Respectful Insolence

I’m back.

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.

When Dr. Gordon was challenged by myself and others to define what he would consider “sufficient” studies, he made a trio of astounding statements.

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):

Prometheus–Every single study you cite was funded by the industry that makes the vaccines and the researchers are also in their thrall. We need independent vaccine research not the usual garbage.

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.

Comments

  1. #1 stewart
    October 16, 2009

    Welcome back, Orac.
    The evidence is overwhelming – we are very good at fooling ourselves, and thinking our experience gives us special knowledge that is omitted from ‘group research studies’. Generally, we’re wrong, and there’s been a lot of psychological work over the past 50 years demonstrating just how bad we are at this. If Dr. Gordon wants to read Danny Kahneman (Nobel recipient for his work in the field, and a good writer), or read the recent APS paper on evidence-based training and practice vs. gut-based practice, he and his patients will be much better off. Critical thinking is not easy or natural – but it’s important.

  2. #2 Katharine
    October 16, 2009

    Orac, first off, I agree with everything you’re saying here.

    Second, how many studies are done lately to figure out, with certain vaccines, why various things go wrong or are perceived to go wrong when they do go wrong or are perceived to go wrong? I am sure there probably are, and I know there’s already a wealth of information on these exact things, but this is your field, not mine, so I want to be absolutely sure of what’s been done.

  3. #3 LovleAnjel
    October 16, 2009

    “…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?”

    Knowing a few aerospace engineers, I’d prefer they leave their “life’s experience” out of the design.

  4. #4 BB
    October 16, 2009

    I’m sorry you didn’t get to deconstruct that bias post from Desifeminist; I would have relished your thoughts on it.
    Welcome back!

  5. #5 skepville
    October 16, 2009

    “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.”

    Oh yeah, I can just picture it -
    The geophysicist goes to the NSF and says, “I want to prove/disprove my climate change hypothesis based on 100 interviews with people in my area. I’ll ask them whether the winters are getting warmer or cooler in their experience. No, wait – I’ll base it on my own 25 years of climate experience.”

    Rots of ruck.

  6. #6 Dianne
    October 16, 2009

    Off topic, but have you seen this article?

    Back on topic: Dr. Jay has maybe 0.01% of a point in that one has to be careful about applying evidence based guidelines. Is the patient equivalent to the patients in the protocol that set up the guideline? If not, is extrapolation reasonable? Can you provide adequate monitoring and will the patient comply with monitoring? Though I can’t imagine how the answer could be “no” to any of the above if the question is in reference to a healthy infant getting routine vaccination.

  7. #7 Joseph
    October 16, 2009

    Even studies by the Geiers and Wakefield are not dismissed out of hand. Just take a look at the Omnibus Autism Proceedings and other vaccine trials. Those studies are dismissed after hundreds of hours of analysis showing exactly what sort of crap they are.

    The MIND Institute study that attempted to replicate Hornig et al. (the autistic mice study) is an example of a vaccine study that was not funded by vaccine manufacturers. The biggest and most rigorous study of autism and thimerosal to date, Thompson et al. (2007), would be another example. The thimerosal removal study based on CalDDS was carried out by the California Department of Public Health. (Of course, in that case conflicts of interest are irrelevant in my view, since the raw data is entirely verifiable by anyone who cares.)

    What really matters is the quality of the study. Studies of low quality will allow biases to creep in.

    The MIND Institute itself has produced humongous turds, with countless errors that make results uninterpretable, e.g. Hertz-Picciotto & Delwiche (2009).

  8. #8 sam
    October 16, 2009

    Excellent post and welcome back. I still find it amazing that people think that people at pharmaceutical companies are out to get them. I can’t see that many pharm companies doing to well if they made products that didn’t work, maybe I’m just niave but a company that pressures their researchers into giving them the results that they want is just setting themselves up for serious problems. I’m not saying that it doesn’t happen but that I can’t see it happening as much as people think it does.

    I’m glad all I have to worry about is a $billion tube of metal not finding the particle it’s supposed to find (to be fair it’ll be a lot more interesting if it doesn’t but I doubt the lay person will appreciate that).

  9. #9 Anthro
    October 16, 2009

    This is a comment following an article in the NY Times (online version) that I think goes a long way in explaining the mindset that so confounds all of us here. It’s long, but worth reading. The article is questionable in itself as it dances close to the edge of presenting the whole thing as a “debate” and the headline is misleading to begin with. Nevertheless, the comments section is filled with the screeds of not only anti-vaxers, but everyday grandmothers who “have their doubts” and “wish that the article has been less ‘biased’”.

    “The flat-earthers are back!

    Well, not exactly, but their descendants have come up with the flat-earth equivalent for the 21st century. They reject vaccination.

    Vaccine rejectionists are all over the web promoting the “dangers” of vaccination. Vaccine rejectionism isn’t about vaccination, though. It’s all about parents and how they wish to view themselves.

    It is important to understand that vaccine rejection is not based on science. There is no scientific data that supports vaccine rejection. Indeed vaccines are one of the greatest public health achievements of all time and virtually every accusation about vaccines by vaccine rejectionists is factually false.

    Vaccines have been around for more than 200 years, and vaccine rejectionists have been around for almost as long. Over the years, they have made countless accusations about the “risks” of vaccines, and they have been wrong every single time. Despite the fact that vaccine rejectionists have been 100% wrong in their understanding of vaccines, statistics, risks and claims of specific dangers, they still have a large following. In large measure that is because the cultural claims of vaccine rejectionists resonate with prevailing cultural assumptions. Vaccine rejection is a social construct that has little if anything to do with objective reality or science.

