When last I wrote about Dr. Vinay Prasad, the apparently 0.2 FTE academic oncologist at UCSF turned COVID-19 contrarian and misinformation amplifier, he had teamed up with another, more senior and prominent academic turned contrarian, Dr. John Ioannidis, to whine about the “obsessive criticism” they and their fellow contrarians encounter on social media. As I noted at the time, one couldn’t help but note the irony of two tenured academics at very respected institutions complaining about “obsessive criticism” on social media in a peer-reviewed journal for which one of them (Prof. Ioannidis) had served until fairly recently as editor-in-chief while the other author (Dr. Prasad) had never been a slouch at rather nasty attacks against his critics himself. I won’t dwell on that aspect other than to note that the article by Dr. Prasad that caught my attention yesterday strikes me as more of. the same. However, the real reason Dr. Prasad’s article rose about the usual noise of his daily efforts to cast fear, uncertainty, and doubt (FUD) on public health interventions against COVID-19 was the central premise of it, which was very much like the central premise of an attack he had launched before the pandemic—and then doubled down on a year later—on “quackbusters”; i.e., skeptics, often physicians and scientists like me, who devote their primary efforts to countering medical pseudoscience, conspiracy theories, misinformation, and disinformation, particularly antivaccine propaganda.
Dr. Prasad published his article on a Substack (Sensible Medicine) that he had founded with a number of other COVID-19 contrarians, among them Dr. Martin Makary (the originator of the false sound bite that medical errors are the third leading cause of death who is now a frequent guest on Fox News—Tucker Carlson’s show, even!—promoting COVID-19 minimization and antivax takes) and Dr. Zubin Damania (a.k.a. ZDoggMD, who has gone from making clever and entertaining videos mocking antivaxxers and calling out antivax influencers to amplifying antimask misinformation and antivax claims about COVID-19 vaccines). The title, The Misinformation Police Strike Out, mildly amused me, but what really caught my attention was the tagline:
Being able to debunk Jade Eggs does not mean you know how many boosters a 20 year old man needs.Apparently, Dr. Prasad has one ad hominem shtick, and that’s to compare any critic who’s ever debunked an alternative medicine claim to someone who just debunks Jade Eggs. Also, given that the most prominent debunker of Goop and Jade Eggs is Dr. Jen Gunter, one can’t help but sense a bit of…misogyny…in Dr. Prasad’s intentional choice to keep repeating this example, rather than, for example, bringing up homeopathy.
As you might imagine, my first thought was, “Oh, it’s on!” And it is. However, before I go into the substance (if you can call it that) of Dr. Prasad’s resurrection of his old trope of likening anyone who criticizes his bad takes on medicine to skeptics debunking Jade Eggs, I can’t help but serve up an observation that I made that really amused me—and will likely amuse old hands on this blog. Specifically, I noticed one prominent commenter Vinu Arumugham. Longtime readers might remember Vinu from years and years ago as a one of the looniest commenters ever on Respectful Insolence. He was so “out there” that for a time he went by “Vinucube,” apparently after another commenter had likened him to the classic crank website Time Cube.
Back then, I labored under what I now realize to have been a misguided delusion of free speech absolutism that led me, in essence, not to moderate my comments at all, allowing cranks like Vinu to periodically run wild, which is why I tolerated him for so long before finally blocking him. Unsurprisingly, five years after he finally disappeared from this blog, Vinu now has his own Substack (Vinu’s Newsletter) where he basically says the same sort of things he used to say here c.2008-2017 or so, only about COVID-19, and is now apparently a regular commenter on the Substacks of COVID-19 contrarians like Dr. Prasad, who, as far as I’m concerned, is welcome to him.
So what is Dr. Prasad’s beef with the “misinformation police”? Who are the “misinformation police”? Let’s take a look.
