I’m always hesitant to write about matters that are more political than scientific or medical, although sometimes the sorts of topics that I blog about inevitably require it (e.g., the 21st Century Cures Act, an act that buys into the myth that to bring “cures” to patients faster we have to neuter the FDA and a retooled version of which is still being considered). This is one of those times. Yesterday, I woke up to the news that President-Elect Donald Trump had chosen Rep. Tom Price (R-GA) as his new Secretary of Health and Human Services. The Department of Health and Human Services (DHHS), of course, figures fairly prominently in a some regular topics discussed on this blog because major federal agencies that I write about are within the DHHS, including the CDC (vaccine issues, Zika virus, etc.), the FDA (drug approval and drug safety), and, of course, the National Institutes of Health (billions of dollars worth of medical research). So the HHS Secretary matters, at least for purposes of discussing science-based medicine. Then there’s also the issue of Donald Trump’s long history of rabid antivaccine views, coupled with the other issue of his having met secretly with Andrew Wakefield in August in Florida and, after the election, antivaccine activists seeking to influence him based on that meeting. Heck, as I’ve noted before, Vice President Mike Pence apparently doesn’t believe that smoking causes cancer and premature death. So I was looking for a signal in whomever Trump picked regarding whether he would actually do anything about vaccine policy potentially harmful to public health.

So why did Tom Price catch my attention more than other Trump cabinet picks? Yes, he detests Obamacare and is likely to be fully enthusiastic about gutting it, but pretty much anyone Trump picked would have been expected to hold that view. It’s pretty much par for the course for the Republican Party these days. I would have been more surprised if Trump had picked someone who was was relatively neutral on the Affordable Care Act. No, what caught my eye was that I learned that Tom Price is a member of the Association of American Physicians and Surgeons (AAPS), and that told me a lot about him, none of it good. For instance, in 2015 Charles Pierce referred to Price as “one of Georgia’s wingnut sawbones” (Price is an orthopedic surgeon), and noted an article by Stephanie Mencimer, The Tea Party’s Favorite Doctors, which included this description of the AAPS:

Yet despite the lab coats and the official-sounding name, the docs of the AAPS are hardly part of mainstream medical society. Think Glenn Beck with an MD. The group (which did not return calls for comment for this story) has been around since 1943. Some of its former leaders were John Birchers, and its political philosophy comes straight out of Ayn Rand. Its general counsel is Andrew Schlafly, son of the legendary conservative activist Phyllis. The AAPS statement of principles declares that it is “evil” and “immoral” for physicians to participate in Medicare and Medicaid, and its journal is a repository for quackery. Its website features claims that tobacco taxes harm public health and electronic medical records are a form of “data control” like that employed by the East German secret police. An article on the AAPS website speculated that Barack Obama may have won the presidency by hypnotizing voters, especially cohorts known to be susceptible to “neurolinguistic programming”—that is, according to the writer, young people, educated people, and possibly Jews.

I realize that just because Tom Price is a member of the AAPS doesn’t necessarily mean that he subscribes to all its views—or even most of them. Maybe he’s like the Trump voters who were attracted by other things about him or hated Hillary Clinton more than they were disturbed by his racism, embrace of the alt right white supremacist movement, misogyny, and conspiracy mongering. Maybe Price was attracted by the AAPS world view that rejects nearly all restrictions on physicians’ practice of medicine, purportedly for the good of the patient; its support of private practice and dislike of government involvement in medicine, either financially or regulatory; and its embrace of an Ayn Rand-style view of doctors as supermen and women whose unfettered judgment results in what’s best for patients and medicine. Perhaps he was so attracted to the AAPS vision of doctors as special and “outside of the herd” to the point that he ignored its simultaneous promotion of dangerous medical quackery, such as antivaccine pseudoscience blaming vaccines for autism, including a view that is extreme even among antivaccine activists, namely that the “shaken baby syndrome” is a “misdiagnosis” for vaccine injury; its HIV/AIDS denialism; its blaming immigrants for crime and disease; its promotion of the pseudoscience claiming that abortion causes breast cancer using some of the most execrable “science” ever; its rejection of evidence-based guidelines as an unacceptable affront on the godlike autonomy of physicians; or the way the AAPS rejects even the concept of a scientific consensus about anything. Let’s just put it this way. The AAPS has featured publications by antivaccine mercury militia “scientists” Mark and David Geier. Even so, the very fact that Price was attracted enough to this organization and liked it enough to actually join it should raise a number of red flags. It certainly did with me, because I know the AAPS all too well.

I haven’t written much about the AAPS, but the first time I ever encountered the group was over a decade ago. Given that Tom Price is now in the news as Trump’s selection for DHHS, now appears to be a good time to revisit the AAPS, although I have already briefly done so because, not surprisingly, the AAPS has been a huge foe of Obamacare. Consistent with the conspiratorial bent of many AAPS leaders, AAPS CEO Dr. Jane Orient peddled medical conspiracy theories that Hillary Clinton was “medically unfit to serve.”

Since it’s been a long time, I decided to peruse the most recent episodes of the Journal of American Physicians and Surgeons (JPANDS), to see what the group has been up to, “scientifically” speaking. Not surprisingly, the Fall 2016 issue contained the usual rants against Medicare and taxes and complaints about the “end of fee-for-service medicine” (perhaps the “threat” that animates the AAPS perhaps more than anything else), but it also contained other typical AAPS bugaboos. For instance, there is this article decrying mandatory influenza vaccination for health care professionals, in which a fictional nurse named Rebecca is demonized by her coworkers for refusing the flu vaccine, along with some familiar anti-flu vaccine tropes.

Then, consistent with the hostility of the AAPS towards evidence-based medicine, there is this “gem” of an article, The Evidence-Based Transformation of American Medicine by Hermann W. Børg, MD. Let’s just say that Dr. Børg writes about evidence-based medicine as though it were a bad thing. If there’s another thing (besides Medicare or any hint of federal “control” of medicine) that the AAPS hates with a passion, it’s evidence-based medicine. Børg’s an article that combines the reasonable, such as questions about pharmaceutical influence in generating EBM guidelines and the contention that for preventative interventions we should pay attention to the number needed to treat and to absolute risk reductions more than relative risk reduction, with real howlers, like this paean to anecdotal evidence:

The very low level of quality assigned to anecdotal evidence in this system requires a brief comment. In keeping with the mantra that “the plural of anecdote is not evidence,” any usefulness of “anecdotes” in clinical practice is dismissed outright by EBM. However, as one wise professor observed, “Every epidemic starts with a single case report” (R.L. Kimber, personal communication, 2000). Serendipitous breakthroughs are made by individuals who make careful observations of patients from close range, seldom or never by a team encumbered by a rigid experimental protocol and the huge number of subjects needed to reach statistical signicance. Single observations may be extremely important, even if not statistically significant in the context of a large trial. Say, for example, a rare, otherwise unexplained event follows a medical intervention: a patient takes a drug and inexplicably goes blind. It might be a coincidence, or it might be a side effect of the drug. One cannot rule out a causal relationship based on lack of a statistically significant difference in this occurrence between the drug and placebo groups in a trial of insufficient power to detect a rare event. One is obligated to investigate further.

This is, of course, a straw man so massive that, were it real, the astronauts living on the International Space Station could see it from orbit. EBM (and science-based medicine) recognize the importance of anecdotes, but as hypothesis-generating observations, not hypothesis-confirming observations. Moreover, serious adverse events, such as blindness, are not dismissed as “correlation not equaling causation” without investigation. Certainly the FDA would not dismiss multiple reports of blindness after a drug dose as “the plural of anecdotes not being data.” While I will concede that sometimes skeptics use that quip about anecdotes a bit too freely, in actual practice clinical observations of a reaction as serious as the example given by Dr. Børg are not dismissed as coincidence without investigation, consistent with the role of anecdotes as hypothesis-generating. Basically, Dr. Børg, again consistent with the AAPS view of the physician as supreme, wants the freedom to be able to use clinical observation in any way he wants without restriction by those pesky EBM guidelines and to interpret medical evidence any way he wants, even if it conflicts with how the vast majority of the field interprets it.