    ‘Trusting blindly can be the biggest risk of all’: organised resistance to childhood vaccination in the UK (Hobson-West, Sociology of Health & Illness Vol. 29 No. 2 2007, pp. 198–215) explores these cultural attitudes. The first social construct is a re-imagining of the meaning of risk:

    A primary way this is achieved … is to construct risk as unknowns… [This] serves as an example of how the realist image of risk as a representation of reality is undermined. In the realist account, uncertainty and unknowns may be recognised but are usually framed as temporary phases that are overcome by more research. For the [vaccine rejectionists], there is a more fundamental ignorance about the body and health and disease that will not necessarily be overcome by more research. Interestingly, this ignorance is constructed as a collective – ‘we’ as a society do not know the true impact of mass vaccination or the causes of health and disease.

    The problem that vaccine rejectionism is based on false premises is elided by ignoring the actual scientific data and focusing instead on whether parents agree with health professionals or refuse to trust them. Agreement with doctors is constructed as a negative and refusal to trust is constructed as a positive cultural attribute:

    Clear dichotomies are constructed between blind faith and active resistance and uncritical following and critical thinking. Non-vaccinators or those who question aspects of vaccination policy are not described in terms of class, gender, location or politics, but are ‘free thinkers’ who have escaped from the disempowerment that is seen to characterise vaccination…

    This characterization of vaccine rejectionists can be unpacked even further; not surprisingly, vaccine rejectionists are portrayed as laudatory and other parents are denigrated.

    … instead of good and bad parent categories being a function of compliance or non-compliance with vaccination advice … the good parent becomes one who spends the time to become informed and educated about vaccination…

    … [vaccine rejectionists] construct trust in others as passive and the easy option. Rather than trust in experts, the alternative scenario is of a parent who becomes the expert themselves, through a difficult process of personal education and empowerment…

    The ultimate goal is to become “empowered”:

    Finally, the moral imperative to become informed is part of a broader shift, evident in the new public health, for which some kind of empowerment, personal responsibility and participation are expressed in highly positive terms.

    So vaccine rejectionism is about the parents and how they would like to see themselves, not about vaccines and not about children. In the socially constructed world of vaccine rejectionists, risks can never be quantified and are always “unknown”. Parents are divided into those (inferior) people who are passive and blindly trust authority figures and (superior) rejectionists who are “educated” and “empowered” by taking “personal responsibility”.

    This view depends on a deliberate re-definition of all the relevant terms, however, and that re-definition is unjustified and self aggrandizing. The risks of vaccination are not unknown. Believing that vaccines work is not a matter of “trust”; it is reality. Questioning authority is not the same as being “educated”; indeed, it isn’t even related. Lacking even basic knowledge of immunology and rejecting medical facts is not a sign of education, independent thinking or taking personal responsibility. It is a lack of education at best, and self serving, self aggrandizing ignorance at worst.”

  10. #10 Jojo
    October 16, 2009

    I work in the aerospace industry. Not only is

    “…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?”

    a strawman, it’s also irrelevant.

    I don’t care how you come up with the design of the aircraft. What I do care about is the modeling, testing, and statistical analysis used to to validate the safety of the aircraft. The process that is followed from conception to flight is filled with steps that are very similar to the process used to develop new medical treatments. You start small, at the component level, and build up to the integrated systems, and finally the completed aircraft. You test and model, make changes, test and model again until you can develop the evidence that supports the safety of the aircraft. Only then do you risk the test pilot’s life with a first flight.

    The only difference between developing your vaccination practices and designing an aircraft the way Dr. Jay suggests is that the disaster it creates is much more obvious and immediate when the aircraft crashes and burns.

  11. #11 ekcol
    October 16, 2009

    “…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?”

    The words “experienced” and “inexperienced” aren’t relevant to the analogy; they’ve just been added because without them the answer is obviously “the one who relied on what he’d read”. I don’t want an engineer who decides not to believe in aerodynamics because Boeing paid for the research, and makes the plane blue because he noticed blue planes crash less often.

  12. #12 Pablo
    October 16, 2009

    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.

    As I pointed out a couple of weeks ago, the problem with this type of argument is that it gets dismissed out of hand. How do you come to the conclusion that homeopathy doesn’t work? By using that worthless “evidence based paradigm”! So all Jay has to do to justify his use of anecdotal experience is to assert that, in his experience, it works. QED. Again, the advantaged of a faith-based approach is that it is completely justified by faith, and there is no way to criticize it. Of course, such a world-view ends up being a free-for-all, with everyone’s “faith” being equally valid, but that only validates them. Their belief is just as good as anyone else’s…

    Then again, if Jay were actually honest about it, it might help. Despite all his proclamations of how “I am a doctor so my experience matters more than any paper in a journal,” he doesn’t actually mean that “Experience by practicioners in the field has more significance than second-hand reports read by non-practicioners.” What he REALLY means is, “I AM ALWAYS RIGHT”

    There is plenty of evidence for this. For example, just two or three weeks ago Uncle Jay had no troubles in dismissing the conclusions of a working pathologist who happened to come to a conclusion that Jay didn’t like (that a vaccine did, in fact, NOT kill a girl). In that case, Jay certainly did not think the experience of a working pathologist matter, and questioned the pathologist’s conclusion based on nothing but newspaper reports. He didn’t even need a stinking scientific study to fall back on!

