Dr. Jay Gordon's profound misunderstanding of science

@Orac:

Which one of those cited examples (or changes in any other facet of medicine) came about because of anecdotes and Internet-fueled fears in direct opposition to scientific evidence, Jay?

Jay responds:

Initially, Bacon, all of them.

To be fair to Jay, I think that he meant that in the sense that "anecdotes can be used to generate hypotheses which are then tested". At least thats what I get out the "Initially".

It is exactly the kind of arrogance that Jay Gordon displays that has led to the use of clinical pathways in hospitals. Clinical pathways that are based on evidence not intuition or a a perceived superiority.

I am only speaking for Australia I should add. Gone are the days when you had a ward with 5 different protocols for the same procedure or condition based on 5 different doctor's preferences. Which were nothing much more than that, in most cases, preferences - because it made THEIR job easier

Well, haven't the antivaxers done a great job exposing the fraudulent vaccine-autism link to "greater scrutiny"? Their calls were heard, the matter was researched, thorroughly, and settled. They have don their job. Can they now please stop?

And another thought, since Jay seems to believe that the "change" in medicine will ultimately lead any fact, theory or hypothesis to be found wrong... will he be willing to accept the same for his side of the trench? That antivaxers will, nay MUST, one day find their ideas to be utterly wrong, even harmful?

I get the impression Jay's just passive-aggressive, plain and simple. I think the controversy he provokes is for the sake of provocation only. Which doesn't mean I don't find it profoundly irritating - I do.

Discussions with Dr Jay are like arguments about death between a devout person and an atheist. Nothing the atheist says can move the devout's faith in eternal life. Nothing the devout person says make sense to the atheist. Both start from points so distant there is almost no path to common ground. Absolute proof is lacking on both sides so the argument can only end when death settles it.

The difference between theoretical debates on death and scientific ones on vaccines is, as Orac states, the evidence. And of course the damage done to herd immunity and by resurgence of vaccine preventable disease.

MikeMa,Iv'e been spending a bit of time lately contemplating the anti/pro vax dichotomy too. As I see it the anti vaxer tries to convince people that vax is more dangerous than the disease. The pro vaxer tries to convince people the disease is more dangerous than the vax. Simple!
When one then looks at those who were damaged by the disease versus those who were damaged by the vax, not to mention all those who were saved damange by vax, then it is a black and white issue. Vax wins hands down.
I don't get the confusion.
BTW I have an Autistic child, so any one who wants to play the pity card can get f!@@#$.

I will credit him with one small thing: he IS right that people view "Science" as "RCTs", an ideology that is definitely promoted at the post-graduate medical education level (try talking to a doctor about the lab science behind chemotherapy rather than what the clinical trials say).

Also, today's SMBC seems rather well timed.

Sharon

As I see it the anti vaxer tries to convince people that vax is more dangerous than the disease.

Wrong!

The pro vaxer tries to convince people the disease is more dangerous than the vax. Simple!

Right!

I don't get the confusion.

Because you haven't bothered to understand the arguments.

Bloodletting actively caused damage to people, even killed them, increasing mortality by a factor of ten according to one crude clinical trial. It is very obvious to us now that removing several liters of blood from a weak and sick person is very unlikely to do any good (leaving aside some rare conditions involving iron overload). Yet doctors like Benjamin Rush who were at least as intelligent as Jay Gordon insisted that their own clinical observations proved to them that bloodletting was beneficial for almost every illness.

If clinical observation was unable to distinguish a large increase in mortality from an intervention, how reliable is it likely to be at detecting the relatively rare adverse effects attributed to vaccines by Dr. Gordon?

"Wrong!" "Right!"

Wow, Augustine, you've convinced me. How could I possibly fail to understand and agree with such cogent arguments?

Teach the controversy Augie! Then wipe the funyon grease off your hands, get off the computer, and head back upstairs. You're using up your mom's 500 free hours on the AOL CDROM she got in the mail.

Apparently a few more have simplistic notions like sharon.

LW

How could I possibly fail to understand and agree with such cogent arguments?

Because you don't want to agree therefore you don't want to understand. That's irresponsible.

Human rights and personal responsibility are not black and white issues that are solved by armchair quarterback scientist wannabes...or actual scientists(if there are any on here).

Augie troll,
Where's the evidence? Not anecdotes, credible evidence?

Not a question of wanting or not wanting. That is a child's approach to debate.

Putting on my Carnac the Magnificent hat, I'll have a go at Jay's answers:

What specific scientific evidence do you have to support your claim that the current vaccine schedule is unsafe.

"More than thirty years of clinical experience."

What specific scientific evidence do you have to support your claim that vaccines cause autism?

"More than thirty years of clinical experience."

What specific scientific evidence do you have to support your claim that vaccines cause asthma and all the other problems that you attribute to them?

"More than thirty years of clinical experience."

Maureen, you hit the nail on the head. I was thinking the same thing about the "clinical pathways" that we attempted to create on our surgical floor when I worked as an RN. Some of our residents would protest that they didn't need no (stinkin) pathways! They were doctors after all: They knew everything they needed to know and didn't need any protocols.
I guess that finally answers my question as to why physicians can embrace such utter nonsense as homeopathy, reiki, etc....Arrogance! They really think they know more, have more experience, have greater "intuition" based on anecdote, etc. Their egos allow them to become delusional.

@Augustine (8)
Exactly what does Sharon not understand?

"As I see it the anti vaxer tries to convince people that vax is more dangerous than the disease.
Wrong!"

What is wrong about that statement?

That is exactly what they try to convince people of. Sharon also could have added; "by forwarding completely debunked arguments, logical fallacies outright lies", but I think her point was concise and accurate.

Methinks Augustine needs to watch Monty Python's argument clinic sketch. He might thereby learn that "Wrong!" and "Right!" are not what we technically term "arguments".

"To be fair to Jay, I think that he meant that in the sense that "anecdotes can be used to generate hypotheses which are then tested". At least thats what I get out the "Initially"."

For Jay, however, the process doesn't need to go beyond anecdotes (a.k.a. My Vast Clinical Experience)*. Jay does not want to acknowledge that changes in medical practice are made on the basis of compelling evidence. If science has tested hypotheses and debunked them (as in the case of antivax fearmongering), Jay can readily dismiss it via undocumented claims of Big Pharma chicanery.

This is the sort of "thinking" that permits Jay and fellow woo-ists to cling to homeopathy, ingesting colloidal silver and the like, despite evidence of ineffectiveness and/or harm. In the dim and distant "someday" they will all be vindicated, and the skeptics who laughed (LAUGHED!) at them will be humbled. And besides, La-La-La-I-Can't-Hear-You and you're all a bunch of uncivil meanies anyway.

*When I hear Jay going on about his extensive clinical experience, I sometimes think of my father and his decades of clinical experience in family practice, both before and after the modern vaccine era began. When he started out, he had to worry about diseases like polio, measles and rubella infecting his patients (and his children). Both his clinical experience and respect for science led him to embrace immunization as a cornerstone of preventive medicine. I can only imagine what he'd think of specimens like Jay Gordon.

I think it's a little more complex than Sharon suggests.

Those opposed to vaccination (the most extreme ones anyway) seem to me to exclude as unreliable any evidence that does not fit with their prejudices. They also seem to me to frequently distort, misquote or otherwise misrepresent evidence to fit their prejudices.

Those favoring vaccination seem to me to have looked at all of the evidence and weighed up its relative reliability and implications. They have come to the conclusion that the probability of a serious adverse reaction to a vaccine is very much lower than the probability of an unvaccinated person catching the disease and experiencing serious complications from it.

As vaccination rates continue to rise and the diseases they protect against become rarer, at some point the (very small) probability of a serious adverse reaction to a vaccine will become higher then the probability of catching the disease and suffering serious complications.

This is when interesting philosophical questions of personal and social responsibility come into play. An individual could reduce their risk by not vaccinating, but if everyone did the same these diseases would return and thousands of people would suffer and die. The question then is just how selfish an individual is. I don't think we have reached that point with any vaccine-preventable diseases yet, but we will eventually.

The time I've spent at RI has changed the way I look at vaccines, autism, epidemiology and science in general.

"I am biased against science."

"As I see it the anti vaxer tries to convince people that vax is more dangerous than the disease.
Wrong!"

What is wrong about that statement?

From my perspective, the problem with that statement is that it implies that anti-vaxxers have actually thought about the real dangers of vaccination, and, more importantly, the risks of disease.

While there are certainly those who base their anti-vax positions on their denial of the risks of disease, I don't think that is common at all among that group. For the most part, their position is "VACCINES ARE EVIL!!!!!!!!!!!!!!!!!!!," generally involving a strawman about how they aren't "perfectly safe" with absolutely no consideration of any of the risks of the disease.

If I thought that anti-vaxxers come to their positions through careful cost-benefit analysis of the effects of vaccination, it would be a different situation completely. In that case, we can have a rational discussion about what are the costs and what are the benefits. But when you hear the screeches of "OMG the TOXINZ!" it's not about rational analysis.

I was actually going to respond to Sharon's statement about this. I disagree with her characterization because I think it is far too generous to the thought processes of the typical anti-vaxxer.

I haven't been following cardiology. What's up with statins?

What specific scientific evidence do you have to support your claim that vaccines cause asthma and all the other problems that you attribute to them?

To be fair, there is some evidence (will try to dig up studies if anyone's interested) that might suggest that vaccination is involved in increased rates of asthma-but in the exact opposite way that anti-vaxxers suggest.

Decreased exposure to antigens may be driving an increase in asthma and allergies. So maybe having children exposed to a single, purified antigen instead of the whole mess of antigens in, say, chicken pox, contributes to the problem. But in that case, shouldn't the rallying cry be not "too many, too soon", but rather, "more, sooner"? If inadequate exposure is, as it seems to be, the problem, increasing the number of vaccines would be better than decreasing them. Especially in a herd immunity situation where exposure to the natural antigen is low.

Of course, there are safer ways to be exposed to antigens. Let the kid run around outside a bit. Stop autoclaving their toys. That sort of thing. They'll get exposed in no time.

Final thought: there is some (weak) evidence that people with allergies are less likely to get brain tumors than those without. Maybe a little allergic rhinitis is no bad thing? Asthma is taking it too far though. Immunology is a tricky field and Dr. Jay et al can reasonably say we don't understand it all yet. But we do know, as securely as we can know anything, that vaccines have nothing to do with autism.

Dianne, as a child of the 50s I grew up in a mixed household: Mother was of the "no germ is a good germ" school and Dad was a farm boy who figured that dirt was good as long as you didn't track it in and you washed before dinner.

Worked for us, but "good honest dirt" is hard for some kids to get.

Which brings the actual point and question: for all the earned Disrespect that "probiotics" get here and elsewhere, I sorta recall trials of a nasal spray for infants loaded with benign bacteria. Any news on that front?

Unfortunately, some doctors cater to the whims of patients because they see financial gain. Without caring for the consequences.

Education is the key, and unfortunately our country is failing this critical aspect of our community.

i set up an internet poll to settle the question of what causes autism. 23 out of 34 of the kindergarten aged responders agreed that blue Play-Doh tastes better than the red Play-Doh.

As I see it the anti vaxer tries to convince people that vax is more dangerous than the disease. The pro vaxer tries to convince people the disease is more dangerous than the vax.

I agree with this statement.

We are never going to change the minds of the dedicated anti-vaccine crowd. My goal in discussions with them, or any other supporter of pseudoscience is to persuade those who are undecided and coming to the issues without understanding that one side is backed by solid research and the other is not.

As I see it the anti vaxer tries to convince people that vax is more dangerous than the disease. The pro vaxer tries to convince people the disease is more dangerous than the vax.

I agree with this statement.

We are never going to change the minds of the dedicated anti-vaccine crowd. My goal in discussions with them, or any other supporter of pseudoscience is to persuade those who are undecided and coming to the issues without understanding that one side is backed by solid research and the other is not.

This is a great post. I'll try to respond as soon as I can. I am flattered beyond words right now.

Science begins as someone's thoughts and anecdotes and continues to serious research and serious clinical studies. Not everyone agrees as things begin to change. Sometimes the conclusions reached are 180 degrees away from the original hypothesis based on anecdotal experience. Sometimes conclusions reached in 2011 are 180 degrees around from those of 2008 or 2009.

Again, thanks for opening up this topic and I look forwarded to a spirited exchange.

Best,

Jay

Any credible studies going on as a result of those thoughts and anecdotes, Dr Jay?

Sometimes conclusions reached in 2011 are 180 degrees around from those of 2008 or 2009.

This is certainly possible. What specific conclusions do you have in mind? I can't think of any major paradigm shifts involving vaccination that have occurred in the last 2 months, but perhaps I've missed it.

@25

Thanks, I needed a good laugh.

@MikeMa #29:

No, of course not. Dr. Jay's personal clinical experience trumps all of medical science. We may as well give up-- we only have science on our side. How can we possibly stand against one certain man? Why should he bother testing that which he knows to be true?

I personally hate argument by quotation, but Dr. Jay would be well-served to spend some time thinking about Feynman's comment:

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.

@ Dianne:

Jay's just saying that to try and duck the fact that, in this case, the science HAS gone on to serious research and serious clinical studies. And he's been proven wrong quite thoroughly. It's the classic "but science can be wrong" gambit.

Yes, it's possible that the scientific consensus could change, but that is not evidence that Jay is right. And if it DOES change it will be through additional serious research and serious clinical studies, not through All-Knowing Infallible Jay's Infinite Knowledge and Wisdom.

Research never ends - because you never know when the next big breakthrough (or incremental improvement / discovery) will occur. Quite a number of studies have started in one direction & ended up with results that were very much different than the original hypothesis. That's why testing and research continues - and as new technology becomes available, things that we couldn't test for in the past, we can now either confirm or deny with the new information that is available.

Now, do I expect that we'll suddenly discover Homeopathy is real? Of course not - because the fundamentals are so incorrect (and physically impossible) that no amount of research will prove otherwise.

Will the development, manufacture, and dispersal methods of vaccines continue to improve? - of course. We already took a big step with the advent of oral & nasal vaccines, instead of additional shots (or in place of the original shots).

One only needs to look at the total number of antigens that are part of the current vaccine schedule, which number less than we had back in the early 90's, even though we had fewer vaccines back then.

And to conduct research, we do need to have an original hypothesis - and in the case of regular medical science, these educated "guesses" are put to the test.

In the case of anti-vaxers, they have the original idea & it is just accepted without any evidence whatsoever.

Science begins as someone's thoughts and anecdotes and continues to serious research and serious clinical studies.

But not every anecdote becomes science. At every stage of the process, the vast majority of ideas die because they are wrong.

Science begins as someone's thoughts and anecdotes and continues to serious research and serious clinical studies.

But that's not exactly what you said; you seemed to claim that anecdotes and Internet fear mongering lead to change. I suppose you might be right in one respect. Anecdotes and Internet fear mongering have led scientists to study whether vaccines cause autism. The resounding answer to that question is: No, there is no scientifically sound evidence linking vaccines to autism.

Not everyone agrees as things begin to change. Sometimes the conclusions reached are 180 degrees away from the original hypothesis based on anecdotal experience. Sometimes conclusions reached in 2011 are 180 degrees around from those of 2008 or 2009.

Ah, the old "science was wrong before" argument. How disappointing and predictable. Before you persist in this argument, Jay, you might want to read these two posts first:

http://skeptico.blogs.com/skeptico/2005/11/science_wrong.html

http://www.ukskeptics.com/article.php?dir=articles&article=science_has_…

Here's the problem: Show me the evidence that science is wrong (or might be wrong) in this case. Simply asserting that it's wrong or that today's scientific findings might be overturned is not enough. Also, before you bring up the example of H. pylori, which almost inevitably follows the "science was wrong before" argument, you might want to read these:

http://www.csicop.org/si/show/bacteria_ulcers_and_ostracism_h._pylori_a…

http://www.sciencebasedmedicine.org/?p=4238

http://www.sciencebasedmedicine.org/?p=4418

The other example that almost inevitably follows is that of Ignaz Semmelweis. It's a case that is more complex than it is typically represented, but I don't have time to explain how right now.

Dr. Jay would be well-served to spend some time thinking about Feynman's comment:

Did Feynman have over thirty years of clinical exeperience�

this SMBC comic says it all

DC,
No, from what I've read, Feynman lacks that extensive clinical background, but Feynman didn't take himself so seriously either.

It seems to me that in a number of cases in which medical practice has changed, it's simply taken some time for medicine to catch up with the science. So yes, people on the internet, or at conferences, or wherever, *may* know something that a practicing GP somewhere doesn't know, especially in an area where practice lags behind research (for example, outdated approaches to the management of type II diabetes).

Then there's the problem of subpar doctors. They start of thinking that it's their job to approach patients with a mental flow-chart and they end up over-prescribing drugs in cases where the cost/benefit analysis doesn't add up. Then when they notice that they're doing more harm than good, they start trying to reinvent science from scratch, as if they just discovered it for themselves. And they end up working only with their own experience and observations. Reiki worked BETTER than the drugs! Simply not taking the drugs would have worked better than the drugs, if they never shouldn't have been prescribed in the first place. Holistic approaches work BETTER than treating patients like statistics without ever looking up from their charts! And so forth.

The difference, Dr. Gordon, is that there have been studies done on the vaccine-autism question that resoundingly state that there's no link between the two. So instead, what I hear from you and others is essentially the argument that because you've *seen* autistic regression after vaccination that vaccines are the cause of said regression. It doesn't matter what the research says, dammit, you know from the evidence-that-shall-not-be-disclosed that you're right.

That isn't science, Jay. That's faith.

@SW - That should read "start OFF" and "never SHOULD have been prescribed". Also, I realize my post sounded condescending. The *best* GP's are open minded because they really do understand the scientific process! But the relationship of clinical experience to the erroneous received wisdom of the medical tradition shouldn't be confused with the relationship of clinical experience to the real conclusions of good research.

what I hear from you and others is essentially the argument that because you've *seen* autistic regression after vaccination that vaccines are the cause of said regression.

Anyone up for a quick round of correlation=/=causation? I've seen-more than once-cytopenias improve after a bone marrow biopsy. No specific treatment, just improvement in cytopenias, sometimes long standing, after biopsy. Does that prove that bone marrow biopsy cures cytopenias?

Off to work now--late as usual--but I'd like to clear up one misconception before I go. I don't think my long clinical experience trumps or supersedes real research and expertise. I just think that it adds to a discussion. If I've ever implied that because I've seen "25 cases of X following Y . . ." and someone who studied thousands of incidents of Y not being related to X has lesser data, that was wrong. Large controlled studies are needed to draw real scientific conclusions. But blind faith in these studies has led to large errors.

In order to write most of your posts, David, you have to ignore how wrong "science" has been on countless occasions over decades. You have to ignore the initial responses to the ideas, hypothesis and instincts of experienced clinicians. Once you begin ignoring that, lapse into sarcasm and disdain, your fingers can fly over the keyboard. You can be so much better than that.

To summarize: My anecdotes and experience do NOT supersede real research. But that research, just like some of my anecdotal conclusions, can end up being found just plain wrong.

Best,

Jay

science is wrong
No, science is often icomplete. Scientists who fool themselves, or allow themselves or their work to be misled and/or misrepresented, are often wrong.

A smoke anybody? Because almost every institution has major baggage that depends on protecting or projecting misrepresentations. Some are built heavily upon them. MCI and Enron were not unique phenomena.

Some claim vitamin D3 is a potential key as a hypothesis in the resolving the autism debacle, and to a degree for other reasons, the vaccine schedule. Other nutrients may reduce adverse reactions and recovery, greatly. Poor nutrition affects illness burden.

To me, much of the way forward to optimizing and resolving some vaccine adminstration issues concerns the nutrition wars, where the proposed radical changes in vitamin D3 applications represent a only single ray of light into a long darkened, and poisoned, hinterland.

Jay - how exactly is research found to be wrong? Why, with more RESEARCH!!!!

People just don't suddenly decide the X is wrong & Y is right - you actually have to take the time to do the work to find out if its true.

You've made a lot of suppositions here, none of which have been based on actual medical research and results. Thoughts, feelings, opinions, etc. mean nothing in the face of concrete evidence.

Again, sure, researchers have been wrong - but in the end, it is only more research that ultimately finds the right answer.

Does anyone else hear in Jay's response Sarah Palin's infamous "I'll try to find you some and I'll bring 'em to ya?" answer.

Last night I expressed my despair for Jake, now I feel similarly for Dr. Jay (who is probably my contemporary):

When I started college, I came to visualize a certain campus byway as a division between two worlds: on one side I got to do my "drawing and writing" gig, on the other, bio and social sciences(primarily, psych and economics). I was very fortunate in that I was able take a major/near-major in 4 areas and manage to fulfill degree requirements.

I hold that many educated, bright people do not see as clear a boundary as I do, that one area of endeavor may bleed into the other. They have strong feelings and can be tempted away from the rigours of the scientific method. Our linguistic designing and abstracting proclivites might pull us away from the facts, the data, the numbers, the stat: drawing up a "cleaner" sketch, creating a more elegant, less complicated "story", so to speak. It's how our minds work. Our minds *also* can see our own tendency to do this and implement controlling restrictions, taking account of our *feelings'* influences as well.

Of course, we might channel our expressive needs into the service of communicating facts, data, and stat precisely, exploring ways to engage an audience or in constructing arguments to convince opponents of the merits of our own view point.

However, cling we must to data, replication of studies, and RCT's because of real world outcomes, the *physical* consequences that affect others profoundly, rather than just affecting ideas and opinions.

It's easier

Hi Jay. Your condesencion is, as ever, appreciated. You remain a dildo. Out of curiosity, does your signature spell FAP with two As because you do it so much?

Best,
Rory

To summarize: My anecdotes and experience do NOT supersede real research. But that research, just like some of my anecdotal conclusions, can end up being found just plain wrong.

Here's the problem. You clearly believe that the research IS wrong. No, no, don't bother to deny it. I could easily do a bit of searching on this very blog and bury you with your own words saying that you believe that vaccines cause autism--based on your clinical experience, of course. Here's the thing. That's not enough. Moreover, just because you believe current science to be incorrect on this issue does not mean that someday in some mystical future science will come around to your point of view. Indeed, it almost certainly won't, because the quantity and quality of the evidence from multiple sources and disciplines converging on the conclusion that vaccines do not cause autism is such that it is unlikely that future studies will find different results. Sure, it's possible, but it's quite unlikely. Clinging to such an unlikely hope that you will one day be vindicated by science is not an argument.

Our host, Orac, is a surgeon. Perhaps it doesn't happen often, but sometimes he'll be in the midst of an operation and find something completely at odds with the best pre-op scientific tools. Something completely different than the angiogram, CT scan or MRI showed.

At that point, he's forced to believe his eyes and his instincts and change the plan without the proof he'd like. His eyes and and his experience guider him as he does the best for his patient.

The best science and the best research must also include observation and experience.

Part of what we know now about pediatric practice will be deemed completely wrong within the next few months or the next few years.

Best,

Jay

Jay: "In order to write most of your posts, David, you have to ignore how wrong "science" has been on countless occasions over decades. You have to ignore the initial responses to the ideas, hypothesis and instincts of experienced clinicians."

Did you read the suggested links on the foolishness of relying on the "science wuz wrong before" argument? Might be well to do so before diving back into fallacy again.

Besides, Jay - in order to use homeopathy to treat children with ear infections, you have had to ignore not only anecdotal evidence of the uselessness of homeopathy, but a sizable body of research and elementary scientific principles debunking it. More than 200 years of woo-ful futility have ensued since Hahnemann first proposed them, but you're still plodding along with homeopathic remedies.

If (as you said before) you think we have a lot to learn from you, you need to set a better example.

To summarize: My anecdotes and experience do NOT supersede real research. But that research, just like some of my anecdotal conclusions, can end up being found just plain wrong.

This is nonsensical. Unless one wishes to claim that anecdotes and experience DO supersede real research, one must admit that the real research is the best available evidence. And then one must admit that the best available evidence does not indicate any link between vaccines and autism. And therefore, the idea that there IS such a connection must be (provisionally) discarded.

Interesting blog post. Its like a libel lawyers dream come true.

@Yoda

Can you point out the specific libelous statements?

Shorter Dr. Jay@44:

Paragraph 1: Of course my experience doesn't trump all of scientific research.

Paragraph 2: Sometimes science is wrong.

Paragraph 3: Based on my more than thirty years of clinical experience⢠this is one of those times.

Dr. Jay - do you believe homeopathy works, in the face of violations of various known physical laws?

"Part of what we know now about pediatric practice will be deemed completely wrong within the next few months or the next few years.

Best, Jay"

Please enlighten us on what we know will be deemed wrong? I'd like to know specifics.

@ D.C. Sessions:

Beautifully put! That does seem to be the crux of it.

I am so confused by Dr. Jay and his comments, which 1) are all over the map in terms of what he is saying and 2) imply that he can see into the future.

Jay's The best science and the best research must also include observation and experience misses one important fact. If Orac finds a second tumor his pre-op work up has missed, he for sure will adjust the operation to deal with this. If he finds a second tumor five times in the next operation, he will adjust his procedures to deal with it, and - wait for it - publish the new observation for others to study. And only then will we find out if Orac just had six very odd patients, or there's something wrong with the work-up and procedure that needs to be changed.
We're still waiting for Jay's published observations, documenting the frequency of vaccine induced autism, opening them up to public scrutiny.
Jay, the way science is proven wrong is by publishing a hypothesis, and backing it up with evidence. Waiting for science to be changed for you to fit your experience isn't going to happen unless you make your experience part of the science. I'm sure AAPS is perfectly willing to publish your results.

@Mu

Now, now. Dr. Gordon is too busy saving people to write up his observations and submit them for publication.

Correct me if I'm wrong, but isn't science the process by which we discover stuff? I mean, I could have been doing this all wrong all these years, but science directs me to look at a theory and test it. If my results are both plausible and reproducible, if I used controls and tried to account for bias and confounding, and if I was honest in the interpretation of the data, then the science is not wrong no matter if ten years or 100 years from now something comes along that modifies my conclusions.

What I'm getting at, Dr. Jay, (thanks for following on Twitter, by the way, I think)... What I'm getting at is that science really can't be wrong. The people doing the science can do it wrong. The method by which the evidence is analyzed can be wrong. But, to paraphrase Seth Mnookin and someone else whose name eludes me (they were both on NPR):

I can go to the top of the building and jump off and fall to the ground. I can do it a million times. I can do it a billion times. Does that mean that humans can't spontaneously fly? No. But it does tell me that a flying human is incredibly unlikely... So unlikely so as to not go jumping off buildings.

So you can try to associate vaccines with autism a billion times and still (somehow) say that vaccines cause autism... But the chance of you being right is so incredibly low that it's better to move on to stuff with better odds of being right.

It's been too long, doc. Put it to rest. Move on.

I somehow doubt that Jay even HAS any observations (meaning careful counting and recording of numbers) as opposed to vague impressions.

I've asked Dr. Jay several times in the past to tell us what his "experience" consists of in more precise terms. I've asked for figures, like number of autistic children in his practice, number of children who have regressed shortly after he vaccinated them (not referred to him because of his reputation), etc. He has always declined to respond.

I somehow doubt that Jay even HAS any observations (meaning careful counting and recording of numbers) as opposed to vague impressions.

Beamup, we've all noticed that but have been too considerate of Dr. Jay's obviously sensitive feelings to actually comment on it.

Orac, you may be right about that. The quantity and quality of the research out now, rife with bias of the publisher and it's pharmaceutical connections, may, frighteningly, continue to show results that are the same. I mean, you're right. If they keep using stupid tricks like Madsen counting a new group of autism diagnosed kids after they decrease thimerosal so it looks like thimerosal removal actually caused more autism! And, if they keep being able to get away with crap like that, of course the results will continue to be the same. But don't worry, people are joining forces to make sure that the stank of that kind of research is known.

No kidding jen, it was just a few weeks ago that we learned about how Wakefield faked his data. Keep on truckin'

At that point, he's forced to believe his eyes and his instincts and change the plan without the proof he'd like. His eyes and and his experience guider him as he does the best for his patient.

However, he does have the options of obtaining that proof by calling for an intra-operative pathology consult (frozen section or cytology), intra-operative xray, or deferring definitive treatment for a second surgical procedure once that proof has been obtained. As in many other areas, a useful guideline in cases like these is "trust, but verify".

Incidentally, it's my opinion that inappropriate antibiotic use in large part stems from "personal clinical experience" rather than following scientific evidence.

Incidentally, it's my opinion that inappropriate antibiotic use in large part stems from "personal clinical experience" rather than following scientific evidence.

I will take it the next step: that "personal clinical experience" is "if I prescribe it, they will go away and leave me alone"

In that respect, I think their "personal clinical experience" is right, but has nothing to do with treatment.

#51 "Part of what we know now about pediatric practice will be deemed completely wrong within the next few months or the next few years. ..."
Posted by: Jay Gordon, MD, FAAP | February 18, 2011 12:26 PM

Part of what you "know" about pediatrics is already deemed wrong. It is easy to find the literature in favor of vaccination.

I'd like to pause for a moment to compare this comment of Dr. Jay's above:

I don't think my long clinical experience trumps or supersedes real research and expertise.

to this one, which includes this gem:

Iâm not sure who invented the hierarchy which places anecdotal evidence at the bottom but I have invented a second hierarchy which places it higher. I have as much support for my hierarchy as you have for yours.

Yes, folks, we're dealing with someone who has said that the hierarchy of scientific evidence is simply an appeal to some Elder Scientist's authority, and that his anecdotes have real scientific value. Except today he disagrees with that statement, because it happened to suit him. Wonder what he'll say tomorrow?

T. Bruce McNeely says: "Incidentally, it's my opinion that inappropriate antibiotic use in large part stems from "personal clinical experience" rather than following scientific evidence."

Nope.

http://www.webmd.com/cold-and-flu/ear-infection/news/20110112/early-ant…

There are still pharmaceutical industry funded researchers out there publishing articles at odds with both clinical experience and solid scientific research showing otitis media responds to watchful waiting as well as it does to antibiotics.

Jay

In all fairness, I myself have criticized the hierarchy of evidence, but not because it places anecdotal evidence at the bottom. That I agree with completely. What I have a problem with is how it places basic science principles close to the bottom. It's that ranking scheme, in which RCTs trump all, that allows CAMsters to cherry pick equivocal clinical trials consistent with placebo effects as being superior evidence to the physics, science, and chemistry that quite definitively show that homeopathy is nonsense.

David, are all posts with a link in them held for review?

Jay

Not all, but if there are several links they are.

Jay plaintively asked: "David, are all posts with a link in them held for review?"

No, just the ones that threaten the New World Order.

Actually I've posted comments with and without single links that have been held for unknown reasons. And that's despite being a Pharma Shill in good standing. ;)

Jay, have you ever considered that chemtrails are responsible for the Autism Epidemic? I mean, science has never demonstrated that there is such a thing as chemtrails, but science has been wrong before. A lot of people have faith that chemtrails exist (take note, jen), and they started getting prominent attention right around the time reported autism cases began increasing. Government claims chemtrails don't exist, so what does that tell you?

This guy realized the truth, and it got him banned, in the same way that They are trying to keep Jay Gordon from posting!

Wake up sheeple!!!

Actually, posts with more than two or three links (I forget which) get automatically held up for moderation.

There are still pharmaceutical industry funded researchers out there publishing articles at odds with both clinical experience and solid scientific research showing otitis media responds to watchful waiting as well as it does to antibiotics.

And the weight of the evidence wins out. What's your point?

Bacon, you're contributing less to this discussion than I am. That's not like you.

"Plaintively??" I merely asked a question. Why bother to increase the unpleasantness with an unnecessary remark like that?

Your chemtrails post is not reductio ad absurdum it's just foolish. My ideas and posts are easy enough to attack without resorting to false equivalencies.

Jay

According to Dr. Gordon, "Part of what we know about pediatric practice will be deemed completely wrong within the next few months or the next few years." Gee, I wonder which parts he means? Dr. Gordon also stated in another blog that he has learned from posters here about epidemiology and immunology and that he is working within his group (The American Academy of Pediatrics) to change opinions about vaccines. I don't think he has been too successful as the Academy's policy papers on childhood immunizations (available on the web at the AAP website) are in accord with the CDC recommendations.

Other policy statements on that site state succinctly why infants and children should have timely, complete series of vaccines. As a result of woo medicine practitioners such as Dr. Gordon and his fellow-travelers, the AAP has issued policy statements about "the autism-vaccine link", "the thimerisol-autism link" and every other nonsense theory about the genesis of autism.

Dr. Gordon states he has learned about the science behind immunizations and the epidemiology of vaccine-preventable diseases from posters here. Really? Every one of the infectious diseases that he would ever see in a pediatric practice...their incidence, their prevalence, their epidemiology and the immunology science of each vaccine is covered in the AAP's "Red Book". I wonder if he has ever perused the book or the journal "Pediatrics" that the AAP publishes.

