Respectful Insolence

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgUnfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of “Best of” reposts lined up. If you’ve been reading less than a year or two, they’re new to you. If not, I hope you enjoy them again. I don’t know when I’ll be back, other than maybe a brief update or two. It could be a couple of days; it could be a couple of weeks. Right now I just don’t know. The following piece has obviously been updated considerably from its original appearance in 2006.

I approach this week’s topic with a bit of trepidation, even though I’ve been meaning to discuss it ever since this blog started. Over the weekend, I decided I had put it off long enough.

Why, you might ask, would I approach this topic with trepidation? A reasonable question, and I will give what I hope to be a reasonable answer. For one thing, this topic forces me to drift to areas more political than I normally like and is likely to provoke some angry reactions. More importantly, though, I’m about to discuss a medical organization that is steeped in an utterly toxic brew of bad science and extreme ideology. So what? you might ask. Well, there are some fairly prominent physicians that belong to this organization, including Ron Paul, among others, and you never know who in my own place of employment or referral base might also belong. For all I know, one of my bosses might belong. I sincerely hope this isn’t the case (or if it is they just don’t know about the organization’s extreme views), but you never know, and what I’m about to write is going to be harsh indeed because articles from the journal published by this organization are often cited by cranks and pseudoscientists. Sometimes they even make their way into the mainstream press as though they were legitimate scientific studies. Make no mistake, though, when it comes to medical science, this organization deserves every harsh word that I am about to write because it is a major booster of antivaccinationism, HIV/AIDS denialism, and the now discredited hypothesis that abortion causes breast cancer, while on its pages it regularly attacks the very concept of evidence-based medicine and peer-review. That it is an organization of physicians is all the more appalling.

The group to which I refer is the Association of American Physicians and Surgeons (AAPS), and its journal is the Journal of American Physicians and Surgeons (abbreviated JPANDS, because “JAPS” has some rather obvious negative connotations). It is not an exaggeration to say that the AAPS, through its journal JPANDS, is waging a war on science- and evidence-based medicine in the name of its politics.


Never having heard of it before, I first discovered JPANDS in early 2006, when it published a paper by Dr. Mark and David Geier purporting to find a downward trend in autism diagnoses after the removal of thimerosal from vaccines. The paper was so ludicrously, execrably bad in design, execution and analysis that I had a hard time believing that any self-respecting journal would publish such tripe. (Indeed, it was even worse than the Geiers’ latest offering, hard as it is to believe.) Poking around back issues of JPANDS, I found that the Geiers were not the only ones torturing epidemiology and medical science in the pages of JPANDS (more on that later). Then I found Kathleen Seidel’s masterful analysis of JPANDS. I owe a debt to her hard work two years ago for inspiring and pointing me in the right direction in the discussion to follow. Because Kathleen did such a thorough job, I’m going to focus on a few specific areas that show JPANDS to be a most unreliable journal for anything resembling good medical science.

The Politics of the AAPS

Kathleen began her exposé by pointing out that many of the purveyors of the hypothesis that autism is a misdiagnosis for mercury poisoning” or that autism is due to mercury in childhood vaccines publish in JPANDS, chief among them Mark and David Geier, whose pseudoscience was featured as the lead article in the very first issue of JPANDS in Spring 2003:

Promoters of the hypothesis that autism is a common adverse reaction to vaccination rely heavily upon articles published in the Journal of American Physicians and Surgeons (JPandS, originally Medical Sentinel). Previous perusals of JPandS tables of contents left me with the general impression that its sponsors tended toward the conservative end of the political spectrum. I therefore decided to make a comprehensive survey of the website of the Association of American Physicians and Surgeons, to get a sense of the convictions driving its editorial policies.

“Tended toward the conservative end of the political spectrum”? That’s an understatement. David Touretsky once said, “I’m a libertarian with a small L. The big-L Libertarians are anarchist loons.” The editorial philosophy of JPANDS reveals it to be a magazine dedicated to big-L Libertarianism writ large in italics and bold. As the AAPS website states:

AAPS members believe this patient-physician relationship must be protected from all forms of third-party intervention. Since its founding in 1943, the AAPS has been the only national organization consistently supporting the principles of the free market in medical practice.