If you want a distillation of how the AAPS views EBM guidelines, Dr. Børg gives it:

Strict application of EBM implies a mechanistic algorithm- driven approach, similar to primitive pre-artificial-intelligence computer programs of the past. In such an approach, the doctor sees the patient as a statistic rather than an individual. This sort of medicine could be practiced by administrators. In the real world, however, clinical trials may tell which treatments are e ective, but not necessarily which patients should receive them.

Modern studies of the human genome and proteome have deepened our understanding of the importance and vast extent of biochemical individuality. The patient could be in a subset of patients whose excellent response to an intervention was diluted out in the large number of randomized subjects. It is recognized, for example, that two genes affect how patients process 25 percent of drugs now on the market. In fact, advances in pharmacogenetics may render the EBM model obsolete and replace it with “Genomic Medicine.” One of the major promises of pharmacogenomics is the ability to precisely predict the individual patient’s response to medical intervention, without the need to indirectly draw such conclusion from the large epidemiology-based studies.

Bloody hell. This is exactly the same sort of rationale that functional medicine quacks use to justify in essence, doing anything they believe in to treat patients, all in the name of respecting the patient’s “biochemical individuality” and as an excuse to make it up as one goes along. (Heck, he even uses the same term!) As I like to point out, there is already room in EBM guidelines for the physician’s clinical judgment. However, if a physician deviates from EBM guidelines significantly, it is expected that he or she should have a damned good reason for doing so.

Also, where nowhere near this precision medicine utopia yet, mainly because we lack understanding of the significance of various mutations and differences in gene expression when measured on a whole genome basis. Clinical trials are still necessary. They are also evolving in order to incorporate genomic data and biomarkers in treating patients. One form these new trials take is the so-called “adaptive trial,” which uses patient outcomes and biomarkers to immediately inform further treatment decisions. So, though, results from these trials have been disappointing. Again, Dr. Børg seems to be invoking genomics more as an excuse to dismiss EBM guidelines than anything else.

Now, one might say that Price might not know anything about articles like this, and that’s certainly possible. On the other hand, the reason I cited Dr. Børg is because his article represents what is perhaps the overarching view that is the cornerstone of the AAPS: The fetishization above all else of the individual doctor’s judgment and hostility to any restriction on physician autonomy, or, as I like to characterize it, anything that smacks of “telling doctors what to do.” Truly AAPS worships “brave maverick doctors” and castigates doctors following EBM as going with the herd. Basically, as I described the first time I discussed the AAPS, the leadership of the AAPS and apparently many who publish in JPANDS seem to be a bit too enamored of their self-proclaimed “maverick” status and give the appearance of thinking that, like Ayn Rand’s hero, they’re “supermen” whose egoism and genius will inevitably prevail over timid traditionalism and social conformism. Reigning them in with evidence only interferes with their autonomy and prevents them from exercising their genius for the good of their patients. If only the “herd” could appreciate that!

Oh, and as recently as the Summer 2016 issue of JPANDS, the AAPS was still publishing risible antivaccine pseudoscience in the form of an article by Neil Z. Miller entitled Combining Childhood Vaccines at One Visit Is Not Safe. Let’s just say that it lived down to the usual very low scientific standards of JPANDS, as I described in detail in June.

Tom Price probably doesn’t buy into all the quackery of the AAPS, but my reading thus far leads me to believe that he fully embraces the and Ayn Rand-worshiping wingnuttery the organization. I do feel obligated to state here, though, that, although I do believe he’s a very bad choice for DHHS, fortunately thus far I have found no evidence that he is antivaccine and have even heard rumblings that antivaccinationists are not happy with this choice for DHHS. I do know that the One Crank To Rule Them All, über-quack Mike Adams, is practically twisting himself into a pretzel justifying a “wait and see” attitude even though he is clearly very upset over this choice because Price voted against GMO labeling. (No, I’m not going to link to Adams.) However, you can learn a lot about a person by the people with whom he associates and the groups he joins and supports. By joining the AAPS, Price has shown that he is clearly attracted to a pre-Medicare vision of a golden era of absolute physician autonomy with minimal or no government interference or programs like Medicare, as well as a hostility towards evidence that conflicts with that vision. There is no arguing this, as these are beliefs that are baked into the DNA of the AAPS; they are central to the organization. Attraction to such beliefs is not a good trait for a Secretary of HHS to be attracted to, and I haven’t even really gotten into Price’s fundamentalist antiabortion beliefs, and his implacable opposition to gun control. It’s going to be a long four years when it comes to health policy.

Comments

  1. #1 Frequent Lurker
    November 30, 2016

    I spoke to an orthopedist friend who was an acquaintance of Price’s for several years about this very thing yesterday. In his opinion, Price is essentially the Paul Ryan of medicine and said personally he could see any Republican president picking him, for better or worse, and rather implied the only reason we’re freaking out about the more quack theories is because Trump has quack opinions and that if it was anyone else who picked him the concerns wouldn’t even be an issue.

    He said he always understood he was a member of the AAPS more for its Ayn Randian ideals and less its pseudoscience (even said once he heard Price just bash the crap out of the antivax movement), and advised that we should be focusing more on the fact that he’s going to gut Medicare/Medicaid because that’s the actual issue, along with women’s health and LGTBQ health.

    Of course, he may have just been trying to make me feel better. I’ve been seeing so many deep state (not Deep State) government employees say they’re going to quit, and that’s worrisome. I get the feeling, but we need those people in there and it’s making the panic grow.

    Also, get your IUDs now, child-bearing-age ladies.

    • #2 Orac
      November 30, 2016

      Oh, I guarantee you that if any other Republican President picked him, as soon as I learned he’s an AAPS member, I would have done what I could to raise the alarm. To be honest, even under Donald Trump, very few news reports mention the AAPS other than in passing at most. So I actually don’t think Trump is making that much of a difference in the reporting on Price.

      I do agree that we should focus most on Price’s plans to repeal the ACA and replace it substitute a much less comprehensive plan that will eliminate coverage for millions, his plan to privatize Medicare, and all the other horrible health policy plans he has, but I don’t think we should ignore the wingnuttery of the AAPS. At the very least, he should be forced to answer for it and state unequivocally which principles of the AAPS he agrees with and which he does not in his confirmation hearings and to explain how he could belong to an organization whose journal promotes such pseudoscience.

  2. #3 Anonymous Pseudonym
    In Your Head
    November 30, 2016

    The AAPS reminds me of that old cliched joke. What’s the difference between God and a doctor. One has delusions of grandeur and the other will save your life.

    It’s a cliche, but the old vision of a doctor for a large percentage of doctors and patients was the god-like personae of the person who could do no wrong in the attempt to save peoples lives. Many find that facade to tempting to give-up, hence organizations that promote that idea. It’s stupid and irrational, but I can understand the thinking behind it.

    Hopefully he doesn’t turn out to be the disaster you fear.

  3. #4 sadmar
    November 30, 2016

    Tom Price’s plan for replacing the AHA is a doozy. It’s just tax credits, of course, but it’s who will get them that’s the prime WTF part. The AHA provided subsidies based on need. Poor people got more money. Price’s tax credits will be based on age. The older you are, the more you get. And there’s no means testing or progressive rate or anything. So the recipients of the biggest tax credits will be… rich old people! That’s right, Medicare for the rich! And as for actual Medicare — of course he wants to repeal that, or completely privatize it with more tax credits. Price is no outlier in any of this. His plan was developed with economists at a well-connected conservative think tank, and is fully approved by Paul Ryan.