Is infant immunization a risk factor for childhood asthma or allergy?
Kemp T, Pearce N, Fitzharris P, Crane J, Fergusson D, St George I, Wickens K, Beasley R.

The 23 children who received no diphtheria/pertussis/tetanus (DPT) and polio immunizations had no recorded asthma episodes or consultations for asthma or other allergic illness before age 10 years; in the immunized children, 23.1% had asthma episodes, 22.5% asthma consultations, and 30.0% consultations for other allergic illness. Similar differences were observed at ages 5 and 16 years
-----------------

Thorax 1998;53:927-932 doi:10.1136/thx.53.11.927
Original article
Early childhood infection and atopic disorder
Logistic regression analysis identified three statistically significant predictors of subsequent atopic disease: maternal atopy immunisation with whole-cell pertussis vaccine and treatment with oral antibiotics in the first two years of life (2.07, 95% CI 1.64 to 2.60, p<0.0001)

"Dr. Jay" was probably in too much of a hurry to notice that he contradicted himself in his response (#45):

"I don't think my long clinical experience trumps or supersedes real research and expertise. I just think that it adds to a discussion. If I've ever implied that because I've seen "25 cases of X following Y . . ." and someone who studied thousands of incidents of Y not being related to X has lesser data, that was wrong."

Seems to contradict:

"To summarize: My anecdotes and experience do NOT supersede real research. But that research, just like some of my anecdotal conclusions, can end up being found just plain wrong.
"

It seems to me that in the second excerpt "Dr. Jay" is implying that his "anecdotal conclusions" are no more likely to be wrong than real scientific research. Or, at least, that since there is a chance that science might be wrong, his "anecdotal conclusions" are no worse than large scientific research projects.

I suppose, as always, the Devil is in the details.

While it is true that scientific research is frequently superceded by subsequent work, it isn't all that common (in the past 50 years or so) to find that legitimate research - replicated by other groups - is "180 degrees" wrong.

What "Dr. Jay" is trying to conflate with replicated medical research are the relatively few times when a "breakthrough" in research (usually by one research group) simply isn't replicatable (i.e., the original data or conclusions were in error). An example of this is Dr. Wakefield's "landmark" discovery of autistic enterocolitis and its association with the MMR vaccine. A better example might be the use of secretin in autism - initial (small, poorly controlled) studies showed promise while later (larger) studies found no effect.

On the other hand, I can't think of too many cases where replicated studies have been completely overturned by later work. The usual examples given are estrogen replacement therapy and (as "Dr. Jay" provided) statins, but the later discovery of adverse health effects only modified the indications for these therapies; the beneficial effects remain, which is why both therapies are still being used.

The "science has been wrong before" argument isn't a valid justification for trusting your own intuition, even if you call it "years of clinical experience". Don't forget, bloodletting, purging, mustard plasters and calomel were used for centuries because the collective "clinical experience" supported their efficacy. I don't think that "Dr. Jay" is any less susceptible to mistaking coincidence with causation than the best medical minds of the 18th and 19th centuries were.

"Dr. Jay" (of course) continues:

"In order to write most of your posts, David, you have to ignore how wrong "science" has been on countless occasions over decades. You have to ignore the initial responses to the ideas, hypothesis and instincts of experienced clinicians. Once you begin ignoring that, lapse into sarcasm and disdain, your fingers can fly over the keyboard. You can be so much better than that."

Wow! The "science has been wrong before" fallacy in combination with concern trolling! I would like to turn that back on "Dr. Jay" - "Dr. Jay, you don't have to be fearful and hostile to scientific progress; you can be so much better than that!".

Just because "science has been wrong before" doesn't mean that it is always or even frequently wrong. In fact, what "Dr. Jay" labels as science being "wrong" is mostly science being incomplete. And the fact that "science" has been wrong before doesn't mean that "Dr. Jay" is right.

Science has been wrong before - it has also been right a lot more often than it has been wrong (and, I suspect, "science" has been right a lot more often than "Dr. Jay"). In addition, science has a built-in correction mechanism - a researcher who successfully challenges the status quo wins fame and often even a little fortune. Anecdotes don't have a self-correction mechanism - they just breed in the darkness.

Finally, "Dr. Jay" keeps referring to "anecdotal" data as if he actually had some - which, as far as I can tell, isn't the case. Anecdotal data would be what "Dr. Jay" would have if he went through his patient records and looked at - for instance - the time lapse between giving the MMR vaccine and the first signs of autism.

What "Dr. Jay" has isn't even up to the level of anecdote. What "Dr. Jay" has is his recollection - his impression, if you will - of what his anecdotal data might be if he were to actually look at them. This is like me saying "Boy, there have been an awful lot of red cars on the expressway this afternoon!" based solely on my impression that I'd seen more red cars that usual.

This is what "Dr. Jay" trusts more than scientific studies: his impression of his recollection of what his anecdotal data might be if he ever bothered to check.

Prometheus

Jen, I have also read claims (on the 14 studies.org website for example) that Madsen's 2003 Pediatrics study was flawed because of the addition of outpatients to the numbers after 1995, which I assume you are alluding to when you wrote, "they keep using stupid tricks like Madsen counting a new group of autism diagnosed kids after they decrease thimerosal so it looks like thimerosal removal actually caused more autism!".

I took the trouble to look at the study itself, which includes the following statement: "In additional analyses we examined data using inpatients only. This was done to elucidate the contribution of the outpatient registration to the change in incidence. The same trend with an increase in the incidence rates from 1990 until the end of the study period was seen."

This is just one of many examples I have come across of the dishonesty of those opposed to vaccination.

"Logistic regression analysis identified three statistically significant predictors of subsequent atopic disease: maternal atopy immunisation with whole-cell pertussis vaccine and treatment with oral antibiotics in the first two years of life "

Maybe that's one reason whole-cell pertussis vaccine isn't used anymore, Sid?

Jay, you are right that you have contributed more to this thread than Bacon has. In fact, this thread wouldn't even exist wiythout your contributions. However, I don't think that "my ineptitude is so monumental that warrants a post of its own" is the type of contribution you should be boasting about.

Alas, Jay, we are not laughing with you; we are laughing at you. Or at least we would be if it weren't so pathetic and sad that you foist this turdpile on your unfortunate patients.

Personal Clinical Experience (frequently) = Cognitive Bias, which has several forms, but usually means "I see and experience what I want to experience".

"Wow! The "science has been wrong before" fallacy in combination with concern trolling"

Prometheus, I'm curious: Why does you're saying this is a fallacy make it a fallacy?

If I said, "Wow! The 'Dr. Gordon is not as much of a scientist as we are' fallacy combined with more ad hominem insults," does that make it a fallacy for sure or only if some board certifies it as a fallacy.

You all are writing absolutely miserable responses to Orac's excellent post. You're quoting me out of context, spinning my subtle changes in point of view (influenced by this site!) into huge discrepancies to support your specious reasoning. This is truly sorry criticism on your part. There's not a valid challenge in the 80 comments. Just spin and exaggeration.

Look, vaccines are absolutely huge medical interventions and--as you've all said before--no one's denying that they create side effects. Just not the dreaded possibility that they might contribute to triggering autism. I'm more than happy to discuss all other aspects of the etiology of this genuine epidemic. Just stop obsessing about how we proven no connection. We've neither a connection nor proven a lack of connection. Could we move on?

Jay

And in a lovely piece of synchronicity, or should I say, the universe offering fulfillment, this was posted today at Saturday Morning Breakfast Cereal...

http://www.smbc-comics.com/comics/20110218.gif

Funyuns should be capitalized.

@Dr.Jay--

The first traffic light you come across today has been green before, therefore it is green now, and will be green when you approach it.

Do you really not see why this is a fallacy, or are you being deliberately obtuse?

One reason that Dr. Gordon really annoys me is that I personally know a doctor in private practice who once concluded that the scientists researching a particular disease had missed something, and that therefore he, alone in all the world, knew the cause of a particular disease.

Sounds like our Dr. Gordon, doesn't it?

Except that this doctor had first exhaustively researched the disease, and when he came up with this idea, he formulated an hypothesis and worked out what he ought to observe if his hypothesis was correct. He then devised a clinical trial and spent years meticulously documenting the results instead of relying on his fallible human memory.

When he was convinced that his hypothesis was borne out, he hired a statistician to examine his results and determine whether he really had something significant, or had just convinced himself that he did. He didn't rely on his own perception because, as Richard Feynman said, "you are the easiest person to fool".

Having been assured by the statistician that he really had something, he then published a series of papers. There were exhaustive trials that confirmed his work. And you know what? I googled his treatment recently and, a quarter century later, it is still one of the front-line treatments. Who knows how many people have benefited from the work of this clinical physician who went to the trouble to do a proper study, properly document his results, and write it up.

So why doesn't Dr. Gordon take his awesome insight and do the same?? Why is he allowing hundreds of thousands, nay millions, of children worldwide to suffer when he could help them?

I'm sure it hasn't escaped notice that Jay avoids answering direct questions. He won't put anything in writing that could jeopardize his standing with the anti- vax crowd.

Dr. Jay, you can't prove a lack of connection. It's impossible to prove a negative. The closest you can get is multiple sources that indicate a connection is unlikely.

@Pablo at #21, I refer to the end point not the means. I certainly did not claim anti vaxers give any serious consideration to their points.

@Augustine, I have given this issue plenty of consideration. I spend at least an hour a day on both pro and anti vax sites. Just because I made a concise point, does not mean I misunderstand.

Lawrence writes: "I'm sure it hasn't escaped notice that Jay avoids answering direct questions. He won't put anything in writing that could jeopardize his standing with the anti- vax crowd"

Here, how's this: Being anti-vaccination is scientifically unsound and I disagree with anyone who opposes all vaccination.

LW: I'd love to have seen or conduct a prospective study of my hypothesis that the way we currently manufacture and administer vaccines has led to an increase in childhood autism. There is no magic grant writing in the world which could get that study funded or approved at the present time.

Dedicated Lurker: I agree with you.

Jay

Even if one takes the way science works to mean we can "never say never," it doesn't follow that we are therefore justified in keeping on at saying "someday, just you wait." Especially not in the face of high quality evidence demonstrating the minuscule chance of that "someday" ever coming to pass.

@Sharon #95

@Augustine, I have given this issue plenty of consideration. I spend at least an hour a day on both pro and anti vax sites. Just because I made a concise point, does not mean I misunderstand.

But Sharon, your concise point doesn't jibe with Augustroll's notions, which are The Truth, therefore by definition you DO misunderstand.

--------------

Back to the main topic, is it just me or is Dr Gordon being evasive?

* What specific scientific evidence do you have to support your claim that the current vaccine schedule is unsafe?
* What specific scientific evidence do you have to support your claim that vaccines cause autism?
* What specific scientific evidence do you have to support your claim that vaccines cause asthma and all the other problems that you attribute to them?

Where are the answers to these simple & direct questions? We ALL KNOW that science has been wrong before and will likely be wrong in the future. The question is: where exactly is science wrong NOW, with regard to this particular topic?

Dr. Gordon, you claim that your beliefs about vaccination are due to your clinical observations. Those observations should be recorded in your files. I suppose I should add that I did the data entry in the study I described, and I went through years of records for that purpose. Why don't you hire an enterprising college student to go through your records and find the evidence that is so unmistakeably present in your records. You don't need a grant for that. The records already exist (don't they?), and college students work cheap.

Jay has hinted around previously that his deathless prose is not getting posted because of, well, some nefarious intent to silence him. He's had it explained to him before that posts with links (typically multiple ones) automatically get held for moderation. Either he's demonstrating Alzheimer's-caliber memory loss or is trolling for sympathy. The correct answer isn't difficult to surmise.

Jay, I concede that I am nowhere near your equal when it comes to posting farcical nonsense. You rulez!

I'm still waiting for Jay to comment on whether his reliance on the science-wuz-wrong-before fallacy explains his use of homeopathy for ear infections. Or his support for the ingestion of colloidal silver. (By the way, I didn't surf all over Jay's website to find this stuff. All one has to do is Google Jay Gordon and (insert type of quackery here) and presto, a link appears).

Jay - it seems to me that your supporters, including Jenny McCarthy, have some pretty deep pockets. Why don't they front the money for all of these studies?

"Look, how's this: Being anti-vaccination is scientifically unsound and I disagree with anyone who opposes all vaccination" (Doctor Jay Gordon at 6:54 PM today). There must be some sort of disconnect here as I just viewed Dr. Jay's Link Library on his website. OMG, Dr. Gordon, some anti-vax trolls must have taken it over! The nasty trolls have removed any links to the CDC and to the American Academy of Pediatrics Immunization Policy Papers and replaced them with their troll-authored bogus science articles.

Keep "working from the inside" Dr. Jay, to change the minds of your colleagues at the FAAP.

lilady, you must read more carefully: Dr. Gordon disagrees with anyone who opposes all vaccination. After all, he may be okay with rabies vaccination for someone severely bitten by an animal known to be rabid. I don't believe he's expressed opinions on that situation.

Jay, ad hominem attacks are not inherently argumentative fallacies. They are fallacies when they are used to attack the person in lieu of the data the person is presenting - i.e. "I don't believe in vaccination because Orac is a poopyhead and he says vaccinations are good." When they are used to discredit a person because that is relevant to the discussion it is not a logical fallacy - i.e. "I don't care to look at any data Andrew Wakefield says support his claims because he is a cheat, a fake, and fabricates findings to suit his own goals" or "Dr. Jay Gordon is self contradictory and duplicitous and brings forth no evidence to support his stance or his claims" are both accurate and logically sound ad hominem arguments. When the issue we are discussing is YOUR VERY CREDIBILITY then inherently the arguments against your stance is against YOU and ad hominem in nature. When the people here take quotes of you to demonstrate that you change your stance and attitude to suit the current conversation and demonstrate you are indeed anti-vax and have NO empirical basis for it that is merely demonstrating the inadequacy of YOUR argumentation. Not ours.

Well, then, I guess Dr. Jay aka "I disagree with anyone who opposes all vaccination" is at odds with Dr. Suzanne Humphries aka "Vaccines are dangerous and should never be injected into anyone for any reason." Maybe he should go on over to the International Medical Council on Vaccination's website and send some comments their way.

"Keep "working from the inside" Dr. Jay, to change the minds of your colleagues at the FAAP*."

I keep getting this image of a dedicated termite.

*Small quibble - it's the AAP (American Academy of Pediatrics). FAAP signifies a "Fellow of the American Academy of Pediatrics", i.e. anyone who is board-certified in Peds (as most practicing peds are, to my knowledge) and pays dues to the AAP.

"I disagree with anyone who opposes all vaccination"

Wait, doesn't one of Dr. Jay's multiple personalities say that the problem is that we just give vaccines too quickly? That one was easy to dance around.

"Could we move on?" Dr Jay
If only. Remind me again - what does a pediatrician actually do? Talk to kiddies and their parents, prescribe a little anti-hurty medicine, recognise the occasional really serious condition. pass it on to experts, and shmooz a lot?
I can't see that you have ever moved on from any opinion you've ever held, you've never changed your mind about anything; heck I bet you've never even saved a life.
Orac has.
Your besetting sins are vanity and self-regard.
Hence your continuing presence on this blog.
The "dildo" epithet applied to you in an earlier post was, I feel, unjustified.
At least the effectiveness of prosthetic penises has been proven by evidence and anecdote throughout millenia. In this regard, your opinions are little more than the orgasms they produce, though somewhat less pleasurable.
So, when are you going to recommend that your young patients are properly vaccinated? (well, apart from tetanus of course, which is only in Africa....)

you have to ignore how wrong "science" has been on countless occasions over decades.

OK. Science has been wrong before, so it might be wrong now. Fair enough.

Here's the thing: Overconfident, passive-aggressive online loudmouths and conspiracy theorists have been wrong at least as often as science. Particularly when they're patting themselves on the back for being ahead of the scientific learning curve.

See why we might want some actual evidence? Or failing that, an argument based on something a little stronger than analogical inference + the old "God's last honest man" routine?

AnthonyK:

If only. Remind me again - what does a pediatrician actually do? Talk to kiddies and their parents, prescribe a little anti-hurty medicine, recognise the occasional really serious condition. pass it on to experts, and shmooz a lot?

I sincerely hope that Dr. Jay has referred Jenny McCarthy to a competent pediatric neurologist for her son. Apparently the poor child has had another seizure recently.

I am thankful that our family doctor did refer us to a good pediatric neurologist. I learned much from the ten page report after the hour long evaluation, and subsequent tests (EEGs, metabolic screens, etc). Fortunately my son did not need any medication, but with the state laws as they were: the health insurance paid for the neurologist "prescribed" speech therapy.

Thanks Dangerous Bacon for picking up on my error. @LW: you raise a valid point, about what would Dr. Gordon recommend if a patient had a bite exposure to an animal known to have rabies. I also am wondering what his recommendations would be for a "possible" rabies exposure from a bat scratch or bite. Perhaps, because he has wide "experience" with vaccine reactions, he will recommend different "spacing" of the post-exposure rabies series of immunizations, as he does with other childhood immunizations.

I revisited Dr. Gordons website "Vaccine Link Library" to look at the rabies section. I found that every article cited and linked in the rabies section discussed the side effects of rabies prophylactic immunizations and HRIG (Human Rabies Immune Globulin) prophylaxis . Some of the articles were about reactions to the rabies vaccine given to domesticated animals, including the most recent puffery authored by Kent Heckenlively, Esq./science teacher. Is Jay Gordon FAAP also a practicing Doctor of Veterinary Medicine? Most of the articles were twenty years old and were devoted to human rabies vaccine that is used in other countries and rabies vaccine that is no longer used in the United States. Noticeably absent were links to to the California Department of Health website, the CDC website and the ACIP (Advisory Committee on Immunization Practices) websites.

I wonder if any of his young parents take exotic trips with their children to areas of the world where rabies are endemic in the local wildlife and in domestic animals. I also wonder what impact Dr. Gordon's vanity press will have on them. If their child gets bitten or scratched by a domesticated animal, will they refuse rabies prophylaxis for their youngster because of their faith in him and because all vaccinations are bad.

The ACIP updated their recommendations for rabies vaccine and HRIG in 1998, based on intensive research. Their site has some very interesting data about rabies incidence in animals and humans in the United States. Immunize.org-Rabies Cases website provides case histories of the recent human rabies diagnosed in the United States.

lilady @111

In 2001 I fished a dead bat out of our dog's water dish one morning (our dog did not have access to that dish overnight). I was about to put the bat in the garbage when it occurred to me that neurologically healthy bat shouldn't drown in a dog's water dish. I took the bat to work with me and after a bit of telephone run around with the public health people I was contacted by the Canadian Food Inspection Agency (who deal with rabies cases) and they sent someone to pick up my bat. It tested positive for rabies and our dog was a month overdue for her rabies booster.

A veterinarian from Food Inspection Agency came out and after checking out the dog and us decided that taking Tesla away for quarantine "would break 3 hearts". He wrote out a loose on e month quarantine order (dog had to be accompanied when she was in the yard and could only be walked on a leash with a second person to keep other dogs away). The vet told us about reading the diary of a local backpacker who died of rabies a few years earlier. This person only felt the bat brush against his face and did not realize he had been bitten until it was too late. A lot of people think that rabid animals are always aggressive, however, sometimes they just go into a depression and a rapid wild animal may act tame. There was an incident in Jasper National Park where some children were playing with a rapid bat. Bottom-line - you may not feel a bat bite you, so if there is any chance of a bat bite it is better to be safe than sorry.

lilady, I tried to look at Dr. Gordon's website with respect to rabies. It is unbelievably unreadable -- a muddy blue background with black text and blue links. The only way to read it without developing eyestrain is to highlight the whole page to get some contrast. Ugh. My ferrets could design a better website.

At any rate, before I gave up in disgust at the effort of reading that mess, I found the page that contains links for rabies. The sole link goes to ... whale.to. That isn't even the work of Dr. Gordon, FAAP.

@Dr. Gordon

"Here, how's this: Being anti-vaccination is scientifically unsound and I disagree with anyone who opposes all vaccination."

Great. Glad to hear it. Ruh roh, what's this?

"There is no magic grant writing in the world which could get that study funded or approved at the present time."

Some days it's like we're Sisyphus and every time we get you to the top of mount reason, you roll down the other side and make some new terrible comment. I thought you were above conspiracy theories on this topic :(

I'm surprised no one has brought up the funniest part of Jay's "science has been wrong before nonsense (perhaps it is too obvious).

Notice that "science has been wrong before, and therefore I am right on this issue" bears with it the implication that, while science has been wrong before, Jay never has!

I mean, if he admits that he has been wrong before is simply, "you have been wrong before, too, so why do you contend you aren't now?"

"Science has been wrong" and "Jay has been wrong" and therefore Jay is right? The only way Jay can make his claim is to back it with the assertion that he has never been wrong.

I'm more than happy to discuss all other aspects of the etiology of this genuine epidemic.

I'd be interested to hear why you use the term "genuine epidemic." Normally this is taken to imply that the ACTUAL incidence of autism (as distinct from DIAGNOSED incidence) has increased in recent years. Is that indeed what you meant, and if so where's your evidence for the proposition?

I'd love to have seen or conduct a prospective study of my hypothesis that the way we currently manufacture and administer vaccines has led to an increase in childhood autism.

You have no hypothesis. You have a random guess unsupported by any actual evidence. And in fact refuted by the evidence showing that if there's BEEN any increase, it must have been small.

There is no magic grant writing in the world which could get that study funded or approved at the present time.

When the support for it is completely nonexistent and the evidence already indicates that the claim is false, this is indeed the case. Only an idiot would waste scarce research funds on the unsubstantiated ramblings of one person. However, if you would actually assemble the "evidence" you claim that you have from your "extensive clinical experience," and actually produce some sort of argument for why it wouldn't just be flushing money down the toilet, you'd have a chance.

I'm more than happy to discuss all other aspects of the etiology of this genuine epidemic.

Here's an interesting one which sounds at least plausible: increasing paternal age. Discuss.

I'd love to have seen or conduct a prospective study of my hypothesis that the way we currently manufacture and administer vaccines has led to an increase in childhood autism. There is no magic grant writing in the world which could get that study funded or approved at the present time.

I tend to agree: no such study would be approved by an IRB. For a clinical trial to be approved, especially in a vulnerable population such as children, one would have to show that the benefits to the study population are likely to outweigh the risks. And it's going to be hard to argue that the benefit of preventing autism outweighs the risk of death and disability due to infectious disease. Especially with all the preliminary data against you.

Also, "the way we currently manufacture and administer vaccines" is extremely vague and essentially non-falsifiable. You'd need a more specific, falsifiable hypothesis to make a decent experiment. What aspect of current manufacturing and/or administration of vaccinations might be causing a problem? What is the preliminary evidence in support of the hypothesis? What is the proposed biological mechanism?

That's my take on it as an IRB committee member.

Dianne, as an IRB committee member, what would you say about a review of the records he already has? Acknowledging, of course, that he actually has no meaningful hypothesis, but if he did, would there be an approval issue with just going through his own files and documenting whatever it is that he claims is so convincing?

@ Militant Agnostic: The Canadians are following the proper protocol for possible exposure to bat rabies.

One notable and sad case of human rabies in a four year old child occurred in Washington State. (MMWR Human Rabies Washington 1995). If you read the MMWR report, you will find that the relatives of the youngster located the bat in the sleeping child's bedroom and buried the bat in the backyard. After the child died one month later, public health staff dug up the decomposing bat, tested it and was positive for rabies negri bodies in the brain.

Thousands of raccoons were shipped up from Florida during the 1970s by "hunting clubs" and thus rabid raccoons were found in such shipments to Virginia. (See "Rabies in translocated Raccoons-Public Health Briefs"). Raccoons are notorious garbage scavenger which prowl around garbage pails and dumpsters. They also stay in a limited geographic area but have been known to "hitch rides" in produce trucks. The CDC and State Health Departments have tracked the spread of rabid raccoons up the Eastern coast and New York State, including New York City have reported raccoons testing positive for rabies virus. Nassau and Suffolk counties, eastern suburbs of New York City remained free of rabies infected raccoons...until August, 2004. A family pet dog mixed it up with a raccoon. The raccoon was trapped and euthanized and found to be rabid. Between 2004 and 2010 a total of 67 rabid raccoons were reported in Nassau County.

A very intensive public health initiative (distribution via trucks and helicopters of rabies vaccine in "bait packs") that is still ongoing, has limited the numbers of infected raccoons to "just sixty-seven" in Nassau County.

Retrospective chart reviews have a much lower bar to pass for IRB approval; so I doubt that such a study would have that much difficulty passing IRB review. SRB (scientific review board) review, on the other hand, might be problematic. Remember, there are two steps to getting a clinical trial approved (other than money, of course). First is the SRB review, which evaluates the study for scientific soundness. Then, if the study passes SRB review, there's IRB review, which evaluates risks to the trial subjects and ethics. The scientific basis of any study Dr. Jay would propose would have to be a lot sharper, with a much more defined hypothesis than the vague one he has now.

what would you say about a review of the records he already has?

Chart review protocols are low risk, usually expedited approvals. As long as he has a decent plan for keeping individual patients' data anonymous, probably no problem.

I hope you don't mind my following up, as I am genuinely curious about the ethics of this.

Suppose that a doctor, reflecting on his clinical experience over the decades, concluded that he had seen a new or at least unrecognized syndrome of some sort. He might not really have any hypothesis at all, just the impression that something is going on that should be looked at.

I would have thought that he could thumb back through his own files, or run various database searches on computerized data, without any kind of approval. Of course, as a practical matter he probably can -- who would know? But would that be considered unethical to do without approval?

If this hypothetical doctor really is just fishing, then he can't possibly present a study exhibiting any scientific soundness, and yet he really might have an insight that could be valuable if followed up -- which it won't be unless he looks back and confirms his suspicions.

At what point would there be a "study" requiring approval?

@Jay Gordon:

I just think that it adds to a discussion.

So... The current epidemiological studies finding no link between vaccination and autism + your clinical experience = a link between vaccination and autism. However, that's not your clinical experience trumping scientific studies. Is it because you find those studies to be flawed? That there hasn't been an epidemiological study for every vaccine and/or every vaccine ingredient?

Or, to go at it from another angle: what sorts of studies would need to be done to would make you go "oops, I guess I was wrong about thinking that vaccines caused autism"? How large would they have to be, and how many times would they have to be replicated?

The best science and the best research must also include observation and experience.

How exactly would you go about including clinical experience in scientific studies?

@augustine:

Human rights and personal responsibility are not black and white issues that are solved by armchair quarterback scientist wannabes...

I've seen anti-vaxxers spending a lot more time arguing against the effectiveness of vaccines, against the data the vaccine preventable diseases aren't that serious of a health risk, and arguing for the idea that vaccines carry a high rate of adverse effects than I've seen them spending time arguing against the idea that children must be vaccinated before they can attend public schools and/or that non-vaccinating parents are leeching on herd immunity. But that's just my experience.

@ Dr. Jay Gordon, MD, FAAP

I'm more than happy to discuss all other aspects of the etiology of this genuine epidemic.

Being from California, are you happy to discuss the genuine counter epidemic of Specific Learning Disabilities Dr. Jay? Decreases in Specific Learning Disabilities more than offset any increases in Autism in California schools. Does your years of clinical experience lend explanation?

Paul @ 84, I appreciate that you looked at the study ( I tried your link but it didn't work). I maintain that just because they state one! Limitation of the study (there are many) doesn't really make it any more valid. Denmark also changed the diagnostic code (for autism diagnosis) which would have further raised the rates. Pediatrics didn't quantify the effect of them adding in older children to the study as well. Safeminds did a good summary of the problems with this study that supposedly "exonerates mercury".
http://putchildrenfirst.org/media5.16.pdf

Wait, Jen, that ... that can't be! Changing the diagnostic code for autism diagnosis would raise the rates? Why, that would suggest that autism diagnosis rates can rise without a rise in autism rates!

Jen, the "putchildrenfirst" website is not considered a reliable or credible source (and it is a broken link). Since we were rejecting Generation Rescue, why would you think that a site that says on its "about us" page?:

This site was created by the parent-founders of Generation Rescue, an all-volunteer organization of more than 300 families dedicated to sharing the truth about the cause and treatment of autism. Comments can be sent to: info@generationrescue.org.

You were asked to provide credible critiques from qualified persons by supplying the journal, title, date and authors of the review. You may provide either the PubMed link, or the PubMed identification number.

One criteria that should help you figure out if it is acceptable is to limit your sources to those that can be found in a medical school library. Thank you.

Also, this is the link Paul was using (you just have to remove the "rel =" bit):
http://pediatrics.aappublications.org/cgi/content/full/112/3/604

Okay, Jen, I found the link you provided:
http://putchildrenfirst.org/media/5.16.pdf (you left out a backslash).

Anyway, it is authored by "Mark Blaxill, Director, Safe Minds"

I am sorry, but Mr. Blaxill has no qualifications to understand and critique medical studies.

MESSAGE------------------------------------------------

Shills and Minions,

Do you not see what is going on? I suppose that I might as well let you in on the delicate negotiations that the good doctor and I have been engaged in for some time now.

Of course, our Dr. Jay sees all of you in your bespoke Porsche Panamera Turbos, wearing your Rolexes and Dolce & Gabbana goatskin motorcycle leathers. But know this: it's not the unending shower of PharmaWealth that draws him time and time again to suffer abuse in our little circle. No shills and minions, it's love and acceptance.

Do you not see how he lights up at Orac's merest mention of his name? I know how he feels. This means far more to him than the money, accolades and fawning of fickle, vacuous and self-absorbed celebrities. No shills and minions, it is the love and acceptance of his peers, nay, his scientific betters that attracts him to the heart of the Corpus.

But change takes time. Humans are delicate. It's not a shopping spree at Carolina Herrera, a suite at the George V or front row seats to the Oscars⢠he wants. These are but hollow and empty things to him. What he wants is more . . . human. It's a lively and argumentative dinner with minion Bacon. Perhaps a merry game of badminton with Minion Wombles and family. Or a holiday spent side by side with our cybernetic host in the lab. It's an honored place at the table at the Orbital HQ Summer Picnic and Phuntime Pharmarama⢠he wants.

He's moving towards our side in increments perhaps too small for your eyes to see, but move he does. So, forgive my intrusion into the thread, I offer no science or statistics to aid you in your battle. I don't know, maybe it's the reptiloid hormonal flush of a middle-aged despot with another batch of hatchlings on the way, but life can't always be about profiting off planetary subjugation and drugging large swaths of populace. Maybe, just this once it could be about helping one struggling monkey to find his place in the vast, cold reaches of an uncaring universe.

Or maybe just eating him, I'm feeling awfully indecisive these days.

Carry on Shills and Minions, carry on . . .

Lord Draconis Zeneca, VC, iH7L

Forward Mavoon of the Great Fleet, Suzerain of V'tar and Pharmaca Magna of Terra

PharmaCOM Orbital HQ

0010101101001

------------------------------------------ MESSAGE ENDS

Hi Jay. Your condesencion is, as ever, appreciated. You remain a .... Out of curiosity, does your signature spell ....

I would really suggest and request that comments of this nature stop. It may make us feel better when we unleash insults on someone who merits ridicule, but in addition to all the other things wrong with doing so, people who are in the wrong can hurl personal insults just as ably as people who are in the right.

What we hope these discussions will accomplish is to make it clearer which views have merit and which ones lack it; the only people who have reason to change the subject to personal qualities instead are those who can't defend their views.

Speaking of which...

I'd love to have seen or conduct a prospective study of my hypothesis that the way we currently manufacture and administer vaccines has led to an increase in childhood autism. There is no magic grant writing in the world which could get that study funded or approved at the present time.

As pointed out by others, Jay, that's not really a hypothesis, as it's far too vague to be falsifiable. What on earth would the control group be? "A population of children whose vaccinations are manufactured and administered in any other way other than the way we currently do so"?

Aside from that, however, you're being quite disingenuous when you complain that no one will approve or fund a prospective study on the issue ... because you should know as well as anyone here that retrospective studies, as opposed to prospective studies, can and have been done, and the results are not supportive of your "hypothesis." Pretending that no other kind of evidence exists except the kind that "they" won't allow to be collected is (besides being dishonest) an example of the "Nirvana fallacy." And yes, if you'd like, I would be happy to clarify for you what makes a fallacy a fallacy.

"It's impossible to prove a negative."

Another little gem from the 'scientists'. Too bad its completely wrong.

@132 - give us ONE example of a negative that has been proven and how.

To play devil's advocate, there are some circumstances where it is possible to prove a negative.

The easiest way is to prove an affirmative which contradicts the negative; I can prove the negative "Paul Smith was not responsible for the death of John Johnson" if I show that John Johnson is alive.

The other, more difficult way is in those circumstances where a true exhaustion of the possibilities is feasible. If I am looking for an elephant the size of my entire backyard, I only have to look briefly before I can say "no, the elephant is NOT in my backyard." Either it is taking up the whole of my backyard or it isn't there; in that circumstance the negative can be proved.

