Respectful Insolence

Dr. Sanjay Gupta for Surgeon General? Yawn.

As I was sitting in the O.R. lounge yesterday afternoon between cases, the television in the lounge was tuned to CNN. One thing I noted was some rather fawning coverage of President Bush regarding the military that seemed as though it belonged on FOX News rather than CNN. Not long after that, Wolf Blitzer breathlessly reported that CNN’s Chief Medical Correspondent, Dr. Sanjay Gupta, had apparently been approached by the Obama Transition Team about becoming the new Surgeon General. I thought to myself, “Hmmm. That’s interesting.” And then I went back to the O.R. to finish up my schedule.

Later on, I just so happened to check my stats, and I noticed a Pharyngulanche. Apparently, P.Z. Myers was incredibly unimpressed by this pick because he seems to view Dr. Gupta as some sort of tool of the capitalist health care system. Oddly enough, he wondered what my opinion was referring to me as “that ol’ conservative.” Of course, these days I’m about as centrist as they come, perhaps slightly right of center, but compared to the predominate groupthink of the ScienceBlogs collective I might as well be a member of the John Birch Society compared to the flaming liberals that surround me. Or at least, so it seems. However, PZ is a the Big Kahuna among ScienceBloggers, and he was nice enough to boost my traffic for a day. So it would be churlish not to weigh in. Besides, everyone else and his grandmother around here appears to be doing the same, and, far be it from me as–gulp–a grand old man of the medical blogosphere (hey, four years is a really long time in terms of blog time)–to deny him or the rest of my readers my stunning insights, for which, no doubt, all wait anxiously with bated breath. (How’s that for a surgical ego?)

Suffice it to say that I, too, am unimpressed, but not for the same reason that PZ is. Indeed, it has little or nothing to do with politics. In this, I’m afraid I’ll be having a rare disagreement with blog buds PalMD, who thinks the appointment is pretty cool, and Abel Pharmboy, who admires Dr. Gupta’s communication skills. It’s pretty unusual for me to disagree with them, but, hey, it sometimes happens.

My reasons for not being too thrilled with Dr. Gupta as the new Surgeon General come down to two areas. First, like Val Jones, I think he lacks gravitas. He’s too young and has no experience as the administrator of a large organization, which is important. Although the Surgeon General is an important position, it is not a policy-making position but rather primarily an administrative position. Dr. Gupta’s academic rank is only Assistant Professor of Neurosurgery, and his other position, Associate Chief of the Neurosurgery Service at Grady Memorial Hospital, isn’t sufficient administrative experience to prepare him to administer the Public Health Service. In brief, the Surgeon General is the chief medical officer for the 6,000 strong Commissioned Corps of the US Public Health Service. It is also an advisory position, being the primary medical science advisor to the Assistant Secretary for Health, who in turn is the principal advisor to the Secretary of Health and Human Services on public health and scientific issues. Depending on what the President wants, the Surgeon General can be simply an administrator with little public role, but an unofficial role of the Surgeon General is to be “America’s chief doctor.”

It is that second role of the Surgeon General that makes me somewhat less than thrilled with the apparent selection of Dr. Gupta. A Surgeon General’s influence with the public and with policy makers derives primarily from his gravitas and his persuasiveness. If the Surgeon General is perceived as a lightweight, legislators and the U.S. public will pay him little mind. One reason that Dr. C. Everett Koop was so influential was because his long history as a pediatric surgeon and his manner led him to be respected throughout the medical community and by policy makers and the movers and shakers in HHS. I just can’t see Dr. Gupta commanding that sort of respect, given his history as a talking head.

However, what concerns me most about Dr. Gupta is his relationship with science-based medicine. Being a medical correspondent is a tough job to have and still stay true to science- and evidence-based medicine. The temptation to “sex a story up” or to do credulous puff pieces about the latest “alternative” medicine in order to drive ratings is strong, and it takes a strong commitment to be able to resist them. In this, Dr. Gupta has made some high profile stumbles. Chris Mooney points out how poorly he performed in the Clonaid fiasco. In actuality, this is something about Dr. Gupta that I had not heard about. I do remember the Raelians and their claim, presented without any evidence, that they had cloned a human being. But I either did not see or hear about Dr. Gupta’s credulous report on the Raelians. It was truly a low point for medical journalism in the last decade, and he was at the center of it. As Mooney points out, he may not have been a willing participant. He may have been inexperienced then. He may not have been confident enough in his position to say no. However, his involvement with that story does not give me confidence in his judgment.

What concerns me even more that that is that, when it comes to one of the most important threats to public health of our time, the antivaccine movement, specifically the movement that claims that vaccines cause autism, Dr. Gupta has shown a maddening tendency to straddle the fence and play both sides in his reporting. His coverage of the Hannah Poling case, in particular, was distressingly credulous, so much so that the crank blog Age of Autism approved of it heartily. Meanwhile, on his own blog, Dr. Gupta was disturbingly sympathetic to the antivaccine viewpoint:

I want to continue the discussion today. Couple of points. First of all, it seems as if parents bring up concerns about vaccines, they are automatically portrayed as anti-vaccine. Why is that? Is it possible to completely believe in the power and benefits of vaccines, but still have legitimate and credible concerns?

That’s not what we’re talking about. We are not talking about parents who worry about whether vaccines can cause harm, most of whom wouldn’t even think of prefacing their comments with “I’m not anti-vaccine,” because it wouldn’t even occur to them that anyone is anti-vaccine. I once passed on this pearl of wisdom. Whenever someone prefaces her argument with earnest and emphatic claim that she is not “antivaccine,” antivaccine pseudoscientific canards almost always follow shortly thereafter. I’m thinking of calling it the Jenny McCarthy Law of Pseudoscience because, heck, Jenny McCarthy and J.B. Handley insist over and over that they are not “antivaccine” before serving up the most outlandish antivaccine canards. It’s a ruse, because they know that if they admitted that they were in fact antivaccine no one outside of the antivaccine movement would take them seriously anymore. That’s where the whole “Green Our Vaccines” and “too many too soon” catchphrases came from.