    The second is more subtle, but an underlying error in everything jay is saying. If you think about you, you realize that Jay is making the mistake of an appeal to false authority, which is himself. The problem is that, whereas Jay is pediatrician, he is NOT an epidemiologist. Therefore, his armchair opinion on epidemiology based on his experience is basically as novice as how it applies to neurology. Similarly, he is NOT an immunologist. So if Jay is going to be honest about his claim that “practicioner’s experience matters more than scientific studies,” then he should be consulting with those people who actually have REAL experience to see what they think. A great place to find out what epidemiologists and immunologists think is to read their papers in the scientific literature…

    He won’t do that, of course, because that isn’t his claim. His claim is simple: “I am always right.”

  13. #13 Tacroy
    October 16, 2009

    I’ll see your Dr. Jay Gordon and raise you a Dr. Richard P. Feynman:

    Science is a way of trying not to fool yourself. The first principle is that you must not fool yourself, and you are the easiest person to fool.

    Sticking your fingers in your ears and going “la la la la, I can’t hear you because you got funding from the pharmaceutical industry” is not a good way of doing science.

  14. #14 mad the swine
    October 16, 2009

    “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.”

    So Dr. Gordon is a postmodernist too? He certainly seems convinced of the validity of ‘other ways of knowing’ as opposed to the Western scientific tradition :P

  15. #15 Dangerous Bacon
    October 16, 2009

    Orac: “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.”

    This reminds me of a dog-training show currently airing on Animal Planet – “It’s The Dog Or Me”. A severe-looking but attractive British woman travels around, visiting homes with misbehaving animals and prescribing training to fix the problems.

    Things have gotten so bad with Dr. Jay that he needs a similar intervention. Maybe we can propose a show entitled “It’s The Pediatrician Or Me”. Or even better, generalize it to include all the physicians and PhDs who embrace moronic ideas and advertise themselves as knowledgeable in fields for which they have no adequate training. There could be a new intervention each week – first Dr. Jay, then Mercola, the Geiers, Doc Egnor…the list is unfortunately long enough for a program run of at least several years.

  16. #16 Squillo
    October 16, 2009

    Excellent post, Orac.

    I would add that I worry far less about the studies in which COIs like industry funding are disclosed than about those that may have undeclared COIs.

  17. #17 Scott
    October 16, 2009

    I would add that I worry far less about the studies in which COIs like industry funding are disclosed than about those that may have undeclared COIs.

    Like the one from which all of Jay’s ‘concerns’ ultimately derive?

  18. #18 joanlujo
    October 16, 2009

    Nice post, I think one of the sad things about people like Dr. Jay is that they don’t get that one of the great pleasures (and pains) of science is having your intuitions turned on their head. When I read a paper (even by a crackpot) I always hope for that. I never dismiss a paper based on its backing a or conclusion.

  19. #19 James Sweet
    October 16, 2009

    Argh, I was really excited to send the article cited by Anthro to a couple of people, but then I found out it was written by Amy Tuteur, which unfortunately completely destroys its credibility in the eyes of any of the people I might send it to. I’m no fan of Tuteur either.

    Tuteur has a big ax to grind in regards to home birth. Granted, the pro-home birth community puts out a lot of misinformation, and that is something worth correcting. Tuteur, on the other hand, goes beyond debunking the misinformation, and instead distorts the risks of home birth far beyond what the data supports.

    Tuteur is kind of like the Orac of home birth — except that while there can be legitimate disagreement between reasonable people over the risks and benefits of home birth — note the positive opinion of the NHS — whereas there cannot really be legitimate disagreement over the risks and benefits of vaccination. So Orac’s insolent position is much more defensible.

  20. #20 Michelle
    October 16, 2009

    Orac:

    I would add something to your description of the “process of science itself”–it’s implied, but not stated implicitly–reproducibility. It doesn’t matter who did the initial study, so long as the results are demonstrably reproducible by other researchers. Of course, it takes time to set up and perform additional studies, which is why being willing and able to intelligently analyze a study’s results when they come out (assuming one has a modicum of common sense and actually wants to consider real evidence) is important in the short term.

  21. #21 Poogles
    October 16, 2009

    “Argh, I was really excited to send the article cited by Anthro to a couple of people, but then I found out it was written by Amy Tuteur, which unfortunately completely destroys its credibility in the eyes of any of the people I might send it to. I’m no fan of Tuteur either.

    Tuteur has a big ax to grind in regards to home birth. Granted, the pro-home birth community puts out a lot of misinformation, and that is something worth correcting. Tuteur, on the other hand, goes beyond debunking the misinformation, and instead distorts the risks of home birth far beyond what the data supports.”

    Ha! I knew it had to be post by her, lol! It was her tone.

    Now, I certainly have my disagreements with Dr. Amy (and especially the way she goes about saying things at times), but I also realize that she is actually doing some good (with regards to HB, anyways). For instance…I was all set on having an unassisted homebirth until I came across her site (the homebirth debate…before she abandoned it). I argued for awhile and eventually realized that she was (for the most part) right. And honestly, if she hadn’t been so damn antagonistic, I probably would’ve just dismissed her claims and been on my way; instead I kept coming back to argue with her, lol.

    Sorry, that was a bit off-topic :-)

  22. #22 Dianne
    October 16, 2009

    And honestly, if she hadn’t been so damn antagonistic, I probably would’ve just dismissed her claims and been on my way;

    So much for the “we should always be nice or we’ll put people off” argument. Of course, your anecdote doesn’t prove that most people won’t be put off by an antagonistic approach.

  23. #23 Antaeus Feldspar
    October 16, 2009

    I’ve always been fascinated by the people who think they’re the real defenders of science when they’re in fact the most egregious offenders against it.

    Recently, I’ve come to suspect that a lot of them subscribe to a common delusion: that the meat of science, the really tough part, the part that separates the real scientists from the wannabes, is devising hypotheses.

