his eating paid off; Nikocado Avocado, as Perry is now better known, has amassed over six million subscribers across six channels on YouTube. By satisfying the escalating demands of his audience, he got his wish of blowing up and being big online. But the cost was that he blew up and became big in ways he hadn’t anticipated.
Basically, Perry, who had been thin and health-conscious before, became morbidly obese and also:
Where Perry was mild-mannered and health conscious, Nikocado is loud, abrasive, and spectacularly grotesque. Where Perry was a picky eater, Nikocado devoured everything he could, including finally Perry himself. The rampant appetite for attention caused the person to be subsumed by the persona.
I’ve often said that antivax and crank beliefs are often about grift, but it is usually the ideology that comes first. While it would be easy to attribute audience capture to grift and the desire to make more money (and certainly greed and grift often play a role), as Bhogal explains, it’s actually more complicated than just financial incentives to be ever more outrageous and radical:
Audience capture is an irresistible force in the world of influencing, because it’s not just a conscious process but also an unconscious one. While it may ostensibly appear to be a simple case of influencers making a business decision to create more of the content they believe audiences want, and then being incentivized by engagement numbers to remain in this niche forever, it’s actually deeper than that. It involves the gradual and unwitting replacement of a person’s identity with one custom-made for the audience. To understand how, we must consider how people come to define themselves. A person’s identity is being constantly refined, so it needs constant feedback. That feedback typically comes from other people, not so much by what they say they see as by what we think they see. We develop our personalities by imagining ourselves through others’ eyes, using their borrowed gazes like mirrors to dress ourselves.
He further notes that such a process was not necessarily a bad thing when humans were living in small communities where most people knew each other, as it helped social cohesion. However, that’s not the case anymore. A social media influencer can interact with people all over the world, nearly none of whom he’s met in person, and they can exercise this influence online.
I would argue that this same process also applied to physicians before the rise of social media who discovered that advocating certain quackery or antivax ideas gained them not just more patients, but more approval—adulation, even—from those patients. Just look at Dr. Stanislaw Burzynski’s adoring patients, whom he wielded as weapons against the Texas Medical Board and the FDA whenever any regulatory or law enforcement bodies tried to hold him accountable for his quackery and tell me that such adulation doesn’t have an effect. Indeed, there’s a reason why I’ve invoked Burzynski’s story as an example of how difficult it has always been to halt medical misinformation.
Again, the vast majority of physicians go into medicine because they want to help people, and helping people through diseases and medical conditions can feel really, really good and be deeply rewarding. This is particularly problematic because there is a culture among physicians in which we tend to view ourselves as above such seemingly petty influences as ego gratification or audience capture. This phenomenon can be seen in other contexts, such as in the way that physicians frequently proclaim that gifts from pharmaceutical representatives have no effect whatsoever on their clinical behavior or judgment, when science overwhelmingly shows that gifts, even small ones, can have a profound influence on behavior. Again, many of my colleagues consider themselves above such considerations. This is the same sort of arrogance that can potentially blind colleagues who develop large social (or even traditional) media followings to this possibility:
When influencers are analyzing audience feedback, they often find that their more outlandish behavior receives the most attention and approval, which leads them to recalibrate their personalities according to far more extreme social cues than those they’d receive in real life. In doing this they exaggerate the more idiosyncratic facets of their personalities, becoming crude caricatures of themselves. The caricature quickly becomes the influencer’s distinct brand, and all subsequent attempts by the influencer to remain on-brand and fulfill audience expectations require them to act like the caricature. As the caricature becomes more familiar than the person, both to the audience and to the influencer, it comes to be regarded by both as the only honest expression of the influencer, so that any deviation from it soon looks and feels inauthentic. At that point the persona has eclipsed the person, and the audience has captured the influencer.
Or, as Dr. Howard described the dynamic between social media influencer physicians who go “contrarian” and their audience:
Their fans often lavish them with praise, telling them they are “fearless” for challenging the orthodoxy. And you can see how some doctors get cornered by their followers and are forced to adopt more extreme positions. The cardinal rule is to never stop being “heterodox”, no matter what. This is how doctors end up praising viruses.
Physicians who are science-based can be prone to such attractions, but in their case it becomes an internal battle over which aspect of their personality and/or “brand” predominates, their dedication to science- and evidence-based medical care or their desire, conscious or unconscious, to satisfy their audience. In any event, I rather suspect that this sort of dynamic is a major part of how so many social media influencers like ZDoggMD, Dr. Drew (who has been both a traditional media influencer and social media influencer over the years), Dr. Prasad, Dr. Bhattacharya, and the like started out just somewhat contrarian with respect to the pandemic and are now parroting antivax talking points retooled for COVID-19 vaccines, whether they realize these talking points are old antivax talking points or not. Everything old is new again, indeed, and “new school” COVID-19 contrarian “antivaxxers” are, more and more, coming to resemble “old school” antivaxxers. I also suspect that physicians who were already social media influencers before the pandemic hit, like ZDoggMD, Dr. Drew, and Dr. Prasad, were likely far more prone to audience capture resulting in their turning into COVID-19 contrarians than those who were not, but, as the case of Drs. Ioannids, Makary, Bhattacharya, and Kuldorff demonstrate, even doctors who had little social media (or media presence) before the pandemic have not been immune. Moreover, no matter how much attention being a contrarian brings a physician, there is nothing particularly admirable in just being a contrarian.