It should go without saying, however, that real-world circumstances are almost never this tidy, and outside those tidy circumstances, demanding proof of a negative is an unreasonable demand.

MESSAGE BEGINS----------

@glaxologist

Put the snark down and back slowly away from it. Really, you shouldn't try to fire live ammo until you've spent a few more years on the firing range.

And while you're at it, find someone with a functioning imagination to make you a new and original sounding handle.

Lord Draconis Zeneca, VC, iH7L

Forward Mavoon of the Great Fleet, Suzerain of V'tar and Pharmaca Magna of Terra

PharmaCOM Orbital HQ

0010101101001

------------------------------------------ MESSAGE ENDS

"give us ONE example of a negative that has been proven and how."

Perhaps you're right. I guess then proving that vaccines don't cause autism is impossible. Therefore, by your argument, there exists the possibility that they do. Does the Orac know you are propounding that vaccines might cause autism?

@ LW:

My suspicion would be that it becomes a study requiring approval when the doctor in question wants to tell others about his results - such as by publishing them. As long as he's just reviewing his own records for his own information, what objection could there possibly be?

But as soon as anything is to be published, there's a risk of privacy violation which calls for due diligence and care.

@Antaeus Feldspar: Thanks - I concede that in very narrowly defined circumstances with few possible options it is feasible to prove a negative - and I suppose in theory it is possible to prove every negative via exhausting every other positive. I suppose I was thinking in practical and meaningful terms where proving a negative is rarely (if ever) so neat and tidy.

Proving a negative:
Dr Jay is not doing the best for his patients.
I rest my case.

"I suppose in theory it is possible to prove every negative via exhausting every other positive. I suppose I was thinking in practical and meaningful terms where proving a negative is rarely (if ever) so neat and tidy."

A valiant attempt at recovery, but you are still wrong, and no, it isn't possible to prove every negative by exhausting every other positive (whatever that means). Some things are provable, others are not. It has nothing to do with - or +. Using your logic, I guess all those negative medical test results aren't practical or meaningful? I fear for science if even simple logic seems to so easily confuse scientists.

Gloxologist, you say you can prove a negative. Prove it.

Some things are provable, others are not. It has nothing to do with - or +. Using your logic, I guess all those negative medical test results aren't practical or meaningful? I fear for science if even simple logic seems to so easily confuse scientists.

Someone (not you) correct me if I'm wrong, but it seems to me that your definition of "proving a negative" is wrong.
A negative test result is not proving a negative. I would have to say that is not proving a positive.

Jay-Gee @73

Incidentally, it's my opinion that inappropriate antibiotic use in large part stems from "personal clinical experience" rather than following scientific evidence.

Nope.

http://www.webmd.com/cold-and-flu/ear-infection/news/20110112/early-ant…

There are still pharmaceutical industry funded researchers out there publishing articles at odds with both clinical experience and solid scientific research showing otitis media responds to watchful waiting as well as it does to antibiotics.

Ooh, pharmashill gambit (and where's your evidence that they were industry funded?). And when you follow the link, you'll find that doc jg is misrepresentin' a bit. European doctors take a wait-and-watch approach to all potential ear infections, while American docs only do so when it is uncertain that there is an ear infection. According to the article, the previous studies only addressed the European approach, these two studies looked at whether treating strictly diagnosed otitis media with anti-biotics is effective.

Here's some quotes:

Infectious disease expert Jerome Klein, MD, of Boston University School of Medicine, notes that U.S. pediatricians wait and watch only when the diagnosis of otitis media is uncertain. In Canada and many European nations, doctors are more likely to wait.

Previous studies of the treatment of middle ear infections have come under fire for failing to ensure that all participants actually had ear infections and not just fluid in the ear. Both of the new studies avoid this problem by including only children with strictly diagnosed otitis media according to stringent criteria -- particularly a bulging eardrum as seen with an otoscope.

"Our study underscores the need to treat only kids who meet stringent criteria for a diagnosis of otitis media," Hoberman says. "lf that is the case, we won't have to treat half the kids now getting antibiotics for uncertain ear infection. The idea is to stick with the ones that have strictly defined otitis media."

Note that this is a perfect example of the decline effect. Also, this is a good example of how clinical experience and even RCTs can be misleading: without careful record-keeping of the diagnostic criteria, it can easily appear that the wait-and-watch approach is nearly as effective as giving antibiotics (especially when side-effects are considered).

@130 Lord Draconis,

I'm still waiting on Dr. Jay to come back to Countering and explain why RFK's piece was so brilliant. It must have struck him dumb the more he thought on it, so brilliant was it.

First Gl[a|o]xologist sneers at "the 'scientists'" for saying that you can't prove a negative, then he/she sneers again at saying that in certain circumstances you can.

In the meantime, the example Gl*x gives seems to indicate that he/she has understood nothing of the what the "prove a negative" issue means in context. "Using your logic, I guess all those negative medical test results aren't practical or meaningful?" On the contrary, they are highly practical and meaningful. As Gl*x would know, if he/she had read and understood the very post from which he extracted a quote for criticism:

Dr. Jay, you can't prove a lack of connection. It's impossible to prove a negative. The closest you can get is multiple sources that indicate a connection is unlikely.

i.e., when you get negative medical test results, when looking for a phenomenon that should, if it exists, manifest itself as positive test results, those negative test results are very practically and meaningfully indicating that the phenomenon probably isn't there.

Gl*x will get no more of my attention, unless he/she shows some inclination to understand and discuss civilly the actual issues, as opposed to snipping tidbits out of context to sneer at.

My dearest Lord Draconis, Grandest of Mavoons,*My* Suzeraine,

As you know, I have been working my long, perfectly manicured, delicate fingers to the bone ( please don't take that literally : it's a metaphor) for you. Your unencumbered generosity has proven to be beyond my wildest imaginings: despite your hectic life- conquering planets, implementing forced vaccinations, persecuting brave maverick doctors, and showing *less dedicated* minions and shills the error of their ways- you always manage to find time to acquire a *little trinket* for me. A perfect trinket. For this, I am eternally grateful, love.

Today I spent the afternoon in the most rarified atmosphere of the British Art Center @ Yale: I contemplated the lovely portraits of elegant, similarly compromised ladies of fashion. Paintings of great estates. Landscapes. Suddenly, it all became clear to me! I need a Turner! Just a small one. A trifle. I have served PharmaCOM Orbital and your majesty tirelessly for years! A Turner. Only one. A fuzzy one will do.

Your gracious Lordship will truly show mercy on me in my hour of need. My great need. I bow before your magnificent scaly majesty, in awe and wonder, contemplating your wisdom and unparalleled, universally-recognized perfection.

Your humble servant,DW

"Gloxologist, you say you can prove a negative. Prove it."

You're kidding right? âYou canât prove a negativeâ is itself a negative. If you could prove it was true, it wouldnât be true. Proving a negative is one of the most fundamental rules of logic. Talk about a profound misunderstanding of science....wow.

Methinks, the person who cannot consistently spell is own 'nym just got caught up in his/her own challenge! If "Proving a negative is one of the most fundamental rules of logic", then why doesn't Gl*xologist do it?

Or are we seeing a true argument from ignorance in action?

I'm sure it hasn't escaped notice that Jay avoids answering direct questions. He won't put anything in writing that could jeopardize his standing with the anti- vax crowd.

Yeah. It's not so much that he moves the goalposts as that he refuses to set up any in the first place.

"Methinks, the person who cannot consistently spell is own 'nym just got caught up in his/her own challenge!

Meknows the misspelling was yours as I copied it directly from your comment above.

"If "Proving a negative is one of the most fundamental rules of logic", then why doesn't Gl*xologist do it?"

I just did, yet you didn't seem to realize it. It is trivial to prove the phrase 'you can't prove a negative' is false since if it was proved true, the phrase, being a negative itself, would be false. This is a proof by contradiction. It proves the statement 'you can't prove a negative' is false. How much clearer can I make it? Its like if Pinochio were to claim "My nose will be growing'.

"Or are we seeing a true argument from ignorance in action?"

Indeed, I think we are.

OT - Brian Deer will be on CBC Radio One Sunday Morning

Probably in the first hour 9:00 to 10:00 You can pick your time zone from here:

http://www.cbc.ca/video/#/Radio

@150 - that should be Sunday Edition

Chris, @#140,

You will disagree with this sentence.

As I understand it, autism spectrum disorders are the result of the brain being wired differently. That is, the ASD child processes information differently than normal children do. As far as I know, the type, degree, and depth of this mis-wiring is such that it occurred prior to birth. That is to say, in fetal development. While a very young child's brain is still largely in development, that sort of development we're talking about in these cases occurred well before the child received any vaccines, or could even be considered for vaccines.

In short, based on what I know, vaccines could not have had any effect on brain development in the fetus, and if mercury was involved it would have to be from exposure to the mother and to such a degree that the mother would show signs of mercury toxicity herself.

This means that a two year old child is too old for vaccines to be the cause of what is most likely a pre-existing condition.

I was taught (way back in the 1980s) that you can't actually prove anything.

You can only disprove.

It doesn't matter whether it's negative or positive.

@130 Lord Draconis,

I'm still waiting on Dr. Jay to come back to Countering and explain why RFK's piece was so brilliant. It must have struck him dumb the more he thought on it, so brilliant was it.

Oops--don't know why that comment appears twice other than a fidgity computer; I posted it as I was going to bed but it was still in the comment box this morning, so I hit post thinking I forgot to last night. Technically, it is true, I remain waiting on Dr. Jay :-)

Another idiot troll proves the rule - "when you can't argue facts, argue semantics!"

Glaxologist--

I think you're confusing pure math with science. For example: "given any prime number, there is a larger prime number" was proven millennia ago. That theorem is often stated as "there is no largest prime number," and indeed, the proof is by showing how to construct a prime larger than any claimed largest prime. But prime numbers are abstractions.

You couldn't prove that theorem if prime numbers were animals, and a proof required inspecting each of them individually. There is lots of good evidence that vaccines do not cause autism. But the proof of a negative that believes in a vaccine-autism connection are demanding is immune to both statistics and logic. There is no form of evidence that they are prepared to accept if it refutes their claim.

It's not just proving a negative. It's proving a negative without using the accepted tools for doing so. Imagine trying to prove that you were not responsible for the death of President Lincoln to someone who dismissed as irrelevant evidence that you were born decades after Lincoln died. Add that the person in question insisted that it wasn't their job to show that you had anything to do with the event, or even that you had ever been in North America.

That's the sort of negative that anti-vaxxers are asking us to prove.

When someone demands that the autism cranks give evidence for their claims, they turn around and insist on a disproof instead. By their standards of proof, they could all be indicted for involvement in every unsolved murder in the United States, because they cannot prove that they weren't in some way involved. (After all, if the shooter is unidentified, how can you prove that you didn't provide him/her shelter afterwards?)

[I've already gone on rather long, but I'll add that there are true mathematical statements that cannot be proven. Gödel proved that. It is not in fact the case that if I can't prove "you can't prove a negative" it must be false.]

Glaxi person:

Meknows the misspelling was yours as I copied it directly from your comment above.

Actually, I copied directly from yours in #139. But you are just playing silly games, and shall be an ignored semantic troll.

Jen @126 (at time of writing), apologies for the broken link (not sure how that happened), and thanks to Chris for fixing it.

A couple of years ago I spent a lot of time looking at Madsen's studies, which have been discussed ad nauseam here and elsewhere. Looking at the study in question, there is no doubt at all that the number of cases of diagnosed autism continued to rise after thimerosal was removed from vaccines in Denmark. I have seen it claimed that changes in diagnostic criteria were responsible for the increase, somehow masking the drop in autism caused by removal of thimerosal.

Thimerosal was removed in 1992 and the diagnostic criteria in Denmark did not change until 1993, but autism rates increased from 1991 to 1993. Outpatient data were not added to the stats until 1995, and rates continues to rise after these were added. Madsen explicitly states that rates increased even if outpatient data were excluded. Given this, I don't see how thimerosal could possibly be responsible for any but a tiny proportion of the autism cases recorded.

Blaxill gets a lot wrong in the piece you link to:

He claims that the addition of outpatient data is responsible for the increase in rates after 1994, "their purported increases after 1994 can be explained entirely by the registration of an existing autism population that did not require hospitalization", yet as I have pointed out, Madsen states this was checked for and increases also occurred in the inpatient population.

He claims that Madsen's study, "relies ... for its definition of the âincidenceâ of autism on the date when cases were entered into the new registry of outpatients". But the study itself states that it was the date of diagnosis, not registration, that was used for calculation of incidence.

He makes much of the different rates of autism in Denmark as compared to other countries, though the point is the change in rate within Denmark that occurred after thimerosal was removed from vaccines. The rates in other countries are irrelevant.

He does not seem to understand the difference between incidence and prevalence, making much of the difference between a reported autism rate of 1 per 10,000 (incidence) in this study and another reported rate of 4 per 10,000 (prevalence) in the 1950s (he even refers to a report titled 'A prevalence investigation of childhood psychoses' which should have been a clue). This does not inspire confidence.

He claims that while the study claims that vaccine uptake exceeded 90%, "a recent report using the same data suggests that completion rates were well below 90%". When I looked up the "recent report" he refers to it states, "vaccination coverage in Denmark has remained high (i.e., almost always â¥90% for all age-specific antigens) since 1980".

I could go on (and on) but there is little point. In summary I don't think Blaxill's objections to Madsen's study are at all valid.

I love how Dr. Jay drops drive by comments concern trolling while still ignoring the basic questions asked in the original post.

So Dr. Jay, when are you going to answer these questions?

What specific scientific evidence do you have to support your claim that the current vaccine schedule is unsafe?

What specific scientific evidence do you have to support your claim that vaccines cause autism?

What specific scientific evidence do you have to support your claim that vaccines cause asthma and all the other problems that you attribute to them?

Until you answer these questions any comments you post are just pissing into the wind, which you seem to enjoy.

DrDuran

So Dr. Jay, when are you going to answer these questions?

I'm much more interested in: what would it take for him to change his mind regarding vaccines and autism?

As a casual reader (non-doctor, non-expert), Dr. Gordon seems more like an internet troll than a medical professional. He's really good at it too.

But as an observer, he does come off a little wacky. Especially the "wait until you see I'm right" thing.

-bill

Dr. Halsey and others taught us to view the use of thimerosal as a preservative: Not the safest way to do things.

If this is supposed to be a foretaste of how vaccination schedules will someday be seen in retrospect, it's a stupid argument, because thimerosal as a preservative is safer than doing without it. Vaccines now, without thimerosal, are more vulnerable to contamination than vaccines that contain it. It was phased out (and replaced with more expensive measures) to assuage a group of no-nothing nimrods -- who have simply moved on to some other excuse for worrying about the purity of their bodily fluids.

So here's another question for Dr. Gordon. If thimerosal was "Not the safest way to do things", then what are the specific risks it brings?

An imperfect analogy: A patient shows up in the office, with a large painful knot on his forearm. Hmmm, looks like a ruptured biceps tendon. But just in case, I get a stat Doppler to make sure it's not, also or instead, a DVT. It's negative, for which I'm very happy, assume that he is also happy, and we get him to orthopedics for repair. But he's all bent out of shape, doesn't want to see me anymore, because the "stupid NP didn't find anything." Do people not understand that, very often in medicine, a negative finding is something to be happy about? Actually in this case, multiple negative findings. Vaccines do not cause autism! Yay! We can protect our children without worrying about that particular consequence!

Argh. Proofreading fail. I meant upper arm.

Complete figures for 2009 Notifiable Diseases Incidence (MMWR August, 2010); 16,858 pertussis cases reported in the United States (includes the 869 pertussis cases in California). 2010 figures for Notifiable Diseases Incidence will not be available until mid-summer 2011 from the CDC.

The California Department of Public Health (CDPH) issued new recommendations in July, 2010 when only 5 infants had died from pertussis (Available on the web at "CDPH Pertussis Immunization Policy").

The "CDPH Pertussis Report January 7, 2011" reports 8,383 confirmed, probable and suspect cases of pertussis including 10 infant death's. Nine of the ten infant deaths were in infant too young to have received the primary series of immunizations against pertussis.

So what does Jay Gordon MD FAAP, have on his web page today about vaccines in general?

"In my office, with families I know well, I believe the main idea I convey is that we should vaccinate later and slower. One shot at a visit starting later in the first year and perhaps in the second year of life. I have many children in my practice whose parents have chosen to give their children no vaccines."

And, what does Jay Gordon MD FAAP have on his web page today about pertussis vaccine?

"Chickenpox vaccine was invented during the 1970s to protect high risk children against varicella severe complications. Natural disease immunity might have been better than that achieved from the shot. My take on this is to try to get your child natural chicken pox for 4-5 years and then get the shot later if you're unsuccessful."

I suppose Dr. Gordon is still "working from within the AAP" to change immunization policy.

lilady quoting Jay Gordon

try to get your child natural chicken pox for 4-5 years

WTF!

and

Natural disease immunity might have been better than that achieved from the shot.

I am sure being personally buried in an avalanche is a better learning experience than a co-worker getting buried in an avalanche, but that doesn't make it a good idea.

Natural chickenpox immunity is better because it comes with bonus shingles, no extra charge.

MESSAGE BEGINS--------------

Shining Shill DW:

Your service has been exemplary and your fawning adulation most gratifying, though surely such soaring praise should be reserved for Her Imperial Highness Cialis Clopidogra Invicta XXIII, Subjugator of Worlds and EggMother of the Glaxxon [always watching, may she live for all time], for it is she who we truly serve. But I digress . . .

That you are a lover of art does not surprise me one jot. Your minioning and shilling are always accomplished with such elán that you should certainly consider yourself an artist. So subtle in your espionage, so . . . creative with a thranzor. So I shall gladly set Cindy on the task of procuring a Turner for you. Please send her a coded missive with a list of your desired paintings in descending order.

We can no doubt pluck one from a museum or private collection and replace it with a replica and nobody will be the wiser, save for you and your loved ones.

Good Minion Wombles:

Has the good doctor contacted you about an afternoon of badminton yet? What better way to explain his devotion to that screechy RFK creature than batting a shuttlecock about with the family? I imagine that he will be "clobbered" by the young Wombling however, but I can think of few primates who require a large serving of humble pie more than this meddlesome medic.

Return to your scelus sceleris my malevolent monkeys, the rebels sleep lightly.

Lord Draconis Zeneca, VC, iH7L

Forward Mavoon of the Great Fleet, Suzerain of V'tar and Pharmaca Magna of Terra

PharmaCOM Orbital HQ

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@LW:

Natural chickenpox immunity is better because it comes with bonus shingles, no extra charge.

I recall reading that the attenuated chickenpox vaccine can also cause shingles, but less often and with less severity than the wild-type strain.

I wonder if, when jay foists this crap on his patients, that he fully discloses that his recomendations do not agree with those of the AAP or the CDC, and that he thinks his colleagues in the AAP are conspiring with Pharmaceutical companies (he has in fact endorsed that accusation here). I'm sure many if not most of his patient's parents would not be affected by this, and in fact might even find it alluring, but there might be some who would be concerned that their doctor, who likes to promote his association with the AAP, does not actuly support their policies and maintains whacko conspiracy theories.

Dr. Jay Gordon MD FAAP on his website acknowledged the pertussis outbreak in California and the death of 5 infants as of June, 2010.

Dr. Gordon's posting on June 25, 2010, begins "California declared a pertussis epidemic this week"

Further down in his posting he states:

"DTaP vaccine prevents whooping cough and may even prevent illness or lessen the severity of illness after the first vaccine. The routine schedule includes 3 doses in the first six months of life, a fourth at eighteen months of age, a fifth at age five and boosters doses of a new adolescent/adult vaccine. I don't think your babies under a year of age should be given any vaccines, including this one.....The CDC and most doctors, including my colleagues in this office disagree...I do not recommend this vaccine for infants unless there are unusual risk factors in a baby's life...Again the vast majority of experts disagree and I understand the need for public health considerations and preservation of herd immunity, but still would rather vaccinate only after 12-24 months of age and feel comfortable, in most cases, giving no vaccine at all."

Yes, Dr. Gordon, most of your colleagues in your office disagree with you regarding this vaccine, as do "experts" at the CDC, the California Department of Public Health, the AAP and...I presume, the parents of the ten infants who died from pertussis infection.

"So what does Jay Gordon MD FAAP, have on his web page today about vaccines in general?

"In my office, with families I know well, I believe the main idea I convey is that we should vaccinate later and slower. One shot at a visit starting later in the first year and perhaps in the second year of life. I have many children in my practice whose parents have chosen to give their children no vaccines."

Hmm. Wasn't it Jay not long ago, after telling us he gave no vaccines at all except for "maybe a DTP" (and possibly a chickenpox shot to those in their teens, if I remember correctly), who conceded that he needed to update his website to reflect this reality? And here he is today, claiming that he's not antivaccine but just gives immunizations "later and slower"?

So Jay either avoids giving vaccines as much as possible, or just spreads them out. It's one or the other, but Jay is far from clear on which it is.

This is the guy who claims he's not anti-vaccine, that he's learned a lot from us, and that we have a great deal to learn from him?

If the lesson is how to not be frank and forthright about one's views and how best to cling to faulty thinking in the face of encroaching evidence, then yes, I suppose he has something to teach us.

No thanks.

Dangerous Bacon: Your post makes no sense at all. Again, not like you.
I give vaccines.
I give them later and far slower than most doctors.
I support parents' rights to have no vaccines at all given to their children.
Vaccines are discussed at every single visit in my office.
I think that the current vaccine schedule is not the best we could do. I claim no proof for this.
What is unclear about that?

Pablo . . . all my patients know what the CDC/AAP and others recommend.

Matthew, thank you.

Lilady: Dig deeper into the cases you've mentioned. These tragedies were probably due to inadequate health care given to certain under-served parts of California's population.

Jay

Dr Jay,

There is at least one unusual risk factor in the lives of your young patients: they are exposed to a larger than usual population of un- and undervaccinated children, simply because they are sitting in your waiting room. This increases their risk of contracting pertussis and other serious illnesses. (If you are making house calls, every time, for every pre-school child, and you yourself are up to date on your vaccines, feel free to correct me on this point.)

If you were, for some reason, giving this advice to only one parent whose children you are caring for, that risk wouldn't be there. By your own testimony, you give it to many parents.

Lord Draconis,
I continue to await the good doctor's return to Countering for an explanation of why RFK was brilliant. Perhaps he might like to visit the blog on how the granddaddy of all vaccine textbooks by Plotkin, Orenstein, and Offit has grown over the last two decades or the blog on Novella's excellent lecture series; there's lots of illuminating information there for him that he's obviously missed out on. Or even gander at the youngest Wombling's Raspberry drawings and bask in her dreams of peace?

Alas, I think Dr. Jay is too busy with his flu patients. We're still waiting to hear from him if that's because he failed to recommend immunization.

And Dr. Jay, I understood Dangerous Bacon perfectly.

:-)

"Dangerous Bacon: Your post makes no sense at all. Again, not like you.
I give vaccines.
I give them later and far slower than most doctors."

C'mon Jay, our memories are far better than yours (to give a charitable explanation). You said in comments here not long ago that your usual practice is to give no vaccines at all to children under the age of 10, except "maybe a DTP" (which you later clarified to be a suboptimal DTaP series). That's far different from just spacing out vaccines - you discourage them and by your own admission give a fraction of what public health experts and the AAP recommend. Here you are as recently as last September (see post #100) saying:

"I give vaccines to many children in my practice but I give far fewer than most pediatricians do in large measure because I don't view vaccination as an unequivocally beneficial nor completely safe medical intervention."

So why not be upfront with your clientele (and parents of potential patients) and acknowledge on your website your severely diminished (and not just delayed) "vaccine schedule", so they can judge for themselves beforehand whether to place their kids and society as a whole at risk by following your recommendations?

I give vaccines.
I give them later and far slower than most doctors.

You also give them reluctantly:

http://scienceblogs.com/bookclub/2008/10/finally_science_pushes_back_ag…

Quote (from you):

gave a half dozen vaccines today. I gave some reluctantly but respected parents' wishes to vaccinate.

In other words, apparently some parents had to drag you, kicking and screaming, to vaccinating their children. Why on earth would you be "reluctant" to give vaccines, Dr. Jay?

Then there was this gem from Dr. Jay (http://www.sciencebasedmedicine.org/?p=301):

I donât give a lot of vaccines.

I still give DPT vaccinations to some children, chicken pox shots to kids who havenât been able to acquire natural immunity by age ten years or so, and I give polio vaccines very infrequently. The polio vaccines are given for what I call âemotionalâ reasons because my exposition of the ânumbersâ (2000 cases of polio out of six or seven billion people) doesnât counteract the very strong memory of a beloved aunt or uncle who had polio in fifties or sixties. And many parents feel much more comfortable traveling to India or parts of Africa with updated polio immunity for their children and themselves. By the way, 2007-2008 statistics donât support that discomfort, but I donât argue much.
In 2007, there were 1314 cases of polio on the planet and 127 of them were in âendemicâ countries: 873 in India, 285 in Nigeria, 41 in the Congo, 32 in Pakistan and 17 in Afghanistan.

Yep. Overall, Dr. Jay's attitude is that he doesn't trust vaccines and poo-poos polio.

I think that the current vaccine schedule is not the best we could do. I claim no proof for this.
What is unclear about that?

Well...for one, where you got that idea in the first place is pretty unclear.
Also, why you think your method is really any better?

I know you have your 30 years of experience and everything, but why do you rely on your gut feeling? If I felt that children were getting medical treatment that wasn't as good as it could be, I would:
A) Find out if this really was the case
Then
B) Try to find a solution or at the very least raise awareness of the specific shortcomings

In fact, I think it may be unethical to do anything else if there was the least bit of suspicion that something was wrong.

You have the suspicion, but haven't done anything about it outside of your own practice. I find that unsettling.

Here's Jay Gordon on what immunizations he gives, commenting in this RI thread (post #293):

"My vaccine schedule? Either none or just a DPT in the first 24 months of life. I think that there's a greater risk vaccinating males under 24 months and would prefer not to unless there are special circumstances. I use very few other shots except the Varivax as a child approaches ten years because teen and adult pox are nasty and even a little dangerous especially during pregnancy. I give Hep B vaccines to nursing student/moms and dads, other medical moms and dads and higher risk teens and college kids."

So, we have you admitting that you give very few vaccines, one of those few is given according to a suboptimal schedule, and you give vaccines "reluctantly". That's a far cry from your current line, "I give vaccines.
I give them later and far slower than most doctors."

Do try to keep your stories straight. And think about being upfront with your patients' families (and potential future clientele), by acknowledging your non-evidence-based practices on your website (since you claim to be losing gobs of money on that site due to having to pay others to maintain it (and are soliciting contributions from the public to help out), at least get your money's worth).

Note to Lord Draconis: I will be submitting an extra-large expense request this month to my Pharma Overlords, based on how long it took me to dredge up Jay's "vaccine schedule" quote. And please stop stamping my checks "Filthy Lucre". They're starting to ask questions at the bank.

"I think that the current vaccine schedule is not the best we could do. I claim no proof for this."

This jerk has a duty to give his patients the best care possible, and he ADMITS to giving medical recommendations that have no basis in scientific fact? Wow.

It pisses me off the guy like him are allowed to practice medicine.

Oh, I love using Dr.Gordon's website for his "feelings" about vaccine-preventable diseases and the reasons why he doesn't give vaccines in the first year...or two...or ever.

Yes, Dr. Gordon I have "emotional" reasons about polio having a close childhood friend die of it, before the Salk vaccine was developed. Measles? I have "emotional" reasons about
this vaccine-preventable disease as well because of a cousin who developed measles encephalopathy.

More recently, I have "emotional" reasons about Pertussis having seen infants die of it, when I worked in public health.

Posters here need only visit Dr. Gordons website to make a determination about his vaccine "feelings."

So, Jay is in favor of keeping those greatest at risk of death or disability (newborns & children under the age of 18 months) if they should in fact catch one of these diseases, unprotected?

Also, you do realize that you're developing your own little high-risk group, should any of your patients come in contact with any infectious, but vaccine-preventable, dieases & then decide the head down to your waiting room for treatment, right?

I'm surprised you've been able to find other doctors that will accept that risk to their own patients. It seems like, just about the time I start to develop a little sympathy for you, you say, do, or something else is revealed that really just throws that sympathy out the door.

Since I have two young children, these issues do hit very close to home.

Wait, even if a child is travelling to parts of the world were polio is still endemic, he's still reluctant to give them the polio vaccine?

Matthew Cline: what, would you deprive them of the opportunity to develop natural immunity?

Drvebyposterz: your comments make absolutely zero sense given that the vaccine issue has become political, not scientific. Pharma has pretty much put the screwS to most people who dare try and publish anything that shows a problem with vaccines or their ingredients. Keep on driving.

Wow Jen - so all of those times that the FDA has ordered recalls or companies voluntarily removed drugs from the market, it was - what?

And who's made the vaccine issue political? You and your ilk have "ideas & opinions," not facts, that fly in the face of all real scientific evidence - and again, you play up the fallacy that vaccines are claimed to be 100% safe and 100% effective - which no one here has ever said they were.

Jen @ 190: The absence of evidence that vaccines are injurious is proof that there is a conspiracy to hush up the injurious nature of vaccines.
There are words for this form of reasoning but they are not flattering.

"Dr. Jay" (#88) appears confused about a comment I made (#83) in which I said:

"Wow! The "science has been wrong before" fallacy in combination with concern trolling"

"Dr. Jay" asks:

"Prometheus, I'm curious: Why does you're [sic] saying this is a fallacy make it a fallacy?"

I'm sorry, "Dr. Jay", I wasn't clear enough, apparently. What I mean was the "Science has been wrong before, so I can assert that science is no more likely to be correct than whatever story I might make up." fallacy.

Does that clear things up?

Yes, science has been wrong before, but its "track record" is so much better than that of its detractors (e.g. "Dr. Jay") that the "smart money" is on science.

When I was an undergraduate, one of my professors (molecular biology) told us that "fifty percent of what I teach you will be shown to be wrong in the next ten years". He was correct, but not in the way that "Dr. Jay" is trying to imply.

Much of what my professor was "wrong" about hasn't been supplanted by a completely different ("180 degrees wrong") mechanism, but instead by a more complex and detailed understanding of the mechanism.

For example, "back in the day" we knew that viruses attached to their host cells using some sort of cell surface molecule. Now, we know which molecules and the structural conformation of the complex between virus and host. However, the basic idea - "viruses attach to host cell molecules" - hasn't changed; we just have more detail.

Likewise, we knew "back in the day" that RNA polymerases were more error-prone than DNA polymerases; now we know why - the fact (RNA polymerases more error-prone than DNA polymerases) didn't change, but our understanding is deeper and more detailed.

Just so "Dr. Jay" understands - the fallacy is in asserting that since "Science has been wrong before" that it is wrong in the specific instance claimed without data supporting the claim that "science is wrong". To be blunt, just because science has been wrong doesn't give license to make stuff up and assert that since "science has been wrong before" that the made up story is in any way valid.

What "Dr. Jay" is calling "ad hominem insults" are honest expressions of scorn. I should also point out - as has been pointed out repeatedly - that an insult (or an honest expression of scorn) isn't a fallacy unless it is used to support a claim. In other words, it would be an ad hominem fallacy to say "Dr. Jay is an idiot, so everything he says is wrong."; it is not an ad hominem fallacy to say "Dr. Jay is wrong in everything he says, so he's an idiot."

No matter how clearly the facts are explained to him, "Dr. Jay" can't seem to get past his closed-minded belief in the infallibility of his own "experience". I wouldn't even bother to address his comments if it weren't for the possibility that someone might read them and - failing to see a rebuttal - mistake them for reality.

Prometheus

jen: "Pharma has pretty much put the screwS to most people who dare try and publish anything that shows a problem with vaccines or their ingredients."

Let's hear it for Those Who Dare.

And may this be their theme song.

Prometheus, you're trying too hard.

Your molecular biology professor was correct and you're also correct in saying that part of what's "wrong" is just deeper understanding. Bur part of what is "wrong" is just incorrect by 180 degrees.

Jay

Dr. Gordon,
As you and Prometheus discussed, the word "wrong" is a relative term, not an absolute. You believe that many things that are current science are wrong in the most extreme extent. Could you name some and why you think they are wrong?
Thanks in advance.

Mephistopheles, that's a great question. I won't use quotation marks.

It's wrong to use psychopharmaceuticals in children as we do now in 2011.

It's wrong to perform eye surgery electively for refractive errors. (Not sure I used good terminology there.)

It's wrong to create a "war on germs" using hand sanitizers.

I think we'll find we are wrong in the way we measure and treat certain types of thyroid hormone conditions.

It's wrong to use statins as we do now.

Just a few.

And, I think it's wrong to vaccinate against an illness just because . . . we can. We should be more judicious in our use of this medical intervention. I might add that I, obviously, don't know where the "right" answers will be in 2, 3, or 10 years, but they'll make many things we doctors do in 2011 look very wrong.

Jay

"Could you name some and why you think they are wrong?"