    Which of course it isn’t. Any fool can concoct a hypothesis; there’s nothing difficult about it. Heck, it could be done Mad Libs-style: “[Dangerous disease] is caused by [substance], but the patient will recover with large doses of[purportedly 'natural' substance].” And any fool can rescue losing hypotheses endlessly: “The natural treatment would have cured the patient but it turns out that [real, actual medical treatment] poisons the body and undoes the benefits of natural treatment.”

    What fools and wannabes fail to realize is where the truly difficult and significant parts of science are: a) devising hypotheses that are consistent with the data already collected; b) devising tests that will relegate the hypothesis to the vast realm of failed hypotheses unless it is correct.

    There are people who talk endlessly about how there are “other ways of knowing” besides Western logic and science. If we torture the definition of “knowing” to mean “generating hypotheses”, then I suppose there are indeed other ways, including Mad Libs and The Magic 8-Ball. If we specify that what we “know” should be actually testably correct, though, then Western logic and science pretty much has the lock. Anyone who says different has the obligation of explaining how those other systems correct their errors.

  24. #24 Prometheus
    October 16, 2009

    How much does Dr Jay earn from the anti-vac loons?

  25. #25 Antaeus Feldspar
    October 16, 2009

    The words “experienced” and “inexperienced” aren’t relevant to the analogy; they’ve just been added because without them the answer is obviously “the one who relied on what he’d read”.

    Ekcol shoots – he scores!

  26. #26 Pablo
    October 16, 2009

    How much does Dr Jay earn from the anti-vac loons?

    Directly? Probably not a lot.

    However, how much does he benefit financially by being known as the “maverick doctor, fighting the evil man, and who is willing to listen to the needs of parents” in his cosy Beverly Hills practice? How many clients does he pull from his competitors through his public appearances and association with celebrity?

    Everyone knows Jenny McCarthy’s pediatrician. How many know Amanda Peet’s?

  27. #27 Sastra
    October 16, 2009

    Antaeus Feldspar #23 wrote:

    Recently, I’ve come to suspect that a lot of them subscribe to a common delusion: that the meat of science, the really tough part, the part that separates the real scientists from the wannabes, is devising hypotheses.

    Interesting. I’ve often thought that the common delusion was that the hard, significant factor in science is “trying something out for yourself.” Don’t just take people’s word on anything, or accept the overwhelming conclusions of multiple studies done over the space of many years in peer review literature. Instead, be a real scientist, and see if something really works by taking the pill, rubbing the ointment, or placing a bar of soap under your pillow — and then watch for the result. That’s a legitimate experiment, good as any.

    From what I can tell, the “other ways of knowing” which counter Western science aren’t really categorized as not-science: they’re science, too, but different kinds of science. After all, they all involve personal experience, and self-evaluation of the results. When you insist that science requires testable hypothesis, critical review, and replication of results, all they hear is that someone else’s “authority” is being placed over the authority of what you’ve seen with your own eyes, or what you felt with your own body. The “scientist” is being asked to go along with a powerful group which is trying to contradict his own experience, his own knowledge.

    Every person is a potential little Galileo.

  28. #28 Jayson Blair
    October 16, 2009

    “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.”

    You are assuming the scientists are competent to decide if it is good science or bad science.

    You are assuming the scientists will be unbiased in their analysis of the material.

    You yourself Orac have refused to discuss various subjects in this blog. You allow your personal feelings to interfere with scientific analysis and discussion.

    Your claim that scientists will give a fair hearing to, and make competent unbiased decisions about what is good or bad science, can easily be proven false using examples from this blog and the actions of the blog author himself.

    It is all a part of the internet record Orac. You cannot deny it and you can’t erase it. Google caches everything. Anyone can pull up examples of you refusing to honestly consider the statements of other individuals, and removing people who effectively contradict you from the conversation.

  29. #29 dedicated lurker
    October 16, 2009

    You know, if you’re going to criticize Orac for not being honest, using the pseudonym “Jayson Blair” doesn’t really help your case.

  30. #30 Chris
    October 16, 2009

    Happeh is back! (and pretending to be Jayson Blair)

  31. #31 bob
    October 16, 2009

    Jayson, I’m having troubling finding what you’re talking about on Google. Would you mind providing some links? Feel free to get in a dig by posting a LMGTFY link.

  32. #32 FYI...
    October 16, 2009

    dedicated lurker, “Jayson Blair” is just the resident whackaloon H*ppeh. He’s whining becuase he’s not allowed to play around here anymore on account of his persistent off-topic, racist, sexist, jackassery.

  33. #33 IBY
    October 16, 2009

    Hhmmm… Jason, you are not Happeh or something, right?
    Whatever it is, he already answered thatt claim. Science is self correcting. There are all kinds of measures involved in science which, if it goes off tracks, puts it back on tracks. In fact, why you picked that quote exactly, I don’t get it, because you are contradicting yourself. So stop with the dishonest bull.

  34. #34 Get in line...
    October 16, 2009

    Get in line for your Swine Flu shots people. Dopes.

  35. #35 KWombles
    October 16, 2009

    I’ll take evidence-based medicine over Dr Jay’s brand of medicine any and every day. I get that medicine is partly art. I get that we don’t know or understand everything about the body and how things can go wrong.

    I’d like to know that my doctor relies heavily on what we empirically know to be true rather than on what a bunch of patients have told him or what he feels to be true.

    I don’t expect my doctors to be infallible; in fact I expect that mistakes will inevitably happen. It’s my job to be aware and ask questions. It’s my doctor’s job to be as knowledgeable as possible and to admit where it is fuzzy and he doesn’t know, so that we can make the best decision that the evidence will allow.