Dr. Prasad vs. the “Misinformation Police”
Before his rant about us apparently Jade Egg debunking “misinformation police,” Dr. Prasad starts by reminding us that science is hard (no kidding):
Science is difficult. Many popular theories turn out to be incorrect, and some ideas— initially thought implausible— are ultimately vindicated. Of course, let’s have perspective: most crazy ideas are, in fact, crazy, but what is true and what is consensus is not always the same. Dr. John Mandrola wrote on this topic brilliantly last month noting, “uncertainty always prevails over certainty—even when experts feel there is a consensus.”
Before I move on, let me just point out a common theme in the arguments of COVID-19 contrarians, which is that “science has been wrong before,” which is then used to claim that efforts to “police misinformation” will entrap innocent physicians and scientists who simply hold a minority viewpoint about an issue and conflating such physicians and scientists with those spreading conspiracy theories, antivax disinformation, and quackery. It’s an intellectually dishonest comparison between apples and oranges, but it’s one that comes up all the time, probably because it resonates with a lot of doctors who don’t understand the difference between quackery and misinformation versus legitimate scientific disagreements and mistakenly view such efforts as “censorship.”
Certainly, that’s what Dr. Mandrola’s article cited by Dr. Prasad is basically saying in a rant against AB 2098, the California law that now empowers the Medical Board of California to discipline physicians who spread medical misinformation, casting as martyrs who might be in for a visit before the
Inquisition Medical Board doctors who are on the “wrong side” of scientific and medical debates over “percutaneous left atrial appendage closure, hypothermia for post–cardiac arrest survivors, transcutaneous edge-to-edge repair for secondary mitral regurgitation, fractional flow reserve for assessment of coronary arteries, and cerebral embolic protection after transcatheter aortic valve implantation—not to mention drugs such as niacin; fibrates; vitamins A, C, E, and D; and folate.” Again, the intellectual dishonesty of such an argument is a feature, not a bug, of COVID-19 contrarians attacking the “misinformation police.” I’m just relieved that Dr. Mandrola controlled himself enough to refrain from mentioning Ignaz Semmelweis, even as he expresses fear about speaking out about one such issue, so as not to be “further labeled a disruptive physician.”
Let’s get to the meat of Dr. Prasad’s jeremiad:
That is why wise scientists are concerned that policing misinformation (particularly using blunt modern tools: censorship, shadow-banning and de-throttling) is dangerous. Policing is different than debating. It’s different than rebutting. It’s using the brute force of the modern algorithmic platforms to slow the spread of your opponent’s ideas. I worry it has been misused.
The COVID19 pandemic reveals the limitations and arrogance of science influencers. Pre-covid they were often on target. In a world of reiki, jade eggs, supplements and cupping, it was easy for health misinformation ‘experts’ to make their mark debunking popular, unproven remedies. Why? Because these things are obvious nonsense, and you don’t need to know much to know that.
But these ‘experts’ were woefully unprepared for the pandemic. Lockdowns, the possibility of lab leak, school closure, masking adults, masking kids, 5 vs 10 days of quarantine, and who should get how many doses of vaccine and when— are complex technical questions that require deep knowledge of biomedicine, trials, trade-offs, statistics, and more.
Notice how Dr. Prasad portrays himself compared to physicians and scientists who had discussed quackery over the years leading up to the pandemic. I’ve written in depth just how Dr. Prasad chose the most ridiculous examples he can think of in order to further his narrative that countering misinformation and quackery is akin to “dunking on a 7′ hoop,” although he did screw up somewhat here, as it is anything but obvious or easy to determine whether a given supplement “works” for a given medical indication. As I discussed before, his entire tactic is to portray what we do as so very, very easy compared to what he does as so incredibly difficult that we supposedly can’t handle it. It’s arrogant, ignorant, and annoying, but those three words describe Dr. Prasad rather well, making it unsurprising that he’d resurrect the same attack.
Then he gets personal:
Science debunkers and influencers—who often don’t work at universities, don’t publish research, don’t understand statistics, don’t peer review for journals, don’t have a good sense of the pre-test probability of interventions, and/or don’t have deep technical understanding of drug regulation—tried to crusade against misinformation, but they made many mistakes. This would be okay if they were merely debating, but repeatedly they sought to use the tools of the platform to extinguish ideas they disliked.