You seem to have read only the first four words of the question.

@Jay Gordon:

And, I think it's wrong to vaccinate against an illness just because . . . we can.

Can you explain why giving the polio vaccine to a child travelling to an area where polio is endemic is merely "vaccinating because we can", rather than actually being a good idea?

"Pharma has pretty much put the screwS to most people who dare try and publish anything that shows a problem with vaccines or their ingredients."

Citation needed.

"And, I think it's wrong to vaccinate against an illness just because . . . we can."

Jay, you pompous ASS! You are a doctor for pete's sake! You just said, for lack of a better way of saying it - WHY SAVE SOMEONE'S LIFE, JUST BECAUSE WE CAN?

So, in your mind, disease eradication is a bad thing? You'd be just fine with smallpox running around again?

You have no problem with people getting diseases that could potentially (if not kill them) cause life-long disabilities - like Polio?

What kind of person are you? You certainly should not be a doctor or treating kids, or treating anyone for that matter.

I thought there might be some glimmer of hope that you'd come around, but that one profoudly stupid statement just proved that you are 100% certifiable nutjob.

@197: Could you support any one of those claims with evidence?

Dr. Gordon might benefit from reading and comprehending Isaac Asimov's The Relativity of Wrong.

I am culling through the above posts for any common sense.

Polio is endemic to India. Last year there were 42 cases among the billion Indians. Someone please compute the likelihood of coming in contact with one of those patients. Nonetheless, I do vaccinate people going to India. Not for medical indications, because they're more likely to be killed on the car ride to the airport, but because it's a reasonable thing to do.

http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

Lawrence, your post barely requires a response. But . . . no, I just can't.

@Dr. Jay

part of what is "wrong" is just incorrect by 180 degrees.

Kind of like how doctors trusting in their extensive personal experience were "just incorrect by 180 degrees" in thinking that bleeding was helping their patients, scoffing at those who actually did controlled observations (science!) to show that it was at best, useless, and at worst harmful?

Dr. Jay,

I can't tell you the number of times I've read comments by you here where I seriously hoped someone else had posted under your name.

I'm no longer convinced you could recognize common sense. There was plenty offered here and concern over your position. You didn't defend your position. Is there some reason for that?

Which diseases would you let children get since you "think it's wrong to vaccinate against an illness just because . . . we can"?

It's wrong to perform eye surgery electively for refractive errors.

Why?

For the record, I had surgery done for severe myopia (I was legally blind without glasses) about 12 years ago. It has improved things in the following ways:

Greatly enhanced my night vision - kind of important for driving.
Noticeably widened my effective visual field.
Greatly reduced fatigue when reading and working - as a pathologist, I put in a lot of microscope and computer terminal time.
Greatly improved my safety while swimming, snowboarding, and doing other activities.

I wear bifocal glasses most of the time, but my distance correction is mild (for astigmatism) and the presbyopia correction works much better in that setting. I don't need my glasses when driving or doing physical activity. I tried contacts, but they were uncomfortable, and less effective.

If you think surgical correction of refraction is only a "vanity" procedure, you are wrong. But then, your opinions in such matters are, to put it "civilly", idiosyncratic.

Jay - I stand by my post. I'm sorry if I've offended you, but in all honesty, you've taken a serious step off the deep end.

You're against vaccinations, you're against laser eye surgery, & you think it is perfectly fine for babies to be exposed to potentially life-threatening diseases - because "you can."

If I had a choice, I would have elected not to be exposed to Chicken Pox - guess what, it really sucked. Now I have a chance of getting Shingles when I get older & I've seen those that have had it - and again, it sucks.

You're making medical (and I would barely call what you do or what you recommend to be "medical" in anything but your own mind) recommendations to impressionable parents that could ultimately injure or even kill their children.

Given that you're in California - and in the front lines of some of more recent major upbreaks of childhood diseases (including the San Diego measles outbreak) how can you possibly recommend to parents that they allow their children to be exposed to these dieases naturally? I'm sure you're absolutely fine with any one of them coming down with one of these diseases, and if they roll the dice and happen to be one of those who are either blinded, rendered sterile, or suffer some other form of diabilitating injury, well, that's the breaks, right?

The science supports vaccination - from even before there was a "Pharma" industry. You are, for lack of a better term, pro-disease. Of course, since you make far more money from treating the diseases, as a doctor, vaccines aren't in your best interest anyway, are they?

And since you're also not in favor of disease eradication - and again, why is that? Tell me please, how badly do you want Smallpox to return? Tell me how many more cases of measles, mumps, rubella & polio do you want to see?

Thank you for making it abundantly clear that you are in favor of more diseases, more children being sick - and against any sort of rational health care for children. I'm surprised you haven't been reported yet - because you sure as hell aren't a doctor.

Jay Gordon said: "I am culling through the above posts for any common sense."

Jay, that's quite rude, especially for someone who's constantly berating us for a lack of civility. When looking through old comments to find that one where you explained your minimalist "vaccine schedule" I noticed that you fling insults about quite commonly, calling other posters silly, perseverating etc. Lame insults, but insults nonetheless. Since you can't control your own behavior, kindly cease advising the rest of us to be civil, and stick to debating the facts.

Now: you scoff at the idea of vaccinating visitors to India for polio because disease incidence is low. How about vaccinating children and adults traveling to India for measles? According to the WHO, in one recent year there were over 51,000 cases of measles and 140 deaths, numbers felt to be a marked underestimate of the true situation since many states with poor vaccination rates don't report their measles cases. I've seen statistics elsewhere suggesting that measles vaccine coverage rates in India are as low as 50% in some Indian states. That's not as bad as your own practice, but alarmingly poor nonetheless.

Do you follow CDC guidelines for immunizing travelers to India for diseases such as measles, mumps, rubella, diphtheria, pertussis, tetanus and hepatitis B? Or do you tell patients that the likelihood of coming into contact with sick people is low enough so that they can forego vaccine protection? (or alternately, that you do not believe in providing immunization protection just because . . . you can)?

And how about patients of yours who travel to other countries, including Third World nations?

Answers most respectfully requested.

What has happened, that the medical profession can't yank the license of an anti-vax pediatrician with a mass media presence? How can this unholy situation be fixed?

Dr Jay:
Mephistopheles asked for examples and explanations from science that you consider wrong. Among your replies:

It's wrong to create a "war on germs" using hand sanitizers.

The blame for that one belongs to marketers, not scientists!

And please elaborate on why eye surgery falls into your âwrongâ list. I quite honestly canât come up with one single reason why correcting someoneâs vision would be a bad thing. We can correct many other conditions surgically â why should eyes be off the table?
Waiting on your explanations, as Mephistopheles requested.

why should eyes be off the table?

Because they should be inside of eye-sockets, not on top of tables.

*ba-dum-ching*

And please elaborate on why eye surgery falls into your âwrongâ list. I quite honestly canât come up with one single reason why correcting someoneâs vision would be a bad thing. We can correct many other conditions surgically â why should eyes be off the table?

You shouldn't repair eyes just because you can. Duh.

Jay Gordon: "I am culling through the above posts for any common sense."

I repeat my earlier question @166 on why distributing vaccines with a preservative was "Not the safest way to do things", and it is safer to increase the risks of infection and difficulties of distribution by taking the preservative out. Not enough common sense?

Reading this discussion it is clear that Dr Jay Gordon has no morals. He is hooked on the easy money lifestyle that comes with being a doctor to pampered and privileged and more than willing to pay his dues: Selling out his intellectual integity for sycophancy to the whims and prejudices of celebrity super-egos.

Bacon--Good points.

Suggesting things--without quotation marks around "wrong--may have confused you all. Please reread it with the implied "--"

Jay

Suggesting things--without quotation marks around "wrong--may have confused you all. Please reread it with the implied "--"

This answer makes my head hurt, Dr. Postmodern.

Dr. Jay,

Fuck you!

I wore glasses and contacts for more than 30 years before getting LASIK surgery a few years ago, people don't get corrective eye surgery "just because we can" they get it so that they can see. My vision was 20/850 in one eye and 20/960 in the other, now it's better than 20/20 in both. Before LASIK I couldn't get out of bed to use the head without finding my glasses, now I don't need them at all.

You're an idiot and a fraud, with any luck you'll be out of business soon.

@jen - 190

Capitalizing the "S" st the end of screws really made your point...NOT!

Ridicule is the only weapon which can be used against unintelligible propositions.
-Thomas Jefferson

Old Tom must have knows Dr Jay would be around someday.

The tone of my posts last evening was a bit harsh - but Dr. Jay's flippant remarks (and continuing not to answer direct questions, repeatedly), plus a review of his website (the FAQ seems harmless enough, until you start reading about his vaccine recommendations - quoting a bunch of disease statistics, then saying its no big deal) really got to me.

I still can't believe this man is a doctor - because based on my experiences with my own pediatrician, he comes across as heartless & dangerous to new parents.

Suggesting things--without quotation marks around "wrong--may have confused you all. Please reread it with the implied "--"

Does that mean we should have read all those as pretend-wrong not real-wrong? That would fit with the doctor's complete refusal to back up any of his claims -- they're just made up anyway.

Dr. Jay,

Next time Jenny brings Evan in, tell her you can't support injecting Botulism toxin into her face just for vanity. Have you compared the LD50 of the Botox she uses to that of thiomersal or formaldehyde that you both freak out over?

Good point - someone who doesn't support corrective eye surgery could never support Botox, or other vanity plastic surgery procedures, right Jay?

"Bacon--Good points."

Still awaiting responses, Jay.

And, I think it's wrong to vaccinate against an illness just because . . . we can.

You know, like with condoms.

It's wrong to use psychopharmaceuticals in children as we do now in 2011.

Actually, this story works against you. I'm reading Anatomy of an Epidemic, and it appears from his account that the evidence of serious problems with these drugs was there from the start and confirmed in study after study. In this case, the science has not been wrong - it's been (often willfully) ignored. You are doing the same thing when you ignore or dismiss the scientific evidence regarding vaccines and promote testimonials and ridiculously bad "research," and you're playing right into corporate hands.

Just...as a totally unrelated side question, what exactly does it take to get someone's license to practice medicine revoked?

Do they need to kill someone with their own two hands?

Or can they just display a total disregard for the safety of their patients.

@226 read here about license revocation http://www.sciencebasedmedicine.org/?p=235

@Jay Gordon. One would think that, at some point, you would stop repeating your claim to expertise and actually look at the literature. Then you could point us to the evidence that you are right (or, more likely, not).

Jay Gordon sez:
It's wrong to use psychopharmaceuticals in children as we do now in 2011.

If a child has bipolar mood disorder, the people around him/her should just learn to deal with it, right? I went to school with a gal who had that. Her medication need shifted just a teensy tiny little bit . . . and she was a complete wreck until that got sorted out. Need *inpatient* care until they could get the new dose right.

Yeah, psychoactive drugs are overprescribed, but to suggest it's wrong to use them in children? Obviously, you haven't had many kids with major psychological problems (which would raise the question of why you purport to know something about autism, but that's another matter).

It's wrong to perform eye surgery electively for refractive errors. (Not sure I used good terminology there.)

Really? I wear eyeglasses. Nearly all of my relatives wear eyeglasses. A few are trying out LASIK and other refractive eye surgery, most recently my brother-in-law. It has changed their lives. They have gone from requiring a prosthetic to being like any other normal person.

And then there's a friend of mine who is legally blind. Glasses are no help. He has a congenital defect of the eye. He *could* have had refractive surgery to improve things to the point where he could manage on coke-bottle-thick glasses, like his mother. However, although his mother was able to get it done on insurance, by the time he got old enough for the procedure, it was deemed "elective" and insurance would not cover. He cannot afford it out of pocket. It would be nice if he could get it now in conjunction with his upcoming cataract surgery, but too many people think exactly like you do, Jay, that seeing clearly is a luxury, not a medical need.

Try going without glasses for a day when you can't even recognize a person standing ten feet away. (That's my vision, not his -- his vision is so poor he needs a cane. I'm not quite that bad, and with my glasses I'm 20/20.)

Refractive surgery, when successful, means you never have to worry about becoming temporarily disabled (i.e. blind) because somebody sat on your glasses by accident, or worse, because your house burned down and you couldn't find the glasses as you evacuated. Friend of mine's house was destroyed in a tornado; they never did find his daughter's glasses and had to get a new pair for her.

I'm too chicken to get refractive surgery; I'll just come right out and say that. Eye surgery freaks me out. But everyone that I've ever talked to who had it done wished they hadn't waited as long as they had. Yes, there have been problems, and probably the biggest has been the proliferation of woefully undertrained practitioners in storefronts. (If you want it done, go to an actual opthamologist, preferably one who has been doing it for a long time.)

It's wrong to create a "war on germs" using hand sanitizers.

Duh! Science agrees! What's your point, then?

I think we'll find we are wrong in the way we measure and treat certain types of thyroid hormone conditions.

That's a hunch, not an example of science being wrong. It's also about as clever as saying you think there might be a flood this coming spring -- while not absolutely certain, it's extremely likely. It's darn near inevitable that scientists will find ways to improve on current practice. So what, exactly, is your point?

It's wrong to use statins as we do now.

And you know this . . . why? How do you think they should be used? What's wrong with current practice? I'm not saying this to refute you, just to show that this isn't much of an argument by itself.

And, I think it's wrong to vaccinate against an illness just because . . . we can. We should be more judicious in our use of this medical intervention.

Given that Americans do not routinely vaccinate against yellow fever, I think it's pretty obvious scientists don't recommend vaccinating just because we can. Hell, when's the last time you gave a rabies vaccination to a schoolkid who has never been exposed to rabies? You're saying science is wrong for something that science doesn't claim. The things that the CDC recommends vaccinating against are not merely because they can. There are actual reasons, and you really have no excuse whatsoever for not knowing them.

@ driveposter and @ Joe: Yes, some of these doctors have faced license suspension/revocation, but they have to really injure or kill someone. NYS Office of Professional Misconduct (OPMC) happens to be an excellent very user-friendly site. I checked out the OPMC site after viewing the Dateline NBC Program this past Sunday evening to check out Dr. Nicholas Gonzalez...he is one of the doctors touted by Suzanne Somers for CAM cancer treatment.

I keyed in the doctor's name and the action against him was listed along with the full documents listing the specific charges. I also used the OPMC site's front page to find out about his "credentials" and any past malpractice cases against him where malpractice insurance paid the plaintiff. There was one case but no details about the circumstances or the payout.

OPMC might be a good site to check out education, residencies, post-doc fellowships and credentialing in their designated specialties before you choose a primary care physician or when you are referred to a specialist. But, as we know from this site, some credentialed doctors still practice quackery.

@Jay Gordon:

Suggesting things--without quotation marks around "wrong--may have confused you all. Please reread it with the implied "--"

Argh! What does wrong-in-quotation-marks mean?

Sigh. I guess we will not be favored with Jay's explanation as to how he deals with patients' immunization requirements for trips to foreign lands where preventable infectious diseases are endemic. It would have been especially interesting to see how a doc who subscribes to the "too many too soon" mantra would handle the need for "catch-up" shots for a child who's never gotten any, and needs a bunch in a hurry before leaving with family for a journey abroad.

Kind of tough to rely on the herd immunity provided by others, when foreigners aren't as considerate as Americans in shielding vaccine refusers from the consequences of their actions.

Reading Orac's article has me reflecting on the many headlines in journalism that can be reused ad infinitum:

"Clocks Go Back Today"
"Violence Erupts In Mideast"
"Lindsay Lohan Arrested Again"

And now we have:

"Dr. Jay Gordon's Profound Misunderstanding Of Science"

That one can be recycled endlessly too. Thanks, Orac, for a great contribution to "green" blogging!

Argh! What does wrong-in-quotation-marks mean?

I would assume it to mean someone else says it is wrong, but he doesn't really believe it is so it is "wrong"? That is how I would read it except then it doesn't make *any* sense (but it's Dr. Jay, and making sense is not one of his strengths).

He's backpedeling because people called him out on his foolishness. Just like he did when he was quoted as saying children shouldn't receive any vaccines before 24 months. He didn't make sense then either.

I know that when I used "wrong" in quotation marks, it was to show unambiguously that I meant the word "wrong" itself and not the concept of wrong. This would be analogous of asking what the meaning of "is" is, or saying that "you" is a pronoun.
I'm not sure what Dr. Gordon means.

What does wrong-in-quotation-marks mean?

Weaseling room for Jay Gordon when he is shown to be full of shit as usual.

Polio is endemic to India. Last year there were 42 cases among the billion Indians. Someone please compute the likelihood of coming in contact with one of those patients.

Yup, dishonest. I'm giving Jay the benefit of not being a complete blithering idiot, since he's already had the difference between "infection with poliovirus" and "paralytic polio" explained to him several times, starting with med school. Not to mention newspapers when he was growing up.

When you have no steak to sell the sizzle is very important.

Dr. Jay Gordon is likely more informed about marketing than you lot. The public do not listen so much to the words as to the status and style of the speakers.

Dr. Jay is here to enact a "debate" with the "scientists" so he may stand shoulder-to-shoulder with his peers before the public.

@ Anonymous: So true. While I track woo, I often am astonished by how image is the _greatest part_ of the message: self-styled "scientists" and "academics", waving ersatz PhDs, talking about their own "research", solemnly quoting madly-constructed "theses" packed with barely related biochemical or physiological references, with a dollop of "quantum" this or that thrown in for good measure: all to appear *learned* to the marks. (God, if I started talking and dressing like the Queen of the Faeries it wouldn't make me that!)

If a child has bipolar mood disorder, the people around him/her should just learn to deal with it, right? I went to school with a gal who had that. Her medication need shifted just a teensy tiny little bit . . . and she was a complete wreck until that got sorted out. Need *inpatient* care until they could get the new dose right.

Yeah, psychoactive drugs are overprescribed, but to suggest it's wrong to use them in children?

You should read the book I mentioned @ #225.

Salty, Anatomy of an Epidemic is by Robert Whitaker. There are a number of prominent Whitakers in Scientology and the CCHR --e.g., 'Whitaker Wellness Center."

I haven't read this book (I can't keep up with the onslaught of anti-psychiatry the other team has been putting out), so I'm in no position to criticize its contents. But please consider: if its thesis requires some belief that psychiatrists are less intelligent or less caring toward their patients than other doctors on planet Earth, it is probably a very bad book.

Recently laws have been passed forbidding the use of prone restraints in residential programs. This is not a rational thing to do, as proning a violent person on a mat is often the safest way to keep people from getting hurt. But some people have been hurt and some have even died while held proned on the ground --usually by police dogpiling on them, which is an entirely different thing.

Well meaning "disability rights" rights groups are encouraged by the CCHR to lobby for such laws. Again though, to want to restrain the practice of psychiatry by law, one must assume the doctors involved are pretty bad.

Anti-psychiatry has become a wedge strategy for the "transformation of society." There is a semi-open conspiracy to combat "materialism" by getting God into healthcare. Christian organizations in Texas and a network of Ayurveda practitioners have some interest in this.

The bad guys are doing an end run around the traditional barriers to incompetence. They've set up their own systems of accreditation, their own professional training programs that avoid protected terms like "psychologist" or "dietician."

In the very near future, when you look up "counselor" in the yellow pages you will see dozens of "psychotherapeutic counselors" and "nutritionists" and "life coaches." Because these people are outside the allied health professions programs that are truly integrated with the practice of medicine, they will not know what they do not know.

Example of one such program: Chrysalis.

Second try with the link: Chrysalis

Salty, Anatomy of an Epidemic is by Robert Whitaker.

Yes, I'm aware of this fact.

There are a number of prominent Whitakers in Scientology and the CCHR --e.g., 'Whitaker Wellness Center."

Wow.

I haven't read this book

Then a conversation can't really be had about it with you, can it?

Salty Current -- I've got such a long reading list right now that there's basically zero chance I'll get to that book. So in lieu of directing me to a book I'm unlikely to read, what is the argument you're making?

The single biggest problem with psychoactive drugs in children is that they are not adequately studied, frequently to the point that they are not approved for pediatric use. This leads to the second biggest problem -- it encourages off-label use by normalizing it. Off-label use isn't, in and of itself, a problem, but if doctors are using drugs off-label more often than not, there's clearly something wrong, and doctors can become so used to it that they start feeling that the manufacturer's instructions are really only guidelines and they can be more creative with them. That's where you start getting kids without serious problems on antipsychotics meant for adults -- or kids with autism taking Lupron.

So clearly, there are problems with the system (such as it is), but that doesn't mean, as Jay seemed to be implying (he's free to clarify, of course, but he hasn't yet), that psychoactive drugs are never appropriate for children. It also overlooks that there ARE drugs which HAVE been studied in children, and for which ample prescribing information is available. The much-reviled methylphenidate (Ritalin, Concerta, etc) is actually a good example, and it is available in many formulations intended specifically for children. First synthesized in 1944 and identified as a stimulant in the 50s, it started being used in children in the 1960s. This is a rare case of a psychoactive drug with safety and prescribing data on children going back fifty years. It's pretty hard to beat that.

Anonymous @240
Crysalis Link is broken

I remember getting junk mail from Julian Whitaker - the guy liked to emphasize how persecuted he was. Not surprised to discover he is a Scientologist. Do you know if this Robert Whitaker is related? I find that a lot of people who appear to be raising legitimate concerns about psychiatric medications turn out to be mental illness denialists.

Salty Current -- I've got such a long reading list right now that there's basically zero chance I'll get to that book. So in lieu of directing me to a book I'm unlikely to read, what is the argument you're making?

You really have to read it. You can also hear him talk about it here:

http://www.c-spanvideo.org/videoLibrary/event.php?id=184523

(Warning: He has a distracting nervous tic.)

He doesn't speak much about children at this talk, but it's a large section of the book, much of which appears to be available in the Google Books preview. He presents evidence from the scientific literature that the drugs are ineffective, have bad side effects, and lead to terrible long-term outcomes.

This is a rare case of a psychoactive drug with safety and prescribing data on children going back fifty years. It's pretty hard to beat that.

Read the book.

Do you know if this Robert Whitaker is related? I find that a lot of people who appear to be raising legitimate concerns about psychiatric medications turn out to be mental illness denialists.

Oh, FFS.

He presents evidence from the scientific literature that the drugs are ineffective, have bad side effects, and lead to terrible long-term outcomes.

Pardon me for being reflexively skeptical of anyone who paints "psychoactive drugs" with that broad a brush.

Our Gracious Host and I have plenty of experience on MHK with that general line and the signature is pretty distinctive. Not conclusive, but strongly indicative.

Salty Current--

You do realize that you're asking us to accept the accuracy of a book that you won't summarize and haven't finished yourself, yes?

If we were discussing whether a novel was well written, asking everyone to at least start the book would be reasonable. In this case, you're trying to convince us of a factual claim. Surely it can be summarized in less than 250 pages.

Is he saying this is a flaw in all psychoactive drugs? Are they all ineffective? Do they all have bad side effects? And do they all head to terrible long-term outcomes? Or is the claim that each of them has at least one of those flaws?

If the latter, yes, if a drug is ineffective for a given condition it shouldn't be used. But what side effects are tolerable depends on the individual patient--both what s/he values and on how serious the condition being treated is. We accept side effects in cancer drugs that we wouldn't accept in a treatment for a sore muscle.

Pardon me for being reflexively skeptical of anyone who paints "psychoactive drugs" with that broad a brush.

This has become a bizarre conversation. I was asked by someone spouting off on a subject but unwilling to read a recent and comprehensive work on the topic to summarize the arguments from one section (relevant to the topic under discussion), which I have. I'm suggesting that people read the book, and is easy enough to do. People (who apparently won't even take a moment to google) are actually talking about the guy's name. They're making Dr. Jay's "years of clinical experience" look good by comparison. I'm sure the book, as pretty much every book, is flawed in many ways, but there is no point in discussing its argument or evidence with people who haven't read it.

You do realize that you're asking us to accept the accuracy of a book that you won't summarize and haven't finished yourself, yes?

WTF? I'm not asking you to accept anything. I'm suggesting that people read it before popping off in uninformed ways.

I summarized the relevant section. The book is available within moments on Amazon. I linked to a talk about it. I recommended the Google Books preview. You can also find links at his web site, I believe. Do you want to to come to your house and read it to you?

[And I finished it yesterday (was almost through when I first posted about it).]

Here are some citations:

http://www.robertwhitaker.org/robertwhitaker.org/Children.html

They can really only be fully addressed in context, though.

Thanks but I'll pass on anything by Robert Whitaker, CCHR shill. I have f_cking had it with these moonbats and their dirty tricks and black PR.

****
CCHR® Presents

Award-winning medical journalist, Robert Whitaker's book:

Journalist Robert Whitaker's written works on the mentally ill and the drug industry have won several awards including the George Polk Award and the National Association of Science Writer's award to name just a few. Critics declare Mad in America is "A must read forâ¦those interested in the history of science and the corporate buyout of a profession." "Tracing over three centuries of 'cures' for madness, Whitaker shows how medical therapies have been used to silence patients and dull their minds."

"This book is one of the most thoroughly researched, truthful and educational portrayals of psychiatry that I have ever read in my 25 years of working to clean up the field of mental health. Easy to read, it is vital for those seeking to understand exactly how psychiatry has falsified studies, lied to governments and turned society into the problem-ridden, drug culture that it has become today."

â Jan Eastgate, President CCHR International
*********

Thanks but I'll pass on anything by Robert Whitaker, CCHR shill.

*sigh*

I was asked by someone spouting off on a subject but unwilling to read a recent and comprehensive work on the topic to summarize the arguments from one section (relevant to the topic under discussion), which I have.

Okay, here's what you gave to Jay (I don't know whether you're referring to him or me as the person "spouting off on a subject but unwiling to read [the book]" but I find that highly offensive either way -- I am not unwilling to read and never said I was, I just wanted to know what case you were making because it wasn't clear):

Actually, this story works against you. I'm reading Anatomy of an Epidemic, and it appears from his account that the evidence of serious problems with these drugs was there from the start and confirmed in study after study. In this case, the science has not been wrong - it's been (often willfully) ignored. You are doing the same thing when you ignore or dismiss the scientific evidence regarding vaccines and promote testimonials and ridiculously bad "research," and you're playing right into corporate hands.

And here's what you said to me when I asked to know what the argument was you were making:

You really have to read it. You can also hear him talk about it here:

http://www.c-spanvideo.org/videoLibrary/event.php?id=184523

(Warning: He has a distracting nervous tic.)

He doesn't speak much about children at this talk, but it's a large section of the book, much of which appears to be available in the Google Books preview. He presents evidence from the scientific literature that the drugs are ineffective, have bad side effects, and lead to terrible long-term outcomes.

Okay, so it's a book arguing that as Jay claims (so I'm unclear how it works against his case as you stated) psychoactive drugs should never be used in children? It's curious you said this in response to my personal anecdote of a classmate with severe bipolar mood disorder. If she weren't on lithium, never mind long-term side effects; she'd be dead almost certainly. Definitely she wouldn't be doing well in class.

There is plenty of scientific evidence that many psychoactive drugs ARE effective. There is also evidence that some aren't in certain circumstances, but just because Paxil might not be effective in mild-to-moderate depression doesn't mean lithium doesn't help people with BPM. I do not follow your case.

(BTW, I agree that harping on the author's name is silly.)

Salty Current,

I was asked by someone spouting off on a subject but unwilling to read a recent and comprehensive work on the topic to summarize the arguments from one section (relevant to the topic under discussion), which I have.

And now you just out-and-out lie. You have not presented a single argument in this thread, unless you consider citing a book an argument?

You claimed that studies showing the ineffectiveness/danger of psycho-pharmaceuticals have been ignored. That's a damn big claim to make without giving a single shred of evidence.

Okay, so it's a book arguing that as Jay claims (so I'm unclear how it works against his case as you stated) psychoactive drugs should never be used in children?

Did you read the link I provided @ #250? It's a complex argument with numerous citations from the literature. But yes, the book makes a case that many if not all of these drugs should not be given to children.

It's curious you said this in response to my personal anecdote of a classmate with severe bipolar mood disorder. If she weren't on lithium, never mind long-term side effects; she'd be dead almost certainly. Definitely she wouldn't be doing well in class.

Your anecdote has as much value as Jay's do. My point, you have missed it.

And now you just out-and-out lie. You have not presented a single argument in this thread, unless you consider citing a book an argument?

You claimed that studies showing the ineffectiveness/danger of psycho-pharmaceuticals have been ignored.

That's an argument, so your above statement is untrue, obviously.

That's a damn big claim to make without giving a single shred of evidence.

I referred to a book with hundreds of citations from the relevant literature and which tells this story. Again, more information was eay enough to find, and I then linked to a small selection of citations from the relevant section of the book.

On SSRIs, e.g.:

The story of research into selective serotonin reuptake inhibitor (SSRI) use in childhood depression is one of confusion, manipulation, and institutional failure. Although published evidence was inconsistent at best, use of SSRIs to treat childhood depression has been encouraged by pharmaceutical companies and clinicians worldwide. Last month, the Canadian Medical Association Journal revealed excerpts from an internal GlaxoSmithKline memorandum demonstrating how the company sought to manipulate the results of published research. Concerning a study of paroxetine use in children, the memorandum states âIt would be unacceptable to include a statement that efficacy had not been demonstrated, as this would undermine the profile
of paroxetineâ. Last year the UK Committee on Safety of Medicines prohibited the treatment of childhood depression with any SSRI except fluoxetine. Despite this, the Food and Drug Administration in the USA appears last week to have failed to act appropriately on information provided to them that these drugs were both ineffective and harmful in children.

In a global medical culture where evidence-based
practice is seen as the gold standard for care, these
failings are a disaster.

From CCHR shill, The Lancet (2004).

SC -- just a word to the wise, quoting two different people without saying who you are quoting can get confusing because it conflates two individuals.

If I've missed your point, maybe you could try clarifying it. At this point, as I've said, I'm still not entirely clear what your point is.

From your quoted article in the Lancet:
"Last year the UK Committee on Safety of Medicines prohibited the treatment of childhood depression with any SSRI except fluoxetine."

I'm trying to figure out why this refutes what I was saying, which is that there are big problems in how psychoactive medications are given to children BUT this should not be taken to mean that no psychoactive medications should be given to children. Heck, the article you quote is talking about problems with paroxetine, but suggests it is acceptable to use fluoxetine.

Now, maybe this actually does support your case. It's hard to tell, as I'm not clear what your position actually is.

* Do you argue that no psychoactive drugs should be given to children, ever?

* Do you believe there is no scientific evidence supporting the pediatric use of specific psychoactive drugs?

* Do you think that the known risk of long-term side effects always outweighs the benefits when considering pediatric psychoactive drugs, or would you accept that there are cases where the short term benefits are sufficient to justify the long-term risks?

BTW, I'm not that interested in what Whitaker's opinion is. I'm more interested in yours. After all, I'm not talking to Whitaker today. I will read your latest link in a bit; you posted while I was typing my last post, and I only just got back from lunch.

I'm trying to figure out why this refutes what I was saying, which is that there are big problems in how psychoactive medications are given to children BUT this should not be taken to mean that no psychoactive medications should be given to children. Heck, the article you quote is talking about problems with paroxetine, but suggests it is acceptable to use fluoxetine.

It says that it wasn't prohibited in the UK at that time (I don't know what the regulatory situation is now, but research since suggests that doctors weren't in fact prescribing this as a substitute after the prohibition of the others). But in fact, the next item at the link I provided @ #250 is from the BMJ, whose conclusions are accurately summarized by Whitaker:

After reviewing the outcomes literature, researchers concluded that clinical trials did not provide evidence that SSRIs, including fluoxetine, were safe and effective in children and adolescents. As such, ârecommending (any antidepressant) as a treatment option, let alone as first-line treatment, would be inappropriate.â [my emphasis]

You're simply wrong in your claims that the problem is that for children research doesn't exist for some, but that extensive evidence exists of efficacy and safety for others.

Read the book.

Titmouse @251

I suspect the Scientologists and other Mental Illness denialists would support anyone who criticized psychiatric drugs even if the the criticism was based on science. Being a hero of the CCHR (whoever they are)does not make Whitaker a shill for them unless he welcomes their endorsement. However, I think if they do endorse him has an obligation to distance himself from them.

Salty, it would be helpful if you gave us some basic idea of what Whitaker is claiming. Does he claim there is no biological basis for mental illness for example?

To yank this discussion back to Dr. Jay: his current position that any tweet that links to a video in which Dr. Offit appears must also include a disclosure of Offit's putative COI

What started it off? I sent:

Why do we vaccinate against HIB? http://youtu.be/xNbVjCdvrdA

the URL is to one of CHOP's excellent series on vaccination for expectant / new parents, "Vaccines and Your Baby".