  36. #36 Jud
    October 16, 2009

    Was listening to “Talk of the Nation” (NPR talk and call-in show, often reasonably informative guests and callers – I really like “Science Fridays”), with Dr. Paul Offit as a guest speaking about the swine flu vaccine.

    A caller said he wasn’t intending to get the vaccine for himself and his family, essentially due to suspicion of anything the government seems to want to force on him. (The more the government tries to get the word out, the more counterproductive it might be with people who think this way.) When you think of all the folks who were protesting “death panels,” etc., it seems to me this sort of generalized suspicion of big government and big business may be responsible for a much larger proportion of the unvaccinated than the Jay Gordons of the world. (Jenny McCarthy may have an outsized influence due to the Oprah connection.)

    A couple of decades ago this sort of suspicion was effectively counterbalanced by a sense of public duty encouraged by the mass media of the day. But today a large part of the citizenry can and does choose to consume media that foments rather than counterbalances such suspicions.

    I wonder what sort of effect it would have if Rush Limbaugh, Glenn Beck, Bill O’Reilly, etc., did PSAs encouraging vaccination?

  37. #37 Orac
    October 16, 2009

    You yourself Orac have refused to discuss various subjects in this blog. You allow your personal feelings to interfere with scientific analysis and discussion.

    Hi, Happeh.

    Bye Happeh.

    Again.

  38. #38 Anthro
    October 16, 2009

    @James Sweet and Poogles:

    I don’t know who this Amy Tuteler is, but will look into it! Sorry, I thought it was just a NY Times Reader and didn’t think about it being someone with an axe to grind. I find this especially uncomfortable because I had three of my four children at home. I’m not going to debate that here and I can see where home birth would get lumped in with woo, but I don’t regret it for a moment and would be happy to discuss it with anyone who is interested. I have never promoted home birth for others as I realize for many it’s just another new age whim along with anti pharma and anti vax type of views and that wasn’t my focus at all. I just have babies really quickly and decided to get well-prepared instead of having them in the car on the way to a hospital.

    I still think the comment I quoted from the Times is very relevant to the overall issue we all talk about here (the increasing prevalence of woo) and more interestingly, why this should be so.

  39. #39 Orac
    October 16, 2009

    I wonder what sort of effect it would have if Rush Limbaugh, Glenn Beck, Bill O’Reilly, etc., did PSAs encouraging vaccination?

    Not gonna happen. Rush Limbaugh and Glenn Beck, at least, have spoken out against vaccination for H1N1, as I recall.

  40. #40 Jennifer B. Phillips
    October 16, 2009

    Not gonna happen. Rush Limbaugh and Glenn Beck, at least, have spoken out against vaccination for H1N1, as I recall.

    Yup, and Rush at least did so in an “I’m not going to get vaccinated now *because* Kathleen Sebilius told me to get vaccinated and that’s SOSHULIZM!!11″ rant that was ridiculously childish even by his standards.

  41. #42 Mithrandir
    October 16, 2009

    One big problem with Jay’s engineer analogy is that it fails as an analogy, at least if he’s trying to cast himself as the engineer “who integrated life’s experiences with research”, because he’s not inergrating research, he’s arbitrarily rejecting it.

    So to answer Jay’s question: “I’d rather have either engineer than one, like you, who ignores the research and relies solely on his personal experience.”

  42. #43 Jeff Read
    October 16, 2009

    …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?

    I love this — people whose life experience trumps everything. “I don’t care what scientists with their foolish books say — acupuncture works because it cured my rheumatoid arthritis/fibromyalgia/cold/cancer/other! Until you have experienced it for yourself, you have no room to talk.” You don’t need to have gone on the Apollo missions and experienced the spherical Earth firsthand to know that anyone who tells you they have firsthand knowledge of the Earth being flat belongs in the loony bin.

  43. #44 Prometheus
    October 16, 2009

    Mithrandir points out some problems with “Dr. Jay’s” aerospace engineer analogy. I’d like to recast this analogy in a way that more accurately represents the situation as “Dr. Jay” has created it:

    Old Analogy –

    “…would you like to fly on a plane designed by an experienced aerospace engineer who integrated life’s experiences [1] with research or one designed by an inexperienced engineer who relied exclusively on what he’d read?”

    New Analogy:

    …would you like to fly on a space craft [2] designed by an experienced aerospace engineer whose previous work experience consisted solely of designing ultralight aircraft [3] or one designed by an aerospace engineer who had education, training and experience in manned space flight [4]?”

    Footnotes:

    [1] “Life’s experiences” is just a “touchy-feely” way of saying “experience”. Everybody – even research scientists – “integrates” their “life’s experiences” into what they do. The important thing to remember is that “life experience” won’t help you to understand the immune system or the replication cycle of a virus or even how to build an airplane. You need education for that.

    “Dr. Jay” appears to be trying to make a “straw man” here – implying that his “vast experience” as a paediatrician somehow gives him special insights into the immune system, virology etc. that other people (especially anonymous ‘bloggers) cannot have. While his knowledge of these topic exceeds that of the general public, it falls woefully short of what he thinks it is (and far, far short of what many people on this ‘blog possess).

    [2] Dr. Jay’s “thirty years of experience” is in general paediatrics. He does not have any special grasp of epidemiology, microbiology, virology, etc., as he has proven repeatedly on this very ‘blog. Comparing what “Dr. Jay” does to what research scientists do is comparing apples and orangutans.

    [3] As much as I respect our paediatrician and paediatricians in general (with a few obvious exceptions), she would be the first to say (and has said to me) that most doctors have no real experience in doing research or even understanding how to evaluate the scientific literature. “Dr. Jay”, by his statements, it not an exception to this general rule.