    Price represents a heavily GOP Congressional district, and has faced only token opposition from Democratic challengers. In 2014 his opponent raised a whopping $8.824 in campaign funds, while Price amassed a war chest of $2,403,022, and though I couldn’t find exact numbers for this year, but according to medical journalist Steven Brill on the Lawrence O’Donnell show last night, they were basically the same. Who, you may wonder, was pumping this largesse to a candidate who didn’t need the money, and just happens to be the most staunch opponent of the AHA and Medicare in Congress ? “Health professionals”, insurance companies, and the pharmaceutical industry.

    Brill noted that in the House, Price is sponsoring a bill to block the Medicare agency from even conducting an experimental program designed to lower the cost of cancer drugs.

    Brill also observed that the largest group of holdings in Donald Trump’s personal financial portfolio, as detailed in a federal filing he was required to make last year, are pharmaceutical stocks. He also has heavy investments in oil companies, and these are the two industries that have seen their stock prices make huge gains since his election.

    I don’t know where Price sits viz “the quackery of AAPS”, but he’s pretty much the poster boy of it’s “Ayn Rand-worshiping wingnuttery”.

  4. #5 darwinslapdog
    At Sea
    November 30, 2016

    Is any of this supposed to somehow put my mind at ease? After reading the NYT, I thought I’d come over here to recover from my despair–hah! I truly cannot process that all this is happening and that the masses who made it possible haven’t a clue.

  5. #6 Eric Lund
    November 30, 2016

    That so many people in this country, including Rep. Price, take Ayn Rand seriously is why we can’t have nice things. I’ll post the obligatory John Rogers quote on the subject:

    There are two novels that can change a bookish fourteen-year old’s life: “The Lord of the Rings” and “Atlas Shrugged”. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs.

  6. #7 Dorit Reiss
    November 30, 2016

    I think, as you pointed out, that we have real concern about Mr. Price’s nomination – but they are not vaccine related. And as a friend pointed out yesterday, I think these policies are going to seriously hurt the autism community.

    Believers of the vaccines-cause-autism myth seem not to realize that there are other things that are very important to autism families, land this nomination is likely to hurt those.

  7. #8 John Mashey
    November 30, 2016

    Thanks!
    For additional perspective, see Anti-Science Associations: Rand Paul, Jane Orient, Art Robinson, Willie Soon And Friends, Plus HHS Nominee Tom Price I wrote early in year, having noticed Rand Paul’s long membership.

    I looked at the overall science denial and interconnects with other “interesting” organizations. Take a look at Doctors for Disaster Preparedness.

  8. #9 Orac
    November 30, 2016

    You should click the links in this post to my previous posts. You’ll see just how far the pseudoscience of AAPS goes into areas other than climate science denial.

  9. #10 Ross Miles
    Barrie ON
    November 30, 2016

    It gets worse. From Medpage Today yesterday:

    Surgery
    10 Questions: Rep. Tom Price, MD (R-Ga.)

    http://www.medpagetoday.com/Surgery/Orthopedics/44217

    Spoiler alert with the Ayn Randish quote:

    “In my more than 20 years practicing medicine, we cared for thousands of patients without insurance or the ability to pay. We never treated them any differently than an individual who had coverage. The only thing holding our current system of healthcare together is the altruism of those providing the care.”

    or for worse:

    Get That IUD Now
    Trump Health Czar Tom Price Is a Nightmare for Women

    http://www.thedailybeast.com/articles/2016/11/29/trump-health-czar-tom-price-is-a-nightmare-for-women.html?via=newsletter&source=DDAfternoon

  10. #11 Orac
    November 30, 2016

    Oh, bloody hell.

  11. #12 Politicalguineapig
    November 30, 2016

    Dorit Reiss: Believers of the vaccines-cause-autism myth seem not to realize that there are other things that are very important to autism families, land this nomination is likely to hurt those.

    Anti-vaxxers are a selfish lot; they really can’t see anything beyond the end of their noses, and they actually really don’t care about their kids, who they had for status reasons in any case. And they don’t want help, because that would force them to admit that there’s a problem in the first place!

    (Also, if they got professional caretakers or took the kids to real doctors, the caretakers or doctors would probably have to report them to CPS. Quacks don’t fall under mandatory reporting guidelines.)

  12. #13 Frequent Lurker
    November 30, 2016

    Orac,

    That’s why I’m wondering if he was trying to make me feel better, and if it really is near the front of his and other doctor’s minds regardless of Trump. *sigh*

    @ Ross #10

    That article is no joke, and anecdotally it’s happening already. I live in NY and immediately made an appointment with my gyno to discuss IUDs and if I was overreacting; she said if I was, I was “overreacting along with several of her patients” and that the risks are SO SO low, she feels it’s worth getting now, when it’s covered. Again, I live in NY, and have great NYS insurance through my hospital, and theoretically shouldn’t have anything to worry about, and yet here we are. I got my new copper friend last Monday and the absolute RELIEF far outweighs the discomfort of insertion and adjustment. And this little guy will take me 10 years, past our new TrumpPence America (provided we actually continue to have elections).

  13. #14 John Mashey
    November 30, 2016

    Thanks. When I was doing that post, I spent many hours enduring the pain of rummaging around in JPandS. I got a copy of the Cumulative Index, highlighted it and looked at articles. I considered going into that, but would have had to write a great deal more, which seemed out-of-focus for DeSmog, although maybe I should do one for Skeptical Inquirer.
    Needless to say, in early 2015, I had no idea an AAPS member would be nominated for HHS.
    I’ll check your links and look at ones I haven’t already seen, although I can only take so much of this at any one time.

    I watched numerous DDP videos and wrote this post, whose attached spreadsheet enumerated all the talks and linked to the videos.
    (Sadly, not too long after I wrote that, many of the then-public videos got marked private, so you cannot have the pleasure of viewing them.)

    I’ve updated my post to link to yours, at the front.

  14. #15 Panacea
    November 30, 2016

    @Ross Miles #10: re Price quote

    “In my more than 20 years practicing medicine, we cared for thousands of patients without insurance or the ability to pay. We never treated them any differently than an individual who had coverage. The only thing holding our current system of healthcare together is the altruism of those providing the care.”

    That must explain the stream of low income patients who came into every ER I’ve ever worked in, with fractures we’d splinted the night before seeking follow up care because of the orthopedist we referred them to. You know, the one who was on call and said “just splint it and I’ll see them in the office tomorrow” rather than come into the ER to see the patient themselves. These are the orthos who refused to see the patient in the office unless they paid cash up front.

    9 different states. Same story.

    Dr. Price is so full of shit.

  15. #16 Narad
    November 30, 2016

    I’ve been pretty amused by AoA while waiting for the coffee to defrost.* Check out Gus the Fuss:

    Maybe Donald Trump`s( were not worthy bow) Georgia Republican Rep. Dr Tom Price who has been picked to serve as the Secretary of Health and Human Services in Donald Trump’s administration will have something to say about these biased meetings.

    Run pharma whilst you can were after ya!

    * I have a bad habit of “just lying down for an hour.”

  16. #17 Julian Frost
    Gauteng East Rand
    November 30, 2016

    I must admit, I’m surprised about the views of some of the more anti-abortion on sex education and contraceptives. You’d think that if they disapproved of abortion so much, they’d do as much as possible to make it unnecessary.

  17. #18 Frequent Lurker
    November 30, 2016

    you’d think that if they disapproved of abortion so much, they’d do as much as possible to make it unnecessary.

    That’s because deep down, all they care about is controlling women in any way they can. It has nothing to do with the actual abortion or “life.”

  18. #19 Eric Lund
    November 30, 2016

    You’d think that if they disapproved of abortion so much, they’d do as much as possible to make it unnecessary.

    I’ll echo FL here. What the “anti-abortion” lobby in the US is really opposed to is the notion that women should be permitted any sexual autonomy whatsoever. In their view, sluts (defined as any female who has non-marital sex) must be punished at all costs.