Do I think Dr. Gupta is sympathetic to antivaccine views? Not at all. But he clearly does not recognize them when he sees them, and he seems tainted by the journalistic tendency to “tell both sides” even when there is no scientific support at all to one of the sides. Such a tendency may have served him well as a journalist (although arguably not as a science or medical journalist), but it would not serve the nation well in a Surgeon General, who must persuade the nation with clear, science-based arguments, gravitas, and moral authority. Again, the Surgeon General’s influence depends on his gravitas and ability to persuade, both of which he can undermine by even being perceived to give credence to cranks and quacks. Moreover, as Jake pointed out, the Surgeon General does not have the luxury of playing both sides of medical pseudodebates in which cranks are pitted against scientific medicine. He has to choose science- and evidence-based medicine, and he has to articulate firmly, using evidence and political persuasion, why he chose that way. He can’t afford to be perceived as lending credence to cranks, as former NIH Director Bernadine Healy has been doing so happily lately. Look at how much the antivaccine loons at AoA point to her as “proof” that scientists take their viewpoint seriously. If they do that when a former Director of the NIH says such things, imagine how much more they would do the same if an actual sitting Surgeon General said something that seemed to be sympathetic to their cause.

I’m not ignoring the considerable strengths that Dr. Gupta could bring to the job as Surgeon General. Again, a Surgeon General rises and falls by his ability to persuade, particularly when he is issuing health warnings to the nation, and Dr. Gupta’s experience and skill as a medical reporter could be most useful in that capacity. He is an excellent communicator and very telegenic. Also, from a personal perspective, I can’t help but think it would be cool to have a fellow graduate of the University of Michigan Medical School, as well as someone who grew up practically right next door to where I did (Novi, Michigan is very close to Livonia, Michigan, where my parents moved when I was 10). If Gupta can learn to dump his journalistic “tell both sides” mentality when it comes to dubious health claims, he might grow into being a formidable Surgeon General.

Unfortunately, that’s a big if.

Comments

  1. #1 tf
    January 7, 2009

    A very interesting analysis, being a newcomer to the blogging scene I’ll be adding Respectful Insolence to list of blogs to check (And yes I did get lured over by the link in Pharyngula)

  2. #2 Radioactive afikomen
    January 7, 2009

    It may be that one of the reasons Obama chose Gupta is because he is young–young, energetic, and not as ideologically calcified. But, he would be making a mistake to assume that’s all it takes to run a government office.

  3. #3 Feynmaniac
    January 7, 2009

    Orac for Surgeon General!

  4. #4 Rogue Medic
    January 7, 2009

    Thank you for the well done article.

    I wrote about the tendency of CNN to misrepresent idiotic claims of recovery from brain death. CNN is Selling Snake Oil – All You Have to Do is Believe. I emailed Dr. Gupta. As the CNN brain-doctor-in-the-house, he should have had some say in these stories. He never responded. While I am nobody important, he did not do anything to change these serious, and continuing, errors.

    I do not get the impression that he has even the gravitas to stand up to Jenny McCarthy. Maybe that is what President-elect Obama wants – someone to pass the buck to, when he agrees to go along with the anti-vaccination child killers.

    A much better choice, for Surgeon General, would have been Dr. Marcia Angell. She has a long record of criticism of the drug companies, yet is intolerant of pseudoscience. The first would make it hard for the anti-vaccination child killers to label her as a tool of Big Pharma. The second would require her to take their arguments apart effectively in the media. Of course, that would only make her a good choice if the President-elect is serious about science and health. Too many of his appointments do not give the impression of being objective scientists. Objective scientist should be redundant, not an oxymoron.

  5. #5 Orac
    January 7, 2009

    Actually, Dr. Gupta’s producer once wrote a paean to the power of prayer to heal. However, I did not mention that because I don’t know if it reflected Dr. Gupta’s views or not. Maybe I should have, as it shows the views of people who are largely responsible for the direction of his television segments.

    Maybe this would be a good time to ask people to post in the comments other examples of bad or credulous medical reporting by Dr. Gupta and CNN>

    Dr. Angell is an intriguing choice, for the reasons you mention. However, we don’t know her politics. Perhaps she is not a Democrat or perhaps she is somehow ideologically unacceptable. Unfortunately, I suspect that it is her very intolerance of pseudoscience and quackery is why she would probably never be chosen because woo-friendly idiots like Tom Harkin would block her confirmation.

  6. #6 Em
    January 7, 2009

    I am less than thrilled, but I remain open to persuasion, having only seen him in his soundbite capacity. Maybe he is smarter than television makes him look.

  7. #7 Joseph C.
    January 7, 2009

    This appointment seems to indicate that Obama doesn’t take the position very seriously. It seems like a good surgeon general would have spent his time in the OR and cranking out research papers, not screwing around on a bad cable news channel. Not that Dr. Gupta is a bad guy or anything, he’s just a little bit young and light on the CV to be America’s chief doc.

    But this is a political appointment, not a real job interview where actual qualifications matter.

  8. #8 mk
    January 7, 2009

    but compared to the predominate groupthink of the ScienceBlogs collective I might as well be a member of the John Birch Society compared to the flaming liberals that surround me.

    “Groupthink”… hmmm, I don’t know, that sounds kinda rude. But OK. Maybe it was just snarky fun. (?)

    I read you fairly often and have yet to detect anything right leaning about your thinking. After all, it is your thinking that brings me back. You, along with some others at Scienceblogs, are my weekly or daily reality check. And as Stephen Colbert has elucidated on a number of occasions… reality has a liberal bias. ;^}

    No matter.