    [4] “Dr. Jay’s” experience in paediatrics does not make him an expert on (or competent in) the fields of epidemiology, immunology, virology, microbiology or virus ecology. Even “thirty years of experience” as a general paediatrician does not substitute for the specialized education, knowledge and training needed to master these fields. The “experience” sword cuts two ways – many of the people on this ‘blog have decades of experience in biological research; something “Dr. Jay” utterly lacks.

    Prometheus

  44. #45 D. C. Sessions
    October 16, 2009

    Oddly enough, Anthro may have done a very good thing here.

    $DAUGHTER is a social psychologist and it dawns upon me that the social psychology of the Mommy-board subculture is well worth research. In fact, getting an NIH grant for that work should be a slam dunk with reasonable preparation since the public health impact is so easy to establish.

    Not her subfield, but she knows a bunch of others. Hmmm.

  45. #46 desiree
    October 16, 2009

    Anthro, dr. amy’s old homebirth website is http://www.homebirthdebate.blogspot.com/ if you’re curious. IMO, she makes fair points about homebirth advocates (that they make a lot of claims they have no evidence for) and about the homebirth research (as of 2008, inadequate. mostly badly done, some possibly dishonest, others far too small to be helpful). she goes a step too far (again, IMO) in putting too much stock in her own re-crunched numbers. it took hundreds of thousands of VBAC births to even begin to clearly conceptualize the risks, and as of 2008, the homebirth research didn’t even approach those numbers. still, i think she is a useful resource in looking critically at homebirth.

  46. #47 riotnerd
    October 16, 2009

    As is always the case, what’s needed here is a logic professor. I am one. What Dr. Jay and others need to sort out is the difference between two variations of classic logical fallacies.

    We are all, I hope, familiar with the ad hominem (attack on the person) and the ad vericundiam (appeal to unqualified authority) fallacies. One commits the former by fallaciously disregarding an argument because or the person making the argument and one commits the latter by asserting that something is true because someone said so despite the fact that that person is not really an expert.

    The first thing it is important to understand is that these are two very very different kinds of fallacies. The ad hominem fallacy falls in the category of fallacies of relevance. That means that the reason it is not a good argument is that it relies on evidence that has nothing what-so-ever to do with the conclusion. The ad vericundiam fallacy, on the other hand, is a fallacy of weak induction. That means that it is an inductive argument and the evidence or premise does have something to do with the conclusion, that is, the evidence is a reason to believe the conclusion but it is not a good or reliable reason.

    Finally, we need to introduce common variants of these two fallacies and then we can parse Dr. Jay’s foolishness. Typically when we think of the ad hominem we think of the ad hominem abusive wherein the person making an argument is attacked simply for who they are, i.e. what Orac says about vaccination is nonsense, he’s such creepoid he doesn’t even use his real name. The variant, which one actually sees much more often, is the ad hominem circumstantial. In this version of the ad hominem the person making the argument is not attacked directly, rather their motives are attacked, i.e. what Orac says about vaccination is nonsense, he’s just in it for the pro-vax groupies. The ad vericundiam fallacy, on the other hand, is something we usually come across in the form of someone who is an expert in one field making claims in some other field because they are an “expert,” i.e. I hold a degree in engineering and teach advanced courses at MIT so I know what I’m talking about when I say the universe was made with a plan by a designer. The variant we need to keep in mind is the version of ad vericundiam that occurs when we cite someone who is in a legitimate position to speak on the matter but for the fact that what they are saying expresses a strong and clear bias, i.e. As a board certified forensic psychiatrist I believe my ex-wife is too bat-shit crazy and evil to have custody of our children.

    Both fallacies have to do with the veracity of testimony but there is a substantial and extremely important difference. The ad vericundiam is a fallacy because it asserts that something is true based on shaky evidence, so we ought to ignore the conclusion because the evidence is inadequate. On the other hand, the ad hominem fallacy doesn’t go wrong because it provides shaky evidence, it goes wrong because it evaluates the argument without considering the evidence at all. Put another way, the ad vericundiam fallacy happens when we treat a subjective claim as if it were objective by taking any old persons word for it while the ad hominem treats an objective claim as if it were subjective, by acting as if the inference from the premises to the conclusion is dependent on the person making the argument. As I tell my students, If the Pope decides to save the world by arguing that if A is bigger than B, and B is bigger than C, then C is bigger than A, the Pope is wrong. If Zombie Hitler says the key to killing all the worlds adorable puppies is found in the fact that A is bigger than C given the same premises there is nothing we can do about it, ZH is right.

    In a nut shell, and what I probably should have said from the start, is that Dr. Jay and many many other people get wrong is that they think they are calling B.S. on an ad vericundiam when they are in fact committing an ad hominem.

    It is rational to question a claim because of the person making it, it is both fallacious and stupid to question an argument for the same reason. Arguments are good if the facts of evidence are true and the inference from the evidence to the conclusion is strong/valid.

  47. #48 BA
    October 16, 2009

    Dr. J, Dr. J? Too painful to reply?

    When I don’t know how to interpret something, I find someone who can and ask them for help. You are getting it without having to ask. The least you could do is accept that help.

  48. #49 Pareidolius
    October 17, 2009

    Analogy fail Dr. Gordon. Interestingly enough, I don’t thing any of the engineers who designed the majority of our spacecraft had any experience in in space travel. I know some of the astronauts consulted with Rockwell on the LEM’s development (I’m talkin’ to you Neil Armstrong), but for the most part, our astronauts had to trust in “number crunchers” and “slide-rule jockeys” to design and build vehicles in which they could pilot themselves safely to the moon and back.