As I put it in 2009:
The other point that is worth emphasizing is that being a contrarian is not in and of itself particularly impressive because scientists are so often wrong. There are far more hypotheses that are falsified than hypotheses that stand up to experimental and observational scrutiny. Indeed, I find “contrarian” scientists who won’t support their doubts of the established consensus with good science (and sometimes not even good logical arguments) of their own to be particularly annoying, like a two-year old who says “No!” to everything. Being “contrarian” is only productive if the contrarian scientist can produce actual evidence using sound experimental and observational methodology suggesting that the consensus is seriously wrong. That’s one reason why “intelligent design” creationists (or, as I’ve increasingly started calling them, evolution denialists) are not taken seriously and should not be taken seriously. They point out what they see as “shortcomings” in evolutionary theory, some valid but most based on gross misunderstandings of what evolutionary biology actually says, and do no research. Indeed, they don’t even try to do any research that might suggest alternatives. The same is true of cranks of all stripes, including “alt-med” cranks, HIV/AIDS denialists, and many other varieties.
Being a contrarian, in other words, is not in and of itself desirable. It’s one thing to be a contrarian who finds faults with existing science based on evidence (and not the cherry picked misinterpretations of evidence most commonly used by the COVID-19 contrarians that we routinely write about here); it’s quite another to be a contrarian for the sake of being a contrarian. Unfortunately, I suspect that it’s not difficult for the latter to lapse into being the former. That could well describe why physicians like Dr. Ioannidis and Prasad so easily lapsed into COVID-19 contrarianism. Before the pandemic hit, their entire “brands” had been based on criticism of the evidence base for various medical interventions and the quality of clinical trials used to justify those interventions. Naturally, the appearance of a novel virus, where the science evolved rapidly and was initially often confusing or even misleading, provided many big fat, juicy targets for their previous skills. That was the “in”. Unfortunately, arrogance and audience capture appear to have done the rest, along with methodolatry, also known as the obscene worship of the randomized clinical trial as the only valid method of clinical investigation. Now these once-respected doctors are pathetic shells of their former selves, scientifically speaking. One can ask whether they’ve changed or if they were always like this. To that, my speculative answer is yes. I suspect that they were always “like this,” but not nearly as much as they have become. In other words, yes, they’ve changed, but that change was an amplification of existing traits, not a change in character.
Avoiding audience capture and the temptation to become a “contrarian” for the sake of being a “contrarian”
Bhogal asks himself the question that all influencers should, namely whether they have been captured by their audience, and I found an echo of my thinking in this passage:
I’m no authority on the degree to which my mind has been captured by you, my audience. But I do suspect that audience capture affects me far less than most influencers because I’ve taken specific steps to avoid it. I was aware of the pitfall long before I became an influencer. I wanted an audience, but I also knew that having the wrong audience would be worse than having no audience, because they’d constrain me with their expectations, forcing me to focus on one tiny niche of my worldview at the expense of everything else, until I became a parody of myself. It was clear to me that the only way to resist becoming what other people wanted me to be was to have a strong sense of who I wanted to be. And who I wanted to be was someone immune to audience capture, someone who thinks his own thoughts, decides his own destiny, and above all, never stops growing.
In this way I ensured that my brand image—the person that my audience expects me to be—was in alignment with my ideal image—the person I want to be. So even though audience capture likely does affect me in some way, it only makes me more like the person I want to be. I hacked the system. My brand image is, admittedly, diffuse and weak.
Me too—I think. To be honest, I’m not even sure that I have a true “brand image.” If I do, it’s not something I’ve consciously cultivated, although no doubt I must have cultivated something like it over the last couple of decades. On the other hand, I did feel something akin to audience capture early in my blogging career. I had started out on previous versions of this blog with a brand based on a pseudonym named after an all-knowing computer from an obscure (in the US, anyway) forty-year old British science fiction show. This computer was characterized by extreme cantankerousness and impatience with humans, which led many of my early posts to be particularly sarcastic and sometimes even nasty. My readers seemed to like that and want more, but, oddly enough, over time I actually mellowed. I can still be quite sarcastic, to be sure, but just compare posts from here (and previous incarnations of this blog) from c.2005-2010 to what I write now if you want to see. Even as late as 2012, I was not above some extreme sarcasm every now and then.
Also oddly enough, too much praise actually makes me very leery and sometimes even acutely uncomfortable; when I encounter it, it’s just as likely to make me question myself and what I’ve written as it is to reinforce my beliefs. Those who’ve met me in person at various skeptical conferences have likely noticed that too much attention and praise actually make me noticeably uncomfortable, particularly when that attention is a lot of praise. (People have commented on it.) I sometimes think that, were I to receive a lot of feedback telling me how “fearless” I am for voicing heterodox opinions, it might actually lead me to seriously question my views and writings.
Another key strategy to avoid audience capture is an openness to considering legitimate criticism. I don’t claim to be perfect on that score, but I do try. One example that comes to mind is from last year, for which I must make a mea culpa. Before the kerfuffle over the positive review of Abigail Shrier’s Irreversible Damage, the not-so-secret other blog for which I serve as editor had been oblivious to the pseudoscience and conspiracy theories regarding gender dysphoria, transgender adolescents, and gender-affirming care. Since then, we have tried to remedy that longstanding oversight with science- and evidence-based discussion and analysis.
Maybe these are the keys to how I’ve (mostly, I think) avoided audience capture. I seem never to have cared nearly as much about growing my personal audience as many influencers do, and there hasn’t been anything resembling a financial motivation for me to garner more traffic in a long time. I also obsessively question my beliefs and actions presented to the public, possibly even more than is healthy. It’s been enough for almost two decades, but I never assume that it will be enough for two more; that is, if I even continue doing this for two more given how old I will be then.
Mr. Bhogal was quite correct when he pointed out that it is worse to have the wrong audience than to have no audience. During the pandemic too many physician social media influencers attracted the wrong audience, and it has corrupted and radicalized them.
70 replies on “What makes a COVID-19 “contrarian” doctor—or any quack?”