    Their stated goal is to overturn Roe v. Wade, which in principle legalized abortion in all US states where it was not already legal. (They have been chipping away in the margins; there are now three US states–MS, SD, ND–that are each down to a single abortion provider.) But they really seem to be going after Griswold v. Connecticut. That’s the decision that allows unmarried persons access to contraception.

  19. #20 Annie
    November 30, 2016

    I’m curious what the antivaccinationists are going to think and say when they catch wind of the fact that Price also voted NO on protecting whistleblowers from employer recrimination.(http://www.ontheissues.org/GA/Tom_Price_Government_Reform.htm)

  20. #21 Orac
    November 30, 2016

    Heheh. Maybe we should make it known to the “CDC whistleblower” contingent, if they don’t already know. 🙂

  21. #22 Lawrence
    November 30, 2016

    It appears that many anti-abortion individual are really “pro-birth” only, since they don’t care one whit about what happens to the baby after it is born.

  22. #23 Annie
    November 30, 2016

    @Orac

    *evil grin*

  23. #24 Sarah A
    November 30, 2016

    In my more than 20 years practicing medicine, we cared for thousands of patients without insurance or the ability to pay. We never treated them any differently than an individual who had coverage. The only thing holding our current system of healthcare together is the altruism of those providing the care.

    I notice that he conspicuously fails to state that they provided that care free of charge. I’m willing to bet that the patients he refers to got bills in the mail – bills they likely couldn’t afford to pay. In any case, the “altruism of those providing care” hasn’t been enough to prevent medical bills from pushing over 11 million Americans into poverty.

  24. #25 Sarah A
    November 30, 2016

    ^that first paragraph should be in blockquotes

  25. #26 Chris
    November 30, 2016

    darwinslapdog: “After reading the NYT,…”

    Yesterday I saw the NYTimes front page on Price. Then on the first page of the Science section there was this article on how expanded Medicaid has helped gunshot victims:
    http://www.nytimes.com/2016/11/28/health/obamacare-gunshots-medicaid.html?_r=0

  26. #27 Narad
    November 30, 2016

    I’m willing to bet that the patients he refers to got bills in the mail – bills they likely couldn’t afford to pay.

    Moreover, individuals can’t just declare bankruptcy over and over again.

  27. #28 EBMOD
    November 30, 2016

    A few anecdotes from my career.

    My first job out of optometry school, was at a medicaid pediatric vision clinic. First, this is absolutely an under-served population. To say that this population would be better off being provided care at the whim of private OD’s is disingenuous. They can be a loss, and certainly are not a high reimbursement.

    But what really stood out to me in my time there, is how lack of access can keep people down for generations. 80% of what we learn comes in through our eyes. If a child can’t see comfortably and clearly, they will not do well in their education. Without education, what chance do they have BUT to end up back on welfare or other public service? This also provides a huge incentive to turn to criminal activity.

    Providing care for these people is HOW to get them out of poverty. How can you bootstrap yourself (conservatives favorite solution for poverty) if you can’t see where the bootstraps are?

    One of the first patients I had at the clinic was a father and son. The son was struggling in school and had been referred to us. Of course, turns out he just needed glasses as he had accommodative insufficiency and couldn’t focus on anything closer than 2 ft to him.

    The father had never had an eye exam, and he was in his early thirties. Sure enough, he ALSO had accommodative insufficiency. Thus a good reason why he was on welfare, he had never been able to see well at near. How can anyone function in a modern job with that? It’s essentially a full disability at that point.

    Second anecdote I want to provide? I did part of my precepting as an intern at a glaucoma/oculoplastics/cataract center in Southern California.

    We would see lots of indigent patients and other California medicare patients, and the reimbursement was WAAY below the break even point. They would rack up about $50-60k per month in fees, yet the state would only reimburse about $20k.

    These patients were treated as such. I remember the ophthalmologist owner telling me to delay referral for cataracts in these patients, we would wait for them to get much worse than for a cash pay or private insurance patient. Same with reasonably benign secondary conditions we would find, if it wasn’t part of the patients chief complaint, we were discouraged from bringing it up with the patient or trying to get those conditions treated. Things like dry eye, dermatochalasis impinging on the line of sight, etc.

    Anyway, just adding to the mountain of evidence that without social safety nets, these people absolutely get neglected, received inferior care and less care overall.

    Putting aside right/left politics, it simply makes sense in the case of medicaid pediatrics for society to invest there. It doesn’t take converting very many kids from a path leading to incarceration or long term welfare to one where they can be productive for it to be a positive ROI for society.

    Not to mention the cost to society of the crimes themselves, not just prosecution and incarceration.

    Want to get tough on crime? Get tough on eliminating barriers to success…

  28. #29 Eric Lund
    November 30, 2016

    the altruism of those providing the care

    Altruism. Ayn Rand disciples keep using that word. I don’t think it means what they think it means.

  29. #30 Eric Lund
    November 30, 2016

    Providing care for these people is HOW to get them out of poverty. How can you bootstrap yourself (conservatives favorite solution for poverty) if you can’t see where the bootstraps are?

    For most Trump voters, that this policy would keep Those People in poverty is a feature, not a bug. They have a Reagan-era vision of people on public assistance being strapping young bucks with T-bone steaks and welfare mothers driving Cadillacs. They don’t seem to realize that more welfare and Medicaid spending goes to rural white people like them than urban blacks and Hispanics.

    Understand that the average Trump voter would be willing to live in a cardboard box and cook a sparrow on a curtain rod as long as he could be assured that the darker-hued person in the next cardboard box had neither a sparrow nor a curtain rod on which to cook it.

  30. #31 EBMOD
    November 30, 2016

    “Altruism. Ayn Rand disciples keep using that word. I don’t think it means what they think it means.”

    Indeed. A close friend of mine, who is a brilliant guy, is a huge adherent of objectivism, Von Mises, etc., which can be aggravating.

    He argues that things like the FDA can be done away with because those in business have a profit motive to not be sued, due to their own altruism. Of course, history has proven that to be excruciatingly false.

    Putting your health at the whim of the profit motive of a medical company executive is pure folly…

  31. #32 EBMOD
    November 30, 2016

    “They have a Reagan-era vision of people on public assistance being strapping young bucks with T-bone steaks and welfare mothers driving Cadillacs. ”

    It’s funny you mention that, as in the 4,000 patients I saw in my year at the medicaid clinic, the vast, vast majority were just kids and families who wanted to do better. There were occasionally ‘welfare queens’ living the ‘ghetto fabulous’ lifestyle and milking the system, but that was an extreme minority as best I could tell.

  32. #33 Lawrence
    November 30, 2016

    Very similar to the problems we have with mass incarceration in this country. “Rehabilitation” has never been a focus of the US prison system & we go out of our way to vilify those who have spent time in prison – and make sure that they have few if any opportunities for gainful employment after….

    What do people expect, given those circumstances? Of course prisons will be revolving doors, for precisely the reasons that all they do is create more hardened criminals, at the same time that society rejects them from getting back to a normal life.

  33. #34 JP
    November 30, 2016

    Raging conservatives describe *needing* the system as milking the system. My Trump voting uncle accused his own daughter of milking the system for getting on Medicaid; she and her husband have a toddler and a baby, and he can’t work at his previous (physical) job because of a serious heart ailment.

    He has not yet given me flak about being on Medicaid and SNAP, but I am, for whatever reason, his favorite niece. Possibly because I put up with him.

    I wonder what he would think if I ever did apply for SSI…

    (BTW, the myth of the “welfare queen” is complete crap. Nobody can live a fabulous lifestyle, “ghetto” or otherwise, on “welfare.” I’ve been doing the financial calculations.