    Anyway… I thought this BBC article might be of interest: http://news.bbc.co.uk/2/hi/health/7813149.stm

    Thank you for all your woo-busting!

    Cheers.

  9. #9 Rogue Medic
    January 7, 2009

    Orac,

    You write, Unfortunately, I suspect that it is her very intolerance of pseudoscience and quackery is why she would probably never be chosen because woo-friendly idiots like Tom Harkin would block her confirmation.

    Wouldn’t that be a significant obstacle for any true scientist nominated for the position?

    We need to educate the public about science. Doctors, nurses, and medics still believe nonsense, such as the full moon causes an increase in the seriousness of injuries, or an increase in the number of emergencies.

    They are afraid to use the words quiet or slow. These magic words might result in an onslaught of patients. As if some supernatural force thinks these doctors, nurses, and medics are so important, that when these words are used some innocent people will be afflicted with emergency conditions as punishment for the comments of the doctor, nurse, or medic.

    In such an environment of medical ignorance, the frauds have the upper hand.

  10. #10 Bernie
    January 7, 2009

    Nicely written piece. I would be interested in seeing your own suggestions for Surgeon General.

  11. #11 Mike
    January 7, 2009

    PZ’s credibility with me took a huge hit when he defended Moore vs. Gupta. Moore was mixing data from different sources to try to make his point, cherry-picking facts. It was disgusting and I was appalled that a science blogger would think Moore was right. And PZ seems impressed that Cuba scored almost as good as the US on the WHO’s scale, which is mostly a measure of healthcare equality, not healthcare quality.

    It just shows that people get silly when politics is involved.

    In re: vaccines. I’m wondering how much of the credibility is Gupta’s and how much is CNN’s. CNN is notorious for insisting that their reporters not judge anyone’s claims, whether they are politicians are peddlers of woo.

  12. #13 Rogue Medic
    January 7, 2009

    Raelian,

    The link to an article in MarketWatch means nothing. How much of what they publish gets any kind of fact checking? They do puff pieces for people pushing stocks. This is not an example of a scientific journal.

    Eventually, somebody will be cloning people, but I doubt the breakthrough will come from this bunch of DSM IV poster children.

  13. #14 Comrade PhysioProf
    January 7, 2009

    Dude, we are in agreement. Here’s my post from yesterday about Gupta:

    http://physioprof.wordpress.com/2009/01/06/wut/

  14. #15 Raelian
    January 7, 2009

    Perhaps you should meet Brigitte yourself. If there is something that means nothing here it’s this article itself.

  15. #16 Ahistoricality
    January 7, 2009

    Most of what Orac says about Gupta does bother me. More to the point, though, it seems like neurosurgeon is a poor specialty from which to understand public health issues. Sure, he’s clearly got some public communication skills, but that’s not such a rare commodity. I would expect an epidemiologist, something like that. Someone with experience in hospital administration would be nice, too.

  16. #17 AnthonyK
    January 7, 2009

    Hey, what about Atul Gawanda for SG? He writes beautifully about healthcare and effective medicine, in The New Yorker, and two brilliant books Better, and Complications, and is a surgeon. What’s not to like. Then again, he may want to just get on and be a good doctor…

  17. #18 The Science Pundit
    January 7, 2009

    Orac,

    You didn’t mention his kissing up to Deepak Chopra.

  18. #19 Mu
    January 7, 2009

    Nice analysis, one tends to forget that the Surgeon General is not a cabinet level position, but rather a minor administrator that, on occasion, has been able to establish enough public standing to help with public awareness on certain health issues. To me, the appointment indicates a role as “press secretary for health issues” for the SG; I’m sure he has a deputy to handle the administrative side.

  19. #20 rrt
    January 7, 2009

    I’m sure PZ’s “ol’ conservative” was a friendly jab, Orac. And “slightly right of center” is pretty much where I (and PZ, I think) ha you pegged. Splitter. :)

    I seriously think you should make a real effort to communicate your vax (and maybe CAM) concerns known to Gupta. With all the noise this proti-administration is making about involving the common man, doing web-based coordination and outreach, etc., I think you’re exactly the kind of blogger they’re likely to at least listen to. Someone there had to notice the RFK flap.

  20. #21 mk
    January 7, 2009

    Shorter Deepak… “Mellow out, man!” ;^}

  21. #22 rrt
    January 7, 2009

    …mmm…iPhone posting…typo-licious!

  22. #23 Orac
    January 7, 2009

    I’m sure PZ’s “ol’ conservative” was a friendly jab, Orac. And “slightly right of center” is pretty much where I (and PZ, I think) ha you pegged. Splitter. :)

    And you don’t think my bit about groupthink and flaming liberals wasn’t also a friendly jab? You do have to admit that, aside from Razib and me (and maybe a couple of others), the political orientation at ScienceBlogs tends to be just to the right of Fidel Castro–but only barely.

    As for whether or not my efforts had anything whatsoever to do with RFK, Jr. not being chosen, in retrospect I have no illusions that they did. Personally, given how soon after the election his consideration was mentioned I think RFK, Jr. was putting up a trial balloon to let the Obama Transition Team know that he wanted to be Secretary of the Interior or Head of the EPA. However, despite the Kennedy name, RFK, Jr. has too much baggage, and that came out immediately. I am, of course, glad if I made some small contribution to that airing of his dirty antivaccination laundry.

  23. #24 Orac
    January 7, 2009

    PZ’s credibility with me took a huge hit when he defended Moore vs. Gupta. Moore was mixing data from different sources to try to make his point, cherry-picking facts. It was disgusting and I was appalled that a science blogger would think Moore was right. And PZ seems impressed that Cuba scored almost as good as the US on the WHO’s scale, which is mostly a measure of healthcare equality, not healthcare quality.

    It just shows that people get silly when politics is involved.