Jay responded:
RT @lizditz: Why do we vaccinate against HIB? http://youtu.be/xNbVjCdvrdA Video link to Paul Offit MUST have Conflict of Interest info

I responded with

.@JayGordonMDFAAP believes that anytime one mentions CHOP or @DrPaulOffit a COI disclosure required. Fine. http://bit.ly/e50ujA #vaxfax

the link is to my blog, in which I published Dr. Offit's statement about his vaccine royalties and my own disclosure

and I went on to tweet:

are you confused, @JayGordonMDFAAP ? why should the rotavirus vax inventor have a COI disclosure for a different vaccine? #vaxfax

and then:

Be fair @JayGordonMDFAAP Where's your demand that Bob Sears divulge his royalties from Vaccine Book, speaking enagements? #vaxfax

crickets on the last one, but this morning

From Dr. Jay:
@lizditz: Why should the vax inventor have a COI disclosure for a different vax? Dr. Offit makes his living with vaccines-should disclose

Salty, it would be helpful if you gave us some basic idea of what Whitaker is claiming. Does he claim there is no biological basis for mental illness for example?

Nowhere that I've seen. Of course, you'd have to be more specific with your question. He argues - convincingly, in my view - that the "chemical imbalance" idea on which the marketing of these drugs has rested has no scientific foundation, and never has. He discusses how they work in the brain, including claiming iatrogenic causes of some mental illness.

I don't think he - and certainly not I - thinks that mental illness isn't biologically based in a fundamental way; the brain is part of the body. Neither do non-drug treatments (regardless of what any individuals claim) rest on such an assertion. I think the brain's plasticity and change in the context of action and social interaction needs to be appreciated (and Whitaker discusses some examples of successful non- and limited-drug treatments for mental illness, including schizophrenia). The problem comes, I think, when "biological" is a) seen as independent and unchanging and b) reduced to claimed mechanisms that are unfounded, as in the case of the "chemical imbalance" notion. (In this sense, the 'biological basis' for childhood depression, say, is of course an important research subject, but at the moment, in practical terms, it seems to be moot: what it is isn't known, and whatever it might be these drugs don't treat it.)

The bad guys are always making a big deal out of "chemical imbalance," as if this short-hand were some sort of evil misdirection. Meh.

Salty you say Whitaker is not opposed to biological interventions for mental disorders. Name one he supports.

The bad guys are always making a big deal out of "chemical imbalance,"

If by "bad guys" you mean pharmaceutical companies:

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.00203…

Salty you say Whitaker is not opposed to biological interventions for mental disorders. Name one he supports.

They're all biological. Humans are living organisms.

They're all biological. Humans are living organisms.

That's avoiding the answer.

How about "biochemical?" Or "medication based?"

That's avoiding the answer.

No, it isn't. It's avoiding certain parties claiming "biological" and "biochemical" for their specific interventions. Challenging the scientific basis for certain interventions and suggesting that others have a better evidence base is in no way antiscientific or a denial of biology.

And the question, however framed, has nothing to do with the subject at hand, nor would I attempt to answer it on someone else's behalf. If people want to try to make a case for the use of particular drugs in children, they should do so, but they should be aware that there is a large literature that doesn't support and contradicts claims of efficacy and safety and the lack of any solid scientific foundation for the claimed mechanism of action.

This whole conversation has been very strange for me. The day before I started Anatomy of an Epidemic I read Ben Goldacre's Bad Science (which I also recommend to anyone who hasn't yet read it), and was reminded by it how tragic the results of bad, manipulated, or ignored/suppressed science can be. I didn't know anything about Whitaker's thesis until I saw him several months ago on BookTV, but it did catch my attention. I would have expected that people would want to investigate a possible problem of these proportions (these drugs are being given to children in huge numbers), even if they conclude differently in the end. Instead, this has largely concerned these weird ad homs about Whitaker (and, to some extent, it seems, me). Very, very strange.

:/

If Mr. Whitaker's book fails to represent the scientific consensus it can be safely ignored.

You should know that the ordinary rules of evidence we rely upon fail in the face of organized crime. That's why we invented the the RICO statutes.

The anti-psychiatry movement has been closely affiliated with organized crime --with spying, destroying careers, black propaganda, suing people into ruin, scapegoating to stir up the political activism, and the promotion of anti-medicine generally including naturopathy, Ayurveda, and the like. The hope is to replace psychiatry with "integrative medicine."

Violence against psychiatry.

Here is a 13-page article on the topic published by Whitaker in 2005 in Ethical Human Psychology and Psychiatry:

CONCLUSION

A century ago, fewer than two people per 1,000 were considered to be "disabled" by mental illness and in need of hospitalisation . By 1955, that number had jumped to 3.38 people per 1,000, and during the past 50 years, a period when psychiatric drugs have been the cornerstone of care, the disability rate has climbed steadily, and has now reached around 20 people per 1,000. (Table 2). As with any epidemic, one would suspect that an outside agent of some type-a virus, a bacterial infection, or an environmental toxin was causing this rise in illness. That is indeed the case here. There is an outside agent fueling this epidemic of mental illness, only it is to be found in the medicine cabinet. Psychiatric drugs perturb normal neurotransmitter function, and while that perturbation may curb symptoms over a short term, over the long run it increases the likelihood that a person will become chronically ill, or ill with new and more severe symptoms. A review of the scientific literature shows quite clearly that it is our drug-based paradigm of care that is fueling this modem-day plague.

I haven't got past the "plague" part; I don't know how much more detail the book provides, but he states in one part:

Up until the 1950s, the number of hospitalized mentally ill provided a rough estimate of this group. Today, the disabled mentally ill typically receive a disability payment either from the Social Security Disability Insurance (SSDI) program or the Supplemental Security Income (SSI) program, and many live in residential shelters or other subsidized living arrangements. Thus, the hospitalized patient of 50 years ago receives either SSDI or SSI today, and this line of evidence reveals that the number of disabled mentally ill has increased nearly sixfold since Thorazine was introduced.

He doesn't mention, however, that SSDI did not become law until 1956. One could state that the willingness to diagnose someone as disabled mentally ill has increased since the method of treating the mentally ill has changed from hospitalization to disability payments?

Calli Arcale says: "Okay, so it's a book arguing that as Jay claims (so I'm unclear how it works against his case as you stated) psychoactive drugs should never be used in children?"

I had said, "It's wrong to use psychopharmaceuticals in children as we do now in 2011."

Calli, you're dishonest person. Simple.

I figured out what's wrong here. This is all a bunch of words games for you. Pseudonyms and pseudoscience. Orac, Prometheus, Dangerous Bacon. it's all about semantics, perseveration, and monolithic "science." For me, it's my daily life. I'm not the parent of a child with autism but I have cared for hundreds of these families over my career. Their lives are not "miserable nor hopeless," but they're made much harder by autism and then by denialists like yourselves. These children have genetic presdispositions to ASD and some of the triggers to autism are iatrogenic in nature.

Word games and pseudoscience. Stop.

Jay

I figured out what's wrong here. This is all a bunch of words games for you. Pseudonyms and pseudoscience. Orac, Prometheus, Dangerous Bacon. it's all about semantics, perseveration, and monolithic "science." For me, it's my daily life.

The ideas of reference?

Clearly SSI payments cause mental illness.

Dr. Jay rejects the scientific consensus concerning vaccines because he is good.

The doctors here accept the scientific consensus because they are bad and only interested in "word games."

Got it, Dr. Jay.

I figured out what's wrong here. This is all a bunch of words games for you. Pseudonyms and pseudoscience. Orac, Prometheus, Dangerous Bacon. it's all about semantics, perseveration, and monolithic "science."

Got it, Jay. You're the only one who cares and anyone who disagrees with you is a heartless SOB who is just playing at it.

Including those of us (/me included) who are either in the patient set or have family in the patient set. We just don't care either -- only you do.

If Mr. Whitaker's book fails to represent the scientific consensus it can be safely ignored.

Of course you have no idea, since you haven't read it. You've neither addressed the science nor engaged with the citations I've presented. Your comments have been oddly perpendicular to any substantive discussion, and can be safely ignored.

***

I don't know how much more detail the book provides,

A significant amount, including about SSI/SSDI (which is no doubt a factor but wouldn't account for the other indicators he notes there in the introduction in any event). The book presents a documented discussion of this timeline beginning prior to the 1950s, including specifically with regard to children. There are some elements it doesn't discuss in depth enough for my taste (I don't know if his previous book did), but it adds other pertinent ones.

***

I had said, "It's wrong to use psychopharmaceuticals in children as we do now in 2011."

Calli, you're dishonest person. Simple.

Your wording was ambiguous at best. It could be read as "use psychopharmaceuticals in children, as we do now" - so all psychopharmaceuticals - or with "as we do now" referring to the specific practices or extent.

I figured out what's wrong here. This is all a bunch of words games for you. Pseudonyms and pseudoscience. Orac, Prometheus, Dangerous Bacon. it's all about semantics, perseveration,

You're a master of projection. As I pointed out way back when, it's a game to you: "So . . . drop the formaldehyde stuff? OK. Can I have the rest then?"

http://scienceblogs.com/insolence/2008/07/dr_jay_gordon_pediatrician_to…

and monolithic "science." For me, it's my daily life.

No, for you it's about arrogantly dismissing the science in favor of anecdote and unevidenced pet notions. It's unethical in the extreme.

These children have genetic presdispositions to ASD and some of the triggers to autism are iatrogenic in nature.

Once again, what is your evidence for this statement? What "triggers" are iatrogenic in nature? How do you know that they are triggering autism and that the apparent appearance of autism isn't just observer bias, i.e. it was already there just harder to observe in a 1 year old than a 2 year old?

For me, it's my daily life. I'm not the parent of a child with autism but I have cared for hundreds of these families over my career.

DIAF Jay!

I am a parent of two children on the spectrum. I live in the trenches Orac, Bacon, Callie et. al. are the ones educating parents like me. They don't blow sunshine, or tell me to seek expensive (useless) "alternative" treatments: The truth is better. We don't know exactly what caused my children to be where they are, but Orac doesn't tell me to leave them susceptible to preventable illnesses on a hunch. You are a narcissistic ass! You act like your observations are the only proof needed to say all science is wrong; all knowing Jay has spoken.

You act like you are the only one here with empathy for our children? Prometheus has a child (only one? can't remember) on the spectrum. So what, he doesn't care as much as you because he knows the science is not there for vaccines being causative? What about Callie? Does she not know as much about it as you?

You don't live in the real world, Jay and neither do most of your patient's parents. I know I am being a little tense: I have a kidney stone and am in pain. I have my daughter's IEP meeting this morning and can't miss it. I have to wake her up in a minute and bath her before getting her dressed because she took her pull-ups off last night and wet her bed (she is five) I was too tired to do more than change her clothes and sheets. I deal with screaming tantrums from her and/or her brother every day. I can't pay someone to clean or cook or watch my children. I take them to all therapy appointments and take their little sister (2) along. I feel guilty every day that I don't get pay her the attention I would like to.

This is my real world, Jay, and the real world for so many parents of children with autism. So don't you even suggest you know what it is like!

Unlike Jenny, I am not going to whine and cry and say 'OMG look what the mean, mean pharma companies did to my babies!!!!!' When we become parents we sign up for good, and for bad. Don't get me wrong, my children bring me much more joy than pain and the rewards of having them in my life far outweigh the challenges. I just wanted to point out your egregious hypocrisy.

These children have genetic presdispositions to ASD and some of the triggers to autism are iatrogenic in nature.

Everything Orac writes has references. I believe you forgot your citation (maybe there is no hyper link for "pulled this from my ass").

Kristen: thank you.

Good to see Dr. Gordon digging deep into the anti-science playbook with a "denialist" blast followed up by an all-too predictable "pseudonym" shot at Orac of all people.

Dr. Gordon, ask Rene how posting under his real name worked out. In fact, ask Orac how his closely guarded real name (.....) protected him from the idiotic attacks of young master Crosby.

The fact that your anti-science allies make real life attacks on the livelihoods of scientists and doctors who disagree with them should indicate why pseudonyms are necessary.

Of course, you being the champion of civility, perhaps you can work on the attitudes of your anti-vaccine buddies and maybe get them to behave and people might feel better posting under their real names.

Not that it matters, but the primary reason I don't use my full name is that when I started visiting science blogs during my last post-doc I didn't feel like having the hr staff at the non-profit tell me to put a disclaimer on everything I say online.

Dr. Gordon, ask Rene how posting under his real name worked out. In fact, ask Orac how his closely guarded real name (.....) protected him from the idiotic attacks of young master Crosby.

I'll tell you how it worked out... I had to post a disclaimer with almost everything I wrote online. I had threats made on my person, my family, and on my profession. I almost lost my job. The police in the borough where I live know me well because of the reports I made to their cyber crimes unit.

"Sid Offit," a known troll, offered to come to my office and "take me to lunch." I really hope he meant lunch.

But you know what? I choose to live without fear because I have an incredible support structure in my friends, family, colleagues... Even my dog, cats, and other quadrupeds have pledged to fight tooth and nail for me. Why? Because I speak the truth, AND I have the science and evidence to back it up.

No pseudonyms or personal attacks here. You will never see me change Dr. Gordon's last name ("Offit" to "prOffit"). Unlike Jake Crosby, I'm not about that. I'm about the science and medicine... The stuff that, in the long run, will work out and prove itself right.

On the other hand, I totally understand why others have to use pseudonyms. There are some disturbing people out there. (Ask my answering machine.) And not all of us want to be bothered. I respect that. (Maybe I don't have as much to lose as they do? I don't know. But I respect it.)

In fact, I might actually back off and fade into the background if I should ever have children. I've seen what AoA is willing to say and do about the children of those who disagree with them... And that really scares me.

I believe you forgot your citation (maybe there is no hyper link for "pulled this from my ass").

:). If there isn't, there should be (maybe a LOLcat...). Hope your day gets better.

Even my dog, cats, and other quadrupeds have pledged to fight tooth and nail for me.

Well, that's a given.

Jay Gordon can kiss my ass.

Reality? After dispensing all his wonderful wisdom, gordon goes home to his cosy Beverly Hills mansion and wastes his night on twitter.

I don't have the same situation as Kristen, of course, but with 2 small ones at home, both under 30 months, I live daily with the risks presented to my family by assholes who refuse to protect themselves and to help protect others for their own selfish vanity.

I have described many times here about how I used to not fret too much about the anti-vaxxers. Never liked them, of course, and saw them as harmful, but when I had my first, things changed. At that moment, it became very real to me about how they were creating a preventable threat to my child. This doesn't end at 5 pm when the last paying customer visits my office, either.

In fact, I might actually back off and fade into the background if I should ever have children.

I never really worried about it when mine were little (more cluelessness than anything admirable) and now that they're grown you may see them chime in from time to time.

Grandchildren? Not yet, and besides they're part of the reason I'm here.

Liz, looking at Dr. Jay's argument in regards to Dr. Offit, I wonder if he discloses his COI every time he makes any anti-vaccine statement. He's making his money (cash only please) of sick children after all.

@ Rene Najara: And I applaud you! And support you!( Only not tooth and nail).I know similar stories beyond your own and Orac's ( and Barrett's) that frighten me as well.

Personally, I am very cautious : I only comment on sites run by sane, respectable people with whom I'm in agreement and am semi-nymous ( I use 2 of my 4 names; thus, a penultimate rather than pen name).

You see, I has assets. I am familiar with charlatans and assorted cranks going after *homes* as well as jobs. A scientist calls out a crank and writes about it on his blog ( that earns nothing) and is dragged into court twice ( it gets thrown out, twice). Another de-constructs HIV/AIDS denialism and is re-paid by having his family harassed and experiencing interference with his employment.

So, more power to the Mighty Ren! But watch it out there. Charlatans often are assisted by legal teams. Which they obviously need more than do regular people .

Pablo,

I don't have the same situation as Kristen, of course, but with 2 small ones at home, both under 30 months, I live daily with the risks presented to my family by assholes who refuse to protect themselves and to help protect others for their own selfish vanity.

I am just another parent. We all have our difficulties (having an NT two-year-old I can attest that "normal" children are not easy) I have a bit of added difficulty is all. This doesn't make me special, nor does it mean I automatically understand what life is like for other parents with developmentally delayed children, or even parents in general.

What does piss me off is some privileged asshole on the internet saying 'I understand' or 'i've lived it' when they have never had to deal with what I do on a daily basis. Especially when that same someone subscribes to the idea that my children are "damaged".

This doesn't end at 5 pm when the last paying customer visits my office, either.

Exactly!

D.C., You're welcome. It was therapeutic, I felt better afterwords. I was just not in the mood this morning for his presumptuousness. :)

Salty, Thank you, my day did...a little. The school designated my daughter autistic (her official diagnosis is PDD-NOS) so she will get the help she needs without us footing the whole bill. I really couldn't ask for more.

Salty,

You read Whitaker's book so you're in the best position to answer the question: Does he summarize the scientific consensus? If so, perhaps you could share a small portion of it --e.g., role of medication in treating aggression associated with autism.

From what you have presented so far I get the feeling Whitaker is arguing that child psychiatry is lies, basically. Well if that is the case, what does he propose we ought to do next?

Is Whitaker advocating for greater financial investment in the field, which arguably is tiny and poorly funded (you might use your fingers to count the full-time academic researchers in the US)?

Or perhaps Whitaker is arguing for love and spirit and chiropractic instead of "drugs."

I had said, "It's wrong to use psychopharmaceuticals in children as we do now in 2011."

So what year would you prefer? Did you like the 1980s better, when we used Mellaril?

Of course that's a rhetorical question. I don't expect an answer or a productive discussion with you. I've downloaded your web site from the Wayback machine and so understand some of your business interests.

"I believe you forgot your citation (maybe there is no hyper link for "pulled this from my ass")."

I have to admit, I really like that one.

I have no mansion, I use my real name, I work by the hour and the vast majority of my income comes from well child checks up and not sick child care. I make no money at all from kids with measles, meningitis,rotavirus, HIB, polio because I see none. None.

Kristen, your anger is understandable. Misdirected though.

Rene, we've seen your picture; You look like a tough guy who could eat Sid's lunch, right?

Have a nice day you bunch of denialists.

Jay

Jay @ 269:

Calli Arcale says: "Okay, so it's a book arguing that as Jay claims (so I'm unclear how it works against his case as you stated) psychoactive drugs should never be used in children?"

I had said, "It's wrong to use psychopharmaceuticals in children as we do now in 2011."

Calli, you're dishonest person. Simple.

Jay, I understood what you said to mean that you don't think they're appropriate in children. As I said before, if I have misunderstood, you are free to clarify. But you don't; you'd rather go off on a brief rant. I can think of other possible interpretations, but after the way you treated me for posting the evidence needed to back up your claim for you the other day, I'm not really inclined to do you any favors.

I make no money at all from kids with measles, meningitis,rotavirus, HIB, polio because I see none. None.

Just like that kid that might have had pertussis but you didn't bother to test for it, right?

I have to run some errands in a few minutes, but...

You read Whitaker's book so you're in the best position to answer the question: Does he summarize the scientific consensus?

On what? I've provided the link to several citations above.

If so, perhaps you could share a small portion of it --e.g., role of medication in treating aggression associated with autism.

I've shared a large portion of it. See my link @ #250; on the lefthand side of that page are links to more. I don't believe he speaks about autism at all. (I won't presume to speak for him, but I suspect that given the evidence he would consider the use of stimulants or antidepressants for this purpose dangerous, especially since you seem to be talking more about control than treatment. But I don't know.)

From what you have presented so far I get the feeling Whitaker is arguing that child psychiatry is lies, basically. Well if that is the case, what does he propose we ought to do next?

He's making very specific arguments about specific "treatments." Seriously, the book doesn't take that long to read. He does discuss some programs (including some newer ones for children in California and Alaska). Here's a bit more:

http://www.robertwhitaker.org/robertwhitaker.org/Solutions.html

I don't think he's claiming to have the answers; just that treatments for mental illness, as in any area of science, should be evidence-based and consider both short- and long-term risks and outcomes. I can't see anything objectionable in that.

Is Whitaker advocating for greater financial investment in the field, which arguably is tiny and poorly funded (you might use your fingers to count the full-time academic researchers in the US)?

Yes, with a broad understanding of "the field." (The psychopharmaceuticals field is of course neither tiny nor poorly funded.)

Or perhaps Whitaker is arguing for love and spirit and chiropractic instead of "drugs."

Look, not that it's relevant, but I've seen no indication that the guy's anything other than a science writer who became interested in this important issue. (I can't really see anyone arguing against love in any event*....) The fact is that the brain is extraordinarily complex and plastic and we understand little of how these illnesses operate, but it seems to be the case, from the evidence, that these drugs do not produce good outcomes. Again, he's arguing for the recognition of this and for trials and evidence-based evaluation of non- and limited-drug programs (I haven't seen any woo in the ones he's mentioned). (I personally would additionally focus more on large-scale social changes.) Even if many of these prove to be unsuccessful (which will undoubtedly happen), that won't magically make the drugs any more successful. I mean, if they're ineffective and highly unsafe, they're ineffective and highly unsafe regardless of the success or failure of any alternatives. Doing nothing is preferable to doing something that doesn't work and is also (costly and) harmful.

*Are you suggesting all forms of pet/animal therapy are necessarily bogus? :)

Salty @ 258:

I wish you'd answered my questions; I'm still more interested in your position than Whitaker's. (It's you I'm having a conversation with, after all.) But if you'd rather do a book club, I guess that's okay. I just don't have the time to go read Whitaker's book right now, so I can't satisfy you there. This is not because I'm unwilling to read it. It's because I don't have the option right now. I have a job, I have kids, I have a life, I have a pretty long booklist already. Whitaker's book would go to the end of the queue, and by the time I got to it, this discussion would be forgotten.

You're simply wrong in your claims that the problem is that for children research doesn't exist for some, but that extensive evidence exists of efficacy and safety for others.

Read the book.

What I'm objecting to is the blanket generalizations made by opponents of mental health treatment. "SSRIs are used inappropriately" does not mean "all psychoactive drugs are bad in children" and it certainly doesn't mean "nobody's studied these things." I'm not sure why you have a problem with that claim, unless you actually do think that there are no effective psychoactive drugs.

BTW, you're wondering why this became a bit of a dogpile on you; I think it's because "read the book" in lieu of actual discussion is hauntingly similar to what that woo-woo gal was saying here recently, so you're running into a bit of a sore spot for a lot of readers.

I did go read the page of studies at Whitaker's site studying "Psychotropics/Child and adolescent disorders". I have some comments now. I did not have time to read all of the studies entirely. Those that I did had a haunting similarity -- they did not support his summaries of them, and seemed to revolve around frankly unrealistic expectations of the medications. Ritalin is not magic, for instance; it will not permanently transform a child into a paragon of virtue with a 4.9 GPA, yet the first study in his list complained that although teachers reported substantial improvement in behavior, parents didn't. The study acknowledged that the dose is likely worn off by the evening, which could easily explain that, but seemed oblivious to other factors -- the home environment has completely different challenges from the school environment, and children are generally tired when they get home. It acknowledged the confounding problem of comorbities, which are common, but made no effort to do anything about it that I could tell. The second study, meanwhile, he seems to be using to say that long-term use is bad for you, but in fact it shows that the medication is effective but is a predictor for poor long-term outlooks. What's interesting to me is that Whitaker does not quote the entire conclusion, which gave several possible explanations which do not include "the drugs made ADHD worse." He wants this study to support that claim, but it doesn't. It might, but it cannot answer *why* the symptoms got worse. Studies 7-9 I did not read completly, but they also do not appear to be making a causal link between the use of stimulants and psychotic or bipolar symptoms. It is important to remember that ADHD is *frequently* comorbid with something else, so this may not be surprising even in the absence of treatment. Again, what is causing what? These studies do not appear to have studied that. Section D collects studies which, in my opinion, mostly show that mental illness in children is a serious problem -- there are children who suffer severe mental disorders. One showed that "Only 41% of adolescents hospitalized for a first bipolar episode functionally recovered within one year." Interestingly, the study itself put it like this: "Most bipolar adolescents experienced syndromic recovery following their first hospitalization. However,
rates of symptomatic and functional recoveries were much lower," and the study did not find that pharmacological treatment was ineffective. It showed that there was considerable room for improvement, which frankly is true of almost everything. It's true of cancer therapy, yet I don't think you'd argue that chemotherapeutic agents are worthless.
http://www.robertwhitaker.org/robertwhitaker.org/Children.html

So all in all, I think the studies he cited (at least the ones I had time to look at) support my view that while there is huge room for improvement, pharmacological treatment for pediatric mental illness may be appropriate in many cases. That it is imperfect is no indictment of the concept. The materials he cited do not address my main complaint with pediatric mental health (that the absence of adequate scientific evidence for pediatric use means that psychiatrists are largely winging it, sometimes to good outcomes and sometimes to bad), but I doubt you'd disagree with that part, that's it very unfortunate psychiatrists don't have better data to go on.

One of my biggest issues with it is that by essentially forcing pediatric psychiatrists to go offlabel most of the time, the whole drug approval process is rendered meaningless. It removes the incentive of drug companies to get things properly studied, it normalizes the idea of practicing in the absence of evidence, and it also makes it harder to recruit an adequate pool of test subjects for the studies that should have been done in the first place.

To Militant Agnostic, you said this:

Nowhere that I've seen. Of course, you'd have to be more specific with your question. He argues - convincingly, in my view - that the "chemical imbalance" idea on which the marketing of these drugs has rested has no scientific foundation, and never has.

Ah -- so am I right in thinking that you do not think psychoactive drugs are ever helpful? If so, you should probably read the studies that Whitaker cited. ;-) Sorry; I'm not trying to be cute by tossing that back at you; I actually mean it. They show evidence that they often *are*. Not at as high a rate as one would like, and sometimes correcting that part of the problem isn't enough to fix the patient's life, but it's not true that manipulating neurotransmitters is never helpful.

Have a nice day you bunch of denialists.

Denialist. You keep using that word. I do not think it means what you think it means.

But, just out of curiosity, I'll bite. Please define "denialist." Then tell us what we are "denialists" of and why.

I'll wait.

I wish I could count on my cat to fight tooth and nail for me; he could too easily be distracted by something like a moth.

More seriously: I just skimmed Whittaker's madinamerica.com website. I also looked at one of the papers for which he linked to full text:

11. Tranquillisers: prevalence, predictors and possible consequences. Ashton, H. British Journal of Addiction 84 (1989):541-6.

Long-term use of benzodiazepines leads to âmalaise, ill-health, and elevated scores for neuroticism.â The drugs contribute to âjob loss, unemployment, and loss of work through illness.â

That's his summary. What the paper actually says is that malaise, ill-health, and elevated scores for neuroticism are correlated with long-term use of benzodiazepines.

Also with lower socioeconomic status, "current smoking in some groups," unemployment, age, and female sex. The authors suggest that the correlation with age is because fewer new prescriptions were being written, so most people using them either were addicted or (my thought) being treated by doctors who would continue a prescription in circumstances where they wouldn't write one for a new patient.

I mention "female sex" to point out that there is at least one correlation for which, if there is causality, it goes the other way. Doctors might be more likely to prescribe these drugs to women (for reasons good or bad); it seems unlikely in the extreme that taking benzodiazepines causes patients who had presented themselves as male to start living or presenting as female.

The difficulty is that, for many of the other correlations identified in this paper, symptoms of mental illness—the reason these drugs might have been prescribed—might also be causative. Those symptoms can make it harder to get or keep a job; conversely, unemployment and poverty can increase anxiety.

[I picked that particular paper because it was recent, and thus more likely to reflect other recent results, and current patters of prescribing. Actually getting the book would mean either spending significant money, or waiting for eight other people to get done with my library system's one copy.]

But, just out of curiosity, I'll bite. Please define "denialist." Then tell us what we are "denialists" of and why.

Well, _I_ deny that gordon is the final arbiter on truth and that his 30 years of clinical experience has served to give him any special insight.

If Jay ("Practice Confined Largely To The Well") Gordon is done with name-calling and projecting his confusion about science and denialism onto others, I'd still appreciate answers about what he does in instances where parents ask him about disease prophylaxis for their kids when planning a trip abroad.

If such a trip is to a country where measles and other preventable infectious diseases are endemic (India, for example), do you justify giving not giving vaccinations because the odds suggest travelers will probably get by unscathed? If you do give the shots, do you follow CDC recommendations (if not, why not?)? If you give the recommended vaccinations to one of the many children in your practice who've never received any, how do you justify to parents giving a bunch of doses at one time, when you've argued against the current regular vaccine schedule as being too many shots over too brief a period?

Answers would be appreciated.

I suggest you listen to Kristen and learn from her real-life experience, rather than patronizingly patting her on the head and telling her that her anger is misplaced.

I figured out what's wrong here. This is all a bunch of words games for you. Pseudonyms and pseudoscience. Orac, Prometheus, Dangerous Bacon. it's all about semantics, perseveration, and monolithic "science." For me, it's my daily life. I'm not the parent of a child with autism but I have cared for hundreds of these families over my career. Their lives are not "miserable nor hopeless," but they're made much harder by autism and then by denialists like yourselves. These children have genetic presdispositions to ASD and some of the triggers to autism are iatrogenic in nature.

Word games and pseudoscience. Stop.

Oh, I assure you this is no game to me, Dr. Jay. I'm deadly serious in my dedication to combatting dangerous pseudoscience like the anti-vaccine movement. Humor and sarcasm are but tools to communicate, but never doubt the seriousness of my intent.

As for "pseudonyms," really, Dr. Jay. After your buddies at AoA tried their damnedest to try to get me fired from my job last summer through a smear job claiming that I am somehow a pawn of Sanofi-Aventis with undisclosed conflicts of interest (a campaign that led the minions over there to write and telephone the board of directors of my university), you have the balls to make a crack about my using a pseudonym? For shame, Dr. Jay! That's just plain despicable. After your buddy J.B. Handley has launched periodic smear jobs to pollute my Google reputation, you dare? Hypocrite. You play the wounded martyr to "civility" so well, but I have seen by your recent behavior that when it comes right down to it you can be just as nasty as those you castigate for "incivility."

And you still can't provide one whit of actual convincing scientific evidence to back up your claims that "These children have genetic presdispositions to ASD and some of the triggers to autism are iatrogenic in nature."

Bacon: I give appropriate vaccines when people travel. Usually polio for Asia, Africa, Hep A for exotic travel, yellow fever for the countries which require it. DTaP boosters when indicated. I have also given measles vaccines but not very often. I give malaria prophylaxis when indicated, too. No, I don't give multiple vaccines in one day. I talk to smart people who understand that different situations mandate different medical interventions. ("Dr. Jay--Practice Confined to the Well and Smart--Gordon")

Kristen, as passionate as she might be, is a sample size of one. My larger experience with families of kids with autism does not match this.

Dr. Jay,

Kristen, as passionate as she might be, is a sample size of one. My larger experience with families of kids with autism does not match this.

I'm not following your point. How am I different (real question, no sarcasm meant)?

But, just out of curiosity, I'll bite. Please define "denialist."

After the break: a second-grader defines "poopyhead".

Also, I wonder just how frequently Orac gets trolled over writing under a nom de plume.

So, Kirsten, one data point, bad, epidemiology, millions of data points, bad, Dr. Jay, 30 years of experience, maybe thousands of data point, good. Interesting application of the bell curve there, I'm sure that its peak of importance matches perfectly with Dr. Jay's opinion of his own importance is strictly coincidental.

Dr. Gordon,

I actually thought you might have been sincere about your willingness to shift your opinion according to the facts. After this very long and revealing exchange, when I read your posts I just see pathological magical-thinking covered with a thin veneer of cynical politeness, held in place by a couple of pieces of dried-up Dentyne. You might fool those who've been rationalists all their lives, but you can never fool a former magical-thinker.

Orac says (and bites) "Denialist. You keep using that word. I do not think it means what you think it means."

http://www.youtube.com/watch?v=G2y8Sx4B2Sk

"Denialism is choosing to deny reality as a way to avoid an uncomfortable truth."

The uncomfortable truth is that there are frequent major side effects from all medication and other surgical interventions. This includes major side effects from vaccines.

Kristen, I get a biased cohort because most of the families I see with autism come because they know I'll support their belief that their child's autism was triggered by vaccines and/or that I'll support their desire to look outside conventional (proven) treatment for their children. Your point of view not only deserves respect but may be more valid than mine. I apologize for any disrespect.

I'm sorry if some of you have had bad experiences when you used your real name. I, of course, get treated with nothing but love, respect and kind words for being open about my beliefs and my identity. For instance, the lovely title to this blog piece . . .

David, this is truly just a game for you. You don't deal with autism or vaccine issues. Your a surgeon and a researcher. Everything you don't agree with is a "gambit." Have a good time disdaining my annoying statements about "30+ years of experience." Your experience with families with autism, vaccine side effects, taking care of sick kids? Borders on zero, right? This "science" abstract for you. Not for me!

Jay

Kristen, I get a biased cohort because most of the families I see with autism come because they know I'll support their belief that their child's autism was triggered by vaccines and/or that I'll support their desire to look outside conventional (proven) treatment for their children.

Which is exactly what I've been trying to point out to you for over five years! Can you not see how such a biased population would lead to a biased conclusion? Are you really so blind?

