If there’s one thing I’ve noticed in the nearly five years that I’ve been doing this blog thing, it’s that getting started again after taking even a few days off is hard. There’s a bit of paralysis that sets in. I get used to not having to think about what I want to write, and often there are a number of things that I almost certainly would have written about. Fortunately, for at least one of them, PalMD took care of it it for me. Otherwise, the blogger whose post he deconstructed would have tasted a bit of the ol’ not-so-Respectful Insolence for in essence laying down a load of po-mo B.S. Unfortunately, the blogger removed the post in a fit of cowardice; so there’s nothing there for me to deconstruct any more.
If there’s another thing I’ve learned about blogging, it’s that I stink at judging which post will garner a lot of comments. A prime example is my post from Saturday, where I simply copied a hilariously lame bit of criticism from someone named John from Australia, which as of this writing had accumulated nearly 200 comments. Among those comments was a series of statements from an old friend of the blog, namely Dr. Jay Gordon, who first graced us with his presence at least as far way back as 2005. Since then, he has intermittently popped up, this time spewing nonsense about formaldehyde in vaccines (nonsense for which he was so seriously schooled by yours truly that I haven’t seen him try that gambit again), that time laying down some serious misinformation in the foreword to Jenny McCarthy’s latest book, and still another time defending the scientifically discredited idea that vaccines cause autism on that font of celebrity doctor glitz every bit as phony and mindless as the silicone-infused starlets of Hollywood, The Doctors. Through it all, “Dr. Jay” (as he is often called) would from time to time show up, like a puppy being yelled at, and try to defend himself. He is generally about as effective as the aforementioned puppy when confronted with the metaphorical rolled up newspaper.
While I was in Chicago, Dr. Jay showed up again. This time around, he inadvertently gave me an idea for a post. While the discussion was about vaccines, his comment actually touched on a much larger issue, albeit again completely inadvertently. It began with this comment:
I give vaccines every day. I have told pregnant women that I defer to their discussions with their obstetricians regarding flu shots and that I respect allergists’ recommendations to vaccinate kids with asthma.
The combinations of vaccines we use today are not supported by sufficient safety and efficacy studies.
To which I replied:
You keep saying that, Dr. Jay, but you can never give specifics. What specific evidence do you find lacking and what is the scientific basis of your doubt? I’m really getting sick of your repeating the same schtick over and over again without being able to provide a single example or a single cogent criticism of a single study other than that you don’t believe it or you don’t find it adequate. Quite frankly, I don’t care what your opinion with regard to medicine is if you either can’t or won’t back it up with science and evidence.
I’m not asking that much, am I? I certainly don’t think I am.
Others joined in, some by asking Dr. Jay to summarize the data supporting the safety and efficacy of the current vaccination schedule, which he cannot do. Others echoed my approach by asking him to provide specifics about the science in order to back up his assertion. Not surprisingly, Dr. Jay can’t do that, either. The back-and-forth continued over dozens of comments, with science-based commenters trying to get Dr. Jay to justify his stance.
It was all fruitless, of course.
Finally, Dr. Jay wrote:
There are no sufficient studies supporting either “my” side of this discussion or the other side.
Here’s astounding statement #1:
Change “sufficient” to “no.”
Does that work better for you?
And now astounding statement #2:
What I meant was that are no studies supporting the safety of vaccinating as we do. None. Fragmented publications of one combination or another but no studies which show that it’s safe to give that many vaccines to a six-week-old baby.
This statement is, of course, demonstrably untrue, because each new vaccine, before being approved, is tested in combination with all previously approved and recommended vaccines. In other words, each new vaccine is tested with in conjunction with all the preexisting vaccines in the schedule. But that’s not what inspired this post. This is, astounding statement #3 (an exchange, really):
I challenged him, asking him if he would apply a similar standard to studies funded by the NVIC or Generation Rescue, to which he responded:
Yes, studies funded by the manufacturer of a vaccine or a medication can be dismissed out of hand. The researchers are paid by the drug companies and they get the conclusions they want a tremendous percentage of the time…
And, yes, I would also dismiss studies funded by NVIC or AOA out of hand.
And here, Dr. Jay reveals the heart of why he is not and never will be a scientist or a skeptic. He may appear skeptical on the surface by dismissing all studies funded by any source with an agenda. However, that is anything but skepticism, and certainly in him that is not true skepticism. It’s merely a knee-jerk reaction. What it is is an intellectually lazy excuse not to have to actually bother to read the studies, think about them, and decide for himself based on science whether the design is sound and the data support the study’s conclusions. In fact, I’d go farther than that. The reflexive dismissal of any study because of its funding source is an intellectually lazy excuse not to have to think, period. It’s a convenient excuse not to have to face evidence that challenges his fervent belief that vaccines cause autism. It’s an excuse not to have to face anything that challenges his belief in his own anecdotal experience that tells him that vaccines cause autism.