    PZ’s great when it comes to evolutionary biology and many other biology topics, as well as the scientific method in general, but when he wanders outside of his area of expertise, like many others (myself included) he sometimes steps in it, and don’t even get me started on how annoying he’s become to me on atheism and religion. However, in all fairness, PZ was correct to point out that Dr. Gupta didn’t exactly do that great a job in countering Moore’s arguments. Gupta missed the big picture and reduced his argments to, in essence, nitpicking Moore’s facts. It’s an exercise that plays to Moore’s strengths rather than to his weaknesses.

    Moore, of course, is a propagandist, and he’s a skillful one. He’s very good at cherrypicking verifiable facts, and, then, when he’s criticized, at loudly proclaiming that his facts are correct, the implication being that his argument must therefore also be correct. However, it’s not the facts he uses per se that make him deceptive at times, it’s how he uses them to weave a deceptive tale, a skill which is the sine qua non of a master propagandist.

    Basically, Moore starts with a story he wants to tell or an argument he wants to make and then cherry picks whatever facts he can find that support that viewpoint, ignoring those that do not or that refute it. He then weaves them together, often deceptively and with highly emotionally loaded imagery, to make his point. He’s very good at it, and he knows that his “facts,” such as they are, will “check out.” Gee, that must mean his overall argument is correct, right? No, not necessarily. Rustum Roy and Dana Ullman do the same sort of thing for homeopathy. So do creationists, actually, when they cherry pick studies and “facts” to argue against evolution. Moore isn’t as bad as that, but it’s the same idea.

    Indeed, it’s the interpretation of what those “facts” mean where Moore all too frequently crosses the line from chronicler to arch propagandist. Fahrenheit 9/11 was an excellent example of this technique, particularly the bit about the Unocal pipeline issue. Where Dr. Gupta went wrong was in arguing the minutiae of Moore’s collection of facts. Moore loves it when his critics do that. It’s exactly what he wants. He was like a pig in mud when Dr. Gupta fell for his preferred tactic, or, more colorfully, like Br’er Rabbit in the briar patch.

  24. #25 rrt
    January 7, 2009

    Oh, yes, I figured you probably were playing along, but…just wanted to make sure. And I couldn’t resist the opportunity for a Python reference. And yeah, I agree about the general political atmosphere here at SB (which is pretty much where I fall too).

    I agree that you probably barely influenced the RFK thing (if at all) by siccing us on the transition team. But my point is that I suspect someone there probably did at least notice the odd blip of comments from science geeks about RFK and vaccines. Which might raise the odds of at least being able to get someone to mention to Gupta that there’s this scienceblogging and skeptical community that says “you’re wrong that we’re dismissing anti-vax cavalierly, and here’s why.”

    Yeah, I know, I’m an optimist. :)

  25. #26 marcia
    January 7, 2009

    “…tainted by the journalistic tendency to “tell both sides” even when there is no scientific support at all to one size.”

    That’s what Gupta, the journalist does:

    “”acupuncture may be difficult to prove, but these things are still used in big hospitals in China.”
    http://www.mtexpress.com/index2.php?ID=2005122479

    I’m hopeful that Gupta, the surgeon general, will lean toward the “demand proof” side of the coin.

  26. #27 Abel Pharmboy
    January 7, 2009

    @Feynmaniac – I actually texted “Orac for Surgeon General” yesterday to PalMD.

    Totally cool to disagree here, Orac, and no offense is taken. In fact, I do defer to you on the military and public health side. revere shares the concern that the journalistic “objectivity” track record leaves us little indication of “what Gupta really thinks.” In fact, he would do well to tap a surgeon commentator/analyst like you on interpreting the science (or lack thereof) behind the issues of woo and denialism that affect public health – I’m not joking.

    I’ve refined my position somewhat since I put up the post yesterday, a gut reaction that took me 8 min to write. However, even with objections around the MSM and blogosphere, I still come down on the side of still supporting Gupta as pick.

  27. #28 Epinephrine
    January 7, 2009

    PZ’s credibility with me took a huge hit when he defended Moore vs. Gupta. Moore was mixing data from different sources to try to make his point, cherry-picking facts. It was disgusting and I was appalled that a science blogger would think Moore was right. And PZ seems impressed that Cuba scored almost as good as the US on the WHO’s scale, which is mostly a measure of healthcare equality, not healthcare quality.

    Right – but by some definitions, health care equality is a measure of quality of the system. The WHO and OECD push strongly for equality of access and masuring discrepancies in distribution of services, but that’s because they are concerned with country level statistics. It doesn’t matter if you have the best hospital on the planet if the majority of the population are having below average care.

    Obviously, coming from a country with social medicine and working in the department of health doing research on these topics, I may have a bias – but while I have many criticisms of the particular choices of indicator used or the inappropriate comparisons that can be madeb between countries, the overall gist is about right – valuing population health and access, not the services available to a tiny elite.

  28. #29 The Perky Skeptic
    January 7, 2009

    May I just point out, I love it when people disagree without getting nasty about it! :) You guys are awesome!

  29. #30 Robster, FCD
    January 7, 2009

    Not thrilled, but not horrified. Yawn is a good way to put it.

    —–

    Raelian,

    Then prove it already!

    Until then, you will be nothing more than a slightly more humorous version of scientology. Of course, after it, you will still be a slightly more humorous version of scientology, either proven to be liars or to have pulled off an unethical cloning procedure. We still can’t make clones that age properly of sheep, so any human clone will likely face old age shortly after puberty.

    100 families helped? 500 blastocysts? And not a publication or tissue sample to prove it. The numbers don’t sound quite right. Typical pregnancy rate from IVF is about 35%, with about 27% live births. Assuming typical implantation procedures, several embryos are used each attempt, so lets use the UK guideline of no more than 2 for a woman under 40, and further assume that all the women are under 40, just to make it simple. So if all the blastocysts were used, which is just plain nuts, you have 250 attempts.