(Emphasis mine.)

It sounds innocuous enough, but think about it a minute. Even a relatively conservative-leaning guy such as myself might reasonable ask: Why should medicine be “protected from all forms of third-party intervention”? No other industry or profession is. Moreover, no other industry or profession is entrusted by society with the responsibility that physicians possess or given the license to delve into the deepest, most personal topics of patients. I sometimes point out that no other profession is granted by society the extreme privilege of being allowed to take a knife to a human being to rearrange said human’s anatomy for therapeutic intent or to administer toxic subtances like chemotherapy to treat disease. Indeed, physicians are granted by society enormous power over life and death and, but that power is granted predicated on their responsible exercise of science- and evidence-based medicine. One can argue about the level of government oversight that is appropriate in a free nation, but to argue that there should be no oversight or intervention puts far more faith in physicians than even I as a physician could ever have.

The AAPS means what it says, too. For example, the AAPS is explicitly opposed to any form of government regulation of health care; considers the FDA and Health Care Financing Administration to be unconstitutional; is utterly opposed to Medicare; urges physicians not to participate in Medicare; describes public health programs as “tyranny“; and liberally quotes Ayn Rand.

Kathleen aptly described the philosphy of the AAPS as “ultra-conservative-libertarian-individualist–with a generous helping of conspiracism thrown into the mix–reminiscent of the philosophy espoused by the John Birch Society.” However, the Libertarianism of the AAPS is not without limits. Most Libertarians regard abortion as an individual right that the state should not interfere with except after fetal viability, arguing that a woman should have the right to control her own body and that abortion is an issue of personal conscience that the state should stay out of. Not the AAPS, despite its apparent belief in complete physician autonomy. Rather, it explicitly opposes abortion. Similarly, many Libertarians support changing the law to allow more open immigration. Not the AAPS. It is explicitly for “closing the borders,” and has even published an outrageously racist anti-illegal immigrant screed Illegal Aliens and American Medicine in the guise of commentary on health care financing and an analysis of the effects of large numbers of illegal immigrants on the health care system.

A couple of excerpts:

Illegal aliens’ stealthy assaults on medicine now must rouse Americans to alert and alarm. Even President Bush describes illegal aliens only as they are seen: strong physical laborers who work hard in undesirable jobs with low wages, who care for their families, and who pursue the American dream.

What is unseen is their free medical care that has degraded and closed some of America’s finest emergency medical facilities, and caused hospital bankruptcies: 84 California hospitals are closing their doors. “Anchor babies” born to illegal aliens instantly qualify as citizens for welfare benefits and have caused enormous rises in Medicaid costs and stipends under Supplemental Security Income and Disability Income.

What is seen is the illegal alien who with strong back may cough, sweat, and bleed, but is assumed healthy even though he and his illegal alien wife and children were never examined for contagious diseases.

By default, we grant health passes to illegal aliens. Yet many illegal aliens harbor fatal diseases that American medicine fought and vanquished long ago, such as drug-resistant tuberculosis, malaria, leprosy, plague, polio, dengue, and Chagas disease.

It goes downhill from there:

Illegal aliens perpetrate much violent crime, the results of which arrive at EDs. “Dump and run” patients, often requiring tracheotomy or thoracotomy for stab or gunshot wounds, are dropped on the hospital sidewalk or at the ED as the car speeds away.

And:

American hospitals welcome “anchor babies.” Illegal alien women come to the hospital in labor and drop their little anchors, each of whom pulls its illegal alien mother, father, and siblings into permanent residency simply by being born within our borders. Anchor babies are citizens, and instantly qualify for public welfare aid.

