Sometimes I wonder if subjecting myself to all this woo is going to my head. Why do I worry that this might be the case? Recently, I made the mistake of getting involved in an e-mail exchange with a prominent antivaccinationist. Perhaps it was my eternal optimism that led me to do this, my inability to believe that any person in the thrall of pseudoscience, no matter how far gone and how active in harassing anyone who counters him, can’t be somehow saved and brought around to understand the value of science and why their previous course was wrong. Such efforts on my part almost inevitably end in failure, putting the lie to my optimism. In this case, replies to me contained the usual litany of logical fallacies and charges and “disappointment” in me. (At least he spared me the “pharma shill” gambit for the most part.) However, one charge that I found quite irritating and that was repeated again and again went like this:
When it comes to autism, you seem to have lost something that I think every physician is well-served to have in abundance: compassion.
This is such a common attack on me and any other physician who would argue against woo that it is worth answering. The charge of being uncompassionate isn’t just a favorite gambit antivaccinationists who believe that vaccines cause autism, either. Indeed, it goes far beyond that. Remember the cases of Starchild Abraham Cherrix and Katie Wernecke, two teens who, along with their parents, chose quackery rather than conventional therapy such as chemotherapy or radiation therapy to fight their lymphomas? The same charges were thrown at me. Never mind that the story written by Katie brought me close to tears. Remember my discussion of the teen Jehovah’s Witness who died for want of a blood transfusion, all because of a bizarre and literal-minded interpretation of a single passage from Leviticus? Same thing, along with charges of religious intolerance. Then there’s a very recent case, namely Madeline Neumann, the 12 year old girl from Wisconsin who just last month died because her parents thought that prayer would save her from diabetic ketoacidoses, when I supported taking the parents’ remaining children away from them and prosecuting them for their negligence? That’s right; it was the same. And don’t even get me started on the number of times I was attacked for not caring about the desperate patients with cancer who were sold based on testimonials, advertising, and an appalling lack of understanding about cancer biology an as yet unproven anticancer drug of uncertain purity by an unscrupulous pesticide salesman.
Still, at least in my experience, from no where else is the charge of meanness, cold-heartedness, and lack of compassion shouted quite as vociferously and with as much venom as from antivaccinationists who believe that their children were made autistic by vaccines. Any attack on their belief that either mercury from vaccines or vaccines themselves is viewed as an attack on them. The reason is obvious. Many of them honestly and deeply believe that vaccines “poisoned” their children their interventions are in the process of “curing” their children, one particularly famous antivaccinationist mother even to the point where she believes that she could make her son autistic again if she were to let up, feed him the wrong foods, or–God forbid!–vaccinate him. Attacks on their beliefs are viewed as direct attacks on them, whether they are or not. The same applies to many in the thrall of so-called “alternative” medicine.
They misunderstand, of course.
I have nothing but the most enormous respect for parents who manage the incredible daily task of raising an autistic child–or any special needs child, for that matter–day in, day out, often with inadequate finances and difficulty obtaining insurance coverag, or even with no insurance coverage at all. It’s a huge challenge that I don’t necessarily know that I could meet were it to fall on me. No one knows if they can handle the job until they are thrust into that situation. Still, my compassion for the difficulties such parents face should not–must not–give them a free pass to spout antivaccinationist misinformation uncountered. The threat to public health is too great, and some of them count on that sympathy for them that reasonable people have in order to stay or blunt any criticism, sometimes seemingly waving it like a talisman in front of them to chase off evil skeptics like me.
So why am I so passionate against antivaccinationism and other forms of quackery, particularly cancer quackery?
It’s compassion for the victims, which far outweighs my feelings about the parents. Think about it. In the case of cancer quackery, even patients who can’t be saved by conventional medicine become victims. Patients who, for example, are seduced by the blandishments of quacks to undergo the Gonzalez protocol, with its coffee enemas and hundreds of supplement pills a day, often do so at the expense of foregoing effective palliative care in order to undergo a harsh regimen that robs them of what little quality of life they might could achieve in the time they have left. Children and teens who choose quackery such as the Hoxsey therapy or high dose vitamin C instead of effective chemotherapy, children like Abraham Cherrix and Katie Wernecke, give up a reasonable chance of a cure and living to a ripe old age. Children whose parents believe that prayer is more effective than medicine in treating life-threatening diseases die when they could have been saved. Children of HIV mothers who don’t believe that HIV causes AIDS die of AIDS-related complications when combination antiretroviral therapy could have prevented their deaths, as do potentially millions of people in Africa. Autistic children whose parents believe that they were made autistic by vaccines are subjected to injections, restrictive diets, hyperbaric oxygen, blood draws, and even chemical castration. Children are subjected to unethical and scientifically worthless “clinical trials” in the service of pseudoscience. Some even die because of these nostrums. Many more will die if antivaccinationists get their way and vaccination rates fall to the point where herd immunity is no longer operative. Indeed, we see a disturbing glimpse of what might be in the resurgence of measles and mumps in the U.K. due to Andrew Wakefield’s litigation-driven pseudoscience.