  34. #35 JustaTech
    November 30, 2016

    Trying very hard not to run down the middle of the street screaming “We’re all going to die of preventable and treatable conditions!”

    So I’ll focus on being nasty at AAPS: no flu shots, so you can give your patients the flu and charge them more. Brilliant! No vaccines of any variety, so your patients catch more diseases and you can charge them more times! Anti-abortion? More patients!

    Really the AAPS is just afraid of Communists. New flash: Fidel Castro is dead! Go boil your heads! (Unless they don’t believe in germ theory either.)

  35. #36 Chris
    November 30, 2016

    What is interesting is that in our state the counties that voted for Trump are the ones where more people depend on Medicaid:
    http://www.seattletimes.com/seattle-news/politics/counties-in-washington-that-rely-most-on-obamacare-voted-for-trump/

    Some of these are those hit harder by reductions in extraction economies, like lumber.

  36. #37 sadmar
    November 30, 2016

    Run pharma whilst you can were after ya!

    …and Narad has provided exactly the comedy to make Frequent Lurker and darwinslapdog feel better. The AVs are imagining Big Pharma will be running from an HHS Secretary who was one of the biggest Big Pharma shills in Congress, and a President whose wealth is leaping ahead thanks to his substantial holdings in Big Pharma stocks. That’s just freakin’ hilarious.

    Alas, I may now drag you back down again. I have no doubt Price has bashed the bejesus out of antivaxers, and has no use for these ‘activists’. But he basically sings that AAPS song about physician autonomy in every interview. So among the doctors whose individual judgements he’ll feitishize above all else are Bob Sears and (sorry Chris H.) Jack Wolfson. If your god-doctor is willing to give your kid a medical exemption, your kids gets a medical exemption, and Big Guvment has no business meddling in the holy doctor-patient (cash payment) relationship. Dorit Reiss noted that Price’s policies “are going to seriously hurt the autism community”. One part of that: since we’ll be deregulating everything, that will give new free reign to all sorts of ‘autism biomed’ quacks preying on parents of ASD kids.

    But here’s an even more depressing thought that I’ve not yet seen mentioned: What happens if the ACA and Medicare are replaced by tax credits toward the purchase of health insurance and ‘health savings accounts’? The conservative masterminds have already admitted that lots of people will only be able to afford plans with ludicrously high deductables — IIRC the guy on NPR the other day was talking about something like $10,000. So there are going to be a bunch of new plans from the old carriers, and probably also plans from carriers new to the market. since these plans will be targeted to individuals, not employers looking to cover their workers in a group, they will be driven by ‘consumer choice’, yes? This will provide an economic incentive for the new plans to expand coverage to areas consumers want. Which, given the coverage $$ limits, will function not as ‘in addition to’ but as ‘instead of’ in pragmatic terms. Health Freedom! Consumer Choice! Ayn Rand!

    So how long will it take for a purely profit driven insurer to figure out it can attract more customers by letting them chose alt-med practitioners for their basic care, and buy supplements instead of prescription meds with their drug benefits? Add naturopathy to chiropractic on the list of legitimated ‘health professions’, and watch the naturopathy clinics spring up faster than you can count.

    If you can tell my why this won’t happen, please, PLEASE do…
    November 30, 2016

    I think, as you pointed out, that we have real concern about Mr. Price’s nomination – but they are not vaccine related. And as a friend pointed out yesterday, I think these policies are going to seriously hurt the autism community. aturopathswil ‘in addition towon’t be targerted tro carriers

    of the individual doctor’s judgment and hostility to any restriction on ,movement)

  37. #38 sirhcton
    November 30, 2016

    Our kind host’s excursion into JPANDS territory reminds me of one of my own from a few years ago, prompted by one of his blog posts. It struck me then and now, that they seem primed for one or more carefully and skillfully executed Sokal-like submissions. Oh, that I had such talent and knowledge.

  38. #39 sadmar
    November 30, 2016

    ^^ Whoops! #37 was supposed to end at “please, PLEASE do…”
    Kindly ignore the spurious paste following…

  39. #40 JustaTech
    November 30, 2016

    sadmar @37: depressingly I think you might well be right, which is why, combined with Chris’s link at 36 is going to result in a distressingly large number of people dying of diabetes and asthma and other totally treatable stuff.

    If I’m being hopeful I see the ranks of the AARP standing up (slowly) and screaming “no”, because thus far all the plans to eliminate Medicare don’t include any “grandfathering” and plenty of people who rely on Medicare (regardless of who they voted for) understand just how much their care costs and how very little insurance they could possibly get on an open market.

  40. #41 EBMOD
    November 30, 2016

    “(BTW, the myth of the “welfare queen” is complete crap. Nobody can live a fabulous lifestyle, “ghetto” or otherwise, on “welfare.” I’ve been doing the financial calculations.”

    Pretty sure they are people who have alternate, black market incomes, who can hide income and milk the system. Think drug dealing, panhandling, prostitution, etc.

    I did have one family come in, and they were all in fancy designer clothes, drove a new Lexus SUV, etc, but sure enough, they were in the system for medicaid. Suspect for sure. And again, an EXTREME minority.

  41. #42 sadmar
    November 30, 2016

    brilliant guy argues that things like the FDA can be done away with because those in business have a profit motive to not be sued

    It’s true businesses have a profit motive not to be sued. It’s also true that they address that by pushing for ‘tort reform’ code for making it too expensive for any regular J. Doe to bring suit against them.

    No need for the FDA when the pharmas are let loose in the realm of unfettered laissez faire caveat emptor capitalism? I guess you’d have to be brilliant as well as a crazed greed-head to construct an intellectual scaffolding that would let you imagine that would ‘work’.*
    ______________

    * As my old ‘commie’ political economy prof. said about Reagan’s ‘Star Wars’, the question isn’t ‘will it work?’, the question is ‘what work will it do?’.

  42. #43 sadmar
    November 30, 2016

    @ JustaTech

    MSNBC was running some not-too-old tape of Price yesterday describing his Medicare proposal, and he said it would only apply to people under 50, with anyone currently on benefits grandfathered in. If that’s changed, I’m gonna have to speed up the timeline for looking into emigration to Canada or the antipodes.

  43. #44 EBMOD
    November 30, 2016

    “No need for the FDA when the pharmas are let loose in the realm of unfettered laissez faire caveat emptor capitalism? I guess you’d have to be brilliant as well as a crazed greed-head to construct an intellectual scaffolding that would let you imagine that would ‘work’.*”

    It really is something that has disappointed me to no end, as I feel he is too smart to not see through it. But he is the proverbial tale of someone who tends to be too smart for his own good.

    It also doesn’t help that he is really in Von Mises, who essentially rejected scientific method preferring a priori arguments and ‘mavericky’ approaches to science over proper method…

  44. #45 JP
    November 30, 2016

    @EBMOD: I suppose the black market income is possible. Or it could be that they had those things from a time when they had more money, or they were gifts from family. I hear people bitch on the Internet about people paying with groceries who are dressed well and have the newest smart phone, etc., but you never know. I have an iPhone SE, but it’s actually the cheapest phone Verizon had, and I’m on a payment plan and on my brother’s family plan.

    In any case, I guess I don’t notice or speculate either way.

  45. […] turned science and medical blogger “Orac” posted about Price at the blog Respectful Insolence, but first issued a caveat about taking on political […]

  46. #47 Emma Crew
    November 30, 2016

    Dorit @7 I’m super stressed out that we’re going to lose health insurance for my 16 year old autistic son. Before the ACA went into effect we were on a group plan through a professional organization that was required to take everyone because his diagnosis disqualified him from any individual plan we could get. That plan that cost $32k/year for our family of 4 (with a deductible of $5k or more per person, I forget), the cost rose twice yearly and it is no longer available.
    Even though no plan we could buy would have covered anything having to do with his autism (ABA or other therapy), he was still an automatic no despite his general health needs being for the most part like any other kid his age.