You believe that vaccines cause autism; so parents who mistakenly believe that their child's autism was caused by vaccines seek you out. There's self-selected population right there! They tell you histories that, thanks to the foibles and vagaries of imperfect human memory, sound convincing. You take them at face value and, because these parents confirm to you your belief that vaccines cause autism, all too willingly confuse correlation with causation. Confirmation bias becomes your ruling principle, as you remember every "hit" in which there is the appearance that vaccines triggered autism and forget every miss. This becomes easier and easier to do as your patient population becomes more and more enriched with the children parents who believe that vaccines trigger autism.

This is your "30 years of clinical experience." This is your "personal experience." This is your anecdotal experience.

It is not science. It is not even a good start, as in anecdotes that suggest a testable hypothesis, because it is not even clear whether you are correct in your recollections or whether it's all a massive case of confirmation bias and a population enriched with children whose parents are anti-vaccine. After all, you haven't documented your claims even with a case series from your own practice. Rather, you have instead confused anecdotes for science. It astonishes me how blind you have become.

Thank you, however, for proving far more concretely than I ever could that my title for this post was spot-on accurate. You do profoundly misunderstand science, and it saddens me.

Jay--

If the title of this post is the worst you've had because of using your real name, good. But it means you don't understand the larger risks.

I've read of people who stopped blogging because people who disliked their posts threatened to kill their dogs. Orac has just reminded us of the attempts to get him fired for his blogging.

Yes, there's a difference: you are promoting yourself as a pediatrician who practices in a certain way, because of certain beliefs. If those beliefs are false, or that practice less than optimal, it's reasonable to publicize that. (It would not be reasonable for me to suggest that people should boycott you, or any other doctor, because you posted for or against Obama in 2008.)

Jay @ #304:

The uncomfortable truth is that there are frequent major side effects from all medication and other surgical interventions. This includes major side effects from vaccines.

The existence of vaccine-related side effects is widely acknowledged in this and other science-based medicine fora.

The development of, say, febrile seizures following vaccination is a known, demonstrated, studied risk (with complex sub-variables affecting said risk). The development of autism following vaccination has not been demonstrated in even a rudimentary sense. Indeed, multiple independent studies (each with their limitations and criticisms, naturally) have looked at varying aspects of this hypothesis and found no credible, causative relationship.

That's your uncomfortable truth.

At long last, a partial answer from Jay.

"I give appropriate vaccines when people travel. Usually polio for Asia, Africa, Hep A for exotic travel, yellow fever for the countries which require it. DTaP boosters when indicated. I have also given measles vaccines but not very often. I give malaria prophylaxis when indicated, too. No, I don't give multiple vaccines in one day."

Unfortunately this raises more questions. "Appropriate vaccines" according to who? Apparently, not according to CDC recommendations. For instance: your answer seems to indicate that you disdain measles vaccines more than others for travel to "exotic" countries. By what logic? "DTaP boosters when indicated". Whose indication? Does this constitute one shot, or the patented Jay Gordon DTaP (suboptimal) series?* Do parents planning foreign travel appreciate having to bring their kids in for multiple visits, since you say you don't give multiple vaccines in one day?

"I talk to smart people who understand that different situations mandate different medical interventions."

Who are these "smart people" who influence your decisions? Your selected database of like-thinking parents? Dr. Bob Sears? Barbara Loe Fisher? AoA?

*I'm curious about something, Jay. As you've already admitted that when you give the DTaP (assuming you can be prodded into it, however reluctantly) you give fewer than the number of doses recommended by the AAP and CDC, what other interventions do you individualize because of a conviction that modern medicine will be found wrong? Do you prescribe smaller doses and shorter periods of treatment with antibiotics, since their use was developed by cold-hearted scientists and benefits Big Pharma? Do you "optimize" other therapies in the same way according to Gordon Intuition?

Thanks for the enlightenment to date.

Dr. Gordon do you have any comment on your attacking people for using pseudonyms after hearing two people recount real life issues caused by your ideological allies?

Dr Jay:

The uncomfortable truth is that there are frequent major side effects from all medication and other surgical interventions. This includes major side effects from vaccines.

Orac and other pro-science commenters do not deny that vaccines can cause adverse effects, even serious (or even fatal) adverse effects.

What you continue to persist in claiming, in the face of carefully-collected evidence, is that autism is one of those effects. What you routinely fail to do to defend your claim is provide evidence to support it.

Your clinical experience does not outweigh the available epidemiological evidence if you are not prepared to provide counter-evidence. If Orac made vague claims to the effect that his clinical (read: personal) experience outweighed the current agglomeration of evidence on some form of breast cancer or another, without providing at least some reasonably sound counter-evidence, he would be subject to the same criticisms as you are - indeed, you would be quite correct to call him out on it.

As far as your whinging on anonymity goes, it is simply absurd. Content is the most important part of any argument, followed by style. The identity of the arguer is usually not important at all. If, say, Timothy McVeigh said 'murder is wrong', would his statement be false just because Timothy McVeigh said it? Similarly, people on this blog using pseudonyms has no relevance as to whether the arguments they make are cogent, sound, valid, etc.

I, of course, get treated with nothing but love, respect and kind words for being open about my beliefs and my identity. For instance, the lovely title to this blog piece . . .

Using your real name does not magically give you the right to expect immunity to criticism, or even scorn, if you persistently fail to defend your positions on vaccines using evidence of comparable quality as that which informs the CDC guidelines for pediatric vaccinations. This appears to be a variant of the same error in logic that informs your opinion of Internet pseudo-/anonymity.

Dr Jay says, I make no money at all from kids with measles, meningitis,rotavirus, HIB, polio because I see none. None.

You don't see any kids with rotavirus, Dr. Jay? None at all?

That's pretty exceptional, considering the CDC and the WHO say that 95% of all kids get rotavirus before the age of 5. The CDC also says that it's responsible for 500,000 doctor visits a year--none of those kids saw you, I guess.

This doctor says that she has been practicing for 30 years and has seen "countless" cases. How did you manage to get so lucky?

http://www.nfid.org/rotavirus/

Lilady posts under her nom de post because of actual threats received in person while testifying on behalf of autistic adults at a neighborhood hearing for siting of a group home in a residential area. NIMBY is alive and well within a small group of homeowners who prefer to not have mentally retarding/developmentally disabled people living next door or down the block.

When I was required to give my real name attached to articles I've written in newspapers about the deplorable conditions in large institutions and the need for funding resources for parents who care for their disabled children at home, I personally received telephone threats as did my young daughter.

I worked down in the trenches in public health for years, not in a boutique pediatrics practice such as Dr. Gordon's and I have quite a lot of experiences associated with infectious diseases and vaccine-preventable infectious diseases.

Dr. Gordon marches to his own drummer by deviating from recommendations for immunizing infants and children against vaccine-preventable diseases. I, on the other hand dealt with actual cases of measles, infantile pertussis cases and bacterial meningitis cases in children who didn't received any or didn't complete the vaccines series recommended by the CDC and by the AAP. Unfortunately, some of these infants and children died; others were left life-long disabilities, organ failure and limb amputations from invasive bacterial illnesses.

I suspect that Dr. Gordon limits his boutique practice to only well (healthy) children as stated in his post above."I make no monay at all from kids with measles, meningitis, rotavirus, Hib, polio, because I see none. None", which leads me to believe that he has no hospital affiliation.

According to Jay Gordon MD FAAP's website, he stated (regarding pertussis) that two children in his practice had active cases of pertussis. I wonder how he knew that? Did he do a naso-pharyngeal swab and transport it in the proper medium to a laboratory? Did he prescribe antibiotics to lessen the severity of the disease and to decrease the chance of infecting others? Did he report the suspect or confirmed pertussis cases to the California Department of Public Health. Did he provide DTaP vaccine to any other children, especially infants that were exposed to his infected patients? Just wondering....

Hi lilady -

Lilady posts under her nom de post because of actual threats received in person while testifying on behalf of autistic adults at a neighborhood hearing for siting of a group home in a residential area.

Were you at the thing regarding the fucking idiots in Norco, California protesting a group home in their neighborhood, a situation that Sullivan wrote about a while ago, here?

http://leftbrainrightbrain.co.uk/2010/06/it-is-free-speech-but-is-it-ap…

If so, I love you.

- pD

Too many people. I've talked to too many parents and heard from too many more to believe that this isn't the the majority opinion among parents of children with autism. I wonder if anyone has actually done this survey. Do you know?

Of course a biased population leads to biased conclusions. I am biased in favor of the conclusion that vaccines can cause large side effects including triggering ASD and you are biased against that conclusion. The major difference being that my bias comes from experience and reading the literature and yours comes only from reading and no firsthand observation. You would make my bias seem wrong but yours right? That's not very scientific of you.

Jay

Vicki says "If the title of this post is the worst you've had because of using your real name, good. But it means you don't understand the larger risks."

I have been threatened. Seriously, seriously threatened for my public points of view.

JohnV queries: "Dr. Gordon do you have any comment on your attacking people for using pseudonyms after hearing two people recount real life issues caused by your ideological allies?"

They were wrong to do this. Stone cold 100% wrong. There is no justification whatsoever for the behavior you're describing.

I don't like the nastiness that emanates from any source including AoA, RI or elsewhere. There are children's lives at stake.

Jay

Of course a biased population leads to biased conclusions. I am biased in favor of the conclusion that vaccines can cause large side effects including triggering ASD and you are biased against that conclusion. The major difference being that my bias comes from experience and reading the literature and yours comes only from reading and no firsthand observation. You would make my bias seem wrong but yours right? That's not very scientific of you.

Uh, no, Dr. Jay. Your bias comes from confirmation bias, selective memory, confusing correlation with causation, and cherry picking the scientific literature. My conclusion is based on science. Now here's the difference between you and me, Dr. Jay, and it's not what you think. The difference between you and me is that, if you were to produce actual scientific evidence from well done studies and lab work that strongly suggest that vaccines do cause autism, I would reconsider my position. If the evidence were compelling enough, I might even change my mind. You have demonstrated that even a--if you'll excuse the term--tsunami of evidence that not only fails to find a link between vaccines and autism but strongly suggests that such a link is incredibly unlikely cannot sway you. You believe what you believe, regardless of scientific evidence. You elevate anecdotal evidence above science, your denial that you do notwithstanding.

That, Dr. Jay, is not very scientific of you at all. But thank you again for reinforcing that the title of my post is very apt.

"I wonder if anyone has actually done this survey. Do you know?"

I doubt that evidence-based care provided by Orac or any of the other physicians posting here is determined by surveys of what patient families believe.

And it's also doubtful that the vast majority of pediatricians (including all those other Fellows of the American Academy of Pediatrics) arrive at best principles of medicine that way either. It seems that Jay is not operating a medical practice, he's running a popularity contest.

Jay (paraphrased): "I'm biased because because I listen only to those people who tell me what I want to believe, and you're biased because you don't have faith in my anecdotes and intuition".

Criminy.

I've given up the idea of billing Jay for ideas to improve his website and replacement irony meters, but the least he can do is reimburse me for the cost of all those bags I must wear over my head because Jay is a fellow physician.

Can't we bring back Michael Egnor, ace neurosurgeon and creationist? Even he wasn't this bad.

If I were a doctor, and a respected physician/scientist said of me that he had tried for years to get me to understand the science in my own field, but reluctantly pronounced me both ignorant and unteachable, I believe that I would (1) slink away in shame or (2) set to work and learn the science so that I would no longer be ignorant and would be demonstrably teachable or (3) set out to *prove* that I was in fact right all along, say by reviewing my thirty years of patient records and making the necessary effort to distill the truth out of them.

But of course, I am not Dr. Gordon.

Can't we bring back Michael Egnor, ace neurosurgeon and creationist? Even he wasn't this bad.

Oh, Dr. Egnor is still around and still blogging occasionally for the Discovery Institute:

http://www.evolutionnews.org/2011/02/abortion_advocates_and_the_phi0436…

Orac, if another cause were found for the huge increase in autism, I would reconsider my position just as quickly as you would. (What's the next post in this thread, "Nyah, nyah, nyah nyah??")

Froggy, I guess I do see rotavirus but in breastfeeding babies, in healthy families it rarely needs in-office care let alone inpatient care. And I never give the rotavirus vaccine. Again, breastfeeding babies do not need it.

Bacon queries: "Do you prescribe smaller doses and shorter periods of treatment with antibiotics, since their use was developed by cold-hearted scientists and benefits Big Pharma? Do you "optimize" other therapies in the same way according to Gordon Intuition?"

Yes, I do individualize care for my patients. I give shorter courses of antibiotics--as is becoming the standard of care:

"Clinicians need to evaluate whether the minimal short-term benefit from longer treatment of antibiotics is worth exposing children to a longer course of antibiotics."

http://www2.cochrane.org/reviews/en/ab001095.html

It's what clinicians do, Dangerous Bacon. We evaluate risks and benefits and individualize care. (Aaah, the "Big Pharma" gambit, Bacon!) And sometimes, by gosh, we have to combine science with experience and . . . intuition.

lilady, I have a medium-to-large-sized practice, not a boutique. I worked in the trenches, too. I like private practice better but in some ways it's just different trenches taking care of kids every day instead of sitting and reading about it. I have been on staff at four excellent hospitals for thirty years. I see patients, I teach and I maintain privileges in good standing.

Orac, the title of your post assumes that you and your cohorts are the absolute arbiters of what is and isn't good science. You're not.

Jay

@Jay Gordon:

Orac, if another cause were found for the huge increase in autism, I would reconsider my position just as quickly as you would.

Is finding another cause the only thing that would make you change your mind? Is there anything that could convince you "We don't know what it is, but it isn't vaccines"?

Silly me! I always assumed that the major "cause" for the "increase" was the publication of the DSM-IV.

Orac, if another cause were found for the huge increase in autism, I would reconsider my position just as quickly as you would. (What's the next post in this thread, "Nyah, nyah, nyah nyah??")

Your statement is very revealing. You believe so fervently that vaccines cause autism that nothing short of iron clad, bulletproof evidence demonstrating another cause for the increased prevalence of autism will sway you. Science doesn't necessarily work that way. In this case, even though we don't know what causes autism, there is copious scientific and clinical evidence that it is not vaccines. There comes a time in science when one cause has been eliminated (i.e., one hypothesis has been thoroughly falsified). When that happens, even though we don't know the cause, we do know one thing that is not the cause. That's what's happened with vaccines.

I'd also point out another thing. Correlation does not necessarily equal causation.

Orac, the title of your post assumes that you and your cohorts are the absolute arbiters of what is and isn't good science. You're not.

Bullshit, Dr. Jay. I call bullshit.

Let's just put it this way: If I'm incorrectly representing the scientific consensus on autism, prove it! Lay out the evidence and prove me wrong. You can't, because it's highly unlikely that I am. Note how I did not simply say that I am right. That's the way a scientist speaks; we always leave a little bit of room for doubt, for the possibility that our hypothesis might ultimately be falsified. In the case of the idea that vaccines cause autism, it is possible that my position will be proven wrong, but, quite frankly, given the state of the evidence, it's vainshingly unlikely.

Here is a scary account of a pathologist who placed his "experience" and "clinical impressions" above accepted scientific consensus. For a time, he was renowned in Canadian forensic pathology. Unfortunately, it was eventually discovered that he was responsible for some heartbreaking miscarriages of justice. He has lost his reputation and his license to practise. He is also facing multiple lawsuits.

I'm sure that his intentions were good and he sincerely believed that his experience was correct. Unfortunately, that is no substitute for knowing your limitations and recognizing that the easiest person to fool is yourself.

As Dirty Harry Callahan said in Magnum Force, "A man's got to know his limitations."

I know mine. Unfortunately, Dr. Jay clearly does not know his. He thinks his personal recollections trump science. I know he's denied that that's the case, but I really think he doesn't understand that that's exactly what he is doing.

ORAC

Note how I did not simply say that I am right. That's the way a scientist speaks; we always leave a little bit of room for doubt, for the possibility that our hypothesis might ultimately be falsified.

You are describing the characteristics of humility and humbleness of which a scientist should have. Yet you do not display those. You have years of posts that contradict those qualities.

You might as well have said "I'm not saying that I'm right. But I am." That's arrogance.

Matthew Cline posts: "Is finding another cause the only thing that would make you change your mind? Is there anything that could convince you "We don't know what it is, but it isn't vaccines"?

That's a great question. Again, even with oft-admitted "confirmation bias, selective memory, confusing correlation with causation, and cherry picking the scientific literature" as David phrases it, I'm still stuck because I've seen so many families convinced that vaccines changed their children for the worse. I've witnessed firsthand temporal relationship between vaccination and regression. Correlation, again, not proof. Perhaps even definable as "evidence." Quite frankly, I'd rather be on "your" side of this debate because it looks easier from here.

But, yes, a good prospective study would help. I know it's not always palpable here in this venue, but my practice has been affected by my exchanges here. I think harder about what I say to patients--almost as if you and Orac were listening--because it's irresponsible to even imply that I'm the only one with the right answers. I still like my answers better, but I respect the public health implications of what you and others say here.

Jay

@Orac:

He thinks his personal recollections trump science. I know he's denied that that's the case, but I really think he doesn't understand that that's exactly what he is doing.

In his defense, his error might not be in thinking that his experience trumps science, but rather in thinking that studies which look for a vaccine/autism connection but find nothing have no evidential value. If it were true that those studies had no evidential value, then there'd be nothing there to be trumped.

@Jay Gordon:

But, yes, a good prospective study would help. I know it's not always palpable here in this venue, but my practice has been affected by my exchanges here.

The only proposed prospective study I know of which is "unpalatable in this venue" is one where half of the participants are, at random, unvaccinated (a double blinded, randomized, placebo controlled study). If that's what you're talking about, it's not just "unpalatable in this venue", it's never going to happen, for two reasons:

1) No IRB would approve it, because it would violate the Common Rule (Belmont Report).

2) No parent would enroll their child in it, since those who want their child to be unvaccinated would have a 50% chance of their child getting vaccinated, and those who want their child to be vaccinated would have a 50% of their child not getting any vaccinations.

Now, if you mean some other prospective study which is "unpalatable in this venue", please specify what it is.

Jay: "Yes, I do individualize care for my patients. I give shorter courses of antibiotics--as is becoming the standard of care...It's what clinicians do, Dangerous Bacon. We evaluate risks and benefits and individualize care."

My understanding is that good clinicians strive to follow the standard of care in all areas of their practice. They do not pick some standards of care to follow and discard others because of personal prejudice. Respect for the standard of care is why your fellow members of the American Academy of Pediatrics overwhelmingly support the value of vaccination and follow evidence-based vaccine schedules to protect their patients from dangerous preventable diseases.

I'm glad to see you referencing the Cochrane database of evidence-based reviews. Since you linked to one about otitis media, supporting the idea that Cochrane is an arbiter of good science, could you find for us the Cochrane Review that supports your use of homeopathy for treating ear infections? Or a Cochrane review validating the use of homeopathy to treat anything?

Here's an accepted definition of standard of care:

"A standard of care is a formal diagnostic and treatment process a doctor will follow for a patient with a certain set of symptoms or a specific illness. That standard will follow guidelines and protocols that experts would agree with as most appropriate, also called "best practice."

Here's Jay's definition (paraphrased): "The standard of care is what I say it is."

-because it's irresponsible to even imply that I'm the only one with the right answers. I still like my answers better

The answers we like are rarely the correct answers. Of course you're not looking for the correct answers, just the ones that make you money.

Matthew, I think that the National Children's Study is going to give us some accidental prospective data to look at. Non-randomized, of course. I agree: The studies that would offer proof can't ever be done.

Jay

http://www.nationalchildrensstudy.gov/Pages/default.aspx

I still like my answers better

I work in the upstream oil & gas industry. I would really like AGW to be wrong. I would like there to be some negative feedback mechanism that prevents increasing CO2 from heating the planet. I would like my personal observation that we are having colder winters and cooler summers in southern Alberta to indicate the earth is not heating up.

The overwhelming consensus of climate scientists says otherwise. I think they are correct. The universe doesn't give a damn about what I like.

Jays reliance on anecdote, personal experience, and what parents think is straight out of the AGW denialist playbook.

That's a great question. Again, even with oft-admitted "confirmation bias, selective memory, confusing correlation with causation, and cherry picking the scientific literature" as David phrases it, I'm still stuck because I've seen so many families convinced that vaccines changed their children for the worse. I've witnessed firsthand temporal relationship between vaccination and regression.

Dr. Jay, why don't you come back to us when you can present us with some form of evidence besides that which was used in the Salem witch trials?

"I just cannot reach any other conclusion than that witches who have sold their souls to the Devil are responsible for all our illnesses and woes. I've just talked to too many people who are convinced that their problems started right after Goodwife Wilson looked at them funny; I've witnessed firsthand temporal relationship between an old woman giving the Evil Eye and the sickness of cows.

"The uncomfortable truth is that some people are willing to do very bad things. This includes bad things which mean illness and death to people and livestock. That means that anyone who denies that some bad people are witches, who cause illness and death to people and livestock through dark powers granted to them by their evil master, Satan, are denialists. They're rejecting the uncomfortable truth."

Here's a news flash, Dr. Jay: The world has moved on since 1692. Perhaps you should too. Otherwise, we'll continue talking about your profound misunderstanding of science, because you'll keep demonstrating it to the world.

Catching up. I'll have to do this in bits and pieces....

What I'm objecting to is the blanket generalizations made by opponents of mental health treatment.

I don't care what you object to about some ill-defined class of people. I referred to a specific book by a specific person, who is in no way an opponent of mental health treatment.

"SSRIs are used inappropriately" does not mean "all psychoactive drugs are bad in children"

Now you're doing exactly what Jay Gordon does. When you say "SSRIs are used inappropriately" are you now saying they should not be given to children or are you saying you support some in certain circumstances? If so, which, when, and on what basis? It's certainly true that the UK prohibition, Lancet, BMJ article together are saying that they should not be given to children. (Note that they also point to the manipulation and suppression of data on the part of these corporations, and I'm a bit saddened that people don't seem to be taking that seriously - these are powerful substances being put in the brains of children - but even then they're not getting evidence of efficacy or safety.)

and it certainly doesn't mean "nobody's studied these things."

Um, I'm not sure who you're quoting but you appear to be arguing with yourself here. You claimed @ #243 that "The single biggest problem with psychoactive drugs in children is that they are not adequately studied, frequently to the point that they are not approved for pediatric use." That is not correct in the case of SSRIs. They have been studied and the evidence does not support their use in children, but they are prescribed in the US regardless.

I'm not sure why you have a problem with that claim, unless you actually do think that there are no effective psychoactive drugs.

Which SSRIs do you think are safe and effective for children and why?

Let's review the epistemic imbalance here:

- Dr. Jay posted his ambiguous, unsupported argument.

- Your response @ #228 consisted of:

If a child has bipolar mood disorder, the people around him/her should just learn to deal with it, right? I went to school with a gal who had that. Her medication need shifted just a teensy tiny little bit . . . and she was a complete wreck until that got sorted out. Need *inpatient* care until they could get the new dose right.

Yeah, psychoactive drugs are overprescribed, but to suggest it's wrong to use them in children? Obviously, you haven't had many kids with major psychological problems (which would raise the question of why you purport to know something about autism, but that's another matter).

This was pure anecdote and speculation, and ignorant of the history of this illness in children. The scientific content of this post was zero. (By the way, lithium pretty much went out with the introduction of the new antidepressants, when they - shockingly - "discovered" all of the problems with it. My friend was on lithium, but that was in like the late '80s before they started switching people over to the cocktails.)

- I recommended the book, which you could easily have googled for more information.

- You replied instead with another unsubstantiated post about the problems as you see them. Science and citations: zero.

- Much time and effort is wasted by you that would have been better spent at least reading some of the materials at the links I provided.

- Now at long last you appear to have read some small part and wish to take issue with it out of context.

Do you see a problem here? On one side of a debate, you're willing to accept and put forth anecdote and wholly unsubstantiated claims, while on the other you expect someone else to make an airtight, documented, and nuanced case in a few blog posts and think entire arguments can be dismissed on all sorts of irrelevant bases. (Leaving aside the fact that the people arguing for a medical intervention have the burden of evidence concerning its safety and efficacy.) Look, I don't care if you read the book, but you should appreciate that it's unwise and unscientific to comment on topics from that sort of weak knowledge base.

I noted when I gave the link that the citations can only really be discussed in context. I might reply to your longer criticism if I have the time, but I'll note one more time that this is a small selection of references, they make the most sense in the context of the story, and there's more to the story that he talks about (the DSM-IV, Sci*gy, and so on). (Again, this is not to say that the book or some of the studies aren't flawed, but many of the issues people are raising are in fact addressed there, and I'm not going to recreate it.)

Those that I did had a haunting similarity -- they did not support his summaries of them,

What is not supported by the Lancet and BMJ articles about SSRIs for children?

BTW, you're wondering why this became a bit of a dogpile on you;

No, I wasn't wondering that. I am wondering why people don't seem even interested in investigating this and quite interested in irrelevancies and ad homs. (Even kooks like Dr. Jay with dumb reasons can be right about some things. That's why the ad hominem fallacy is a fallacy.) I was also wondering why people on a science/skeptic blog seem so accepting of anecdote and "common wisdom" on one side and so information-resistant and hypercritical concerning challenges to said common wisdom on the other.

I think it's because "read the book" in lieu of actual discussion is hauntingly similar to what that woo-woo gal was saying here recently, so you're running into a bit of a sore spot for a lot of readers.

Well, as I've been commenting at Sb (including here) for years now and people can easily click over to my blog to see what I'm about, I didn't expect that anyone would confuse me with a "woo-woo gal."

Nowhere that I've seen. Of course, you'd have to be more specific with your question. He argues - convincingly, in my view - that the "chemical imbalance" idea on which the marketing of these drugs has rested has no scientific foundation, and never has.

Ah -- so am I right in thinking that you do not think psychoactive drugs are ever helpful? If so, you should probably read the studies that Whitaker cited. ;-) Sorry; I'm not trying to be cute by tossing that back at you;

What are you even talking about? That non sequitur is making my head spin! I was asked if he denied any biological basis for mental illness, and was replying with a more clear and specific discussion of the claimed mechanism of action used to sell these drugs to the public. But are you arguing that the serotonin hypothesis/monoamine hypothesis/chemical imbalance notion is correct and supported by evidence?

***By the way, many books are available at Amazon for download to a computer (the link is over on the right). There's a free Kindle for computers. You download it in a few seconds, and then you can download the books in a few more. This one is about $9.

Dr. Jay Gordon (#321):

"Orac, if another cause were found for the huge increase in autism, I would reconsider my position just as quickly as you would."

Try it this way:

"If you could show me definitively what does cause all autism, I could let go of my unsupported attachment to the idea that vaccines - which I don't like much, anyway - cause autism."

This makes as much (or as little) sense as keeping a person in jail for murder - even though the only evidence connecting them to the case was that they were in the neighbourhood at the time of the killing - because you don't know who did commit the murder.

The evidence connecting vaccines to autism is extraordinarily frail - it consists only of a weak temporal association - yet Dr. Gordon is afraid to let go of it until he knows what causes autism.

Well, Dr. Gordon, what if it turns out that there isn't one or two or a dozen things that cause autism? What if it turns out - as seems likely - that autism is a multi-genic disorder that has no "cause"? What if nobody ever finds out the cause? How long will you cling to an unsupported idea? How much data will you let pile up before you admit that - even though we don't know what does cause autism - we can be pretty sure that vaccines don't?

And why am I sure that even if we found what caused 99+% of all autism, Dr. Gordon would hold out for that last 0.00001% being caused by vaccines?

Before today, I would have said that nothing could make me think less of Dr. Gordon. Clearly, I was wrong.

As has been said before, one difference between genius and stupidity is that genius has limits.

You are limitless, Dr. Gordon.

Prometheus

JohnV queries: "Dr. Gordon do you have any comment on your attacking people for using pseudonyms after hearing two people recount real life issues caused by your ideological allies?"

They were wrong to do this. Stone cold 100% wrong. There is no justification whatsoever for the behavior you're describing.

Dandy, Jay. Just what we've come to expect from you: never mind that people were threatened, all you can do is call pseudonymity "Stone cold 100% wrong" with no justification whatever.

Meanwhile, you don't have any problem at all talking parents out of providing lifesaving preventive care to their children.

@D.C. Sessions:

all you can do is call pseudonymity "Stone cold 100% wrong" with no justification whatever.

He wasn't calling those using pseudonyms "100% wrong", but those anti-vaxxers who had caused real-life problems for pro-vaxxers.

Ooh! I almost forgot: I'll probably write a blog post about it, but in the December (2010) American Sociological Review there's an article by Schwed and Bearman, "The Temporal Structure of Scientific Consensus Formation." It's primarily about their new method for measuring scientific consensus over time through a statistical analysis of peer-reviewed journal articles. The beauty of it is that you don't need expert knowledge - it's generic and can be used to analyze consensus formation over time in any area. I have a few issues with the approach and the article, but the approach is neat. (They talk in the discussion about developing it and integrating it with search engines and using it to examine consensus in the blogosphere, which would be cool.)

Anyway, they use it to analyze consensus formation in several cases, including AGW, smoking-cancer, and vaccines and autism. The caption to the graph on this last contains "The scientific discussion of vaccinations as a cause of autism was never contested." They suggest:

[I]t is evident that the scientific community has consensus refuting the relationship. Yet anecdotal information from parents of children with autism generates strong sentiment in many lay communities that vaccines are causally related to autism.... [D]oubts about the scientific consensus lead individuals to withdraw from vaccinations, risking the loss of herd immunity for diseases once largely eradicated from the developing world [references]. As with other contested issues that are not really contested...identifying when science has got the story right may have important policy implications.

So Salty you're saying there is no evidence to justify the use of psychotropics in persons under 18.

So why do physicians use them?

You are describing the characteristics of humility and humbleness of which a scientist should have. Yet you do not display those. You have years of posts that contradict those qualities.

Bending the knee to reality is humility. Bending the knee to your personal feelings is just ew, cuz you're a twat.

Ritalin is not magic, for instance; it will not permanently transform a child into a paragon of virtue with a 4.9 GPA, yet the first study in his list complained that although teachers reported substantial improvement in behavior, parents didn't. The study acknowledged that the dose is likely worn off by the evening, which could easily explain that, but seemed oblivious to other factors --

Argh, Calli, you're confused. I don't know where to start. First, you're assuming, rather amusingly, that because Whitaker links to something it agrees with him. The people behind that study are not on Whitaker's side in this; they're precisely the people he's taking issue with, and those are their outcomes. He criticizes the study design in the book, but notes that even given this manipulation and other attempts at spin this research still didn't support the use of stimulants. (You really should have noticed that he presents it with "In the 1990s, the NIMH mounted a long-term study of ADHD treatments. As it did so, researchers acknowledged that the 'long-term efficacy of stimulant medication has not been demonstrated for any domain of child functioning'.") It would have been evident if you read the book and had some context, but really the language in the article should have been a giveaway. It's fascinating that, because you believed it to be coming from a certain position, you read complaints and acknowledgments into it. Second, the first three articles are the same friggin' study. It's the initial short-term report, and then two follow-ups to assess long-term outcomes (which were not good).

You're seriously confused.

http://www.preemieprimer.com/terbutaline-and-preterm-labor-just-say-no/

Another bit of "science" bites the dust.

Ah the "science was wrong before" argument. We've been through that, Dr. Jay. Yes, science is often wrong, but let's compare it to how often "personal experience" comes to wrong scientific conclusions. Let's put it this way, on the question of whether vaccines cause autism or not, who's more likely to be right? Scientists or Dr. Jay? Until Dr. Jay can actually produce some scientific evidence as compelling as the science that fails to find a link between vaccines and autism, I'm putting my money on science every time.

Dr. Jay, I do have some advice for you. When you find yourself in a hole, stop digging.

So why do physicians use them?

The ones we've been discussing? Several reasons, all of which are discussed by Whitaker:

- They're unaware of a large amount of scientific evidence, and much of the research and data they do see is manipulated or spun. Further, the companies are intimately involved with the APA and shape its views. I do think there are many doctors who have the best intentions and simply don't know, and many probably put trust in the FDA. It's easy not to question an approach when it's so widespread, and if the drugs are aggravating the conditions and creating new problems it's easy to conclude that these were pre-existing and the drugs are necessary to treat them, and on and on.

- For psychiatrists, their professional identity has for several decades been bound up with this approach, which would be hard to let go of in any substantial way.

- Models or support or funding for other treatment approaches and their evaluation are relatively unavailable (in the US, at least).

- The drugs are marketed to doctors as well as "consumers" (who ask for them). There are sometimes perks. And for those with prestige, well... Orac's joking about being a pharma shill is funny because he clearly isn't. But would it be coming from Joseph Biederman?

http://www.nytimes.com/2008/06/08/us/08conflict.html

I'm ridiculously far from an expert on the subject, and my views are not fully formed and always open to change, but from what I've seen this deserves a serious reconsideration.