Don’t all these people deserve compassion?
I say yes!. It is my compassion for them that drives me and my disgust at how they are taken advantage of by promises that no human can keep. As I have argued here and elsewhere many times, science- and evidence-based medicine are the best methods that we have to determine what causes disease and how to treat it. Whatever its faults (and there are many), science- and evidence-based medicine is at least constrained by law, ethics, and science itself to restrain the natural human impulse to promise more than can be delivered. When the shortcomings of EBM are revealed, I assure you, it’s almost never pseudoscientists and “brave maverick” doctors who think that they know better than scientific medicine that bring shortcomings and ethical lapses to light. It’s medical scientists and ethicists who bring the darkness to light.
Besides, if we’re going to play the compassion game, I’ll match my compassion with those of the practitioners who inflict this quackery on desperate patients and parents. How much do Mark and David Geier charge for administering Lupron to autistic children? You can be sure it’s not cheap. What about Dr. Roy Kerry, whose quackery and incompetence killed a five year old child? You can bet he didn’t do it for free, and let’s not forget the horror of the description of that child’s final hours, as he was held stuck multiple times to get an IV going, having been subjected to unnecessary IV infusions many times before. Then there’s Dr. Rashid Buttar, who charged dying cancer patients tens of thousands of dollars while leaving their care primarily in the hands of a nurse-practitioner, with himself rarely to be found. He even tried to collect his blood money from the estates of his victims!
I could also ask: What about compassion towards the victim of Dr. Roy Kerry’s quackery, for example? Where’s that Here’s an example in which a woman named Jan responded to the observation that chelation therapy killed Tariq Nadama:
We shall wait and see, and if it did, it happens, as with all procedures.
If I tried to defend an iatrogenic complication or death that occurred while a patient was undergoing “conventional therapy” with such a blasé riposte, you can bet that Jan, and others like her, would be outraged. Now compare Jan’s reaction to Tariq’s death with her reaction to the death of Jesse Gelsinger, the 18 year old who died while participating in a gene therapy trial in 1999:
Isn’t that most strange,,,,,,,,,,,,,,,,,,,,
This health fraud that KILLED a volunteering, caring, loving teenager, helping man kind, and the doctor who KILLED him who committed, FRUAD, COVER UPS, FALSE AND MISLEADING *REPEATED* AND *DELIBERATE* VIOLATIONS,,,,,,,,,,,,,,,,,,,, ,,,,remains on staff.
I detest either outcome: Death from quackery or death due to a clinical trial design that wasn’t as safe as its subjects were led to believe. That’s why efforts of pseudscientists to get their trials approved by dubious IRBs packed with cronies and friends outrage me so. If they can get away with it, then big pharma can get away with it too.
The “lack of compassion” gambit is nothing more than a variant of the “mean skeptic” gambit. It’s a gambit that’s frequently used against scientists who argue against other forms of non-medical pseudoscience, such as “intelligent design” creationism, but it is a particularly potent gambit in medicine, because there is virtually always a suffering patient at the receiving end of the pseudoscience who thinks (or whose relatives or parents think) it will really, really help. Attacks on the pseudoscience can thus lead to the perception that the skeptic wants patients to suffer and does not want them to be “healed.” (Never mind that, as far as science can tell, no one is being “healed” for the most part.) In reality, what the “compassion gambit” is really designed to do is to neuter any criticism. Skeptics hesitate because they do not want to be perceived as ganging up or being unduly harsh on people who may be truly suffering or desperate or who may truly believe that the woo under criticism is the only chance for them or their children. Even though I try to reserve my harshest attacks and sarcasm for people who have demonstrated time and time again that they support pseudoscience and quackery and that they are virtually uneducable, I can’t always parry that attack. It’s a “heads I win, tails you lose” game. If as a skeptic I hold my fire or give undue respect to ideas that do not deserve it, pseudoscience is granted an undeserved patina of respectability, as though it really is a viable alternative to scientific medicine. If as a skeptic I am too harsh, I am accused of having “no compassion” for the suffering who turn to woo.
The way out I have chosen, which may or may not be the best way out, is not to play the game and to fire away. I may not always match the vociferousness of my attack perfectly to the level of the offense against science and reason, and hopefully I will usually recognize when or if I have “gone too far.” Either way, I will not allow the charge of not being sufficiently compassionate (in reality, not showing sufficient deference to pseudoscience) stop me. The victims of quackery deserve no less.