Becoming a Covid contrarian/ minimiser/ anti-vaxxer has an additional benefit because it immediately attracts support from political sources who have espoused the same beliefs, translating to a larger audience.
It’s very difficult to check your own biases but often because deniers/ minimisers usually present their positions in such black-and-white terms, it’s obvious that nothing can be that simple. Most studies about vaccines’ benefits/ harms show effects that are
much more complex when taken together: who bases their position on a single damning or approving study? Yet that’s what opposers usually quote.
Opposing consensus- which is the product of many scientists over time- requires a lack of self-criticism beyond realistic appraisal. If you think you’re the next Galileo, odds are, you’re not.
You are describing extremists in general, whether pro vax or anti vax. Orac is ALWAYS on one extreme side of this debate. He is ALWAYS on the side of the medical/drug industry regarding vaccines and other medical interventions. I have NEVER seen him complain about the obvious corruption between powerful drug companies and our health agencies, for example. NEVER.
Speaking about medical industry, pharma payments to doctors are public knowledge:
Check your favorite doctor here.
The same phenomenon happens with influencers who aren’t doctors. Russell Brand used to claim he was a socialist, and he may still think of himself as being on the left, but once COVID happened, he began giving a platform to right-wing celebrities and JAQing off about the virus.
He doesn’t feel his opinions have to conform to either “left” or “right.” You see a problem with that?
Not conforming left or right mean that you are neutral. Quite common thing, not everybody is partisan.
I always say that no one it’s truly neutral and anyone who claims to be “neutral” is either deluding themselves or doesn’t want to admit their bias.
What if you have biases to many directions ? Such things happen.
I’ve discussed a lot of what he gets wrong here, but a lot more has been discussed at Science-Based Medicine, in particular by Jonathan Howard.
“I always say that no one it’s truly neutral and anyone who claims to be “neutral” is either deluding themselves or doesn’t want to admit their bias.”
Well, if everyone is biased, it would be nice to stop lecturing patients about not being objective.
(Oh! I’m pissed…)
Serendipitously, there’s a fairly good column in the NYT today, “The Rise of the Republican Apostate” by Andy Kroll. (https://www.nytimes.com/2022/10/31/opinion/republican-apostate-midterms.html). It discusses how right-wing political figures present themselves not just as “anti-establishment”, but as apostates who have had some great changing revelation about the corruption of the establishments to which they (putatively, anyway) once belonged. The lead-off example is antivax MD Scott Jensen, who rode COVID denialism first to Fox News celebrity and thence to the GOP gubernatorial nomination in Minnesota. Where he (of course, unsurpisingly, if depressingly), while behind in the polls, is still given an outside chance of defeating DFL incumbent Tim Walz (who led a pretty effective COVID response, but, you know, gas and grocery prices and “CRIME!” and whatnot…)
The essay doesn’t have a lot of revelation on the subject of “brave mavericks” that we haven’t discussed here, but I think it’s worth a read as slightly different angle on the subject…
That is a good article. You’ll find the narrative of the apostate very frequently among antivaxxers too. Prominent antivaxxers all brag about how they vaccinated their children and were provaccine—until something happened. It’s a super common narrative. Jenny McCarthy used it 15 years ago, for example.
Not that it matters now for him (now that he’s been “wakefielded”, lol), but quack Paul Thomas has stated several times that he thinks his kids were vaccine injured including “blank stares”, being “gone” and getting ADHD from vaccines. Even loonier is Thomas claims he himself has ADHD even though he only had a few vaccines growing up. His level of contradiction in his “my kidz got hurtzed from vaccinez” fable is as bad as McCarthy’s.
Orac somehow never notices the corrupt relationships between the medical/drug industries and the CDC and FDA, and congress. He somehow didn’t notice that medical doctors and researchers who questioned the covid policies risked their reputations and careers.
There have been very good reasons for being skeptical of the lockdown and vaccine policies. Orac just does not want to believe the skeptics could be reasonable and honest.
I used to wonder why Orac always takes the side of the huge drug companies, and always supports whatever mainstream consensus there might be on any medical question. I wondered if these huge companies could be rewarding him for working so hard to trash any skepticism.
But now I am thinking that Orac gets no personal advantage for his mission, and that he honestly believes in it. My latest hypothesis is that he represents a certain personality type that absolutely needs to believe in the status quo. I have seen that personality type all over the place since the pandemic started.
Any kind of rebellion or dissent against the mass consensus is seen as a dangerous threat. The people criticized in this post, such as Vinay Prasad, are independent thinkers. They have the courage to speak out loudly if they think policies have been wrong and harmful.
Not all dissenters are reasonable, and not all are honest. But I think most are. And I don’t think Orac is crazy or stupid either. I think he has a deep need to uphold the status quo, and that is a very common personality type. He hates rebellion and independent thinking. And most of the commenters at this blog are the same. They become a snarling mob as soon as anyone dares to criticize any aspect of the official covid narrative and policies. If you could time travel anywhere, I think you would see similar mobs attacking free thinkers.
Americans are not nearly as anxious as they used to be to run out and get the latest covid shot. And people are starting to regret the damage done to children by school closings. But here at this blog, I doubt you could find many commenters who doubt anything at all about even the most extreme policies.
That is a strange way of looking at the world. Lots of people disagree with the scientific consensus over lots of topics. Mostly they get dismissed as cranks. Where scientists push back is when these cranks gain a platform and their unsupported arguments are used to promote harmful actions.
“Independent thinkers” is a term often used by cranks in order to avoid following the evidence. Vinay Prasad is not so much an independent thinker, but wrong. His statements are not supported by the evidence. The fact that he continues to make them regardless means we should ignore his statements. Speaking out with the evidence supporting you is one thing, speaking out because you rate your feelings over the evidence is the sure sign of crankery.