Regardless of your position on immigration, doesn’t the sheer racism apparent in the above passages sicken you? It does me. The rest of the article is no better. It portrays illegal immigrants primarily as not-too-bright carriers of disease and crime that are a blight upon our nation and a threat to our health care system. (When I first read the article, I almost expected an argument for eugenic measures to follow.) While it is true that unreimbursed care of illegal immigrants is a significant financial problem in many border states, rhetoric such as in the above article sheds much more heat than light on the issue and seems more designed to inflame anti-immigrant sentiments than to suggest policy solutions to the current predicament in which some border states find themselves paying for unreimbursed care for illegal immigrants. Read the whole thing if you don’t believe me.

As can be seen, JPANDS regularly supports positions that can be considered part of a far-right wing agenda. Indeed, the most recent issue shows very strong opposition to gun regulation, as well as glowing reviews of the latest books by Michelle Malkin and Laura Ingraham. (Come to think of it, I’ve never seen a negative review of a conservative book in JPANDS.) Recent issues have even featured screeds against the science of anthropogenic global climate change (regardless of one’s position on how settled or not settled the science is behind global climate change, what this has to do with medicine, I have no idea), while the journal itself publishes attacks on government health programs like Medicare too numerous to mention. Whatever your position is on these issues, it should be apparent that the AAPS and JPANDS stakes out a position on the extreme end of the conservative spectrum.

Now that we’ve established that the AAPS and JPANDS are motivated by an extreme political orientation, the reader may ask: So what? Although the explicitly political advocacy of the AAPS certainly casts doubt on the editorial objectivity of JPANDS, in and of itself such advocacy doesn’t necessarily mean that JPANDS is not a reliable medical journal. If we make an analogy to the Wall Street Journal, whose editorial page is about as outspokenly conservative in outlook as it gets but whose straight journalism is among the finest there is, an argument could certainly be made that perhaps JPANDs is cut from a similar cloth. Perhaps, one could argue, the political and advocacy functions of the AAPS do not undermine the quality of the medical science published in JPANDS. One could make that argument; that is, until one actually looks a little more closely at how that very political orientation influences the choice of publications appearing in JPANDS.

AAPS: Antivaccinationism a-go-go

One area where JPANDS strays far from the medical mainstream is in its explicit stand against mandatory vaccination and its call for a “moratorium” on vaccine “mandates.” Not surprisingly, JPANDS has been receptive ground for antivaccination articles, including, but not limited to, the Geiers’ publications linking autism with mercury in childhood vaccines. Going back to Medical Sentinel and proceeding to this very day, the AAPS has consistently viewed mandatory vaccination as a “tool of the state” and a threat to physician autonomy, while minimizing the contribution of mass vaccination to the elimination of various infectious diseases.The AAPS even maintains a web page chock full of “skepticism” about vaccines. Ms. Seidel listed a number of explicitly antivaccination articles that have appeared in JPANDS over the three years prior to her post. Titles range from Is Vaccine Dissent Dangerous? to World Health Organization Vaccine Recommendations: Scientific Flaws or Scientific Misconduct? All have two things in common: First, they do not just question the risk-benefit ratio or complication rates of various vaccines, as “conventional” physicians do all the time; rather the agenda behind these articles is either explicitly or implicitly antivaccine. Second, they are either editorials or “scientific papers” in which the science is consistently of the same poor quality as that found in the Geiers’ article mentioned before. Advocates of a link between mercury and autism will no doubt claim that the clear editorial stance of JPANDS does not necessarily invalidate what is published there. True enough; I made that very point. The shoddy science published within the pages of JPANDS does a good enough job in and of itself of invalidating it, and JPAND’s editorial stance is merely icing on the cake, not to mention a likely explanation why JPANDS would publish such poorly designed and conducted studies in the first place. Worse, articles from JPANDS and the stance of the AAPS are not infrequently cited by antivaccinationists as a mainstream medical society believing that vaccines are unsafe when the AAPS is anything but mainstream.