    If each family tried once and only once, you would have 88 successful implantations, with 68 live births, rounding up. Now unless “Rael” picked up some neat alien tech while hanging out with alien Jesus and alien Mohammad, Brigitte’s numbers don’t add up. In fact, she needs to outperform the Canadian average by another 50% to have actually helped 100 families have kids. Of course, if she meant that they had performed wallet lightening procedures, I would certainly believe that.

  30. #31 Robster, FCD
    January 7, 2009

    Sorry, the above calculations were kind of off the cuff, and once I gave it some more thought, I needed to go back and do them correctly.

    Still doesn’t come out well for Brigitte. Perhaps thats the problem when you put a “Bishop” in charge of your scientific venture. Criticizing Bishop Brigitte is probably not looked on kindly by Rael and friends.

    OK, so we have 100 families, 500 blastocysts, 2 used per attempt. Average for Canada is 35% implant, 27% result in live birth. Every attempt at pregnancy is an independent event, and the previous results have no bearing on present or future success or failure.

    For our first attempt, we have 100 families, 27 live births. We have used 200 embryos.

    We now have 73 families still trying. This time, we get 20 live births, and have used 346 embryos.

    For the third attempt, we have 53 families, 14 live births, and have used 452 embryos.

    Fourth attempt. 39 families, 12 live births, 530 embryos have been used, which is 30 more than we started with.

    The numbers just don’t add up.

  31. #32 spiny norman
    January 7, 2009

    Well ya know, just as a Southern democrat is famously like a Northern Republican, an American “centrist” is like the rest of the west’s conservative.

  32. #33 DLC
    January 7, 2009

    I liked hearing that Dr Gupta donated some OR time while traveling in Iraq following the invasion. But, I disliked that he seems to be a bit too credulous when it comes to woo.
    Also, I recall him saying something about Cell phones and brain tumors. It was an off-the-cuff statement, but basically said “yes, they will find a connection between cell phones and brain tumors.” Or maybe I’m remembering it wrong.
    CNN killed it’s science division, which bothers me.
    It seems like they’ve gone from the usual “a bit too credulous” to “Oh what do we care, here’s some woo for you!”

  33. #34 Rogue Medic
    January 7, 2009

    There is one premise that is wrong, here. Journalists are not supposed to report everything that can be reported, just because somebody makes some absurd claim. Journalists are supposed to approach their subject objectively.

    What other group is supposed to have the same approach? Scientists.

    A journalist, who reports something that is appealing, but wrong, is not a good journalist.

    Claiming that Dr. Gupta is being too influenced by his journalism background is wrong. Dr. Gupta was not a good journalist. He is too easily misled. He does not seem to be able to recognize faulty logic or bad science.

    A good journalist should make a good scientist and vice versa. We have just become accustomed to low standards pretty much everywhere.

  34. #35 Rev Matt
    January 7, 2009

    “these things are still used in big hospitals in China”

    What is lacking in that statement is an understanding of why. I’ve several friends in China who have told me, and have also heard/read interviews (including one with James Randi on SGU), that this boils down to two things.

    1 – if a patient insists on being seen even though they don’t have any treatable condition (e.g. vague complaints of being sore, etc) the Chinese hospitals will offer them placebo treatments to make them happy (acupuncture, et al)

    2 – This is the legacy of the Mao policies where the CCP realized they simply didn’t have the resources to provide modern medicine to the entire country and opted to start by providing it to the party power structure first slowly to filter out to the major cities and someday to the provinces.

    There is also of course a generational factor to this, in that the younger generations are far less interested in TCM and vocally clamor for modern ‘Western’ medicine.

  35. #36 John H
    January 7, 2009

    @ RRT

    A bit off topic but where is the Python reference ?

    As a 50-something Brit I think all the MPFC scripts are engraved in my brain (sorry if that offends any neurosurgeons) but for the life of me I could not find any reference to MP.

    And for what it is worth Gupta appears to be a real lightweight. Anyone who is even vaguely tolerant of acupuncture and jabbophobes ought to be self-disqualifying. His tonguelicking of Chopra is dire.

    Any chance of a URL for Moore v Gupta. It might be there somewhere but I have lost my glasses and have the screen on 400X magnification, which makes it a bastard to read.

    I don’t know what you colonial cousins think of Moore but you could never accuse him of sitting on the fence and giving a balanced view of nonsense. Of course I might be totally wrong but that is the way he comes across on UK television and in his books.

  36. #37 rrt
    January 7, 2009

    John H:

    Hehe, sorry, it was a rather limited reference, I didn’t really give enough to go on. It’s when I said: “And “slightly right of center” is pretty much where I had you (Orac) pegged. Splitter.” In the context of us pretending to bicker over political differences, I was attempting to allude to Life of Brian’s PFJ/JPF bit.

  37. #38 RickD
    January 7, 2009

    The problem with Gupta’s criticism of Moore is that he said blatantly that Moore had “fudged facts”. As you note, this is not the problem with Moore’s work. Moore has his own point of view, but he doesn’t go so far as to lie to present his work.

    Accusing a person of lying is a very serious charge, and yet Gupta was quite happy to do so w.r.t. Michael Moore. I suspect that he felt confident he would get away with it because the CW about Moore is that he is an “extremist” (whatever that is supposed to mean). But whether one likes Moore or not, the way Gupta went after him was cheap and dishonest. To me, it felt like a situation where a popular, privileged kid makes fun of a kid who is less well-off. Moore doesn’t have the education to effectively debate Gupta face-to-face, but we should notice that Gupta’s arguments against Moore were shoddy.

    Which is a nice way of saying that Gupta was a liar.

  38. #39 klster
    January 7, 2009

    Of course it’s too early to pass judgment, but I think the appointment somewhat supports the right’s assertion that Obama remains the “Hollywood” politician; heavy on celebrity and light on substance. It’s not a problem now, but it’s something to watch out for.