There has been a lot of very vocal skepticism of lockdown and vaccine policies. Most of it has been without evidence and has been proven to be wrong. The experiment has been done. Lockdowns worked to slow the spread of COVID-19 and to reduce the incidence until vaccines became available. They meant hospitals did not become overloaded. Vaccination policies resulted in a reduction in the proportion of infected people ending up in hospitals and dying. Compare the situation in Australia to the situation in the US. There is a good reason the case fatality rate for COVID-19 in Australia is a sixth of that of the US. Australia implemented lockdown policies that kept COVID-19 out or at low levels. They then achieved high rates of vaccination in the population before letting COVID-19 loose again. The US only partly implemented these policies and have suffered for that failure.
The final bingo piece – the shill gambit. It is played by science deniers of all stripes. Because it can’t be that knowledgeable people disagree with their opinions, because that is what the evidence shows, no they must be being paid to disagree. Playing the shill gambit is a way of avoiding dealing with the data and sure fire evidence that the argument is lost.
The pharma shill gambit is a propaganda tactic to amplify largely justified public skepticism of the pharmas and deflect it to scurrilous ends. Especially as invoked by antivaxers and right-wing ‘populists’, the gambit relies on blatant ignorance of the realities of the pharmas: how and where they make money, how their corporate interests are reflected in their politics, etc. etc.
As far as relationships with Congress goes, the pharmas devote far more support to antivax and COVID denialist GOP politicos than they do to pro-public-health Dems, because the latter support negotiating drug pricing for Medicare, and the former (of course) are opposed.
You took that out of context. I said I WONDERED. And then I said I do NOT think he gets paid to support the drug industry.
In otherwords, IR, you were JAQing Off. Making leading and loaded remarks and asking leading and loaded questions, then hiding behind the claim that you “wondered”.
Everyone here is wise to that tactic.
The term JAQung off is an indicator that you new part of a cult. God forbid anyone question anything.
Nope. It’s just a technique of disinformation that has been long described.
“nay Prasad is not so much an independent thinker, but wrong. His statements are not supported by the evidence. “ which statements did he make that aren’t supported by evidence?
“..the shill gambit. It is played by science deniers of all stripes. Because it can’t be that knowledgeable people disagree with their opinions, because that is what the evidence shows, no they must be being paid to disagree. “
But that’s not what Rebel said. Rebel chalked it up to personality type rather than pecuniary gain. Highly possible. I think it’s indirect requirement based on peer pressure, pharma dictated eduction and yes some amount of opportunity cost to Orac for challenging anything establishment.
A better question would be “what statements on Covid-19 and vaccinations has he made that are well supported by published scientific evidence including actual numbers?”
My assessment based on watching several of his videos (where he never links to sources) is NONE.
But you are welcome to share a contrary example for my consideration.
LOLOL. Economists, not epidemiologists. A white paper, not a peer-reviewed study.
I posted a different critique of this elsewhere on this blog. Here’s another one:
Yet here you are, indie rebel w/o an effin clue.
You need to stop the ad hominem. The problem we have is that the usual herd of independent thinkers Has no diversity of thought. There aren’t any controversies . I never hear Gorski Remonstrating anyone who agrees with him. I guess as long as you follow the party line what you say can’t be wrong.
Actually, I have told comments on “my” side to tone it down. I just haven’t had to do that nearly as often as I have for the antivaxxers.
” Orac… represents a certain personality type that absolutely needs to believe in the status quo”
No. He carefully considers everything related to an issue and sticks with what the data tells him. He occasionally changes his mind. Some sceptics even disagree with how he ” shoots at a 6 foot hoop”, i.e. picks easy targets such as really extreme natural health salesmen.
I know his method for over ten years and have seen how his views have evolved on certain issues. You might be confusing how conformists gravitate to popular views with how a professional considers consensus based on research. When he ventures into other fields outside his own, he takes a similar path: when writing about things I’ve studied seriously, he arrives somewhere similar to where I have and bases his position greatly on research and a huge reading list.
Science is not a fraternity/ sorority where each member takes a vow and chants in unison but is an adversarial process, argued out in journals,
supported by data. There are “schools of thought” in specific areas that do NOT agree on specific issues or points.
Many of his targets- contrarians/ doctors who don’t support consensus/ non-SBM giving medical opinions on Covid/ the general public- who disagree go FAR from the data that have led to consensus. Some of them dispute that vaccines HELP or even, worse, believe that vaccines HARM. They rely upon partial information, poor studies or they misrepresent data that is available. One doesn’t have to be a “conformist” to call their views crap.
If you think Orac just goes along with popular choices, you should see his musical choices.
“Orac… represents a certain personality type that absolutely needs to believe in the status quo”
Typical projection from the woo-afflicted.
That personality type has a need to believe anything that fits into its mindset, no matter how ludicrous. One current example is Steve Kirsch’s dramatic revelation of a “screenshot” supposedly of a text exchange between an anonymous doctor and an anonymous second person, in which the supposed doctor reveals that the ICU at his/her unnamed hospital only contains vaccinated people – PROOF that the Covid-19 vaccines don’t work and make people sick. Naturally Kirsch’s fans are eating this vague crap up, because they absolutely need reinforcement for their nonsensical beliefs.
Indie is in the same camp.
I am not a conformist. I judge ideas by how reasonable they seem, not by how many people believe them.
Orac frequently refers to the scientific consensus. He believes whatever the majority believe at any moment.
“I judge ideas by how reasonable they seem, no matter how unqualified I might be to make that judgement or how little actual evidence there may be”
IR in a nutshell
As the evidence presented here shows, by “reasonable” Indie Rebel really means how well the ideas agree with their position. This is an exercise in confirmation bias.