Particularly disgusting is the way in which the authors publishing in JPANDS regularly use antivaccination rhetoric for truly odious purposes. For example, JPANDS has become arguably the foremost “respectable” promoter of the claim that many cases of “shaken baby syndrome” are in actuality due to “vaccine-induced” encephalitis. Indeed, it has published numerous articles making this very argument. There was even an issue of JPANDS whose theme seemed to be to make that argument, featuring three articles devoted either to casting doubt on the concept of shaken baby syndrome or trying to blame most cases on vaccine complications, or both. (As a capper, it was the very same issue that contained the Geier & Geier article I mentioned earlier.) Meanwhile the AAPS maintains a web page on the shaken baby syndrome containing links to articles that make this very same argument.

I note that the claim that shaken baby syndrome is a “misdiagnosis” for vaccine-induced encephalitis is the very same odious defense that Alan Yurko, a man who was convicted of shaking his girlfriend’s ten week old baby son Alan to death in 1999 in Florida, used in his appeals. Strangely enough, he became a hero of the antivaccination movement, which mobilized behind him in a bizarre “Free Yurko” campaign that claimed that baby Alan’s death was due to “vaccine-induced encephalitis,” not Yurko’s violent shaking, a decision that Australian skeptic and outspoken critic of antivaccinationists Peter Bowditch lambasted.

Prominent among Yurko’s defenders was Dr. Harold Buttram, who–surprise, surprise!–published an argument for this very concept of shaken baby syndrome as being due to vaccine injury in Medical Sentinel back in 2001 and in JPANDS in 2004 (an issue that also featured two articles claiming a link between MMR and autism). Also prominent among Yurko’s defenders was veterinarian toxicologist Dr. Mohammed Al-Bayati, who, although not a pathologist, wrote a dubious “report” in which he purported to demonstrate that baby Alan’s cerebral hemorrhages were not due to violent shaking but rather to a combination of antibiotics and vaccination injury. Of course, Dr. Al-Bayati is not too selective about selling his special “talents.” He performed a similar service for Christine Maggiore, the HIV-positive AIDS “dissident” who does not believe that HIV causes AIDS, a belief that likely contributed to the death of her daughter from AIDS-related complications. Dr. Al-Bayati’s “report” blamed Eliza Jane’s death primarily on an allergic reaction to amoxicillin and a parvovirus infection, rather than on Pneumocystis cariini pneumonia and HIV encephalitis, which is what the L.A. County Coroner had identified as the cause of death. The Al-Bayati “report” has been thoroughly debunked as an example of bad medicine and bad science based on speculation without a foundation in the autopsy findings or in what is known about parvovirus and allergic reactions to amoxicillin. This brings us to the next topic where the AAPS and JPANDS stray far from the medical mainstream.

The AAPS and HIV/AIDS denialism

The AAPS has also published several articles that “question” the link between HIV and AIDS. Indeed, the Winter 2006 issue of JPANDS featured an article by HIV/AIDS “skepticRebecca Culshaw (the bad mathematics of which is deconstructed here), and more recently glowing reviews of two HIV/AIDS denialist books, Science Sold Out: Does HIV Really Cause AIDS? by Rebecca Culshaw (rebutted here) and The Origin, Persistence, and Failings of
the HIV/AIDS Theory
, by Henry H. Bauer were published. Indeed, in the Winter 2007 issue, an article by Dr. Bauer entitled Questioning HIV/AIDS: Morally Reprehensible or Scientifically Warranted? was published. A small excerpt will give you the flavor of the entire article:

Following the announced discovery in 1984 of human immunodeficiency virus (HIV) as the probable cause of acquired immunodeficiency syndrome (AIDS), this hypothesis soon became the ruling theory. Doubts about the hypothesis were ignored; for instance, Duesberg’s 1989 article has an editorial footnote promising a rejoinder that never came.