    The same goes for flying Cassini 1.2 billions kilometers and threading the needle of Saturn’s rings to place a school bus-sized probe into a perfect orbit. Did they use “old country doctor” hands-on experience and common sense to accomplish that feat? No, they used physics and math. Lots and lots of math.

  49. #50 titmouse
    October 17, 2009

    Hey that was cool, riotnerd. But let me make sure I understand.

    If my opponent makes an argument, I can’t fairly call him a douche. I must examine his argument.

    If my oppenent makes a factual claim, I can call him a douche, if being or not being a douche is relevant to his credibility in bearing witness to the claim.

  50. #51 riotnerd
    October 17, 2009

    titmouse,
    You got it!

    If some douche tells you that crystals can heal you for five easy payments of $5.99 you can just call him a douche. If the same douche explains to you why his crystals can heal you, you can’t call him a douche until he trots out his argument, at which point you can call him a douche who is also bad at science and thinking.

  51. #52 titmouse
    October 17, 2009

    at which point you can call him a douche who is also bad at science and thinking.

    You make me think we need three categories of response, each serving slightly different ends.

    1. Show the weak basis for his factual claim.
    2. Show the flaw in his argument.
    3. Let your freak flag fly.

    So…
    1. If acceptance of an opponent’s factual claim requires acceptance of his credibility though he be a douche, one ought to helpfully point out his douche-ness.

    2. An opponent’s douchebaggy nature really is beside the point whilst sacking his logic.

    3. If an opponent be a douche, saying “douche!” does make one’s feelings plain. Free expression is no doubt cleansing of thetans or toxins or engrams or something that might cause adverse health effects if allowed to remain bottled up inside.

  52. #53 Amy Tuteur, MD
    October 17, 2009

    “Tuteur is kind of like the Orac of home birth”

    Wow, high praise indeed. That’s exactly what I have tried to do, be the Orac of homebirth. Of course I am viewed within the “natural” childbirth community as the spawn of Satan (or worse), but that’s a small price to pay.

  53. #54 Corina Becker
    October 17, 2009

    I find it completely hypocritical for a doctor such as Dr. Jay to be so idiotic and lazy about studies, and yet takes on anecdotes as data and evidence. This does not sound like a person who successfully studied medicine, nor have the sound reasoning to practice medicine.

    But then, of course, immediately dismissing all studies based on funding must leave him a lot of time to grace us with his presence and call us mean because we’re critical of his scientific understanding.

    Seriously, I’m not even a scientist, and I can see flaws in his reasoning. If he doesn’t think any study is or will be sufficient to prove any case, then he really has no ground to stand on regarding any scientific matter. Since he bases his medical viewpoint on anecdotes and gut-feelings, then maybe he’s in the wrong profession. But then, I don’t think all faith-healers get this much publicity or money.

    Finally, I must say that I have said before is my individual opinion and my expression of contempt for Dr. Jay.

  54. #55 Alison
    October 17, 2009

    Dr. Amy – quite honestly I think you taking on Home Birth and the mythology surrounding natural parenting (and of course the Sanctimommies) is a breath of fresh air. I don’t always agree with you on every thing, however I enjoy reading your blog!

    Meh, who needs science… my gut is all I need (well maybe not, isn’t my gut filled with parasites and whatnot?? ;) )….

  55. #56 Iain George
    October 17, 2009

    A bored Saturday surfing on the internet led me to this – http://www.whale.to/vaccine/sf.html – load of woo.

    http://www.whale.to/vaccine/typhoidmary.html – “Whether or not the doctors find typhoid bacilli in the patients does not prove a thing, because all kinds of germs are found in sick people. The germs do not cause the disease; they evolve out of the dying cells and do a useful, remedial work.”

  56. #57 Chris
    October 17, 2009

    Iain George, hence the existence of Scokpie’s Law:

    In any discussion involving science or medicine, citing Whale.to as a credible source loses you the argument immediately …and gets you laughed out of the room.

  57. #58 Dangerous Bacon
    October 17, 2009

    I was saddened to see that in an otherwise good article in the N.Y. Times yesterday on the H1N1 vaccine, our intrepid antivaxer, Dr. Jay did not get a mention. Instead the Times quoted Barbara Loe Fisher for the Loe-down on what antivaxers are trying to do during the current outbreak to advance their agenda (breaking with the usual lazy/misguided media tradition of giving equal weight to “both sides”, the Times actually gave the knowledgeable, evidence-based proponents of immunization more space than the wack-a-doodles).

    Poor Dr. Jay. He’s getting shut out of the mainstream press when they look for antivax spokesmen, and instead having to spread his message on websites like Cookiemag.com. Even the popular alt med crazy-sites aren’t seeking out Dr. Jay (it’s been ever so long since he had an update posted on Mike Adams’ “Natural News”).

    The problem may be that Dr. Jay’s views are too ridiculous for him to be taken seriously as a “maverick” voice by mainstream media, and yet not nutty enough to appeal to the conspiracy-drooling antivax outlets. For instance, when rense.com goes to war on the subject of H1N1 vaccine, their go-to guy is “public health expert” Dr. Leonard Horowitz:

    “From the White House to Oprah.com, H1N1 swine flu vaccine promoters and promotions, costing taxpayers tens of millions of dollars, are serving ‘BigPharma’ advancing a genocidal agenda,” reports public health expert and media analyst, Dr. Leonard Horowitz. “Dismissing harmful vaccine side effects that may sicken millions of people following injections of immune-system intoxicating chemicals, heavy metals, viral proteins, and foreign genetic materials reflects gross criminal malfeasance,” he says.”