I was asked on Twitter why I reacted to this paragraph as though he were attacking me personally, because I noted there that I do publish research, am a professor at a university, understand statistics, peer review for journals, and have a good grasp of pretest probability honed in advocacy of science-based medicine (SBM) compared to evidence-based medicine (EBM). I even have a decent technical understanding of drug regulation and, as far as I can tell, unlike Dr. Prasad have actually written clinical trials. I will admit that the one investigator=initiated clinical trial I did actually administer failed due to lack of accrual, but failure often teaches better than success. Finally, to understand why I (somewhat) took this attack personally, you need to be aware of our previous interactions, including this one before the pandemic, when he Tweeted (and then later deleted) in late 2019:
Of course, I’m a surgeon, but in context it was obviously about me. You’ll just have to take my word for it, though, because Dr. Prasad deleted most of his Tweets from this time period in which he attacked quackbusters as doing something very, very easy. As I wrote the last time I discussed this issue, his bit on how alternative medicine and antivax disinformation are “soft targets” betrayed the same ignorance that John Horgan did when he used the same shtick in a talk at NECSS six years ago. Unsurprisingly, Dr. Prasad approvingly cited Horgan in his post:
Years ago, in a piece in Scientific America, John Horgan urged debunkers to spend less time on the soft targets— cupping— and more time on the hard ones— mammography. Ironically, when influencers turned to hard targets during the pandemic—such as vaccine induced thrombocytopenia and thrombosis, mRNA myocarditis, late gadolinium enhancement, and the tradeoff from boosting after infection— they were woefully unprepared to think about these issues. Perhaps Horgan’s message should have been simpler: debunk what you understand and know your limits.
This is some serious projection, because if there’s one thing that Dr. Prasad and his fellow “don’t worry, be happy” COVID-19 contrarians exhibit, it’s incredible arrogance and a failure to know their limitations. The funny thing is, if there’s one thing I’ve observed about skeptics (e.g., Steve Novella), it’s that they are quite aware of their own limitations, acknowledge them, and try to work within them. Indeed, there’s a reason why I particularly like this quote from a Dirty Harry movie, Magnum Force:
There’s some even more epic projection on Dr. Prasad’s part in his post as well:
Interestingly, influencers almost universally share the same political views— mixing debunking with far left socio-political positions and open endorsement of Democratic candidates. They draw upon tactics used in politics and the culture war and import them to medicine: opposing ideas are not just wrong, they are dangerous and harmful. We can’t fight speech with speech, we have to censor, label, de-platform, and down-throttle.
I debated whether to write more about why this is projection, but it’s easier just to point you to a post that I wrote a year ago, after Dr. Prasad had gone full Godwin on public health, likening COVID-19 interventions to incipient fascism. (He even entitled his post How Democracy Ends.) I think that will suffice and will therefore move on, even though I can provide many more examples.
A made up term?
No jeremiad against those nasty skeptics would be complete without examples of their supposed arrogance and overreach. I’m not going to refute each one here, as some of the examples that Dr. Prasad chooses would likely require a full blog post themselves. Also, he keeps bragging about an 8,000 word “technical treatise” and “formal academic article” on vaccines that is not peer-reviewed but is hosted conveniently on a preprint server in order to make it look as though it’s in the pipeline for publication COVID-19 vaccines: history of the pandemic’s great scientific success & flawed policy implementation. I can say that this is unlikely to be published anywhere in the peer-reviewed literature because 8,000 words is far beyond the word count limitation for even review articles of nearly every medical and scientific journal, but I see what Dr. Prasad did there. Just perusing it briefly, I see so much obvious spin and so many questionable assertions about the vaccines, myocarditis, and mandates, as well as revisionist history about the rollout of the vaccines, that I’m half tempted to do my own post about it in the near future, although if I have to match 8,000 words in a rebuttal that would be long even for a post at my not-so-super-secret other blog. We’ll see.