For more than two decades, dissenters from the assertion that HIV = AIDS have published books and articles and maintained a presence on the Internet, but major media have paid little if any attention; thus most people seem unaware that there are any serious doubts about the matter. The media silence was breached briefly in 2000 when President Thabo Mbeki of South Africa convened a group comprising both HIV/AIDS believers and HIV/AIDS skeptics to advise him on the scientific status of the issue. However, the media coverage gave short shrift to the doubters’ views by comparison to the believers’ Durban Declaration with its 5,000 signatures, which asserted: “The evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous, meeting the highest standards of science…. It is unfortunate that a few vocal people deny the evidence. This position will cost countless lives.”

Dr. Bauer’s article is critiqued here. Also, note the rhetoric about demonization, persecution, and the reigning paradigm. Never does it occur to Dr. Bauer that perhaps the reason HIV/AIDS “skeptics” are not taken seriously is because, like pseudoscientists of all stripes, they neither make compelling arguments that the current understanding of the disease is fatally flawed nor do they propose any reasonable–and most importantly–testable alternative hypotheses that would explain the pathogenesis of the disease better than HIV or lead to more effective treatments for AIDS or means of halting its spread. Never does it occur to them that the science simply does not support their “skepticism” that HIV causes AIDS or that HIV/AIDS denialism is dangerous pseudoscience. Although it is not a major theme in JPANDS, JPANDS nonetheless is used to give an undeserved imprimature of medical plausibility to the myth that HIV does not cause AIDS and is one more compelling bit of evidence that JPANDS is not a reliable medical science journal.

Abortion and Breast Cancer

One other topic into where JPANDS also gets it wrong is in championing the claim that abortion is associated with an increased risk of breast cancer. Five years ago, the AAPS published an article with a dramatic-sounding title The Abortion-Breast Cancer Link: How Politics Trumped Science and Informed Consent. This editorial was written by Karen Malec, an antiabortion activist who runs an advocacy website called The Coalition on Abortion/Breast Cancer, whose purpose is to promote the idea that having abortions is a very strong risk factor for the future development of breast cancer. Clearly that abortion leads straight to breast cancer is a major plank in the belief system of the AAPS, which has published numerous dubious studies and editorials claiming to present evidence for just such a link1, 2, 3, 4, 5. Indeed, the AAPS trumpeted the article with a press release, thusly:

Scientists, women’s groups, and the media have consistently suppressed or ignored research that establishes a direct link between abortion and breast cancer for their own political purposes. Further, women considering abortion are not given true informed consent about the real risks of the procedure as a result of withholding this evidence.

Those are the conclusions of the new study published in the Summer 2003 Issue of the peer-reviewed Journal of American Physicians and Surgeons (JP&S) titled “The Abortion-Breast Cancer Link: How Politics Trumped Science and Informed Consent.” The article discusses the epidemiologic evidence of an ABC link; the silence and denial of the National Cancer Institute, the American Cancer Society, the American Medical Association and women’s groups; media bias; the bitter opposition of pro-abortion politicians; the implications for patient care; and medical malpractice issues.

I am not going to wade into the morass of the debate over whether abortion is murder or a neutral medical procedure. That is not the point of my mentioning the AAPS position on whether abortion causes breast cancer. Rather, I would hope that we could all agree that the debate over abortion is primarily a religious and moral issue and that whatever science is brought to bear on the moral debate should be of high quality. I would also hope that we could agree that any risks attributed to the procedure of abortion should be risks supported and quantified by strong science, rather than nebulous, dubious “risks” based on bad science whose primary purpoose is to frighten women. Unfortunately, JPANDS is a major contributor to bad science claiming a link that science does not support. Perhaps the most egregious example of the awful science marshalled in support of this idea is an outrageously bad paper published last fall in JPANDS entitled The Breast Cancer Epidemic: Modeling and Forecasts Based on Abortion and Other Risk Factors.