  39. #40 Skeptic-in-training
    January 7, 2009

    John H.,

    I wasn’t able to pull up the Moore-Gupta clip right away, but chances are good someone posted it on Paul Krugman’s blog:

    http://krugman.blogs.nytimes.com/2009/01/06/the-trouble-with-sanjay-gupta/

    Orac, thanks for focusing your post on the science and woo aspects of the controversy. All I’ve been reading all day has been the Michael Moore stuff, which seems nitpicky and tangential to me. I *knew* I’d had other, science-based reasons to be wary of Gupta.

    For what it’s worth, like you scientists, some of us health journalists are also skeptical of Dr. Gupta as Surgeon General:

    http://blog.lib.umn.edu/schwitz/healthnews/

  40. #41 Phoenix Woman
    January 7, 2009

    Surgeon Generals, unfortunately, have typically been picked because they are hacks, usually party hacks. Most infamously, Lincoln’s SG may have hastened Lincoln’s death from Booth’s bullet by doing some ill-advised fossicking through what was left of Lincoln’s grey matter looking for the projectile. (Though to be fair, the back-to-front path the bullet took would have likely guaranteed a fatal outcome anyway.)

  41. #42 RickD
    January 7, 2009

    You can find various links to the Moore-Gupta argument at DailyKos.

  42. #43 anonimouse
    January 7, 2009

    Not that I’m an academic snob or anything, but you’d think Gupta could actually have made associate professor at Emory before trying to snag the number-one health-related job in the U.S. If he’s a clinical associate professor and not an academic one, well, that’s even worse, because just about any halfway-decent doctor can get a clinical appointment.

  43. #44 Joel
    January 7, 2009

    It may be that one of the reasons Obama chose Gupta is because he is young–young, energetic, and not as ideologically calcified.

    Yeah, just what we need. Throw all experience down the drain. Worthless old bastards they are.

  44. #45 Will TS
    January 7, 2009

    Wasn’t Mehmet Oz available?

  45. #46 Tom
    January 7, 2009

    Question: does anyone care about the Surgeon General? I mean, really? I can’t even name him or her. And I’m pretty sure I’ve read his/her name in the last 24 hours. I just don’t think people particularly care, and I don’t see how it truly affects the public.

  46. #47 The Science Pundit
    January 7, 2009

    It seems that “James Randi” (The quotation mark are because I can’t confirm that this was the actual James Randi who left this comment on Paul Krugman’s blog since there’s nothing–yet–about Gupta on the official JREF site.) doesn’t like the pick.

    A compelling reason for rejecting Gupta for this position, is his endorsement of the nonsense known as “Facilitated Communication” – which he recommends as a proper way to treat autistics. FC has been investigated repeatedly, and has ALWAYS failed proper, double-blind, tests. It seriously harms autistic persons, their families, and those who fund it. We’ve offered our million-dollar prize to any person who can show that FC actually works, and none of these experts have chosen to step forward. It’s a cruel hoax that eats up government funding, and wastes facilities that might be used to find something genuine. Gupta has supported this and other nonsense such a acupuncture, and is not qualified to hold this very important — and critical — position.

  47. #48 Dawn
    January 7, 2009

    I was initially against Gupta as Surgeon General, but if he’s in any way sympathetic to people who are suspicious of the medical industry’s vaccine pushing, I believe I might change my mind. When you have a government official trying to force a vaccine for a non-epidemic disease (Gardasil) on schoolgirls, you know that vaccine is something to stay away from. Thanks for letting me know about Gupta! I feel a whole lot better about him now.

  48. #49 Robster, FCD
    January 7, 2009

    Dawn, perhaps you should look up a few things. First, the definitions of epidemic and endemic. Next, the incidence of HPV infection.

  49. #50 David Harmon
    January 8, 2009

    Science Pundit: Perhaps you should read this article by an autistic person who’s actually used Facilitated Communication, as a “facilitee”. Note the supportive comment by Bob Shaw, including:

    Of all the people who are the worst examples of this sort of nonsense, the “Amazing Randi” comes first to mind.

    .

  50. #51 David Harmon
    January 8, 2009

    Whoops, the commenter I meant to cite above is Bob King, not Bob Shaw. That’s what I get for juggling too many tabs at once!

  51. #52 The Science Pundit
    January 8, 2009

    David Harmon,

    I read the article you linked to and I must say that I am thoroughly unimpressed with that anecdote.

    As for Bob King’s comment, let’s look at the entire paragraph that your quote came from.

    Of all the people who are the worst examples of this sort of nonsense, the “Amazing Randi” comes first to mind. As an illusionist, he can fake nearly anything. Therefore, he believes in nothing extra-ordinary – forgetting that most people couldn’t fake something extraordinary to save their lives.

    This is your best argument in support of FC? LOLOLOL!!

    Well, if Mr. King claims that said communication can occur without trickery, then why doesn’t he prove it? To quote Randi (from the quote above–you can see the full context for yourself)

    FC has been investigated repeatedly, and has ALWAYS failed proper, double-blind, tests … We’ve offered our million-dollar prize to any person who can show that FC actually works, and none of these experts have chosen to step forward.

    I’m sorry, but links to woo-blogs won’t do it for me. At this point I want hard empirical evidence.

  52. #53 John H
    January 8, 2009

    Dawn

    If you are not sympathetic to the concept of vaccination it might be worthwhile looking at Harrison’s Principles of Internal Medicine (16th Ed, page 713)which shows the number of lives saved in the US by vaccination.

    It is reprinted online in Professor David Colquhoun’s Improbable Science site at:

    http://dcscience.net/?p=260

    It is in Post 37. I stole this reference from him.

    The figures relate to the US so you can multiply them many fold to cover the rest of the world. Perhaps even raise them to a power for the developing world where simple illnesses can kill.

    Three 100% success rates, three 99.9% success rates, another 99% success rate and a few 98% rates. The “worst” success rate is for whooping cough and even that is 94.6% – I guess this has some particular complications.