It might be instructive to consider how my thought has been influenced about a particular issue well known to sceptics- vaccines and autism:
— when Wakefield published his infamous paper in 1998, I was already suspicious because it ran contrary to everything I had studied about development of the brain, pre- and postnatally (cognitive development, physiology of the CNS, related topics about language, disabilty- causes/ therapies).
— in 2001, my cousin who had a new baby, was worried about vaccination because of rumours about ASDs: I assured him that there was little to worry about. He vaccinated his son; as anti-vaxxers became more prevalent in the news, I read more. I also investigated who promoted these views.
— I became aware of RI and read a great deal before I commented. I read Orac’s linked suggestions on this and many other topics.
— simultaneously, I followed alt med entrepreneurs ( “cultopreneurs”) in detail- who they were, how they thought, how they benefitted financially.
— when Wakefield was struck off, I predicted that that action might deal a lethal blow to anti-vax. I was WRONG.
— since then, I continued to study alt med personae, their MOs and how people succumb to pseudoscience.
“He somehow didn’t notice that medical doctors and researchers who questioned the covid policies risked their reputations and careers”
Ahh but think of the money. They could end up with their own tv show. Lucrative interviews. Paid substack blogs. Maybe even join up with Del and Andy to make a docudrama. Anyway, reputation is relative. They may lose it from their peers but there’s a much bigger pool of worshippers on social media.
Maybe they all see themselves as politicians. Be interesting to see if any of them manage to reveal “the big conspiracy” if they get into power eh? Prediction – they won’t.
They could get ge patients they have scared and misled, or sell lots of supplements.
I remember thinking that the internet was going to be this great force for good. It would expose people to ideas they would not otherwise encounter – creationists to evolutionary theory, for example. Now I see how naïve I was. A bullshit tweet gets halfway around the world before the debunking email hits the drafts folder.
Douglas Adams has you covered:
““Meanwhile, the poor Babel fish, by effectively removing all barriers to communication between different races and cultures, has caused more and bloodier wars than anything else in the history of creation.”
Years before the internet was widely used by the general public I heard someone, in the course of an interview on TV, say “The good thing about the internet is that anyone can publish anything. The bad thing about the internet is that anyone can publish anything.” Alas, I don’t know the name of the person who said that.
“when Wakefield published his infamous paper in 1998, I was already suspicious because it ran contrary to everything I had studied about development of the brain”
Wakefield noticed the now mainstream-accepted connection between gut and brain. (I doubt you learned about that in your studies). He also noticed the now accepted connection between gut and immune system.
In some vulnerable children, certain vaccines seemed to disrupt these important connections.
I doubt anyone can deny that Wakefield’s observations about the important of the gut. Some of that had been long known in holistic medicine, but mainstream medicine sometimes lags way behind.
I don’t know if some vaccines can cause autism in some children. I do know that Wakefield had some valuable insights, which are completely by pro-vax activists.
Complete and utter rot, Polly.
Wakefield was hired by lawyers to find a connection between the MMR vaccine and autism. He loaded the deck by examining autistic children of parents taking part in the lawsuit, used unethical means to get his data, and when the results returned no correlation between MMR and autism, he cooked them to suggest a connection.
There is a reason why Wakefield was struck off and his “case study” retracted. His findings aren’t worth the paper they are written on.
“Wakefield noticed the now mainstream-accepted connection between gut and brain. (I doubt you learned about that in your studies). He also noticed the now accepted connection between gut and immune system.”
A slight of hand there, Polly! Wakefield’s hypothesis on the gut/brain connection was reliant on the presence of measles virus in the gut which in the UK class action lawsuit was said to have been introduced via the MR or MMR vaccines. Almost twenty years on from the collapse of the litigation, I’m not aware of any “mainstream” acceptance of that!
You write: “Wakefield noticed the now mainstream-accepted connection between gut and brain. (I doubt you learned about that in your studies). He also noticed the now accepted connection between gut and immune system.”
First, Wendy Stephen is absolutely right; however, immunology 101 going back decades recognized connection between gut and immune system. Of course there is a connection. From the mouth on down microbes enter the body and, guess what, wherever microbes enter body the immune system exists. As for brain and gut, yep, when we anticipate eating our brains often call for salivation, etc. and when food enters gut, our brain gets feedback on nutrition, fullness, etc. And if we get cramps, etc. our brain obviously recognizes them, etc. So what?
Where did you get the idea that Wakefield had any major role in the above? Give references! ! !
Good grief, pls tell me you’re not Polly T, Andrew Wakefraud’s biggest fan.
First, you give NO references.
Second, Wakefield got NOTHING right. If you even pretend to have an open mind, read my peer-reviewed article, available free online:
Joel A. Harrison, PhD, MPH (2013). Wrong About Vaccine Safety: A Review of Andrew Wakefield’s “Callous Disregard”. The Open Vaccine Journal; 6: 9-25. https://benthamopen.com/contents/pdf/TOVACJ/TOVACJ-6-9.pdf
Also, a great book is: Brian Deer’s “The Doctor Who Fooled the World”, which documents in excruciating detail what a dishonest fraud Wakefield was and is.
Apparently, you don’t understand the basics of vaccines, that is immunology. Quite simply, our adapted immune system, antibodies, etc. don’t recognize whole microbes; e.g., bacteria, viruses; but small sections of them called antigenic determinants. Once infected it takes our adapted immune system around 10 – 14 days to recognize, rev up, and, hopefully defeat them. However, during this 10 – 14 days we suffer, fevers, sore muscles, headaches, rashes, etc. and can sometimes die or develop long-term disabilities. Our adapted immune systems then develops memory cells that can immediately recognize the same or similar microbes and immediately rev up, even to much higher numbers, so often we don’t even know we have been infected. A good inexpensive intro book is: Lauren Sompayrac’s “How the Immune System Works.”