The article was ludicrously, laughably bad. Basically, the study’s investigator, Patrick S. Carroll, looked at national cancer registration data in eight European countries for which, it is asserted, there is comprehensive data on abortion incidence. The study claims to look at seven different reproductive risk factors for breast cancer, including induced abortion, reporting a correlation between abortion and risk of subsequent breast cancer. In essence, Carroll looked at a number of breast cancer risk factors and did a simple linear regression analysis to try to correlate these factors to breast cancer incidence in the age 50-54 cohort, and throwing out the factors that didn’t have a high enough correlation coefficient. This left him with only fertility and abortion as correlating factors. No, I’m not making this up. I wish I were, but I’m not. Carroll actually threw out known risk factors for breast cancer, factors supported by huge cohort and prospective studies, just because the graphs he found didn’t fit his linear regression. He also conveniently chose a time period for his analysis that included decreasing legal restrictions on abortion in the U.K., virtually guaranteeing that the number of abortions would be increasing. If you know that the incidence of breast cancer also increased during that time, you’re virtually guaranteed the appearance of a correlation if you pick a variable that also went up during that time period, and that’s just what Carroll appears to have done. Never mind that he didn’t even make even the most rudimentary effort to control for confounding factors..

I’m not going to go into much more detail than this, as the study has been thoroughly deconstructed elsewhere, but I can’t resist pointing to Carroll’s paper as an example of how it’s possible to find a tight “correlation” between almost two variables that happen to be changing with time, in much the same way that a correlation between the decreasing number of pirates and global warming has been facetiously proposed. I also can’t resist pointing out that science doesn’t support the claim that abortion is a risk factor for cancer and that there are numerous well-designed studies that have failed to find a link between breast cancer and abortion1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17. Given the preponderance of evidence, although it is still possible that there may be a link between abortion and breast cancer, it is highly unlikely that there is a real association. In this, it is not unlike the state of evidence regarding vaccines and autism, which the AAPS also rejects. Current evidence does not support such a link between abortion and breast cancer, and there are now enough studies to allow us to conclude that there almost certainly is none. Nonetheless, the AAPS and JPANDS continue to promote this link as though the scientific consensus actually supported it, further evidence of how the political agenda of the AAPS consistently warps its scientific views.

Putting it all together: Mavericks, not sheeple

Is there a common thread here, besides an extreme political orientation and a willingness either to ignore evidence that doesn’t conform to the preconceived beliefs espoused by AAPS or torture it until it appears to? I believe there is and that Kathleen found it when she quoted this article by Editor-In-Chief of JPANDS and former President of AAPS Lawrence Huntoon:

Inescapably, the herd is a force to be reckoned with in all of our professional lives. We must be prepared to travel with it or alongside it, to one degree or another, without being trampled or singled out for extermination. And, for those few physicians who still believe in individual-based medicine practiced according to the principles of Hippocrates, and in watching out for one another when one of our own is attacked, fortunately we have the AAPS. We are a fellowship of “different doctors,” and the distinction is apparent.

“Singled out for extermination” as a maverick? That’s a bit overblown, but that’s the attitude at AAPS. “Different doctors”? It’s hard to argue with that, but it is unclear whether “different” means “better.” What is clear is that the AAPS values “maverick” status and total physician autonomy above all else. Now, don’t get me wrong. There’s not necessarily anything inherently wrong with prizing “maverick” status or bucking the status quo, at least to a point. That’s one important way by which science advances, although the incremental building upon what has gone before is the predominant method of scientific progress. Mavericks buck the status quo, and do sometimes lead to the overthrow of existing paradigms and the acquisition of new scientific knowledge. When that happens, it’s a good thing. Here’s the rub, though: Mavericks follow the wrong path far more frequently than they follow the right path. As Michael Shermer once famously said, “Heresy does not equal correctness,” and continued in his book Pseudoscience, Superstition, and Other Confusions of Our Time:

For every Galileo shown the instruments of torture for advocating scientific truth, there are a thousand (or ten thousand) unknowns whose ‘truths’ never pass scientific muster with other scientists.