Dr. Jay Gordon still has not addressed the issue of timely and complete childhood immunizations. Instead he substitutes his "thirty years in practice" and his science based on anecdotal information from parents. He refuses to counsel his patient's parents about the efficacy of vaccines and in fact puts nonsense up on his website about the dangers inherent in vaccines. He will never get "nailed" by the California Department of Public Health on incompetence charges for not immunizing a child because his parents have the California "sincere personal belief" regulation to opt out of some or all of the recommended childhood immunizations.

You are so right Dr. Gordon about the patients you see versus patients I saw while working in public health. I saw actual case of TB and contacts of TB patients, some of them actually were infected with the HIV virus. I saw pediatric patients in public health clinics who, as you stated in a prior post "have little or no access to health care". And, when there were shortages of Prevnar vaccine, I participated in a program to distribute limited supplies to infants who were most vulnerable. I immunized hundreds of children with doses of MMR vaccine, released by the CDC whenever we had a local outbreak and immune globulin against hepatitis A, when food-borne cases were identified. Recently when seasonal flu vaccines were in short supply, I worked tirelessly to immunize thousands of vulnerable children and adults with the limited amount of seasonal flu vaccine released by the CDC.

I and my colleagues (physicians and other public health nurses) did not sit around reading books but did refer to the CDC guidelines, the AAP Red Book and other updated texts for case surveillance, case reporting, proper testing to determine disease status and prophylaxis of contacts during out every day contacts with physicians, hospital based infection control practitioners school nurses and patients. We provided them with information based on the recommendations of the CDC, and the AAP. We also attended "grand rounds" meetings at all the hospitals under our jurisdiction,yearly teleconferences and frequent updates through teleconferences at the CDC and From the State health department.

If I messed up by providing wrong information or information based on patient anecdotes, or what I heard on TV on the Oprah show, I stood to lose my license. You,on the other hand are in little danger of putting your license on the chopping block, "because you basically see children for well visits" and because you have a select group of patients.

@PassionlessDrone: I missed that hearing for a group home in Norco; I was there in spirit and hope you still love me.

Interesting to note, the XMRV retrovirus (HIV is another retrovirus) seems to have an association with CFS. There are studies that were all published the same day trying to say the Lo/Alter study was flawed. They pointed out that contamination can cause false positive PCR results, but they fail to debunk the antibody response and western blot. Itâs too early to tell if itâs a cause or not though.

However, it appears this same retrovirus *might* be associated with Autism. We'll have to wait for quality studies.

Anyway, when they injected foreign peptides into Rhesus Macaque Monkeys, it triggered XMRV to reactivate/replicate.

So if XMRV activation is at the root of Autism, The vaccine/Autism link may actually be very real.

While I will never agree with using thimerosal as a preservative (sorry guys), debunking a thimerosal/Autism link does not debunk a vaccine/Autism link. If mercury isnât a factor, you still canât make the assumption that vaccines are perfectly safe. (note: I am allergic to eggs so therefore do not get vaccinations).

Dr. Jay @ 354:

The article you have linked describes doctors who continue using terbutaline to prevent premature labour, even though scientific studies have shown it to be ineffective. The doctors continue to use it because:

The truth is (whether they are willing to admit it, or not) many OB/GYNs prescribe terbutaline because they want to do something/feel helpless/hope the mother will feel better because she is doing something/think maybe it reduces contractions so they will get less calls (it doesnât)

You know, that reminds me of another group of doctors who continue a practice (not giving vaccinations) even though there is no proof that it is effective (in preventing autism) for irrational reasons (they have seen infants regress at some point after getting vaccines and "know" that the vaccine is responsible).

Dr. Gordon, do you even read the references you post?

TheAnalyst:

So if XMRV activation is at the root of Autism, The vaccine/Autism link may actually be very real.

Without supporting evidence we will assume that everything you write was made up out of thin air.

You continue:

(note: I am allergic to eggs so therefore do not get vaccinations).

All the more reason for you to support strengthening herd immunity. Perhaps you should think more carefully about spouting unsupported claims.

Also, nothing you wrote pertained to the main subject of the article ("Dr. Jay Gordon's Profound Misunderstanding of Science"), so we can now also conclude you are just trolling for kicks and giggles. Good luck with that. Kick and scream all you want, but until you provide actual evidence for your claims you should be ignored.

if another cause were found for the huge increase in autism, I would reconsider my position just as quickly as you would.

Alien abductions.

Bacon,

I doubt that evidence-based care provided by Orac or any of the other physicians posting here is determined by surveys of what patient families believe.

And it's also doubtful that the vast majority of pediatricians (including all those other Fellows of the American Academy of Pediatrics) arrive at best principles of medicine that way either. It seems that Jay is not operating a medical practice, he's running a popularity contest.

I, for one (although I am obviously abnormal) would never trust a Ped if he/she told me "well if you think _____ is what is wrong and it is caused by _____ you know your child best". If I wanted to have validation for my preconceived notions I would talk to my mom.

Froggy, I guess I do see rotavirus but in breastfeeding babies, in healthy families it rarely needs in-office care let alone inpatient care. And I never give the rotavirus vaccine. Again, breastfeeding babies do not need it.

Once again, Dr. Jay you are an asshole.

I breastfed all of my children, two exclusively for six months and the third didn't seem to want solids until seven-and-a-half months (she was low birth weight, guess it took her a little longer). They were all breastfed for at least 18 months, the only one who ever had a bottle at all was the LBW girl and it had breast milk in it!

Two of my three children were hospitalized with Rotovirus. Can you guess why the third wasn't? Ask Dr. Offit. The two who were hospitalized were born before the vaccine became available. I don't know what the problem is with an oral vaccine anyway.

So tell me, after breastfeeding for 16 months why did my daughter lose 23% of her weight and have to be in the hospital until her electrolytes were normalized (2 days)? We're middle class, I cook every day because I am a runner so we eat healthfully. Where did I fail? Because obviously if my child gets Rotovirus I wasn't breast feeding enough or we aren't healthy enough.

I am just a mother and I don't have much else to add other than my experience which is why I am here and why I love listening to the experts here. I learn so much. You say you learn here, Dr. Jay, but if you truly were learning anything at all you would be willing to change your views in the light of the mountains of evidence against them.

Thanks again, Kristen.

Don't "mompetition" and "blame the victim" just infuriate you? They do me, because they're all about self-justification without regard for anyone else. Least of all the children.

But then, we've known that about Jay for a long time.

Thanks for your comment, Kristen. I was just about to ask Dr. Jay why my breastfed 8 month old was hospitalized for rotavirus. Guess my milk didn't have enough magic ju-ju in it.

It was awful to see my child suffer the way he did. Because of the constant caustic diarrhea he got a diaper rash so severe he bled. When he finally felt well enough to be thirsty again (thanks to the IV), he could only handle a teaspoon full of Pedialyte every half hour. He sat on my lap all night in the hospital, crying from thirst in between spoonfuls. I cannot imagine what mothers and babies go through in countries where there is substandard or unavailable medical care.

We will certainly be getting the vaccine for our newborn. It's so sad and so telling that Dr. Jay demonizes Dr. Offit for inventing a vaccine that saves so many children worldwide from such misery.

@Dr Jay #344
>http://www.preemieprimer.com/terbutaline-and-preterm-labor->just-say-no/

Did you even read this? My favorite quote:

"The truth is (whether they are willing to admit it, or not) many OB/GYNs prescribe terbutaline because they want to do something/feel helpless/hope the mother will feel better"

Just to pound the point home--this article actually decrys a practice that sounds identical to Dr. Jay's treatment of his autistic families. Dr Jay tells them what they want to hear and endorses unproven treatments because they make the parents feel better. Even if those treatments and practices are not supported by any evidence.

Dr. Jay really picked the wrong thing to quote. THe author is, in fact, using recent medical evidence to caution against a common clinical practice (I bet some of those OB/GYNs who prescribe terbutaline have *30* years of clinical experience too!)

I also notice that this blog has a recent article called "Show your love for a preemie: Get up to date on your vaccines". What a nice idea.

MB

@348

Oops, missed you making the same point.

Dr Jay @ 344:

http://www.preemieprimer.com/terbutaline-and-preterm-labor-just-say-no/

Another bit of "science" bites the dust.

As documented by T. Bruce McNeely @348 & mb @354, Dr Jay is engaged in some serious (& ironic) quote-mining.

Supporting a claim Christopher Monckton-style, Dr Jay? Shame on you. What an appalling lack of integrity and intellectual honesty.

Kristen and grenouille -

I think you are missing jay's point. The fact that your kids had rotovirus despite being breastfed just means it is your fault for some other reason besides not breastfeeding.

HTH

What an appalling lack of integrity and intellectual honesty.

Appalling, perhaps, but not unexpected.

Salty, we're obviously talking past each other. We're also seriously digressing from the topic of this post. Since one of us has to be the one to stop first, I choose to be that one.

Orac comments: "Let's put it this way, on the question of whether vaccines cause autism or not, who's more likely to be right? Scientists or Dr. Jay? Until Dr. Jay can actually produce some scientific evidence as compelling as the science that fails to find a link between vaccines and autism, I'm putting my money on science every time."

Orac, there is no scientific proof that vaccines do not trigger autism in susceptible children. Period. Please understand that. No proof at all. Studies, evidence, yes, I agree they exist. There are also studies which you may not like which give evidence that vaccines may trigger the onset of autism. Simple issue. Case not closed.

Jay

Kristen opines: "Once again, Dr. Jay you are an asshole.

So tell me, after breastfeeding for 16 months why did my daughter lose 23% of her weight and have to be in the hospital until her electrolytes were normalized (2 days)? We're middle class, I cook every day because I am a runner so we eat healthfully. Where did I fail? Because obviously if my child gets Rotovirus I wasn't breast feeding enough or we aren't healthy enough."

Kristen, what you're describing is not medically possible. (Except the part about my being an asshole. That's very possible on my bad days.) Your child did not experience a 23% weight loss.

You've lost me. You had me, you lost me. You're fibbing now.

Jay

Orac, there is no scientific proof that vaccines do not trigger autism in susceptible children. Period.

Oh, SWEET! I know those rules. Those are the rules where Jay Gordon has no proof, no proof at all, that he's not a Reptilian!

Orac, there is no scientific proof that vaccines do not trigger autism in susceptible children. Period. Please understand that. No proof at all. Studies, evidence, yes, I agree they exist. There are also studies which you may not like which give evidence that vaccines may trigger the onset of autism. Simple issue. Case not closed.

Dr. Jay, I advised you once that when you find yourself in a deep hole it is best to stop digging. It was sincere, friendly advice, but clearly you didn't listen. On the other hand, your statement above demonstrates once again that the title of my post is not only accurate, but more accurate than even I thought at the time I wrote this! The way you blithely dismiss all that scientific evidence with a wave of your hand is truly astounding!

Let's put it this way. We've had this conversation before, and I (and many of my readers, whose patience is that of saints) explained ad nauseam to you many times over the years why what you are saying is not only a straw man but a misunderstanding of the nature of science. Yet, there you go again! Once again, it's impossible ever to completely prove a negative in science. It is, however, possible to estimate the odds that the "negative" (in this case, the hypothesis that there is no relationship between vaccines and autism and that vaccines do not cause autism) is incorrect. Based on the number of studies, including epidemiological studies of hundreds of thousands of children, we can say with great confidence that the odds that the negative conclusion regarding a relationship between vaccines and autism exists is a false negative are very, very low indeed. This makes the odds that vaccines actually do cause autism similarly very, very low. It's not zero, but it's clearly vanishingly small, given the lack of scientific plausibility, the number of basic and epidemiological studies.

Let's stack this up against your "feelings," "personal experience," and beliefs, for which you are unable or unwilling to provide even the barest shred of scientific evidence. When we do that, the choice remains obvious. We go with science, not with Dr. Jay.

Of course, I've explained this to you before many, many times. That it has not sunk in yet either says that I'm a horrible teacher or that you are a horrible student. I tend to think the latter not so much because I think so highly of my own teaching abilities but rather because blog readers whose teaching abilities impress me a great deal have also tried to educate you right here on this very blog in the comments. As I have, they appear also to have failed. Your misunderstanding of science remains untouched.

Froggy states: "We will certainly be getting the vaccine for our newborn. It's so sad and so telling that Dr. Jay demonizes Dr. Offit for inventing a vaccine that saves so many children worldwide from such misery."

Paul Offit invented a vaccine that could save hundreds of thousands of lives in the Third World. He deserves praise and perhaps a large international prize if he manages to get this vaccine to the all countries where it belongs.

However, he is inextricably linked with the business end of vaccines and should disclose this whenever he writes or speaks.

Jay

However, he is inextricably linked with the business end of vaccines and should disclose this whenever he writes or speaks.

As I recall, Dr. Offit has stated that he has not made any money from vaccines in several years. Even journal COI disclosure guidelines usually have a "statute of limitations" of around five years.

Of course, if you wish, I could easily locate on this very blog examples of your being much less charitable towards Dr. Offit.

Orac shouts, "That it has not sunk in yet either says that I'm a horrible teacher or that you are a horrible student."

Orac, I'll split the difference: You're too arrogant and pedantic to be a great teacher and I'm too stubborn and arrogant to be a great student. You sure as hell do write well, though. How did you find the time for the Mike Adams piece??

David, do you even read my posts?? The evidence is there on both sides. The proof is lacking. I might even admit that the bulk of accepted studies point to lack of association. BUT, there are too many lives at stake to continue the course we're on based on incomplete, biased "scientific" evidence. We have to slow down the vaccine money juggernaut. The real danger is not resurgence of illnesses, it's increased autism. I think if you had more experience "on the ground" as a primary care doctor instead of a researcher and surgeon you'd understand that better.

Jay

Quoth Dr. Gordon,

http://www.preemieprimer.com/terbutaline-and-preterm-labor-just-say-no/

Another bit of "science" bites the dust.

But what does this article actually say?

Well, [terbutaline] doesnât work. This is a medical fact, because it has been studied extensively. Using oral terbutaline is no more effective than placebo at stopping preterm labor.

So, real scientists, doing real research, found that practicing physicians with decades of clinical experience incorrectly believed that this treatment is effective.  How does this mean any part of science bites the dust?

Oh, wait! I see!  Real scientists, doing real research, disagreed with practicing physicians with decades of clinical experience, and therefore the scientists are wrong and their research is worthless. Ah, now it makes perfect sense.  

Orac, I'll split the difference: You're too arrogant and pedantic to be a great teacher and I'm too stubborn and arrogant to be a great student.

Even if the former were true, that does not explain the inability of many of my readers, some of whom have the patience of saints and have devoted much time to trying to educate you, to get through to you about science.

And, yes, I read your posts. Have you read mine, the ones where I analyze these "studies" that you seem to find so compelling and point out their extreme flaws, flaws that invalidate their results?

How about this? List some of these studies that you find so convincing. Provide the PubMed links. Let's see how good your "evidence" really is.

When discussing Jay Gordon's lack of evidence, embrace of quackery, and profound misunderstanding of science in this forum, the great majority of us do so on a factual basis without referencing Jay's own conflicts of interest.

Should we insist that somewhere in Jay's comments there always appear a COI statement acknowledging that he benefits financially from expressing antivax ideology (for instance through his practice, which depends on pleasing antivax parents and via sale of DVDs)?

Personally I don't think it is necessary, but if Jay insists...

Kristen, what you're describing is not medically possible. (Except the part about my being an asshole. That's very possible on my bad days.) Your child did not experience a 23% weight loss.

This speaks for itself.

Personally I don't think it is necessary, but if Jay insists...

Heh. Indeed.

Of course, there are also non-financial COIs. If Dr. Jay ever embraced vaccine science and admitted that the vast preponderance of the evidence does not support the notion that vaccines cause autism, overnight he'd lose the adoration of the anti-vaccine movement, the ability to hang with Hollywood celebrities, and the privilege of being the go-to pediatrician that the media choose whenever they need some vaccine "skepticism." Of course, "Dr. Bob" Sears is already muscling in on that territory...

No, Dr. Jay, I am not casting aspersions on your motivations--at least not any more than you are casting aspersions on Dr. Offit's motivations. Sauce for the goose, as they say. Actually, what I am doing is merely pointing out that COIs consist of more than just financial benefits.

Kristen, what you're describing is not medically possible. [...] Your child did not experience a 23% weight loss.

Jay, I could write a textbook about fallacious reasoning with no other examples than those you provide. You're truly checking off the list at an impressive rate.

For instance, here we have Jay "I trust my patients' parents impressions regarding medical causality" Gordon insisting that a 23% weight loss is impossible in an infant due to diarrheal illness. Why is it impossible? Because it would call into doubt Jay's rock-solid faith that breastfeeding is sovereign against all forms of infant illness, of course (otherwise vaccines might have some value, which Jay knows is absurd.)

Since it's impossible, there's no need to consult the literature on the subject. How convenient.

Of course, not having thirty years experience⢠I had to actually look up the numbers. How curious. So tell us, Dr. Jay, how much of a healthy infant's body weight is fat, and how much can a healthy infant lose due to fever and dehydration?

Of course, this assumes that in thirty years experience⢠you've actually had patients with fever and diarrhea; since yours are all breastfed maybe that never happens, since as we all know breastfed babies are all perfectly healthy -- there was no infant mortality prior to the introduction of bottle feeding.

Bacon, excellent point.

Yes, I believe that much of my practice's success is based on my willingness to be very supportive of parents who choose alternative vaccine schedules or no vaccinations at all.

However, this actually leads to lesser economic success: I schedule one visit per hour and even though I bill more per visit than most pediatricians, I collect far less per hour. Also, in spite of docs crying poor about vaccines not being profitable, they are. I would make much more money if I ran a far more more conventional practice. This financial success would be based on my standing and longevity in the community and how incredibly hard I work at my job. And selling a lot more vaccines. I sell no supplements in my office and never have. My DVD is tremendously unprofitable. My website has no ads and costs me money each month. Drjaygordon.com has been a tremendous help to tens of thousands of breastfeeding families, which was it's original intent a decade ago and to this very day.

You have everything wrong. Again, unlike you, Bacon.

Orac, you have given me an excellent weekend project. Thank you. (I may not succeed . . .)

Jay

Dr. Jay:

There is no scientific proof that blue automobiles do not cause autism.

On the evidence, that's a more likely hypothesis than that vaccines do, because the vaccine hypothesis has been tested, and the blue automobile one has not.

Let's pretend for the moment that we had unlimited funds, and lots of help recruiting participants. Is there _any_ ethical experiment that could produce results that would convince you that vaccines do not cause autism?

I'm going to describe a hypothetical study below. It would be very expensive, but it might pass ethical tests. But take it as a hypothetical.

Suppose you could enroll every infant born in North America, at birth. We keep detailed records of what, if any, vaccines they receive, and when. This study will, of course, include parents who choose not to vaccinate, and children who have received very few vaccines because of allergies or other medical issues. We have, also, the records from all their pediatrician visits, both those for specific problems and their well baby visits. We have parental observations of the children's development, including anything from birthday party videos to emails to grandparents saying "Mary said her first word today." Those records are anonymized: each child is assigned a code number that is not connected to their name, location, or social security number. At some meaningful point or points (meaningful in terms of normal human development and when autism is likely to be diagnosed) a group of people use those anonymized records to identify the children with autism. (Yes, this would be a huge undertaking. We're being hypothetical here.)

Those diagnosis records could be correlated with total number of vaccines received, and with the records for any specific vaccine.

If children who received a specific vaccine were twice as likely to be on the spectrum, that would be evidence that that vaccine was connected to autism. It might not be proof of causality--there might be some other reason for the correlation--but it would be evidence of a connection. I think we can agree on that.

Now suppose that there was no such correlation with any vaccine, or with the total number or timing of vaccines. Would that convince you that vaccines did not cause autism?

When you find out that you're in a hole, don't fire up the backhoe.

Dr Jay, I assume you are familiar with Shattuck 2006, regarding autism/ASD prevalence in the United States?

I think these two quotes from the paper are rather significant as pertains to your insistence that there is a vaccine-autism link:

RESULTS. The average administrative prevalence of autism among children increased from 0.6 to 3.1 per 1000 from 1994 to 2003. By 2003, only 17 states had a special education prevalence of autism that was within the range of recent epidemiological estimates. During the same period, the prevalence of mental retardation and learning disabilities declined by 2.8 and 8.3 per 1000, respectively. Higher autism prevalence was significantly associated with corresponding declines in the prevalence of mental retardation and learning disabilities. The declining prevalence of mental retardation and learning disabilities from 1994 to 2003 represented a significant downward deflection in their preexisting trajectories of prevalence from 1984 to 1993. California was one of a handful of states that did not clearly follow this pattern. [From the abstract.]

and

[T]he administrative prevalence of autism, as of 2003, in the majority of states was below what we would expect based on recent epidemiological estimates of the prevalence of autism among children ages 3 to 10 in the United States, which ranged from 3.4 to 6.8.32,33 The mean administrative prevalence of autism in US special education among children ages 6 to 11 in 1994 was only 0.6 per 1000, less than one-fifth of the lowest CDC estimate from Atlanta (based on surveillance data from 1996). Therefore, special education counts of children with autism in the early 1990s were dramatic underestimates of population prevalence and really had nowhere to go but up. [Discussions, second paragraph of the section.]

I'm sure, however, that others have long ago tried to point out studies like this one to you.

There is no scientific proof that blue automobiles do not cause autism.

On the evidence, that's a more likely hypothesis than that vaccines do, because the vaccine hypothesis has been tested, and the blue automobile one has not.

That's a bit overstated. The blue automobile hypothesis hasn't been directly tested, no, but it suffers from an almost complete lack of biological plausibility. Ergo, it's hard to say it's more likely - both may be confidently ruled out, for different reasons. Kind of like saying that the use of homeopathy is a more likely cause of autism.

It may be less rhetorically striking, but using something like broccoli as the example would be a bit more accurate.

@ Kristee and Grenouille: Thank you for sharing your experiences with your children infected by rotavirus. Yes, children who are breast fed do contract the virus, in spite of what Dr. Gordon states that they don't. Dr. Gordon who fancies himself an "expert" in vaccines...in spite of his "experiences" and in spite of his never seeing rotovirus in his practice, categorically stated that breast fed children never get rotavirus. Obviously your children were misdiagnosed, according to Dr. Gordon. There is a preliminary report on the effectiveness of the rotavirus vaccine in partially immunized populations on the web at PATH: New Data on Rotavirus Vaccines From Mexico and Africa.

Grenouille posed a question about how parents in countries where there is no availability to get IV hydration manage to get their kids to the point when they can resume oral feedings. The answer is that their infants die quickly from lack of hydration and electrolyte imbalances, before they can reach a faraway medical facility.

Is anyone wondering how Dr. Gordon avoids censure from the licensing board in California and how many medical excuses he provides to parents so that children can attend daycare and school programs? The answer is none. California health and education regulations allow parents to opt out of childhood immunizations by declaring a "sincere philosophical objection" to any (pick and chose)...or all immunizations.

I suspect that Dr. Gordon has particular strong feelings about Rotateq vaccine due to his venomous hatred of Dr. Paul Offit.

Wow - I miss a few days of checking & Jay is back to his old routine again.

Jay - there is no proof that the following don't cause autism either:

The weather
Breathing
A Blue Sky on Mondays
A Tree Falling in the Forest
Oreos
Cotton
My Smart Phone
Your Smart Phone
Computers
The rotation of the Earth
Professional Wrestling
Etc, etc, etc.

And Jay - what is the profit margin on a vaccine, compared to say, Viagra?

Also, what's the profit margin on Homeopathy? You know, because of the lack of need for any formal education, testing, or just the fact that its fraking WATER!

You are absolutely convinced of your position & you cater to parents who believe as you believe & its a vicious cycle of constant reinforcement of your core beliefs. No amount of science will convince you that you are wrong - whereas the rest of us do look at the Science & are full prepared to accept changes if necessary.

There is no scientific proof that blue automobiles do not cause autism.

We have had a couple of folks come here with their own pet hypotheses about the causes of autism. Remember the commenter who attributed to the increase of fluorescent lighting? While most of ultimately thought that it probably wasn't supported as strongly as the person claimed, it was also true that the idea was intriguing, and there was a case to be made to warrant further investigation. I have (only semi-facetiously) suggested that it is the increased use of the creamy version of Desitin. As I have noted, when I contacted Johnson and Johnson to try to find out when creamy Desitin came on the market, I got a complete run-around. They directed me to the website, but I pointed out that only mentioned the Original Formula (the thick, goopy stuff), and did not discuss the creamy version. Then I got brushed off.

For the statement, "People started doing more of X, and autism rates increase" there are countless values of X that can be postulated. If the only thing jay can come up with is vaccines, then he is just not trying.

My favorite example is the World Wide Web and Internet use. After all, if I remember correctly it was 1994 when Netscape was released and spawned the explosion in web usage that continues to this day. The early to mid-1990s is when most "vaccines cause autism" advocates pin point as the time when the "autism epidemic" began. Clearly the Internet causes autism.

Dr. Jay,

Also, in spite of docs crying poor about vaccines not being profitable, they are.

Since you don't often vaccinate, how the hell would you know?

Your child did not experience a 23% weight loss.

Many years ago, a neighbours' daughter went from 26kg to 19kg in a very short space of time. She had undiagnosed diabetes.
One last thing, Dr. Jay. I find it really distasteful and patronising that you regularly refer to Orac by his real first name.

Dr Jay,

I am sorry you are correct. I just went to look in her baby book. She went from 28.4 lbs (at 15 month well visit) to 22.1 lbs. (upon hospital admission somewhere around 16 months) I mis-mathed in my head. Please let me know how your math works out on that one (believe it comes out to 21.071428571428571...% not 23%). Perhaps it was because she was rather chubby to begin with? I don't know, but it is in fact possible because it happened (I find it rather interesting that you will believe a mother when she says "[soon after the shots] boom -- the soul's gone from his eyes." but you doubt me).

We took her to the hospital when she stopped keeping down mere teaspoons of Pedialyte and we couldn't wake her up (she would open her eyes and after a few seconds they would roll back). We were trying to wait for her Dr.'s office to open (longest night of my life). I kick myself every day because we waited too long. Just recounting the story makes me cry.

Thanks for calling me a liar though.

Pablo,

I think you are missing jay's point. The fact that your kids had rotovirus despite being breastfed just means it is your fault for some other reason besides not breastfeeding.

Thank you, obviously I was misreading him. I knew it was my fault somehow.

Jay @ #360:

Orac, there is no scientific proof that vaccines do not trigger autism in susceptible children. Period. Please understand that. No proof at all. Studies, evidence, yes, I agree they exist. There are also studies which you may not like which give evidence that vaccines may trigger the onset of autism. Simple issue. Case not closed.

A few things.

1. Jay is right that the negative hasn't been proven. Jay is wrong to expect that it should be. He can't seriously want people to consider him a scientist (or at least scientific) with this kind or argument, can he?

2. The term "susceptible children" is probably deliberately undefined. Jay certainly doesn't know how to identify "susceptible" from "non-susceptible," I'm sure. It's a medical-y science-y sounding word that is devoid of any real substance. This carries the advantage of morphing on-the-fly for the claimant as a quasi God of the Gaps argument: trot it out to criticize any study for a resolution insufficient to determine vaccine effects on some indeterminate sub-population that is merely asserted to exist and not demonstrated.

1. I would really like to see Jay's citation list of the "studies which ... give evidence that vaccines may trigger the onset of autism." Let's see 'em.

Kristen:

We were trying to wait for her Dr.'s office to open (longest night of my life). I kick myself every day because we waited too long. Just recounting the story makes me cry.

Yeah, I see what you mean. Though it was the family doctor who was kicking himself since he has told me that my son was on the mend the day before he had a seizure from the screwed up electrolytes due to dehydration.

What I am kicking myself for was taking the advice of "natural baby care" book to use diluted apple juice, since my kid refused the pedialyte. Apparently apple juice makes diarrhea worse. When we got back from the hospital that book went into the fireplace and burned.

You're right, the color of the automobile is irrelevant.

For biological plausibility, consider what comes out of an automobile while it's running. Some of those chemicals have known, harmful effects.

That increased use of automobiles may cause decreases in exercise is probably irrelevant, given that the age of diagnosis is before kids might otherwise be walking or bicycling to get to school or visit a friend.

Vicki jokes: "There is no scientific proof that blue automobiles do not cause autism."
Ad absurdum's no fun. Been there. No thank you.

But . . . "Now suppose that there was no such correlation with any vaccine, or with the total number or timing of vaccines. Would that convince you that vaccines did not cause autism?"

Yes, that would do it for me. I'd be thrilled to move on to other possible causes and triggers.

Lilady says: "I suspect that Dr. Gordon has particular strong feelings about Rotateq vaccine due to his venomous hatred of Dr. Paul Offit."

Wrong. I like Paul Offit. He's biased. I'm biased. I know him. I like him.

Julian, that's his name. (May I call you Julian?)

No, Kristen is not being honest.

I know the cost of all vaccines--I have those vials in my refrigerator here--I know what they cost and what other doctors and I sell them for. The profit margin is anywhere from 40-100%. Buy it for 20 bucks and sell it for 40.

Jay

Jay: "Yes, I believe that much of my practice's success is based on my willingness to be very supportive of parents who choose alternative vaccine schedules or no vaccinations at all."

Of course - you fill a "niche", such as it is. And that arguably gives you a marketing advantage over the overwhelming majority of pediatricians, who follow evidence-based immunization practice and thus lack appeal to your antivax parent base.

Despite your claims of relative poverty, we can't accept that you make less money than other peds based solely on your say-so, any more than the other anecdotal "evidence" you throw our way.
And I think you're going to have a hard time selling the idea that other pediatricians are making sizable bucks selling vaccines, while at the same time insinuating that it's Big Pharma cleaning up on them. A complaint from many pediatricians, after all, is that for a number of vaccines, the costs are sufficiently high that they can't recover them in fees and so are losing money per dose. So you're going to have difficulty trashing both your colleagues (another reason your fellow FAAPs must love you) and the pharmaceutical industry at the same time.

"I would make much more money if I ran a far more more conventional practice. This financial success would be based on my standing and longevity in the community and how incredibly hard I work at my job."

Oh no! How awful, having to contemplate the prospect of working hard at your job!

"My DVD is tremendously unprofitable."

C'mon. As of today your antivax DVD ranks close to 37,000th on the Amazon sales list for movies/DVDs. That ought to be worth at least $1.25 a month, easy.

"My website has no ads and costs me money each month."

How is your online solicitation of funds for that website going?

"Drjaygordon.com has been a tremendous help to tens of thousands of breastfeeding families, which was it's original intent a decade ago and to this very day."

And a most valuable service it is. I'm sure we all admire your standing as southern California's most prominent male lactation consultant (as one of your admirers recently referred to you).

You do miss the point however, Jay. One doesn't have to make a fortune from promoting a particular idea or product to have a financial conflict of interest. It's sufficient that one derives income from such activities, period - so if you're going to keep indignantly insisting that your opponents on the subject of vaccines have COIs and must reveal them, you'll need to do the same - constantly. (the non-financial COIs in your case as pointed out by Orac may well be even more problematic than the financial ones).

Or, you could recognize that perpetually going on about COIs, pharma shills and the like (as done ad nauseaum by antivaxers and health quackery advocates in general) is an unworthy tactic meant to obscure and overshadow pertinent clinical evidence in favor of unwarranted personal attack.

I'm always willing to cordially discuss vaccine-related evidence with you, and suspect others here feel the same. We do get weary of the standard Gordon Riposte, i.e. medicine-wuz-wrong-before-my-30-years-of-clinical-experience-you're-silly-dishonest-perseverating-arrogant-lying-shills-and-you're-uncivil-to-me-science-will-prove-me-right-I'm-too-busy-saving-lives-in-the-trenches-to-provide-evidence-gotta-run-Bye!

It's a wonder anyone still wants to engage you in conversation, as opposed to just pointing and laughing.

I'm always willing to cordially discuss vaccine-related evidence with you, and suspect others here feel the same.

Not me.

:0)

Let's see: nobody has tested the idea that blue automobiles cause autism. Many people have tested the idea that vaccines cause autism, and found no evidence for it.

As a Bayesian, I have to be skeptical of the blue automobile hypothesis (on the grounds of prior plausibility). Evidence-based medicine tells me to be even more skeptical of the autism hypothesis, because it has repeatedly been tried and found wanting.

If we care about the causes of autism, it's time to look elsewhere. Or, we can say that we don't know what the causes are, but we know that there are a lot of people with autism, and ask what they need. After all, whether the cause is environmental or genetic, identifying it is unlikely to lead to a "cure" for people who already have autism. (And not all of those people want a cure, but that's a separate argument.) Whether the causes are genetic, environmental, or some combination, these are people who can use specific educational services. (If I were recording books for blind users, I wouldn't be asking how the person who was going to use this textbook became blind. It doesn't matter for that purpose.)

"My favorite example is the World Wide Web and Internet use. After all, if I remember correctly it was 1994"

Pink Floyd's last studio album was released in 1994. Pink Floyd goes out, autism comes in. You can't explain that.