At the risk of that dreaded charge of “arrogance,” I contrast myself to Dr. Jay in this. I routinely read journal articles that purport to challenge the scientific consensus that vaccines don’t cause autism. As painful as it is to my psyche (although, more frequently, to my sense of science, logic, and evidence) I take them seriously and treat them as such. Hell, I spend hours reading them and deconstructing them. Even when I end up concluding that they are crap, for example the recent Hewitson/Wakefield monkey study, I’ve taken them seriously enough to spend anywhere from 2-5 hours reading and analyzing them.
It must be easy to be Dr. Jay. If I followed his example, I could dispense with all that work and just dismiss the studies because of who the investigators are or who funded the study. Easy! Of course, I can’t help but note that, as a pediatrician, damned near each and every drug that Dr. Jay prescribes was originally approved based on research conducted by the pharmaceutical company that sells the drug. It’s a very selective “skepticism” that Dr. Jay exhibits, primarily all about vaccines. He shows no evidence of being so restrictive in his demand for evidence free of any hint of taint of a conflict of interest with regard to funding for any other medical intervention other than vaccines.
In reality, Dr. Jay’s false “balance” is every bit as pernicious as the false “balance” that credulous journalists use when addressing stories involving pseudoscience. It’s a crutch supporting his faith-based belief that vaccines caust autism. By rejecting studies funded by “either side,” Dr. Jay leaves the path open for him to continue to cling to his preconceived belief that vaccines cause autism, with no threatening evidence from “either side.” In other words, by believing nothing in terms of scientific studies, he will (and does) believe anything. By rejecting any study funded by a source he views as “biased,” he gives himself carte blanche to define what is and is not a “biased” funding source.
I have news for Dr. Jay: Everybody has biases, and no funding source is truly independent. In the U.S., arguably the NIH comes the closest to truly “independent” funding, but to obtain the funding for large studies there has to be a lot of preliminary evidence to justify such trials. Be that as it may, every foundation that funds research has an agenda. Every single one. Foundations exist to push an agenda and to fund research that, or so they hope, forwards their agenda, be it to cure breast cancer or promote various initiatives, be they promoting vaccination or promoting HIV testing. If it’s a pharmaceutical company, it wants to show that its new drug works and is safe.
None of this even takes into account other biases. No investigator spends years working on a project without becoming emotionally invested in it. Careers depend upon the results of experiments. Medical researchers generally want the results of their work to lead to better and more effective treatments. It hurts–quite literally–when something I’ve worked on for years ends up petering out and not going anywhere. It would hurt even more if a therapy I developed ended up doing no good in clinical trials. For example, if the clinical trial I’ve just started now doesn’t work out, I will be one hurting puppy, one unhappy camper.
Yes, we’re all biased in one way or another, funding agencies, researchers, even Orac.
So how does one get around this? Two things are key. The first is transparency. Conflicts of interest must be disclosed. All funding sources must be revealed, as must be all financial interests that any investigators might have in a study. The results of all clinical trials must be revealed, even if they’re negative. To this end, the requirement by the NIH and journals that all clinical trials be registered before they start and the results posted on a website regardless of whether the results are ever published or not, so that negative results don’t fall victim to the “file drawer” effect.
The second is the process of science itself, which is self-correcting. When results are published, other scientists can look at them, the methodology used to obtain them, and how the data were analyzed. This will allow them to decide whether what was done was good science or bad science. Couple that with a consideration of the funding source, and scientists can and do adjust their level of skepticism and scrutiny accordingly. Dr. Jay may not have any confidence in it (certainly he does seem to value his own “personal clinical experience” over epidemiology, basic science, and clinical trials), but science actually does work. It may be messier than we would like, so much so that lay people (and, let’s face it, when it comes to his understanding of medical research, Dr. Jay functions more or less as a lay person) wonder how any conclusions can be made. They can and are, even though the process of coming to a scientific consensus can be a lot like making sausage. The final product may be quite tasty, but watching the process of making it may not be all that edifying.
Alas, I fear that this lesson will fall on deaf ears, because yesterday Dr. Jay said something that shows him to be utterly clueless with regards to science-based medicine:
Research is important but putting experience on the bottom rung of the hierarchy of science is just something that you or Orac or someone else made up.
Actually, I didn’t make that up. The creators of the evidence-based paradigm made that up, and tey did so for good reason. Anecdotal evidence can be inherently misleading. As has been repeated over and over and over again here, it can lead to practitioners believing crazy things, such as that homeopathy works.
Or that vaccines cause autism.
Then, when challenged by a commenter saying, “Bloody hellfire. I’d hate to fly on an aeroplane designed by a Jay-alike engineer,” Dr. Jay responded:
…would you like to fly on a plane designed by an experienced aerospace engineer who integrated life’s experiences with research or one designed by an inexperienced engineer who relied exclusively on what he’d read?
Which is a massive straw man counterargument to the criticism. A better example is that I’d prefer an experienced engineer who changes his practices in response to new scientific data and new engineering practices backed up by new science and doesn’t just keep clinging to his preferences based on his own personal experiences. Likewise, I want a doctor with experience who doesn’t just keep doing the same thing but rather changes his practice in response to new scientific medicine.
In other words, I want a physician who practices science-based medicine, and, sad to say, although he appears to be a nice guy Dr. Jay is clearly not such a doctor when it comes to vaccines.