So, what does a vaccine do? It presents either a killed microbe, an extremely weakened microbe, or just some of the antigenic determinants, so our adapted immune system learns to recognize them without us suffering from a live full strength microbe and develops memory cells ready to immediately act if ever confronted with the live microbe. Quite simply it is the same adaptive immune system development of memory cells, whether in response to a full strength microbe or the above mentioned. So, please explain how the aforementioned can cause problems, especially compared to the live full strength microbe? Name a microbe linked to autism? And give references.
Actually almost ALL the children in Wakefield’s 1998 were NOT diagnosed with Autism.
@Joel A. Harrison, PhD, MPH
Thank you so much for trying to teach me about the immune system. But sorry, I already understand. And what you do not understand is what I said about connections between the gut and the immune system, and between the gut and the brain. This was not mainstream medicine, until more recently, so of course you don’t know about it.
I have no strong opinion one way or the other about Wakefield. But I do know that the vaccine industry needed to discredit his research. And I also know that what he found about the immune system — gut — brain makes a heck of a lot of sense, and could explain why a small minority of children react badly to certain vaccines.
“I have no strong position one way or the other about Wakefield.”
That tells me all I need to know about you: You’re an antivax quack.
Wakefield had an invented syndrom called autistic enterocolitis. It is certaily not mainstream.
It was evaluated in autism omnibus proceedings. Result was not even close.
@Indie Rebel, PhD,MPS
“I have no strong opinion one way or the other about Wakefield. But I do know that the vaccine industry needed to discredit his research”.
He achieved that all by himself when he failed to accept funding and resources from his employers at the RFH to provide material/evidence which endorsed his hypothesis.
“He’d turn down a scientist’s gift of a lifetime”
[Brian Deer, The Doctor Who Fooled The World] Chapter 15
Your comments show that to be a lie.
Interesting how you, ir, congenital liar that you are, left off that last bit,
Please define “recently”, because Peyer’s patches (lymph tissue of the gut) were known to be lymph tissue that is part of the gut wall in 1850. So it’s not exactly a brand-new idea that the gut has a lot of immune cells and tissues.
(I’m not saying that there was a modern understanding of how Peyer’s patches are part of the immune system in 1850, but they were known to exist.)
“I don’t know if some vaccines can cause autism in some children. I do know that Wakefield had some valuable insights, which are completely by pro-vax activists.”
Please, for my benefit, expand on Wakefield’s “valuable insights” because I sat through years of litigation intended to establish causation between measles virus in M, MR and MMR vaccines and ASD and IBD, (which ultimately failed), perused a small mountain of claim forms, court papers, transcripts, paperwork on the lead claimants, biochemical mechanisms, experts reports (including Wakefield’s) and submissions to the Legal Services Commission for legal Aid funding, and I haven’t come across any.
His “valuable insights” (whatever you think them to be) were clearly not viewed as such by the UK court and did nothing for the child litigants.
News from French Big Quackery. Quoting:
“Perronne himself did not foresee such a lenient verdict. On October 21st, professor Perronne has been cleared of all charges by the disciplinary chamber of the Regional Council of the Medical Board in Île-de-France (Paris). In a nonsenical decision, this jurisdiction stated that the infectious disease specialist did not promote an insufficiently proven medical treatment, nor did he confront a “confrère” [it is a medical crime to criticise another doctor when you are a doctor in France, which is here considered as a “frère”, i.e. brother…] “nor had antivax public positions” ! A grotesque farce given the successive positions taken publicly by this energic promoter of hydroxychloroquine who, two years ago, claimed he was “proud” to be a “conspiracy theorist”.” — Rudy Reichstadt, Franc-Tireur n° 51.
I just love it.
French medicine is rotten.
A doctor cannot criticise another doctor, and, when one promotes HCQ to the point of endorsing the label of “conspiracy theorist”, that’s scientifically OK.
Because the crime is not being anti-science as an MD in France. It’s criticising other doctors. Nothing else.
Oh ! And my psychiatrist-mother just called me a terrorist. Had my kid witness that in front of the cops the other day. But I’m still on the lookout for the MD that will dare criticise my mother MD. Seems that it is a crime to do so, according to the medical board.
France is rotten.
@ Orac. Just so you know: I changed my email address.
Indie Rebel, PhD, MPS (haha think you’re the only one here who can put letters after your name?)says:
November 1, 2022 at 5:14 pm
@Joel A. Harrison, PhD, MPH
First, I earned my PhD and MPH and one can find proof of this on multiple sites, including peer-reviewed journal articles. Give proof that you actually earned a PhD and MPS.
You write: “Thank you so much for trying to teach me about the immune system. But sorry, I already understand. And what you do not understand is what I said about connections between the gut and the immune system, and between the gut and the brain. This was not mainstream medicine, until more recently, so of course you don’t know about it.”
I keep up with immunology research, regularly search PubMed for recent articles, especially reviews and meta-analyses and every few years get hold of a new edition of textbook. As for your understanding of the immune system, no indication as your hostility to vaccines make clear. Read carefully my response to Polly.
You write: “I have no strong opinion one way or the other about Wakefield. But I do know that the vaccine industry needed to discredit his research.”
First, his 1998 study was found to be TOTALLY fraudulent. Again, find reference to my peer-reviewed paper on Wakefield above, and Brian Deer’s book. And also that Wakefield was invested in a univalent measles vaccine, so he needed to discredit the MMR. I guess you are unaware of this. As for the vaccine industry. I’ve written in previous comments over the years that trying to make a profit says nothing about value of product. One can buy potato chips, donuts, and soft drinks in a supermarket or fresh fruit and vegetables. The supermarket makes a profit on both and so does the companies supplying the supermarkets. Maybe you don’t understand the difference; but most people would agree that fruit and vegetables are healthy, potato chips, donuts, and soft drinks are not. This is one major example of the absolute stupidity of antivaxxers, simply focusing on profits. Do you really think any industry would produce and market a product, regardless of how good it is, and not try to make a profit?