    See, Dr. Jay – to get that prime media exposure you have to step up your rhetoric a notch – instead of darkly hinting about Big Pharma’s promoting vaccines just to make money, you need to expose a full-blown Genocidal Agenda. And you must go beyond lambasting the bevy of research vindicating the safety and efficacy of vaccines and its evidence-based supporters, and tie them into the conspiracy too!

    Fulminate, Dr. Jay! Otherwise the publicity express will pass you by.

  58. #59 Alison
    October 17, 2009

    You gotta love that Dr. Horowitz (the Public health expert who trained as a dentist) is hawking “OxySilver”.. $49.50 for an 8oz bottle..

  59. #60 hermit
    October 17, 2009

    Do you find Cochrane’s Tom Jefferson and his body of research about influenza vaccination to be “anti-vax” too?
    Somewhere in the middle of all of this lies the truth. Your tone throughout this entire discussion is dismissive of the very real credibility problem that your profession now faces and laying it ALL at the blame of conspiracy wacko’s and showmen is disingenuous.

  60. #61 Chris
    October 17, 2009

    hermit, is Dr. Jefferson the subject of this blog posting?

    You might want to try elsewhere, like:
    Flu Vaccine Efficacy
    and
    Crank “scientific” conferences: A parody of science-based medicine that can deceive even reputable scientists and institutions

    Enjoy.

  61. #62 trrll
    October 19, 2009

    The reality is that everybody is biased. On rare exceptions, one might do an experiment where all of the possible outcomes are equally appealing, but usually, one possible outcome is more novel, more publishable, more consistent with our hypothesis and previous data, or simply more interesting than the others. Bias can manifest in multiple ways:

    1) Biased discussion or interpretation: I see this in most papers. The discussion highlights results that fit the investigators’ hypothesis, with minimal discussion of alternate explanations, while there is extensive discussion of how apparent discrepant results could be accommodated without changing the core features of the hypothesis. Peer reviewers may demand that the authors acknowledge other possible interpretations of their data or weaken the language (e.g. change “demonstrates” to “suggests”), but this rarely goes so far as requiring all possibilities to get equal emphasis. Experienced scientists expect this and compensate for it, drawing their own conclusions from the data rather than simply accepting those offered by the authors.

    A good example is Merck’s VIGOR study of rofecoxib (Vioxx). The data showed that patients chronically treated with rofecoxib had a higher rate of cardiovascular complications than those receiving naproxen. This was forthrightly acknowledged, but the authors speculated that this could have been due to the lack of a protective effect of naproxen, rather than a harmful effect of rofecoxib. This was plausible–some earlier studies had suggested such an effect (although current evidence suggests that all NSAIDs, with the possible exception of low-dose aspirin, carry some degree of cardiovascular risk). But this looked a bit like wishful thinking, because the magnitude of the hypothesized protective effect of naproxen was toward the high-end of what was suggested from other studies. So if you just read the conclusions–fewer GI complications with rofecoxib–you could easily have missed the red flag that was clear in the data. Merck was probably more worried than they let on, because they carefully monitored cardiovascular problems in the subsequent APPROVe trial, and pulled the drug when the problem cropped up again.

    So in one sense, this is an example of the kind of bias that could result in industry-funded research tending to reach more favorable conclusions for drugs than independent studies (as a number of surveys have documented). On the other hand, if you simply rejected all industry-funded research without bothering to think about the data, as Dr. Gordon advocates, then you would not have received an early warning of the possible cardiovascular hazards of NSAIDs.

    2) Data snooping: This probably is the second most common form of bias, and is a bit more insidious. In data snooping, the planned statistical tests do not show a significant effect supporting the investigators’ hypothesis, so they do a bunch more statistical tests, find something statistically “significant,” and highlight that in the publication. This is a problem, because the standard criterion of statistical significance, “p less than 0.05,” is really only appropriate for a study that uses a modest number of tests, because 1 in experiment in 20 is expected to meet that criterion purely by chance even when there is no real effect. So if you do a couple of dozen statistical comparisons, a barely “significant” result is quite likely to be a statistical artifact, and a more stringent criterion is required. Honest, rigorous researchers disclose what are the primary measures being tested in a study, which are considered secondary, and which are after-the-fact “exploratory” data analyses, so that readers have an idea of how much confidence to place in a result. Failure to do this is more difficult to catch, although an alert reader can often pick up the telltale signs of data snooping, as Orac did in examining the recent study by Wakefield’s group that claimed to detect subtle adverse effects of vaccines in monkeys.

    3) Selective publication. This is also fairly common. An investigator is more likely to seek publication of results that fit his hypothesis, and journals are more likely to accept reports of positive findings than negative ones. While many advocate that negative results should be published, the line between “negative” and “inconclusive” is often a fine one, and thus easily influenced by bias. Of course, this is no reason to ignore results that are being published, but it means that we need to be alert for “the dog that doesn’t bark in the night.” If an obvious study or experiment has not been reported, we tend to wonder why not. It is worth noting that it has become harder for pharm companies to withhold results of clinical trials, as clinical trials are supposed to be disclosed in advance on clinicaltrials.gov.

    4) Selective experimentation. A researcher is more likely to carry out studies that he expects to yield positive results. Many researchers are in possession of data from small, exploratory studies, which may not be definitive enough to publish, but that still provide a clue as to what is going to happen. This is almost always the case for clinical trials funded by pharm, as pharm companies typically have a lot of unpublished data from preclinical animal experimentation before they embark on human trials. This may be another reason why pharm-sponsored research is more likely than independent research to yield positive results, but again provides no justification for ignoring the results that are published.