    I do not think these results have been “forced” upon the American public other than for the very simple reason of keeping many of them alive and kicking.

    The reason many of us are not dead or facially disfigured by smallpox is because vaccination eradicated it globally. No alternative medicine, quackery, charlatanry or other form of specious drivel has managed anything even remotely close to this (which is odd really given how “gentle”, “natural” and “in harmony with the body’s natural quantum bio energy” they are supposed to be.)

    Please do not accept the glib comments from the jabbophobes, spewed out on sites of mind-numbing banality and venom. The mortality figures for post-HPV vaccinations bandied about by the anti-vax brigade include deaths from car crashes and other extraneous causes which could not even be remotely connected with vaccination (apart from in the lurid fantasies of the jabbophobes – but, hey, why spoil a good statistic).

    If you have kids get them vaccinated. If you don’t then play Russian Roulette with their health/life and keep your fingers crossed that your neighbours do.

  53. #54 SURESH
    January 8, 2009

    The news as CNN’s Chief Medical Correspondent, Dr. Sanjay Gupta, had becoming the new Surgeon General.
    A great appreciable thing.
    Agreat thing done by AMERICAN PRESIDENT

  54. #55 e.d.
    January 8, 2009

    Dawn, regarding Gardasil. Males are asymptomatic for the strains of HPV that cause cervical cancer in women. While the answer for some may be “close your legs”, until we achieve comprehensive sex education and de-*stigma*tize sex for our young people, vaccinating young women from contracting a strain that could silently kill them is not a bad thing. If every woman could get proper GYN care, annually as recommended, this would not be an issue, but we are still in a society where a sexual woman is A Bad Thing ™ in many areas.

    Please, read up on cervical cancers caused by HPV. The stats on how many women come into contact with one of these virus strains is sobering.

  55. #56 Ranson
    January 8, 2009

    Folks, don’t bother trying to engage Dawn on vaccines. This blog was dominated by that argument a while back. No one budged, much vitriol was spewn, and everyone’s time was wasted.

    Also, the JREF does have something up now centering around Gupta and FC. so I’d say the comment linked above is legit.

  56. #57 cooler
    January 8, 2009

    HPV another fraud, another viral hypothesis based solely on a partial correlation, (since most people with HPV are totally healthy and will never get cancer.) Got to make money for Merck though!

  57. #58 Robster, FCD
    January 8, 2009

    e.d., It is worth noting that there are three groups of women are affected by cervical cancer. Women without access to medical care, women with access but don’t use it, and lastly women with care, who use it, but their cancer moves too quickly for annual checkups to catch.

    A vaccine catches all three of these. Also, HPV has been strongly linked to certain esophageal cancers, anal cancers, (both of which can occur in men or women) and cancer of the penis. I would predict that rates for cancer of the penis will go up in the US as circumcision drops, as the tissue most commonly infected by HPV leading to cancer of the penis is the foreskin. I’d like to see recommendations for Gardasil expanded to both sexes.

    —-

    cooler, new assignment for you. Find me a case of cervical cancer without evidence of HPV infection.

  58. #59 cooler
    January 8, 2009

    Robster, just read Dr. Harald zur Hausen paper, a significant amount of cervical cancer patients had no HPV, meanwhile millions of people have the virus and no disease. Nice pathetic weak correlation again. But I guess in the mad world of being a pharmashill this proves causality.

    Can I get the Nobel prize for discovering wrinkles cause death in old people? This is a 100% correlation!

    http://www.pnas.org/content/80/12/3812

  59. #60 rrt
    January 8, 2009

    Pshaw. That’s nothing, Cooler. Hell, I’ve got another 1983 article that shows NOBODY with AIDS had HIV!

  60. #61 Dr Aust
    January 8, 2009

    You do have to admit that, aside from Razib and me (and maybe a couple of others), the political orientation at ScienceBlogs tends to be just to the right of Fidel Castro–but only barely.

    Hmmm. It’s all relative – if they moved over here to Europe those guys could all be “centrists”, while Orac would be a mainstream conservative, and the vast bulk of the Republican party would be teetering on the edge of what we call “far right ideologues”

  61. #62 cooler
    January 8, 2009

    Those papers were before HIV was discovered, rrt, you dope. BTW Zur hausen just won the Nobel prize for these papers so they are pretty important, Sadly,it is just another bogus partial correlation.

    But a hypothesis must be true if it’s supported by a drug company or the crooked politicans that run the CDC/NIAID right?

  62. #63 Robster, FCD
    January 8, 2009

    Wow, cooler, when you fail, you fail big time. That paper is about the discovery of a new HPV virus, new in 1983 that is.

    Keep trying, cooler. Perhaps you should try something more… current.

  63. #64 cooler
    January 8, 2009

    Why dont you? Your’re the one arguing it causes cervical cancer, well cite the papers then, too scared all you’ll find is a partial correlation?

  64. #65 HCN
    January 8, 2009

    Why is cooler obsessed with sexually transmitted diseases? It seems very odd.

  65. #66 Robster, FCD
    January 8, 2009

    From

    Cervical cancer has been shown to have a central causal agent, HPV infection [3]. HPV infection is now considered a necessary intermediate step in the genesis of cervical cancer [8-10]. This conclusion is unique in cancer research; no human cancer has yet been shown to have a necessary cause, so clearly identified. Some of the well-studied paradigms of cancer prevention, such as tobacco smoking in lung cancer and chronic hepatitis B in liver carcinoma, are among the strongest epidemiologic associations, but they do not represent necessary causal relations. Lung cancers can occur in people who never smoked and had only minimal exposure to environmental tobacco smoke and liver cancer may occur in individuals who never had hepatitis B.

    From that paper, you can access the IARC monograph that is citation 3, and you can find at least 2 of the 3 for citations 8-10 for free with a little careful use of google scholar.