You write: “Orac somehow never notices the corrupt relationships between the medical/drug industries and the CDC and FDA, and congress. He somehow didn’t notice that medical doctors and researchers who questioned the covid policies risked their reputations and careers. . . I used to wonder why Orac always takes the side of the huge drug companies, and always supports whatever mainstream consensus there might be on any medical question.”
First, do you understand what “consensus” means nowadays? Simply, a panel of experts review ALL the valid research studies and summarize them. But also this consensus report is reviewed by numerous groups and individuals. As for “corrupt” relationship, I guess in your warped mind if drug industry presents well-done research and CDC and FDA review it thoroughly, must be corrupt. And, yep, I admit that sometimes drug industry breaks law by only submitting studies with positive results; but when discovered FDA and CDC act; however, it isn’t “corrupt” to evaluate 1000s of pages of research presented to them by drug companies.
So, yep, Orac, I and others do accept consensus reports. However, new info can result in changes; e.g., discovery that rare cases of myocarditis result from Covid vaccines which CDC doesn’t deny; but posts of their website; however, we also know that risk of myocarditis much higher from actual virus. And CDC lists conditions that should either not be given vaccines and/or delayed, etc.
Finally, in a previous comment you called the S-Spike protein a toxin. There are two ways of defining a toxin:
1. Enters and damages cells
2. Elicit immune response.
The S-Spike protein does the latter. It can’t enter a cell. It is the external part of Covid virus that attaches to cell, then reforms to created opening for the actual viral RNA to enter cell, hijack its machinery and kill it. By analogy, think of a key that opens a lock; but it is the person entering the building who does potential harm. However, the mRNA covid vaccine’s mRNA is modified, two prolines, so it looks like the regular S-Spike protein; but can’t change confirmation. So, yep, most projected on outside of cells that vaccine entered, that is, mRNA attached to ribosomes, created S-Spike protein, and then projected onto cell surface where immune cells could recognize, see as foreign, and destroy, also creating memory cells. Some of the vaccine-produced S-Spike proteins break lose and get into blood and/or lymph vessels; but still recognized and removed by immune system. Since mRNA disintegrates after usually a few hours; but the vaccine version lasts a bit longer, S-Spike protein only produced for short time. And, yep, any response of immune system to foreign elements can sometimes result in sore arm, fever, etc.; but compared to Covid virus, a minor discomfort. And, yep, a rare few may react in a worse way; but rare compared to risk from virus itself.
And those who find mRNA vaccines new need to understand that there are literally 100s of thousands of peer-reviewed articles on mRNA going back to 1960s when it was discovered and over 70 peer-reviewed studies from around 1990 on developing an mRNA vaccine. One study went up to Phase 2 with SARS; but the SARS ended no one exposed to, so couldn’t run phase 3 and also tested on several different animals who we’re given deadly doses of virus. The Emergency Usage Authorization was based on all phases, animal, Phases 1 thru 3 and minimum two months follow-up. Anyone who has studied history of vaccines understands that the risk of serious adverse events after two months in minuscule. And now we have studies from all over the world, including reviews/evaluations by health authorities in numerous other nations. Do you really believe that these authorities are all in pockets of drug industry? That all are willing to risk their own people?
Nope, you don’t understand the immune system and, yep, you are a paranoid twisted conspiracy theorists.
@ Joel A. Harrison, PhD, MPH
@ Monsieur F
I’m so glad to read both of you. Now, where is Narad?
I hope your situation improves, M F. You are a terrorist, if “terrorist” means being scathingly honest.
he never did research on the brain, the nervous system or on psychological aspects of ASDs.
he was a research surgical gastroenterologist who investigated transplantation of small intestine rejection in animals ( Canada) and liver transplantation ( UK)
before his major contribution, he was studying Crohn’s disease which he tried to link to measles/ measles vaccination. And the rest is history.
“You are a terrorist, if “terrorist” means being scathingly honest.”
Well, for my mom, it means being a disobedient little brat. Nothing else. But it ends up in records. And she eroticises the violence that label brings on me, starting to have this glimmer on a women’s face when strongly built male cops just crack down on her terrorist son in order to save that frightened little princess she is. A kind of reverse-fantasy White Knight syndrome that legitimises violence on her terrorist son.
Oh ! She also told me that she wanted concentration camps for arabs. I disagreed. That also motivates the terrorist label. Because disagreeing with mommy is terrorism. And taking the side of arabs too…
In the end, I have to face it: my mother is a n-zi psychiatrist. Maybe not in every sense of the word. But she is a n-zi. And she is a psychiatrist.
And I’m fed up.
“I always say that no one it’s truly neutral and anyone who claims to be “neutral” is either deluding themselves or doesn’t want to admit their bias.”
I don’t decide my opinions on medical or scientific questions based on political party. Orac’s opinions ALWAYS align with one of the two big parties. That would not be possible if he were basing his opinions entirely on science and logic.
What politicians happen to say has nothing to do with what I think. Why should it? That is not being neutral, that is being sane.
That was true 10-20 years ago—today, sadly, not so much. I wish it were otherwise, but it’s largely not, at least not for the issues that I routinely discuss here. I like to quote a famous essay I Miss Republicans. It basically describes my feelings on the matter, and, amazingly, it was written in 2004, when GWB was President. While it’s true that I now think the essay exaggerates how rational Republicans supposedly were back in the day compared to Democrats, it captures my sentiment.