Instead, let me just look at one claim going around that Dr. Prasad repeats:
Recently an account called “unbiased science” (Of course, it is unbiased!) put out a video claiming the idea of immune debt— that avoiding infections through severe societal disruption for years makes us more susceptible to future infection is— is not true.
This led Dr. Prasad to cite someone who was very unhappy about the Tik Tok video to which he was referring, Alasdair Munro:
Amusingly, the above quote-Tweet actually leads to a thread that, if anything, reinforces Dr. Andrea Love’s point, as I’ll discuss. Basically, if you search PubMed for the term “immunity debt,” you’ll soon find that it’s nowhere in the medical literature before 2021, which is quite…odd…if the term wasn’t recently made up and that nearly all the papers that Munro cites date back no further than 2021.
It’s a term that’s been weaponized as a talking point claiming that the reason we are seeing surges in influenza and respiratory syncytial virus (RSV) in children is because they were kept home for so long and therefore never encountered these pathogens, leaving their immune system in “debt” that is now being repaid in the form of the current surges in pediatric flu and RSV.
Even more amusingly, in “debunking” the “debunker,” Munro cites one of his own medical op-ed pieces, leading to this rather good retort:
Per the Counter Disinformation Project:
Since 2021 Immunity debt has been used to explain why people, in particular children should be exposed to infectious diseases, the concept is that not being regularly exposed to pathogens their immune systems are unprepared when they do encounter them. The concept has been cited as a lockdown harm and as a reason why masks and in some cases even ventilation and clean air should not be used as mitigation measures in schools. It has been argued by some paediatricians in the UK and elsewhere that due to immunity debt infections don’t just catch up but overshoot.
Immunity debt is a form of extension of hygiene dogma, in practise it looks a lot like an extension of the thinking that supported herd immunity by infection as a strategy to handling the pandemic.
It is worth noting that those who raise concerns about immunity debt are generally the same people who initially claimed children were considerably less likely to be infected and didn’t contribute significantly to transmission. These are also generally the same people who still claim the majority of covid infections in children occur outside of schools. This is despite contact tracing and testing studies demonstrating the direction of transmission, the latest being a comprehensive study from Italy.It’s worth reading the entire long article to learn the origin of the term “immunity debt” and how it is being used by the same people who have pushed herd immunity approaches to the pandemic.
The bottom line is that wearing a face mask and maintaining social distancing over the past two years is unlikely to have made you more susceptible to respiratory infections now. There’s no real evidence that this has resulted in a so-called “immunity debt.” Give your immune system more credit than that.
I think I’ve beat this example into the ground, but I can’t resist one more.
Dr. Prasad understands VAERS better than you do!
Regular readers know that I’ve been writing since 2006 about how antivaxxers have been using, misusing, and abusing the Vaccine Adverse Events Reporting System (VAERS) database in order to blame vaccines for everything from autism to sudden infant death syndrome (SIDS). I’ve also written extensively on how in the age of the pandemic the weaponization of VAERS to spread FUD about vaccines has gone mainstream. To recap briefly, the main problem with using VAERS to estimate the frequency of adverse events (AEs) after vaccination is that, in essence, anyone with access to the Internet, mail, or the telephone can report anything to VAERS, as was demonstrated by bloggers years and years ago when one autism advocate filed a report claiming that the flu vaccine had turned him into The Incredible Hulk and another claimed a vaccine had turned his daughter into Wonder Woman. Both reports were accepted. In fairness, ultimately someone from VAERS did contact these people to ask about the reports, and the reports were removed. However, had they refused, reports that vaccines might turn one into the Hulk or Wonder Woman might still be in the database.