  47. #48 EBMOD
    November 30, 2016

    “In any case, I guess I don’t notice or speculate either way.”

    Yeah, the only reason they stuck out is that one of my hobbies is cars (I now have a Porsche Cayman S myself) and they had driven up in a then brand new Lexus IS350 F Sport. A car that is $54k new.

    With my income as a new grad, I myself could not afford that car at that time. Which is why it stuck out. I fully agree they weren’t paying for it with any welfare, there had to be another income one way or another.

  48. #49 JP
    November 30, 2016

    Actually, now I’m wondering how average prostitutes and drug dealers *do* get their health care…

  49. #50 Chris
    November 30, 2016

    Emma Crew: “Dorit @7 I’m super stressed out that we’re going to lose health insurance for my 16 year old autistic son.”

    I also worry about my autistic son, who is on state’s Medicaid plan. He is 28 years old, and hopefully with help from the state’s health and human services he will soon be getting a supported job. Though at first it will be part time, so no health benefits.

  50. #51 John Pace
    United States
    November 30, 2016

    jftr, The Charles Pierce (aka Charlie Pierce) whose piece is linked in the second paragraph is a sports writer cum political commentator, not an ortho surgeon.

    • #52 Orac
      November 30, 2016

      Uh, this is what I wrote:

      For instance, in 2015 Charles Pierce referred to Price as “one of Georgia’s wingnut sawbones” (Price is an orthopedic surgeon), and noted an article by Stephanie Mencimer, The Tea Party’s Favorite Doctors, which included this description of the AAPS:

      I never said he was an orthopod. I said Tom Price is.

  51. #53 Eric Lund
    November 30, 2016

    BTW, the myth of the “welfare queen” is complete crap. Nobody can live a fabulous lifestyle, “ghetto” or otherwise, on “welfare.” I’ve been doing the financial calculations.

    The image of the Cadillac-driving welfare queen was based on an actual case in the 1970s of a Chicago woman defrauding the system by obtaining welfare benefits under multiple identities. When Ronald Reagan told the story, he implied that this was a commonplace thing. What he didn’t tell his audiences was that in this case the system ultimately worked as designed: the woman in question was caught and prosecuted. The fraud rate for welfare claims is lower than what you see in more “respectable” parts of society, such as Wall Street.

    But this is post-factual America, where good stories are valued over facts. That was Reagan’s MO, and his Republican successors have gotten ever more brazen about it since then. A country that respected truth would never have considered a serial deadbeat conspiracy monger a serious contender for high political office, let alone elect him President.

  52. #54 John Mashey
    November 30, 2016

    Back to AAPS – Orac did a great job, but really, people owe themselves a chance to plumb the depths with a brief immersion into a talk by woman who runs AAPS.

    As described in #8 Anti-Science Associations: Rand Paul, Jane Orient, Art Robinson, Willie Soon And Friends, Plus HHS Nominee Tom Price Jane Orient runs AAPS & Doctors for Disaster Preparedness. .

    To get a feel for her thinking, listen to her 16min intro at DDP 2013, Agenda here.
    (Start the video and listen while doing something else, mostly talk, not many slides.)

    Does anybody see what we see? (Need for homeland defense, nobody seems to care.)
    NASA was doing great exploring space, but now NASA GISS can stop temperature and sea level rising.
    What did happen on 9/11? had blue–ribbon commission, like Warren Commission, and nobody believes that.
    Tree at Ground Zero, NY stock exchange symbol; terrorism started by Assyria, whose language is ancestor of Arabic…. Obama killing coal industry.
    Petr Beckmann (an engineer who spent much of his life disproving relativity.) Real foundations of science. Listen to real prophets.

    Andrew Schlafly is general counsel for AAPS, sued against Obamacare. See Conservapedia.

    Anyone who wants to experience more can visit the DDP post linked in #8.

  53. #56 John Mashey
    November 30, 2016

    Hmm, maybe that CSI Fellow “friend” could write an article akin to this blog post for Skeptical Inquirer,. I’m a Sci/Tech Consuitant so I suspect we know a few folks in common.
    Should that occur, I’d be glad to help, but clearly there is much more on the medical side than the climate side.
    Of course, Orient played with Big Tobacco, too.

  54. #57 Narad
    November 30, 2016

    I’m super stressed out that we’re going to lose health insurance for my 16 year old autistic son.

    Emma, your needs sound greater than mine, but I’m scared sh*tless about being uninsured again myself. No more Medicaid expansion, and it’s all over. I’m thinking about asking my PCP to double my HTN meds for hoarding purposes. At least amoxicillin is available OTC (for aquariums). Anyway…

    Yeah, the only reason they stuck out is that one of my hobbies is cars (I now have a Porsche Cayman S myself) and they had driven up in a then brand new Lexus IS350 F Sport. A car that is $54k new.

    My brother has worked off and on in auto dealerships. I’d have to go over it again with him to be sure, but my recollection is that the repo cost is basically built in for such customers, who can be seen coming a mile away.

  55. #58 Chris
    November 30, 2016

    I remember years ago when we still had a phone modem how Jane Orient behaved on the HealthFraud listserv. She got banned for just dragging down everything by repeating absolute nonsense, especially with vaccines.

    Later it was amusing to see her and her cohorts freak out about the Year 2000 “bug.” The Oregon Institute of Science and Medicine was part of that:
    http://www.sourcewatch.org/index.php/Oregon_Institute_of_Science_and_Medicine

  56. #59 Narad
    November 30, 2016

    Actually, now I’m wondering how average prostitutes and drug dealers *do* get their health care…

    Drug dealing is largely a job for young (-ish) males, who may not really feel the need for a regular doctor, and Medicaid has always been a lot easier to obtain for women.

  57. #60 JP
    November 30, 2016

    Drug dealing is largely a job for young (-ish) males,

    Indeed, a school friend’s little brother is a petty dealer. You don’t exactly make a fortune selling dime bags, which is sort of why I was wondering.

    who may not really feel the need for a regular doctor,

    I went from age 18 to 22 without health insurance, from the time I aged out of Basic Health until I went to grad school. Luckily I didn’t have any major crises that involved hospitalization, but my (untreated) psychiatric problems did wreak havoc in my life/studies at least a couple of time.

    and Medicaid has always been a lot easier to obtain for women.

    Even for single, childless women?

  58. #61 David
    PDX
    December 1, 2016

    Recently it has been suggested that Trump’s son has autism. I am thinking if this might be a reason for him being such a Anti-vaxxer.

  59. #62 sadmar
    December 1, 2016

    ..anndd…
    The House has just passed the 21st Century Cures Act, 392-26. The ‘No’ votes came from 6 progressive Democrats and 20 conservative Republicans. (There aren’t that many measures where Louis Gomert and Barbara Lee vote the same way…)
    The bill is expected to face more opposition in the Senate. Elizabeth Warren and Bernie Sanders are not happy with it, to put it mildly: http://tinyurl.com/jptmdwr. However, it is expected to pass there as well.

    We’ll see how much the value of Trump’s pharma stocks goes up tomorrow. My approximate guess is ‘a lot’.

    • #63 Orac
      December 1, 2016

      Yeah, I’ve basically given up on the 21st Century Cures Act. It’s pretty much a done deal, and President Obama won’t veto it because it contains funding for his Precision Medicine Initiative, which is almost certainly last thing he ever gets passed. I guess we’ll get to see how much weakening the FDA opens the spigot on all those “cures” from pharma. My prediction: Not much, if at all. More likely not at all.

  60. #64 Lawrence
    December 1, 2016

    The really sad part about this will be the fact that it will take something akin to Thalidomide getting through this “expedited” process & harming a whole lot of people, before we start to see the pendulum swing back the other way….

  61. #65 Todd W.
    http://www.harpocratesspeaks.com
    December 1, 2016

    And the American Medical Association has come out in support of Price.