Another thing. I’ve discussed this many times on Twitter, but I used to be very conservative politically. My drift away from the Republican Party began in the 1990s and took about a decade. Why did it happen? I got more and more disturbed by the anti-intellectualism, hostility to science (e.g., evolution, climate science), and conspiracy theories that seriously began their rise 30 years ago. By the time I gave up on the Republican Party around 2003, even I couldn’t imagine how bad the party would get in just a dozen years, with the rise of Donald Trump. The Democrats have a lot of problems, including their own loons, but, right here, right now, in 2022, the Republican Party is so much worse as for there to be no comparison.
Now, the Republican Party embraces COVID-19 minimization/denial, antivaccine views, and outright conspiracy theories about not just COVID-19 but so much more that I just can’t any more. I did support the odd Republican between 2003-2015, but these days I just can’t any more. And I’ve been very straightforward in saying that. Also, that’s basically admitting my preexisting biases, which allows me to try to take them into account and, when needed, compensate for them in evaluating evidence.
I have the same issue with the left / right divide. I used to be PLR in Switzerland and center-right in France. I never changed. But there are things I cannot stand anymore. And for all the nonsense on the left, it’s not as bad as the nonsense on the right.
IR: “I don’t decide my opinions on medical or scientific questions based on political party.”
On the contrary, much of your spewings echo those of the Canary Party (the one headquartered in Minnesota, not the party of the same name in Tenerife).* However, you might fit in even better with the Batshit Insane Party (Russell Blaylock, president; James Lyons-Weiler, treasurer).
*speaking of Canary Party activities, Mark Blaxill was for a time running as a Republican congressional candidate in Minnesota’s 3rd District as a “proven conservative voice”. Alas, he didn’t appear on the ballot for the August Republican primary, opening the way for the party’s eventual nominee Tom Weiler, characterized by the DFL as “anti-vaccine, anti-science, pro-Trump” – positions which would have badly undercut Blaxill’s already feeble base of support. The last poll I saw a few months ago had the DFL candidate leading Weiler by 21 points.
@ Indie Rebel
You write: “I don’t decide my opinions on medical or scientific questions based on political party. Orac’s opinions ALWAYS align with one of the two big parties. That would not be possible if he were basing his opinions entirely on science and logic.”
First, the current Republican party has made it clear in many ways that they reject science, including climate change, etc. The Democratic party when it comes to climate change, pandemics, etc. has followed the science. As for Orac has ALWAYS aligned with them, I would have to look into his entire past; but it doesn’t matter as you have made it clear that you DON’T understand immunology, thus are an antivaxxer based on ignorance, so I guess since you can’t support your ignorance your only options is to attack others, attacks based on nothing more than your sick mind.
By the way, the Republican party under Richard Nixon created the EPA, OSHA, etc., so, clearly, the current Republican party has changed drastically. Quite possibly back then that Orac’s opinions, based on the science, aligned with some of the Republican parties positions, just as mine did. The fact that his opinions align with anyone doesn’t prove anything except in your sick mind. And once again you “don’t decide your opinion on medical or scientific questions of science.”
WHY DO YOU KEEP MAKING A FOOL OF YOURSELF??? My previous comments shredded your thinking on several issues; yet you continue.
@ Indie Rebel
Actually I have seldom if ever agreed completely with any political party, though I have agreed with some members on some issues. While the Democratic Party has been far better, for instance, than the Republican Party over the past few decades on global warming, they have not done near enough. We were warned by world experts to keep CO2 under 400 parts per million and now it is 415 parts per million. So, climate change and a host of bad things are now happening. The Republican Party stood against any reasonable programs; but the Democratic Party compromised and did not do enough, so all we can do now is try to stop climate change from getting even worse and we aren’t doing that; e.g., targeting net zero years in the future when it will mean even more CO2 in the atmosphere.
I would be willing to bet that Orac’s position on a number of points also only partly agrees with the Democratic Party’s official position, though closer to them than to the anti-science Republican Party.
Typical of you to make absolute statements; e.g., ” Orac’s opinions ALWAYS align with one of the two big parties.”
“Align” implies agrees completely. You really see the world in extremes of black and white. Wow!
When I vote, I seldom vote because I really like one candidate; but choose the lesser of the two evils. Though occasionally there has been a candidate that I actually really liked.
@Rebel the end of Joel’s comments are hilarious and never disappoint. Like arguing with a schoolyard mob on this site. Good for a bit of entertainment in the morning.
You believe in freedom of choice and lean libertarian.
Both Orac and Joel support education, science and public health, so how could they support anyone other than whom they do?
Aren’t many of the right’s/ libertarian positions on Covid-19 focused upon economic issues? Shutting down businesses in 2020 harmed earnings.
People were asked to be vaccinated which some believed interfered with their freedom. But public health is first concerned with medical outcomes and earnings come second: one way the two positions differ.
You are free to live wherever you choose:
certain locales value state sponsored education and science based governance ( public health, climate rules) whilst others do not value them most.
For example, my SO has relatives who live in more libertarian places ( so I’ve read a lot about them): less strict rules about Covid for people and business, also for climate concerns and less money for public education and safety. Both of these places now have greatly relaxed rules about who can become a teacher. Both of these places have witnessed huge growth in gated communities and private schools/charter schools which cost residents money. These places will be the absolute worst victims of climate change ** with rising temperatures and rising seas. What will they be like in 10-20 years?
Less educated citizens, 120 degrees being common, oceans rising into seaside towns?
Of course, people with enough money can easily compensate but these places are not especially rich. You can find maps of crime and poverty across the country which are instructive.
** mentioning it was even forbidden in one of them
Ben Shapiro reassures us about rising sea levels. You can just sell your (underwater) house and move.
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