Moreover, going back to the early 2000s, VAERS has been distorted by attorneys seeking to game the system by encouraging reports to be entered for AEs highly unlikely to be due to vaccines. Also, if you don’t consider the baseline rate of the AE being examined, VAERS data are pretty much worthless for determining if there is a safety signal. That’s why VAERS was never intended as a reliable tool to measure changes in the actual prevalence of AEs due to vaccines. Rather, it was always intended as a “canary in the coal mine” sort of early warning system to generate hypotheses that can be tested using better systems, for example active surveillance databases like the Vaccine Safety Datalink.
None of this stops Dr. Prasad from pontificating about vaccine induced thrombocytopenia and thrombosis:
The truth is understanding passive surveillance systems is harder than debunking cupping. I knew that VITT was a serious concern for adenoviral vector vaccines, and said so at the time. Of course, the signal was real. Runaway platelet activation and clotting has essential no base rate (in the absence of heparin exposure); and, as such, all events are likely causal.
I urged the FDA to suspend authorization, at least in women under 50. It took the (pro corporate) FDA 1 year to come around to my thinking, but eventually they did, and deprioritized these products. This was only after needless harm to Americans.
It is a common claim by antivaxxers and those who, either knowingly or unknowingly, amplify antivax talking points, that vaccine advocates downplayed the possible risk of thrombosis due to adenovirus-based COVID-19 vaccines last year. At best it’s an exaggeration; at worst it’s a lie. For example, a number of us discussed this issue and, as data came in, became more and more accepting of a link. In other words, we doubted it at first but fairly quickly changed our minds as more data rolled in. We also noted, contrary to claims by people like Dr. Prasad, that the detection of low frequency events like this was good evidence that current vaccine safety monitoring systems actually work rather well. We also brought nuance, unlike Dr. Prasad, by pointing out how hard it is to weigh the risk of uncommon adverse events versus a disease like COVID-19 in the middle of a pandemic in the face of major uncertainty about the data—rather the opposite of what Dr. Prasad does and demonstrating that projection really is his thing.
Dr. Prasad also declares “victory” about myocarditis after the vaccines, lambasting those of us who pointed out how bad a dumpster-dive into VAERS coauthored by one of the members of Sensible Medicine was:
Yet, science influencers derided the authors saying that they misused VAERS. It merely confirmed the old adage: a little learning is a dangerous thing. Influencers knew enough to know that VAERS could be misused, but they lacked a nuanced understanding of what exactly misuse would look like, and how to detect it.
They assumed that any use that could lend caution to the widespread vaccination of young men was misuse. But that is hardly the case. Their heuristic was too simple. A heuristic that works well for jade eggs and cupping, but was ill suited to novel mRNA vaccine products developed on a short time span, with little to no dose optimization.
One notes that when the paper was published, Dr. Prasad was ecstatic in his praise:
Actually, we knew exactly what to look for in misuse of VAERS, having analyzed various antivax misuses of VAERS for 15 years (at least) before that, and that paper had it all. Worse, one of the co-authors was a member of an antivax organization, Rational Ground, something that. Dr. Prasad conveniently forgets to mention. In fact, skeptics can do more than one thing at once. We can deal with claims about Jade Eggs, homeopathy, and the like, but many of us also have high level knowledge about VAERS, clinical trials, and epidemiology, all of which can be necessary to deal with various pseudoscientific claims.
Hilariously, Dr. Prasad then urges:
Side note: go back and read the Medscape piece and look at the final published paper by the authors. Ask yourself if that constitutes fair and balanced journalism. If you ask me it was a hatchet job.
One notes that the criticism was about the preprint version of the paper! To their credit, the authors seemed (somewhat) chastened by the criticism and did make some changes. One notes that it was five months later before this paper was published, as well. One also notes that the Sensible Medicine member (a certain cardiologist) who had been a co-author was no longer an author of the final published version. One wonders why, one still does, even more than a year after the preprint and 9 months after the final publication. What one does not wonder is why Dr. Prasad didn’t mention this context or why he fails to understand that, even if the paper ultimately came to an estimate of the rate of myocarditis after vaccination with mRNA-based COVID-19 vaccines that is within the rather wide range of estimates from other sources, it does not mean that their methods were any less atrocious. It just means that they got lucky.