    What a difference a dozen or so years makes.

    cooler, you are the one arguing against the scientific consensus, years of scientific research, and the peer review process with outdated information to make exceptional and evidence free claims. You need to present evidence to support your position if anybody is to take you seriously. I found this in a few minutes while watching the BCS game. That was all I needed. It isn’t that hard to do, which is why I asked you to do it in the first place.

    At this point, all you have done is prove that you are either pathologically dishonest or completely incapable of reading and comprehending scientific literature, hence you rely on google videos and fiction. I feel sorry for you, and for your mom for having to let you live in her basement.

  66. #68 cooler
    January 9, 2009

    LOL. did you even read the studies loser? You just found them? So you took the hypothesis on faith before? God someone like you must be the most pathetic trailer trash that ever existed!

  67. #69 rrt
    January 9, 2009

    Wow.

    I must confess that was a little trap, cooler, but I didn’t expect it to work so completely. Yes, cooler, the article I presented predated the identification of HIV as the cause of AIDS. I was curious to see if you would actually miss the point, so I upped the ante. I had hoped it might prompt you to ask yourself “why does rrt think a pre-virus paper is relevant?” and actually think on it.

    I begin to wonder if you’d have missed it even if I’d offered this one first. Since now I have to accept that possibility, I’d better spell it out for you: In addition to Robster’s points above, the point I am making is that the HPV article came during the time that a strong causal link between HPV and some cancers was being made. The body of knowledge was clearly still developing. To argue that since in 1983 the paper notes HPV had not yet been found in all incidences of these cancers it could not have caused them is a similar error to asserting that since HIV wasn’t fully associated with AIDS in 1983 it couldn’t have caused AIDS. The error is functionally the same regardless of the size of the gap in knowledge, though more egregious when the gap is narrower, as it was in the HPV paper. And to further spell it out for you, the Gallo abstract I linked (a bit of an important paper itself, Montagnier priority aside) specifically states that HTLV-III was not found in a significant number of sampled AIDS patients from varying groups, and yet (rightly) confidently suggests a causal link.

    I’m sure there’s also some meaningful discussion that could be had about the unlikelihood of finding any pathogen in absolutely 100% of the patients afflicted by its typical pathology, but not by me.

  68. #70 Robster, FCD
    January 9, 2009

    cooler, did you read them? Do you dispute my interpretation of them? Or are you just mad that I showed that you don’t know what you are talking about. Again.

    I had read one of the papers that the one I linked to cites before, for a public health class. I had also discussed it with a gyn/onc surgeon I used to work with for whom HPV was a specialty. But to show you how easy it is, I did the search again. Just for you.

    I did not take the hypothesis on faith, but on trust. Trust that the researchers had performed their work properly, and that their findings were reported properly. All scientists are forced to do this to some extent or another, since we don’t have time or resources to repeat all the work that we refer to. However, if our work relies on a particular premise of that work, and our experiment fails, one possible reason for that is that the previous work was wrong. That happened to a colleague of mine.

    Long story short, everybody assumed that, due to a particular paper, that translation followed a certain pattern of initiation throughout the cell cycle. By stopping the cell cycle at different points, then checking the translation profile, he found something different. He asked a friend to double check his work, and it turned out that he was correct, and the previous work, which relied on only one cell line was not as correct as his. Why was his more correct? Because the one cell line still had the odd profile. It was the exception, rather than the rule.

    This is why your request that we show you early papers that prove HIV causes AIDS falls flat. If those tens of thousands of research projects didn’t work, the earlier work would fall into doubt.

  69. #71 HCN
    January 9, 2009

    Robster, FCD said (you are very patient and a cool dude!) said “cooler, did you read them?”

    NO, cooler did not read them! It is obvious that cooler is a sex disease obsessed troll, s/he/it should be ignored.

  70. #72 söve
    January 9, 2009

    thanks.

  71. #73 Copper Castings
    September 2, 2009

    thanks for the great information,

  72. #74 bonnie jones
    October 30, 2009

    Dr Sanjay Gupta, my family practioner, as told me that I can not be inocculation with the regular, annual flu shot, until I have been innocculated with the H1N1 flu shot. Is this a fact? If so, why do they have to be administered in this order?

  73. #75 komik videolar
    November 15, 2009

    Why is cooler obsessed with sexually transmitted diseases? It seems very odd.

  74. #76 konteyner
    September 11, 2010

    Gupta. A Surgeon General’s influence with the public and with policy makers derives primarily from his gravitas and his persuasiveness. If the Surgeon General is perceived as a lightweight, legislators and the U.S. public will pay him little mind. One reason that Dr. C. Everett Koop was so influential was because his long history as a pediatric surgeon and his manner led him to be resp

  75. #77 su deposu
    September 21, 2010

    work was wrong. That happened to a colleague of mine.

    Long story short, everybody assumed that, due to a particular paper, that translation followed a certain pattern of initiation throughout the cell cycle. By stopping the cell cycle at different points, then checking the translation profile, he found something different. He asked a friend to double check his work, and it turned out that he was correct, and the previous work, which relied on only one cell line was not as correct as his. Why was his m

  76. #78 konteyner
    November 4, 2010

    be next? It’s very nice to see how creative people can be. 10 years from now, surely we would have already come up with something better than these, by the time when we look back, everything would be history. :-)

  77. #79 prefabricated
    November 22, 2010

    I was sitting in the O.R. lounge yesterday afternoon between cases, the television in the lounge was tuned to CNN. One thing I noted was some rather fawning coverage of President Bush regarding the military that seemed as though it belonged on FOX News rather than CNN. Not long after that, Wolf Blitzer breathlessly

    http://www.karmod.eu

  78. #80 haber
    December 18, 2010

    than the temporary direct traffic from the links. But since I kept the proper keyword in the title, people who linked to the post used the title as anchor text, and the post got more