Indeed. Or:

For every Galileo, Ignaz Semmelweis, Nicolaus Copernicus, Charles Darwin, Louis Pasteur, etc., whose scientific ideas were either ignored, rejected, or vigorously attacked by the scientific community of his time and then later accepted, there are untold numbers of others whose ideas were either ignored or rejected initially and then were never accepted–and never will be accepted. Why? Because they were wrong! The reason the ideas of Galileo, Semmelweis, Copernicus, Darwin, Pasteur, et al, were ultimately accepted as correct by the scientific community is because they turned out to be correct! Their observations and ideas stood up to repeated observation and scientific experimentation by many scientists in many places over many years. The weight of data supporting their ideas was so overwhelming that eventually even the biggest skeptics could no longer stand. That’s the way science works. It may be messy, and it may take longer, occasionally even decades or even longer, than we in the business might like to admit, but eventually in science the truth wins out. In fact, the best way for a scientist to become famous and successful in his or her field is to come up with evidence that strongly challenges established theories and concepts and then weave that evidence into a new theory. Albert Einstein didn’t end up in the history books by simply reconfirming and recapitulating Newton’s Laws. Semmelweis and Pasteur didn’t wind up in the history books by confirming the concept that disease was caused by an “imbalance of humours” (although Semmelweis probably did hurt himself by refusing to publish his results for many years; his data was so compelling it remains puzzling why he did not do so). I daresay that none of the Nobel Prize winners won that prestigious award by demonstrating something that the scientific establishment already believed. No! They won it by discovering something new and important!

It’s also hard not to point out the arrogant tone of Dr. Huntoon’s article. To him, the AAPS is devoted to “different doctors” who don’t meekly follow science- and evidence-based guidelines, as the rest of what he views to be the “herd” does or adhere to nitpicky little things like the careful science that leads to those guidelines. No! AAPS doctors are different and, by inference, better, more capable of independent thought than the rest of us poor, pathetic “sheeples.” Or at least so the leadership of the AAPS apparently thinks. Indeed, reading JPANDS, I sometimes suspect that the editors really don’t care all that much whether what is being published constitutes good science or not. All that seems to matter is that it be “maverick” and buck the existing paradigms. Certainly, the journal is not particularly receptive to criticism or to issuing corrections or retractions, as Joseph at Autism Natural Variation demonstrated when he criticized the Geier & Geier paper mentioned earlier.

The leadership of the AAPS and apparently many who publish in JPANDS seem to be a bit too enamored of their self-proclaimed “maverick” status and give the appearance of thinking that, like Ayn Rand’s hero, they’re “supermen” whose egoism and genius will inevitably prevail over timid traditionalism and social conformism. Reining them in with evidence only interferes with their autonomy and prevents them from exercising their genius for the good of their patients. If only the “herd” could appreciate that! No wonder JPANDS has published several articles with titles such as Evidence-based Guidelines: Not Recommended, The Effect of Peer Review on Progress: Looking Back on 50 Years in Science (featuring another scornful dismissal of the “herd instinct” and “conformity” and a fair amount of exaggeration of how much scientific progress is due to “violent confrontation” of old paradigms and how much is due to the slow accumulation of knowledge), and editorials attacking evidence-based medicine. To the AAPS, evidence-based guidelines are unacceptable limits on the autonomy of physicians, as are any government regulations or third party payer systems.

Does any of this also sound familiar? Cranks and pseudoscientists often have the same attitude, along the lines of: “Damn those pesky ‘conventional’ scientists, with their insistence on careful observation, hypothesis generation, and experimentation! They don’t have the insight to see that I am right!” Although some of the authors publishing in JPANDS are probably not cranks and most of the membership is very likely not made up of cranks, it’s clear that the the AAPS appears to be an organization custom-designed to attract cranks regardless of their political orientation. Even those opposed to the political core beliefs of the AAPS could well be attracted by the AAPS’s promise to work towards the restoration a mythical golden time when the authority and autonomy of physicians were unquestioned and onerous Medicare and third party payer restrictions did not exist. Even I can see the appeal of that sort of vision. Equally attractive is its attitude that there should be no constraints on the practice of medicine other than what physicians themselves decide there should be. I could even see the attractiveness of that position as well were it not that the AAPS includes science- and evidence-based practice guidelines with those hated restraints. Those who view themselves as “mavericks” in their fields might also be so attracted, even if they don’t necessarily buy into all the political baggage that comes with the AAPS, and it’s probably likely that many members don’t even know (or that they somehow manage to ignore) the pseudoscience because they agree with the politics.