  62. #66 Nick
    Milwaukee
    December 1, 2016

    What’s heartening, amidst yet another “Trump did what?!” maneuver is to see the eloquence of the post and the number of thoughtful (and funny) comments, especially as a pre-med student gearing up to apply and get more involved in bench-style autism research. (Anti-vaxxers horrify me, partly because I am autistic, so whatever I can contribute to the field so that reason triumphs over magical thinking would be worth my currently nightmarish advanced organic chemistry course; a nightmarish outbreak of measles, not to mention a nightmarish suppression of women and of the poor, is much worse.)

  63. […] The new Secretary of Health and Human Services is a member of a fringe medical organization. Here’… […]

  64. #68 Ruth Hull Chatlien
    December 1, 2016

    Please stop with the deceptive click bait headlines. He is not the new secretary. He’s the nominee. We have a process that he has to go through first, and it doesn’t help when the media ignore that fact.

    • #69 Orac
      December 1, 2016

      Give me a break. You apparently don’t know how much pedantry irritates me. Or maybe you do.

      I’m also amused at the accusation “click bait” headlines. Regular readers know that, if anything, my headlines could use more “click-bait” to them, because usually they’re pretty dull. I could probably get considerably more traffic if I learned how to do click bait headlines, but I don’t. I’m too busy writing content.

  65. #70 Lawrence
    December 1, 2016

    Of course he’s only the nominee – but the chances that he won’t be confirmed are vanishingly small…..

    Your “complaint” is just quite ignorant.

  66. #71 Hania
    December 1, 2016

    An addition to the “he’s just a nominee” comment. If Trump and his administration had any decency at all a person like this wouldn’t even be a nominee. Moreover, there are plenty of equally and even more egregious (hard to believe that’s possible) who are already being granted positions. Moreover, he not only has a deaf ear to unprecedented and well-founded protest against his “nominees,” he and his cadre are relishing in the chaos to do exactly what they set out to do all along to undermine this entire country except for the benefit of the super wealthy. So the time for “giving him a chance” and meaningless nuances is long, long past.

  67. #72 Chris
    December 1, 2016

    Ms. Chatlien: “We have a process that he has to go through first, and it doesn’t help when the media ignore that fact.”

    All the more reason to alert everyone to his ideas that will harm poor voters, elderly, women, the disabled and other vulnerable people. The earlier, the better. There is no reason we need to be silent to this travesty.

  68. #73 Momper
    Earth
    December 1, 2016

    Here’s a fringe medical hypothesis for ya:

    There is a, as yet unknown, “radiation”, that radiates ubiquitously throughout the galaxy. The distribution, however, is not uniform with some areas of the cosmos nearly devoid of the stuff and other parsecs just LOADED!
    Further, this “radiation” bombards Earth at intervals of about fifty years, lasting for five years.
    The effect of the “radiation” on higher cognitive functions is dramatic; experts are eschewed for ideas championed by those fringe-thinkers, who, (when the stream is particularly heavy), obtain political power to implement their ideals as social policy.

    You may consider us in such a storm now.

    Just email me notification of my Nobel, I shan’t attend.

  69. #74 Joe Burns
    Ireland
    December 1, 2016

    This article is exactly what I was talking about when I wrote a response to a story in the British Medical Journal which was published today. When did Science become a Religion?

    It was a given that Dr Squier would be re-instated in the High Court, her contributions to Humanity
    and Medical Science are not in question by anyone. But there is a far bigger issue that stems from
    the defaming and prosecution of Dr Squier, and many others, that urgently needs to be addressed.
    The question that this case raises is;
    – Why has Medicine degenerated into a Religion based on Faith and Belief?
    With regard to Science and Shaken Baby Syndrome, a recent survey found that most doctors
    believe that if an infant is shaken, that it will produce what is known as the Triad of
    signs and symptoms within the brain1. And yet, what Science tells us is that an athletic male cannot
    generate sufficient forces to disrupt the Bridging Veins of the Dura Mater, but short falls can2.
    I have struggled for years with the concept where two doctors could examine a patient and have
    completely opposing views. If we all adhered to the “Belief” that shaking a baby produces the Triad,
    it would leave no room for Scientists (such as Dr Squier), to raise questions. When they stray out of
    the “widely held beliefs”, they are branded Heretics, Deniers and Non Believers and their
    reputations are burned at the proverbial Stake. This is what Medicine has become.
    Science relies on questions and constant dialog. With “Peer Review” a theory is either bolstered or
    ruined by constant attack. Anyone falling afoul of the Herd Thinking is to be reported to the GMC
    as a Denier and attacked personally rather than challenging their theories. Isn’t that called “Witch
    Hunting”?
    But we have to remember that the Witch Hunters of Salem, Mass. were good, God-fearing people
    even though they brutally killed their own citizens. Their faith in the Devil was equal to their faith
    in God. I have long been a proponent of Evidenced Based Medicine and a Forensic Diagnosis being
    reached before allegations being made.
    My position is SBS could not exist, not my opinion but scientific fact. In fact I would go further and
    suggest that any Physician who “Believes” it it possible to cause the Triad by shaking alone is
    dangerous to patients and shouldn’t be allowed to practice. SBS has never been more than an
    unproven hypothesis and the original theorist Dr Norman Gutkelch has never stood by this theory.
    SBS is dangerous because the dogma says that shaking an infant produces the Triad, but short falls
    from a couch or bed are not harmful, scientific experiments prove the complete opposite is true. See
    note3 Biomechanical studies prove beyond all doubt that even the most violent shaking can only
    produce 1/12 of the Acceleration as a short fall. There are documented cases now of physicians
    dismissing babies who have fallen from beds or couches and dismissed because the dogma. Indeed,
    even the factually incorrect information on the Crown Prosecution website4 claims that short falls
    are not harmful. A theory, as yet unstudied, is that the Subdural bleeding builds up over days,
    increases Intra-cranial Pressure and causes Retinal Haemorrhage (Triad), will never be studied as
    long as 90% of physicians believe that short falls are not harmful. Even if you are not familiar with
    the mathematics involved in the Biomechanical studies by Lloyd et al, this short video should be
    sufficient to see that the current dogma “believed” by the 90% is incompatible with Science.5 or a
    longer version6 Science shows that falls produce 12 times nore force than the most vigorous
    shaking. The Brain does not “float” within the skull, the “free space” is taken up with CSF which
    maintains a constant pressure. The brain cannot “bounce off” the skull and if it did would more
    likely produce Epidural rather than Subdural bleeding. Take an egg and shake it as hard as you like
    for as long as you like. When you break open the shell, the yolk will be intact. Now try dropping an
    egg from 3 feet (1M) onto concrete.
    Dogma must be replaced with Evidence Based Medicine. What we can also learn from
    Biomechanics is is that Helmets protect the head, but do not protect the brain. We have seen athletes
    such as boxers dying for years in the ring and wrongly believing that the punch and not the fall was
    the cause of death. As a physician, if you treat a baby who has fallen from a couch or a bed, don’t
    be guided in your diagnosis by dogma alone. Dr Gutkelch original theory on shaking was out of
    concern for babies dying for inexplicable reasons. We are no further ahead today in the study of
    Sudden Infant Death Syndrome, other than placing babies on their back, than we were 35 years ago
    suggested we look at shaking as a possible cause. Hundreds of caregivers have been caught on
    video violently shaking babies, and none of those babies suffered the Triad. In the hundreds of
    prosecutions for SBS, nobody has ever witnessed a baby being shaken where the baby was
    diagnosed with the Triad. They have even re-branded SBS into Abusive Head Trauma, the
    implication being that the Triad is caused by abuse causing trauma, thereby eliminating the
    possibility that the 21 other known causes of the Triad.7
    My hope is that doctors will stop killing babies with junk science. While many are sceptical on
    SBS, sticking their head above the parapet leads to a Witch Hunt. Sweden has decided recently that
    SBS is unproven.8 Again, this is all reminiscent of a Moral Panic that occurred hundreds of years
    ago in Salem. 90% of people have an unshakable faith in a Devil, a Devil that Science has proven
    cannot exist.
    It is unbelievable that in 2016 that we are even having this conversation.
    Joe Burns
    Dublin, Ireland.