Projection, thy name is Dr. Prasad!
The last section of Dr. Prasad’s jeremiad is truly an exercise in projection, so much so that I’m half tempted just to quote some of it and write nothing else. Of course, Orac being Orac, you know I’ll have a little something to say. Such is life.
The Venn diagram of science influencers, far left socio political views, and a desire for canceled culture tactics have coalesced to create #TheScience — a bizarre group of individuals who insist on policing information they barely understand.
Counterpoint: The Venn diagram of COVID-19 contrarians influencers, far right sociopolitical views, and false claims of cancel culture tactics have coalesced to create #AlternativeScience — a bizarre group of individuals who resist any attempt to counter disinformation, viewing such misinformation as “Free Speech.”
Most of science influencing is like this. Superficial understanding of a topic, but dressed in bravado. That’s okay when the thing you are debunking is equally superficial. But that’s not okay when we’re talking about complex drug products or widespread screening campaigns.
And Dr. Prasad destroys yet another irony meter.
Seriously, what is Dr. Prasad’s pandemic career but one long exercise in right wing-friendly COVID-19 minimization and fear mongering about vaccines?
I will admit that Dr. Prasad did write one thing that I (sort of, partially) agree with:
Without a doubt, there was a lot of misinformation during the pandemic. Science influencers might feel like they helped reduce that amount, but I doubt they even made a dent in it. It was massive.
It is indeed arguable how much of an effect we skeptics have had countering misinformation, but the main reason is not what Dr. Prasad claims. Rather, it’s because we are so few, with few resources, facing a veritable firehose of disinformation coming from both malign actors and their useful idiots like Dr. Prasad, who claims the mantle of True Science™:
Instead, their true legacy was interfering with legitimate scientific debate they didn’t fully understand, leading to unnecessary harm across many domains. In the end, misinformation continued largely unchecked, while real scientists were dissuaded from discussing how to give vaccines more safety, among other questions. Something tells me I won’t see a tiktok video with that lesson anytime soon.
The sad thing is, there was a time when Dr. Prasad actually wasn’t a useful idiot for antivax and anti-public health actors. There was a time when he did important research looking at the rigor of clinical trials used to approve new cancer therapies and finding them wanting (especially for accelerated approval) and voicing skepticism about the Cancer Moonshot. Unfortunately, he appears rarely to have done original research, instead staking his career on “meta-research” that examines the results of other people’s original research. It’s an important function, but I’ve come to the conclusion that it’s a branch of research that leads to a certain hubris and failure to follow Dirty Harry’s advice to know his limitations, much as Dr. John Ioannidis has gone down the same route.
More importantly, the lesson that I use Dr. Prasad to illustrate is exactly the opposite of the lesson he takes from “science influencers” who pivoted from dealing with alternative medicine and pre-pandemic antivax claims to dealing with misinformation/disinformation about COVID-19 and COVID-19 vaccines. While Dr. Prasad points to them as examples of people who lack the necessary skills to examine misinformation in the age of the pandemic, in fact they are precisely the people possessing precisely the skills needed to deconstruct such disinformation. In contrast, Dr. Prasad, who fancies himself as doing The Hard Work compared to skeptics, who in his world are dim to do anything but debunk obvious nonsense like Jade Eggs, is actually Exhibit A for why skills that we skeptics have tried to inculcate for decades are more critical than ever now that a veritable tsunami of misinformation about the pandemic has been washing over us for nearly three years. For all his self-proclaimed high level knowledge and skills in statistics, peer review, clinical trials, Bayesian analysis, and Science in general, he clearly lacks some very basic skills in skepticism, such as recognizing conspiracy theories, logical fallacies, and techniques of misinformation, coupled with the ability to make a conscious effort to separate one’s own preexisting ideological beliefs from one’s science. That’s why he has become a useful idiot for COVID-19 deniers in much the same way that scientists in the middle part of the last century became useful idiots for tobacco companies.
Projection, thy name is Vinay Prasad.