Unfortunately, this apparent attitude towards evidence is in conflict with science. Good scientists always doubt, always wonder, if they are correct. The true scientist is always testing his hypotheses against the data and wondering if there was something he might have missed. Science involves careful experimentation and interpretation of the results of those experiments in a cautious light, with knowledge of what science has found before. Yes, sometimes there’s a bolt out of the blue and an existing paradigm must be overthrown, but more often science builds on what has gone before.

No wonder JPANDS is not indexed in MEDLINE, and no wonder so much dubious, ideology-driven “science” somehow manages to appear there first. If I were a crank or a quack, JPANDS is certainly one of the first places I’d send my papers–as a “maverick,” of course. That’s why, whenever I see an article from JPANDS being cited as evidence for a medical or scientific claim, my skeptical antennae start twitching violently. Yours should, too, as you peruse the last couple of issues, in which JPANDS seems to be forging ahead into new areas of dubious medicine, such as “bioidentical” hormones (shades of Suzanne Somers and also discussed by Harriet Hall) and the argument that low doses of radiation are good for you.

But, then, what do I know? I’m just a sheeple.

Comments

  1. #1 Angsuman Chakraborty
    February 18, 2009

    I am sorry for your loss.

    I want to thank you for exposing this organization. I had no idea about them.I will henceforth ensure that none of their articles are used as sources for our health blogs.

    I have very recently started reading your blog (2nd article) and I am loving it, to say the least. Keep up the great work.

  2. #2 Phoenix Woman
    February 18, 2009

    Hugs to you and your wife, Orac: ((((hugs))))

    As for your post: You had me at “Ron Paul”. Any group in which he’s a prominent member is almost by definition nuttier than a pecan pie. Lemme guess: They loves them some colloidal silver, too, don’t they?

  3. #3 MissyMiss
    February 18, 2009

    If shaking babies was good enough for their parents, it should be good enough for everyone!

  4. #4 khan
    February 18, 2009

    An example of ‘crank convergence’.

    Abortions are bad but shaking babies to death is good?

    Ayn Rand + tendency toward ‘doctor ego’ + keeping them females knocked up for their own good = maggoty swill.

  5. #5 Alison Cummins
    February 18, 2009

    Orac, when you’re feeling better I think you might enjoy this bit of black humour from the Onion.

    Courageous Man Refuses To Believe He Has Cancer http://bit.ly/XdIj8

  6. #6 melior
    February 18, 2009

    I hope your pause brings you the healing that you need after the loss of someone so close.

    We miss you!

  7. #7 storkdok
    February 19, 2009

    How did I not know of this organization for the last 20 years? It must be pretty marginal. I’m going to ask around to see if any other docs know of this one.

  8. #8 Enkidu
    February 19, 2009

    Gah, people on parenting boards actually cite this organization as evidence that there are good doctors that oppose vaccination. It makes me want to reach through the computer screen and shake some sense into them…

  9. #9 davea0511
    February 21, 2009

    I’m not too impressed with AAPS either … but then I think Physicians and Surgeons are at their medical best when they stay out of politics entirely. The AMA, APA, ACS, WHO, etc are all guilty of flexing a political muscle that is all to often non-Hippocratic in nature.

    It’s surprising to me how it seems the care of the patient has become a secondary issue in many of these societies, and many of the adherents similarly seem more interested in following the guidelines of a medical society than in doing what’s best for the patient. For example: disparaging antibiotics because it’s tell-tale for “I don’t know what the hell is wrong with my patient”. Many other treatments are avoided or preferred for similar reasons – fear of peer pressure within the medical organization in which they want to advance and prosper.

    I judge physicians solely on one thing: whether they are wholly committed to the Hippocratic oath, regardless what medical organization he belongs to.