No, Kristen is not being honest.

Please explain why. And how you know that.

Dr. Jay asserts,

No, Kristen is not being honest.

I have related the weights which are listed in my daughter's baby book. I wrote them next to the pathetic picture of her with her I.V.

I am very curious: I know there are other pediatricians who comment here regularly, does anyone else think I am lying? I will admit my numbers could be off (I did write it down shortly after), I am not infallible (I'm not Dr. Jay after all). It truly is important for me that I have this right, if I am in err I will spend the $15 to get her records and will post a screenshot on my Twitter (minus personal info).

Does anyone else think my story is "impossible"?

It's a wonder anyone still wants to engage you in conversation, as opposed to just pointing and laughing.

We all have guilty pleasures. Dr. Jay is one of mine, I confess. Right up there with leaving the toilet seat up in mens' washrooms.

I find that as I get older I take pleasure in more and more trivial sins.

@D. C. Sessions:
Mine too, but I comment less often, as it's difficult to put "shaking head slowly, mouth agape at the inanity and/or assholery" into words.

@Kristen

I am not a pediatrician, but I've been lurking on this blog long enough to have seen quite a few of your comments. You have never, ever given any indication of being a dishonest person. On the contrary, you have been very forthcoming in sharing details from your own life and, unlike the subject of this post, you have always acknowledged what you don't know.

I think Jay owes you an apology. Of course, I know better by now than to expect much from that braying jackass.

So Dr Jay, who has been caught on this comment thread engaged in quote-mining, asks us to doubt the word of Kristen, who has not.

This is despite the fact that Kristen, at least, has given numbers to support her case, as compared to Dr Jay, who has yet to post scientific evidence directly supporting his position and whose closest effort (on this thread, anyway), consisted of the above-noted quote-mine.

Tell me again who I should believe, Dr Jay?

does anyone else think I am lying?

Fibbing. He actually said fibbing. About your child's illness. I would love to hear him say that to the mother of a child in his practice. It would be one thing if he had accused you of posing as a mother - it's the internet and all - but he appears to accept that you are a mother and think that you would "fib" about something like that. Nasty and condescending. I guess his support and respect have their limits.

Given that I know that jay will deny reality when confronted with inconvenient facts, I take his protests with a grain of salt.

@Jay Gordon:

BUT, there are too many lives at stake to continue the course we're on based on incomplete, biased "scientific" evidence.

How are they biased, and why the scare quotes?

Quote-mining. I'm not sure that word means what you think it means. I posted a link to an excellent article. Terbutaline for PTL used to be standard of care based on "scientific" studies. Now, it's wrong.

Kristen, I apologize. I was wrong before, I might even be wrong again in the future, and I was definitely wrong to argue with a mother about her child's illness. I'm terribly sorry you had to go through that frightening experience and even sorrier that I was insensitive enough to argue with you about it.

Jay

Here's my positive vote for Kristen's honesty (and integrity and competence as a mother).

@Jay Gordon:

I posted a link to an excellent article. Terbutaline for PTL used to be standard of care based on "scientific" studies. Now, it's wrong.

By the scare quotes, do you mean to imply that the original studies were somehow flawed, and terbutaline would never have become the standard for care if the studies had been done right?

Also, regarding the two mothers commenting here whose breastfed children were still hospitalized by the rotavirus: do you consider them to be statistical outliers ("the exception which proves the rule"), or do you think there's some reason that their breastfeeding wasn't sufficient?

The quote marks around scientific are my feeble attempt at humor. The studies supporting the use of terbutaline were probably well done enough, and may have suffered from the "decline effect."

It's highly unusual for a healthy breastfeeding child to be hospitalized in my practice. I've thought harder about it and I think I have actually had a couple kids admitted for diarrhea and dehydration over the past ten years who tested positive for diarrhea.. The numbers below indicate tens of thousands but there's no data in the first article for BF vs formula fed babies. I have articles which show the benefit of BF but don't want this held for multiple links. Maybe using the word "dot" in the second and third articles will work.

http://www.idsociety.org/Content.aspx?id=16604

http://www dot ncbi.nlm.nih.gov/pubmed/17133157

http://www.nfid.org/publications/pediatric_archive/rotavirus dot html

Jay

Terbutaline for PTL used to be standard of care based on "scientific" studies. Now, it's wrong.

Yes, but they were proved wrong by scientific studies, not by some asshole who thinks he what he knows trumps all.

"I'm terribly sorry you had to go through that frightening experience and even sorrier that I was insensitive enough to argue with you about it. "

You didn't just argue with her, but made an entirely unsupported accusation of dishonesty.

You, sir, have a very peculiar way of being 'civil'.

I think it might be wise for jay to go hide under a rock for a while. This whole thread originates from the premise that he is clueless, and as time carried on, instead of disavowing anyone from that notion, he only served to reinforce it. Of course, not satisfied with being a clueless git, he then had to go on to show hmself to be a senseless dick.

Sometimes it is wise to step away, and hope that when you come back, people will overlook your past indescretions. In this case, it is so aggregious that I wouldn't count on it, but it's better than sticking around and pouring gas on the flames.

Dr. Jay,

I could be wrong, but that read like the most insincere and condescending apology I have ever seen. My apologies if you weren't being disingenuous, but it seemed a little forced.
What you have said has not upset me in the least, actually. What a person says is a testament to that ones character IMHO.

If you have a reason to disbelieve my story please share it, I really want to know if I am wrong-it is important to me to be accurate.

Han, Composer99, SC, lilady, Dedj, Chris and so many others,

Thank You

I try to be the first one to admit when I am wrong, especially here. I count it a privilege to converse with so many learned individuals. Due to the current complexity of my life it is highly unlikely that I would be able to hear diverse experts opine on things that fascinate me anywhere else (yay internet!). I have always been a slow learner, so my understanding of things is often incomplete but the commenters here point me in the right direction (nicely or not so nicely). I have always wanted to be a scientist, perhaps I will be someday, but for now this is enough.

I appreciate you allowing me to share my experiences, I have had some extraordinary ones. It is my personality to give TMI (I make no apologies for that).*

*Mushy, mushy comment, sorry. It has been a hard week and I get overly sentimental. I'm not looking for a pat on the back, just always tell what is on my mind. I don't have much of an inner monologue. ;)

@ John V., who says,"Pink Floyd goes out, autism comes in. You can't explain that."

John, my dear, I believe that I *can* explain that:
Pink Floyd , by constantly re-iterating the tragic fate of one Sid Barrett, whose mental illness reduced his nearly non-existent social skills to nought, enabled listeners to *cathartically* purge themselves of any self-isolating, repetitive, and non-communicative behaviors and, via a social network of fans, to discourage any such tendencies in their own offspring. When PF disbanded, the fans only had *old* material to play over and over, repetitiously and exclusively, in isolation. Thus, autism increased.

Kristen, what you're describing is not medically possible. [...] Your child did not experience a 23% weight loss.

Today I have learned that Dr Gordon believes in Listening to Parents and valuing their first-hand experiences, except for those times when he doesn't.

You know, Kristen, the apology was sincere and in no way meant to be condescending.

I will stay out of here for a while because the general tone gets so vicious, nasty, uncivil that
I sometimes fall into the general rhythm and then feel terrible and wrong later. Again, I was wrong to doubt you, to lump you in with the rest of them and I am sorry.

(DrDuran: "Yes, but they were proved wrong by scientific studies, not by some asshole who thinks he what he knows trumps all")

DrDuran, thanks for closing this on a nice high note.

Jay

Today I have learned that Dr Gordon believes in Listening to Parents and valuing their first-hand experiences, except for those times when he doesn't.

Now now....everyone lay off of Dr. Jay.

I'm sure he is sincere and honest and totally incapable of many things, one of which is condescension.
And if his apology came across in such a manner, he is probably deeply grieved that you hate him so much to expect incivility from him.

DrDuran, thanks for closing this on a nice high note.

Jay

Would be so much less ironic if you hadn't said

the general tone gets so vicious, nasty, uncivil...I was wrong to doubt you, to lump you in with the rest of them and I am sorry.

[emphasis mine]

Stop pretending that you aren't a cunt, Jay.

It's so civil of Dr Jay to blame his dismissiveness and his baseless accusations on other people.

Again.

Dr Jay appears to have a profound misunderstanding of what civility is.

Hm. I actually think that Dr. Jay's apology was sincere (don't get me wrong - he's shameless in many ways). It's interesting that he equated an accusation of dishonesty with arguing. I think this is because he has a malformed idea of respect for parents in the context of his professional role.

A pediatrician is supposed to be an expert in the medical care of children. That's why parents entrust their children to pediatricians' care, and it's a heavy responsibility. It means listening to parents and children and appreciating their concerns, but it requires that your treatment and advice are based on the best available science, and that you make an effort to know about that and evaluate it as critically and fairly as you possibly can. It means being honest with yourself and with parents about the level of certainty of the science; and it means being able, including having the confidence in your expertise that can only come from an honest search for knowledge, to tell parents who honestly want the best for their children when their interpretations are wrong. Because you're supposed to be an expert. They're not. You're not respecting people if they come to you and entrust your children to you because of your expertise and you don't have or use it.

Orac, you have given me an excellent weekend project. Thank you. (I may not succeed . . .)

I hope you do.

Again.

Dr Jay appears to have a profound misunderstanding of what civility is.

Dr Jay seems to have a profound misunderstanding in general.

Dr Jay has M/U's?! Maybe Kirstie Alley can explain Study Tech to him.
http://www.lermanet.com/exit/mu_yawn.htm

Dr. Jay, the idea that breastfed babies NEVER get sick irkes the heck out of me. It's over-promotion of small benefits that make moms like me cry small rivers when no milk comes out.

@Enkidu:

Dr. Jay, the idea that breastfed babies NEVER get sick irkes the heck out of me.

At least with regards to rotavirus, he's probably not claiming that breastfed babies never get sick, but rather that breast-milk contains an anti-rotavirus protein:

Human milk contains a 46 kDa mucin-associated glycoprotein, lactadherin, which binds specifically to rotavirus and inhibits its replication.

Which isn't to say that Gordon isn't overselling the anti-rotavirus effectiveness of breast-milk.

Okay, now that we have all given Dr. Jay Gordon his just desserts about Rotavirus and Rotateq vaccine, can we move on?

I'd like to move on to his "expert" on breastfeeding who writes about "Thrush identification and Treatment" on his website. I give Dr. Gordon high marks for pursuing certification as a lactation specialist, which certification is only available to licensed medical professionals. I question why he has chosen this particular person who has no medical knowledge (her BA and MA are in music..she's pursuing a Ph.D in music education)...and she has a CBE (Certified Breast Feeding Educator) "certification". Now trying to figure out what the heck is CBE certification is another "trip" on the internet. I found some information on this "certification" on the "Lacatation Consultant Services" website.

Thrush (oral candidiasis albicams yeast infection) is a fairly common condition diagnosed in infants who are breast fed and formula fed. It can occur more frequently in infants and children who have taken courses of prescribed antibiotics recently. The first line of treatment is Nystatin and second line of treatment would be difulcam...for cases resistant to Nystatin drops in the mouth.

According to Cheryl Taylor, BA, MA, CBE who manages the entire section on breastfeed on Dr. Gordon's website,

"Nystatin contains sugar to make it palatable, yeast feeds on sugar..."Difulcam (long harangue about possible side effects to mother and infant)... I prefer to begin with grapeseed extract as the first line of defense...Test have shown that GSE (grapeseed extract) is dramatically more effective than colloidal silver, iodine, tea tree oil and Clorox...

I'm not a lawyer...but I question why this "mommy blogger" manages Dr. Gordon's breastfeeding web pages. She is prescribing treatment for oral yeast infections, doesn't that constitute a crime like practicing/prescribing treatment without a medical license?

Jay Gordon (#412)

I will stay out of here for a while because the general tone gets so vicious, nasty, uncivil that
I sometimes fall into the general rhythm and then feel terrible and wrong later.

Oh, sure, blame everyone else for you being a dickhole. If the environment here could so easily rub off on you, one would think you'd have developed a proper appreciation of science by now instead of clinging to misguided mimicry.

Test have shown that GSE (grapeseed extract) is dramatically more effective than colloidal silver, iodine, tea tree oil and Clorox...

Lilady wins the Silver Medal for the first sighting of colloidal silver quackery on Jay Gordon's website.

Test have shown that GSE (grapeseed extract) is dramatically more effective than colloidal silver, iodine, tea tree oil and Clorox...

It's nice that Jay's site also implies that one can use bleach to cure thrush. That sounds like the FUN method.

I did some further internet research for citations (none were given by Cheryl Taylor BA MA CBE...doctor Gordon's "expert" on breast feeding, diagnosing and treatment of oral candidiasis albicams) and keyed in the researcher who she cited "Dr. John Mainarich Bio Research Labs". What came up was Livestrong.com. I visited the site to find all the research and products that contain the wonder drug GSE (grapeseed extract) along with references back to Jay Gordon's website.

For reliable up-to-date information about "thrush" visit Healthy Children.org keying in "Thrush and Other Candida Infections". Healthy Children.org is a site maintained by the American Academy of Pediatrics. I see nothing at this site that recommends any alternative medicine treatments such a grapeseed extract, etc.

When I was in nursing school and did rotations in the hospital I saw many immunocompromised patients who had oral candidiasis albicams infections; treatment provided was via "swish and swallow" antifungal medications, as referenced in the article I cited.

Further along in my career in public health we received reports of invasive candida albicams infections in immunocompromised (from cancer treatments and AIDs) children and adults...also addressed in the article.

At the risk of incurring Dr. Gordon's wrath and censure I will share my child's experience with thrush. On her third birthday she awoke with a temperature of 103 F. and refused any fluids. She had a very reddened mouth and gums. She hadn't had any recent antibiotics...in fact had never antibiotics prescribed for her. She had been weaned from the breast to the cup in early childhood and did not use a pacifier. I took her to an emergency room and because she didn't have any tell-tale white spots in her oral cavity, was prescribed antibiotics. I finally reached her pediatrician the following day, when the white spots were apparent and she was put on Nystatin, which quickly cured her. Treatment recommendations from the AAP for childhood oral candidiasis albicams infection has not changed during the intervening thirty seven years.

"Lilady wins the Silver Medal for the first sighting of colloidal silver quackery on Jay Gordon's website."

It's worse than that, as noted here previously.

Jay has an article up on his site (in the "alternative" treatments section on managing colds) in which it's recommended that you give kids colloidal silver as an "immune system booster".

It's bad enough that adults put themselves at risk of permanent skin discoloration and other serious side effects under the delusion that colloidal silves will work wonders for them, but to subject children to this is in my view unconscionable. From NCCAM's website:

"There is a lack of evidence for effectiveness and a risk for serious side effects from colloidal silver products. The FDA does not consider colloidal silver to be safe or effective for treating any disease or condition...Argyria (blue-gray skin discoloration from silver deposition) is permanent and cannot be treated or reversed. Other side effects from using colloidal silver products may include neurologic problems (such as seizures), kidney damage, stomach distress, headaches, fatigue, and skin irritation. Colloidal silver may interfere with the body's absorption of some drugs"

Variation in the amount of silver contained in supplements could also place children at heightened risk of side effects.

Do any of these warnings about using colloidal silver appear on Jay's website? I haven't seen them.

In addition, Jay describes treating ear infections with homeopathic remedies.

"I like to put mullein/garlic oil in the ears hourly for a day or two and give pulsatilla 6X or 12C (homeopathic strengthâthe range I have given indicates homeopathic ignorance⦠but it works) or lachesis homeopathically hourly for two days."

His site also contains a denialist article blasting water flouridation as "a massive toxicological experiment".

Dr. Jay Gordon, Crank Magnet.

Orac, I posted about two hours ago regarding Nystatin; did this techie deficient lilady mess up...again?

@ Dangerous Bacon: I cede my Silver Medal to you, for cruising Dr. Gordon's website for other mention of colloidal silver and mullein/garlic oil. I prefer my garlic to be ingested in food recipes...garlic is a separate food group on my food pyramid.

Dr Jay @402:

Quote-mining. I'm not sure that word means what you think it means. I posted a link to an excellent article. Terbutaline for PTL used to be standard of care based on "scientific" studies. Now, it's wrong.

And from the evidence posted by the blogger you linked to, Dr Jay, that is no doubt the case. Neither Orac nor other serious commenters here will deny that standards of care change and evolve in response to new and updated scientific evidence - indeed, such a response is held up as one of the strengths of science-based medicine.

However, where the quote-mining comes in is because you represented the article as just being about an old standard of care 'biting the dust' based on new evidence.

However, another thrust of the article, ironically given your position on vaccines & autism, is summed up in this sentence, which I have cut & paste from it (although someone else already did upthread):

The truth is (whether they are willing to admit it, or not) many OB/GYNs prescribe terbutaline because they want to do something/feel helpless/hope the mother will feel better because she is doing something/think maybe it reduces contractions so they will get less calls (it doesnât). All of these are the wrong reasons to prescribe a medication.

You (or anyone else) may feel free to correct me on this next point, but unless I am mistaken terbutaline is available by prescription only. So for a woman to be taking it, she needs a prescrition from an OB/GYN who is ignoring the scientific evidence in favour of their personal experience, patient expectations, anecdotes, and the like.

This is analagous to a certain California pediatrician who persists in ignoring the scientific evidence regarding the etiology of ASDs and the safety/efficacy of vaccines in favour of his personal experience, patient expectations, anecdotes, and the like.

In short, the article favours Orac's position more than it does yours.

I conclude that the accusation of quote-mining - or at least misrepresention of the blog post you linked to - stands.

(Here is a re-link to the arcticle linked to by Dr Jay.)

I just visited the ACOG (American Congress of Obstetricians and Gynecologists)...the credentialing medical association for U.S. Obs/Gyns. On their front page is a link to the FDA Drug Safety site. On the FDA Drug Safety is "New Warning Against use of Terbutaline to Treat Preterm Labor" (February 17, 2011). It provides the scientific data about the drug and the history of the FDA issuing advisories about the "Off Label" use of the drug for preterm labor.

As Orac and a number of posters have stated numerous times, "science" has been proven wrong....after further intensive scientific studies.

God forbid this woman walk into Jay's practice -

http://www.cnn.com/2011/HEALTH/02/26/measles.exposure/index.html?hpt=T2

There are presently four confirmed or suspected case of measles in Boston. The index case is a woman who works at the French Consulate there. (See Boston Globe Measles Cases February 26, 2011). Public health nurses have already set up clinics to provide immunizations. There isn't any history of recent airplane travel that's be reported by the Globe...yet.

"God forbid this woman walk into Jay's practice"

Lawrence, are you kidding? This is the ideal opportunity for his patients to obtain natural immunity! It's time for a measles party! And with any luck, they can trigger an outbreak and infect everyone around them who is not immune, whether unimmunized, too young to have been immunized, immunocompromised, or simply a vaccine failure. A win all around!

Except for the possible deaths, grave complications, and permanent brain damage, of course.

@Matthew Cline: I was over-generalizing; I know in this case Dr Jay was specifically referring to rotavirus, but I'm sure if asked he'd be happy to list many other diseases breastfed babies never get.

Also from his quote: "I do see rotavirus but in breastfeeding babies, in healthy families it rarely needs in-office care let alone inpatient care. And I never give the rotavirus vaccine. Again, breastfeeding babies do not need it." I wonder if this means that Dr Jay does not see any formula-fed babies?

Quote-mining. I'm not sure that word means what you think it means. I posted a link to an excellent article. Terbutaline for PTL used to be standard of care based on "scientific" studies. Now, it's wrong.

And it turns out that it wasn't science that was wrong, but rather our doc (jg) and his approach of using clinical experience. From the actual FDA press release:

Terbutaline is FDA-approved to prevent and treat narrowing of the airways (bronchospasm) associated with asthma, bronchitis, and emphysema. The drug is used off-label for obstetric purposes, including treating preterm labor and treating uterine hyperstimulation. Terbutaline has also been used in an attempt to prevent recurrent preterm labor. There is no evidence, however, that use of terbutaline to prevent preterm labor improves infant outcomes. Serious adverse events, including maternal deaths, have been reported with such use in pregnant patients.

Off-label use is based on clinical experience, jaygee's favored method, not scientific studies. So what happened when they actually did do scientific studies for this usage?

The decision to require a Boxed Warning and Contraindication is based on the FDAâs review of post-market safety reports of heart problems and even death associated with terbutaline use for obstetric indications, as well as data from medical literature documenting the lack of safety and effectiveness of terbutaline for preventing preterm labor, and animal data suggesting potential risks. Based on this information, the FDA concluded that the risk of serious adverse events outweighs any potential benefit to pregnant patients for either prolonged use of terbutaline injection beyond 48-72 hours or use of oral terbutaline for prevention or treatment of preterm labor.

Had it gone through the normal route of clinical trials, it would probably never have made it past animal trials for this indication. Note that the studies do not call into question it's FDA-approved use in asthma and the like, which were based on actual scientific studies.

Seems your jig, doctor, was a little premature.

[h/t lilady]

I have a comment in moderation limbo following up on lilady's comment about ACOG, the FDA, and terbutaline. In essence, Doc JG is wrong about the standard of care being based on scientific studies, as off-label use is based on clinical experience. And it was scientific studies that showed that this clinical experience, the same clinical experience that the good doctor so heavily promotes, was wrong.

@ W. Kevin Vicklund: Right you are; I didn't connect the dots properly regarding off-label versus licensed by the FDA for treatment...apologies.

The FDA continual monitors how drugs are marketed by manufacturers and has "nailed" a number of them for direct to consumer advertising and information provided to doctors by drug reps about "off-label" usage. In recent years drug and medical device manufacturers have paid hundreds of millions dollars in fines.

Since they can track this outbreak back to Patient Zero - I wonder if any infected would be able to file a successful suite against that person?

Apparently France is playing "catch-up" due to major outbreaks of measles during the past two years. Measles only became a "mandatory notifiable disease" in 2005, thirty or more years behind the United States classifying measles as a "mandatory notifiable infectious disease".

An excellent report about measles outbreaks in France is available on the web at: "Spotlight on Measles 2010 Update on the Ongoing Measles Outbreak in France 2008-2010" (September 9, 2010). Of particular note is the high incidence of confirmed measles cases in unvaccinated or partially vaccinated individuals,the few cases "imported" from foreign countries and the under-reporting of suspect or confirmed cases by physicians.

It's worse than that, as noted here previously.
Jay has an article up on his site (in the "alternative" treatments section on managing colds) in which it's recommended that you give kids colloidal silver as an "immune system booster".

Have you tried colloidal silver? What's your experience?

It's bad enough that adults put themselves at risk of permanent skin discoloration and other serious side effects under the delusion that colloidal silves will work wonders for them, but to subject children to this is in my view unconscionable. From NCCAM's website:

"There is a lack of evidence for effectiveness and a risk for serious side effects from colloidal silver products. The FDA does not consider colloidal silver to be safe or effective for treating any disease or condition...Argyria (blue-gray skin discoloration from silver deposition) is permanent and cannot be treated or reversed. Other side effects from using colloidal silver products may include neurologic problems (such as seizures), kidney damage, stomach distress, headaches, fatigue, and skin irritation. Colloidal silver may interfere with the body's absorption of some drugs"

There are FDA-approved antibiotics out there that can turn you blue. In fact, they can also can kill you, and if not death, you will end up looking like a burned victim (SJS/TEN). I would be worried about the other side effects you mentioned, and everyone is always so hyperfocused on a bluish tint when you can probably count the number of cases on one hand.

Show me studies about the Colloidal silver causing the other side effects you mentioned. Please exclude silver salts, silver nitrate, and such. Also exclude author's ideas/theories.

NCCAM doesn't seem to supply these.

I took a look at the CDC (one of NCCAM's references), and they don't mention any of the side effects besides argyria.

http://www.atsdr.cdc.gov/tfacts146.html

Variation in the amount of silver contained in supplements could also place children at heightened risk of side effects.

I'd like to see some case studies about the side effects in children from variation of the amount of silver.

Do any of these warnings about using colloidal silver appear on Jay's website? I haven't seen them.

Are these warnings backed by science?

NK:

Show me studies about the Colloidal silver causing the other side effects you mentioned.

First you must show that colloidal silver works as an antibiotic when taken orally and not just on surfaces.

NK:

Have you tried colloidal silver? What's your experience?

You could ask the same about methamphetamine. The wise learn from personal experience, the foolish learn exclusively from it.

There are FDA-approved antibiotics out there that can turn you blue. In fact, they can also can kill you, and if not death, you will end up looking like a burned victim (SJS/TEN).

Antibiotics, in general, work when used correctly, and rarely produce severe side effects. It's called risks vs. benefits, and is one of the most basic concepts out there.

I would be worried about the other side effects you mentioned, and everyone is always so hyperfocused on a bluish tint when you can probably count the number of cases on one hand.

Actually, we're focused on the fact that colloidal silver doesn't work. In other words, it's a unnecessary risk without reward. You have to prove otherwise. Simple as that.

NK "immune system booster" is usually a good sign of bullshit.

The known effects of silver are antibiotic, not "boosting the immune system". Boosting the immune system is usually not a good idea anyway.

Since they can track this outbreak back to Patient Zero - I wonder if any infected would be able to file a successful suite against that person?

While invoking the standard IANAL disclaimer, I believe the common-sense defense that: the patient did not know he/she had a communicable disease, he/she was not specifically advised against travel, and that it's an "act of god" will absolve him or her.

First you must show that colloidal silver works as an antibiotic when taken orally and not just on surfaces.

Or, as a first step, show that the silver particles are able to pass through the stomach/intestinal lining into the blood.

Or, as a first step, show that the silver particles are able to pass through the stomach/intestinal lining into the blood.

Or the mucous membranes in the mouth perhaps?

Oh, and if you are going to study sublingual administration and the stomach, you might as well study the colon/rectum as well.

I wonder if this means that Dr Jay does not see any formula-fed babies?

It's simpler than that. Since Jay's patients are all exclusively breastfed, any serious diarrheal illnesses must be due to some other cause. This follows from the fact that breastfed babies never get seriously ill from rotavirus.

QED.

NK, if you are claiming silver kills bacteria and colloidal silver is an effective oral antibiotic, then what about this article: Bacterial Killing by Dry Metallic Copper Surfaces? Will you now switch to colloidal copper?

NK, if you are claiming silver kills bacteria and colloidal silver is an effective oral antibiotic, then what about this article: Bacterial Killing by Dry Metallic Copper Surfaces? Will you now switch to colloidal copper?

Excess copper is known to be toxic to the human body. Arsenic and Mercury kills bacteria as well. Hell, many toxic metals kill bacteria.

I don't get your point.

I usually don't respond to trolls, but NK did you read the article provided by Chris and the silly nuances in her posting? Before you look at the link again, try to understand the difference between disinfectants and antiseptics.

Everyone knows that copper bracelets (available on the internet) protect you from bacterial, viral diseases and.....

BTW copper is a trace element in the body and used by the body to maintain stasis; silver is not a trace element.

Chris and I are still waiting for citations from you about the effectiveness of colloidal silver against any microbe.

#441 Militant Agnostic

Boosting the immune system is usually not a good idea anyway.

We can't expect woo worshippers to actually possess any genuine knowledge of basicimmune system mechanisms.

Thank you, lilady, I was trying to remember the word "antiseptic."

NK, bleach is also effective at killing bacteria, I just don't think I want to consume it!

(I listened a podcast about the copper killing bacteria, downloaded from http://www.virology.ws/2011/02/23/this-week-in-microbiology/ )

@lilady

There is a small amount of silver in the body. I'll get the reference tomorrow at work (and the actual amount). We looked up a chart (sourced to some medical text book) because of a reviewer comment on a manuscript about the content of a particular mineral in a human.

Excess copper is known to be toxic to the human body.

If you can't metabolize copper at all it's also a bad thing. Look up Wilson's disease.

Link fail!

immune system mechanisms

Link fail.
It was just the wiki on "cytokine storm". Doubt NK is interested in detail anyway seeing as technical details often tend to interfere with belief.

@ dedicated lurker: Yes Wilson's Disease can be a deadly disorder..but that doesn't stop the "pushers" on the internet from marketing Colloidal copper. I must look into a business plan to market colloidal kryptonite on the internet

Where is the runaway bride Dr. Gordon?

@305 Jay Wrote, "Kristen, I get a biased cohort because most of the families I see with autism come because they know I'll support their belief that their child's autism was triggered by vaccines and/or that I'll support their desire to look outside conventional (proven) treatment for their children.

It's a walled garden. You get into a closed loop, spinning along, reinforcing each others beliefs, rejecting any conflicting information.

It's not just the cohort that is biased, Jay. It's you.

While we are waiting for NK to provide evidence of the efficacy of colloidal silver you can watch a colloidal silver entrepreneur versus the dragons.

http://www.youtube.com/watch?v=FHL6L9i2AWA&feature=player_detailpage

@456 quoting Jay @305

It as if when Jay Gordon finds himself in a hole, and the backhoe isn't working out for him, he sends for a bucketwheel excavator.

NK is upset that I criticized Jay Gordon for enabling colloidal silver quackery on his website. NK's first comeback is a classic wooist rejoinder:

"Have you tried colloidal silver? What's your experience?"

Meaning that I can't possibly have anything of value to say about a therapy unless I've tried it myself. Well, I haven't slurped down any colloidal silver supplements. I also haven't tried ear candling, burning off skin lesions with caustic bloodroot paste, drunk my own urine or tried the thousands of untested, unproven and potentially hazardous supplements on the market. I don't need to be a guinea pig to know that it's foolish to try to medicate myself with things not shown to have benefit, but to have harmful side effects - like silver supplements.

"There are FDA-approved antibiotics out there that can turn you blue. In fact, they can also can kill you, and if not death, you will end up looking like a burned victim (SJS/TEN)."

I don't know about "turning you blue", but yes, approved antibiotics have the potential for harm. The big difference between them and colloidal silver products is that antibiotics work.

Did you get that, NK? They work. They save lives. People make rational choices to use them based on a risk/benefit ratio. It's very hard to calculate such a ratio for colloidal silver supplements, since the known benefit is zero. The reason that mainstream medicine has been warning against internal silver consumption for at least half a century (and the FDA weighed in against it) is simple - without effectiveness, there's no reason to risk the harm these products can cause.

As for studies, you'll find plenty of published papers in reference to animal and human toxicity due to silver here.

What can explain the fascination of woo adherents with drugs and treatments discarded long, long ago by medical science? I have a feeling that if health experts, the CDC and the American Academy of Pediatrics suddenly decided vaccination was bad, the Mike Adamses, Gary Nulls and Jay Gordons of the world would do an equally rapid turnaround and decide that vaccination was a marvelous natural disease preventative worth promoting by brave mavericks like themselves, and that the medical establishment opposed it only because letting people get sick with infectious diseases means they can be prescribed lots of Big Pharma medicines.

@438 ... just look up "argyria" on Google images.

http://www.silvermedicine.org/argyria.html

http://www.rosemaryjacobs.com/april27_2003.jpg is a nice picture.

everyone is always so hyperfocused on a bluish tint when you can probably count the number of cases on one hand.

There is this thing called "Google" which, when used judiciously, can reduce the use of words like "probably", and also reduce the number of times one is wrong.

this is pretty far off topic by now, but i figured since i mentioned it upthread i would actually dig out the reference.

in the human body
copper 72 mg / 70 kg
mercury 6 mg / 70 kg
silver: 2 mg / 70 kg
gold: 0.2 mg / 70 kg
uranium: 0.1 mg / 70 kg

from http://web2.airmail.net/uthman/elements_of_body.html which is sourced to "Emsley, John, The Elements, 3rd ed., Clarendon Press, Oxford, 1998"

Lilady is not playing lawyer here but just a comment about legal culpability regarding the measles case in Boston. From what I have read she was not aware that she was infected with measles when she boarded the plane in France. Measles and some other vaccine-preventable diseases (pertussis) have a long prodromal (asymptomatic period) before the onset of symptoms. The measles prodromal period is at least 12 days... when a person can unknowingly infect others.

I do know that in food-borne disease outbreaks caused by bacteria such as salmonella, hepatitis A and shigella, that people have successfully sued for damages. E.coli infections caused by undercooking of hamburgers have caused major organ failure and deaths and the fast food restaurants implicated, have been sued. Major egg producing distributors and pre-washed salad greens companies have been implicated in other food-borne multi-state outbreaks of infectious diseases. Not only have they been sued by individuals, they have been fined for unsafe practices, by regulatory food monitoring agencies.

On the local level, if a determination is made that an individual restaurant caused a food-borne illness due to cross contamination of salads by raw eggs or chickens, deviation from safe food handling practices..such as safe temperature range for "holding" salads at buffets, cooking eggs and poultry completely or employing food handlers with a diarrheal illness, face major fines. (I tend to eat at home and am very selective in menu choices in restaurants).

If a local health department has to provide immunizations for the patrons exposed to a food borne illness in a restaurant, they will also make a claim and collect for the costs associated with providing prophylactic treatment to restaurant patrons.