    1 http://psychcentral.com/news/2016/07/24/diagnosis-of-shaken-baby-syndrome-accepted-bymajority-of-physicians/107572.html
    2 https://www.researchgate.net/publication/236530600_Biomechanical_Evaluation_of_Head_Kinematics_During_Infant_Shaking_Versus_Pediatric_Activities_of_Daily_Living
    3 https://www.youtube.com/watch?v=N7_gxIpiI08
    4 http://www.cps.gov.uk/legal/l_to_o/non_accidental_head_injury_cases/
    5 https://www.youtube.com/watch?v=N7_gxIpiI08
    6 https://www.youtube.com/watch?v=8xxR0MtCZj8
    7 https://onsbs.com/home/triad-only-defined/
    8 https://onsbs.com/2016/10/28/swedish-reviewdeclaresshaken-baby-theory-unproven/

  70. #75 Science Mom
    http://justthevax.blogspot.com/
    December 1, 2016

    Seems someone known to this blog received nice coverage about this subject: http://nymag.com/scienceofus/2016/12/tom-price-belongs-to-a-really-scary-medical-organization.html

  71. #76 Orac
    December 1, 2016

    It also seems that the wider coverage of this post has brought some new readers with some…odd…views.

  72. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  73. […] Rep. Tom Price (R-GA), new Secretary of HHS, is a member of a fringe medical organization. Anti-science Bircher / Ayn Randian nutters. […]

  74. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  75. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  76. #81 sadmar
    December 1, 2016

    “wider coverage of this post has brought some new readers with some…odd…views.”

    And very bad manners in not deleting carriage returns from cut-and-paste copy…

  77. #82 Narad
    December 1, 2016

    Sheesh, you meet with a new social worker and 60 comments happen in the meantime.

  78. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  79. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  80. […] is also a member of an anti-science fringe group, the AAPS, which declares in its statement of principles that it is “evil” and “immoral” […]

  81. #86 Narad
    December 1, 2016

    (Please ignore the previous comment; I do need to be worked like a rented mule, but I got confused as to which was the newest thread.)

    Indeed, a school friend’s little brother is a petty dealer. You don’t exactly make a fortune selling dime bags, which is sort of why I was wondering.

    Bags of dime bags, on the other hand, have been a business model at least since the El Rukns owned a local gas station. Still a young person’s gig, but there’s room for advancement.

    and Medicaid has always been a lot easier to obtain for women.

    Even for single, childless women?

    Oh, you’re going to bring up technicalities? I did actually check Florida’s site earlier today; this is a state that hasn’t expanded Medicaid. It appears that being a caretaker for a related child is a gateway to entry. Clearly, it’s illegal to discriminate based on sex, but that might salvage an effective theory from my original remark. I don’t know what the pre-ACA rules were like in, e.g., Illinois.

  82. #87 Gilbert
    December 1, 2016

    @Joe Burns #74,

    If one were going to shake a baby, would it be better to do it up and down in the vertical or side-to-side/front-to-back in the horizontal?

  83. #88 herr doktor bimler
    December 1, 2016

    The effect of the “radiation” on higher cognitive functions is dramatic; experts are eschewed for ideas championed by those fringe-thinkers

    Earth is passing through the Bozone Layer.

  84. #89 herr doktor bimler
    December 1, 2016

    And very bad manners in not deleting carriage returns from cut-and-paste copy…

    Someone believes in the occult properties of Eandom Capitalisation. A Magus of Majuscules.

  85. #90 Joe Burns
    Ireland
    December 1, 2016

    @Gilbert 87, are you seriously asking me how you should abuse a baby?

  86. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  87. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  88. #93 mts
    hollywood, ca
    December 1, 2016

    I just wanted to say that this is the first time in years that I have read through the comments section of any article without a single troll. What a relief. I plan on spending much more time here at scienceblogs

  89. #94 JustaTech
    December 1, 2016

    Joe Burns @90: Well, your original comment does seem to suggest that shaking babies won’t hurt them, therefore it should matter.
    Also, your original comment was almost impossible to read 1) because it referenced a whole bunch of people and events that are not part of the original post here and 2) the formatting makes it almost impossible for the eye to track comfortably.

  90. #95 Narad
    December 1, 2016

    @Gilbert 87, are you seriously asking me how you should abuse a baby?

    I’m seriously tempted to turn off the killfile for a bit.

  91. #96 Gilbert
    December 1, 2016

    NO JOE!!! It’s just, hypothetically, how would one do it if it were a Rosemary’s baby?

  92. #97 Chris
    December 1, 2016

    Yes, Joe Burns, he was. That is how Gilbert rolls, to be as obnoxious as possible. Though your cut and paste probably deserved it. Next time spam with something that is more on topic. Also, here is a hint to get rid of the carriage returns: put your cut and paste in a plain text file, and just delete them.

  93. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  94. #99 herr doktor bimler
    December 1, 2016

    Yes, Joe Burns, he was. That is how Gilbert rolls, to be as obnoxious as possible. Though your cut and paste probably deserved it.

    Well it is possible that the real Joe Burns (Ireland), incoherent baby-killer apologist, wrote a comment for Sue Luttner’s blog and then thought “You know, that expresses My Point so well with all the Random Capitals, I will copy-paste it to an unrelated thread at Respectful Insolence.” And that the “Joe Burns” @74 is the real thing.

    Or alternatively, the usual lazy-arsed troll decided to pose as Joe Burns and steal his comment for sh1ts-n-giggles.

    Either way, he deserves as much obnoxiousness as Gilbert can provide.

  95. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  96. #101 John Mashey
    United States
    December 2, 2016

    From nearly a year ago, we find What Kind of Man Spends Millions to Elect Ted Cruz?, described Robert Mercer (of Breitbart fame), who then switched to Trump and has become rather infliuential.

    He actually attended Jane Orient’s DDP meeting(s), provided funding, as well as to Art Robinson’s OISM and for Art’s candidacies, so far unsuccessful.

  97. #102 sadmar
    December 2, 2016

    ^^ Wow.
    Mercer. Orient. TrumpMercer-Puppet. Price. FDA shackled. Medicare privatization. Pharma stocks.

    That we’re all diddling about vaccines in the face of this…

    As s. g. collins has observed, that’s the problem with irrational conspiracy theories: they blind us to the real conspiracies being perpertrated on us. Which I’ll elaborate as they they consume all the oxygen in the room, leaving a foggy gas obscuring the really serious goings on and no space for considering them.

    Paraphrasing collins, if I was pharmaceutical capital, I would much rather have people questioning ‘the CDC whistleblower’ and a guest lecture at NYU than questioning The 21st Century Cures Act, the effects of healthcare privatization and deregulation, and the windfall profits about to be reaped by the same power-brokers spreading neo-fascism, and my cozy COI relationships with the neo-fascists controlling the federal government.

  98. #103 Orac
    December 2, 2016

    Of course, I’ve also been questioning the effects of the 21st Century Cures Act, etc. Walk and chew gum. I have, however, unfortunately been forced to conclude that the 21st Century Cures Act is now unstoppable and will be become law. At least, that’s my reading of the tea leafs.

  99. #104 Great. – guchijavahaus
    December 2, 2016

    […] hates healthy populations and belongs to the Association of American Physicians and Surgeons (AAPS), a right wing group of physicians who disavow evidence-based medicine and believe that doctors are […]

  100. […] Blogs managing editor David Gorski, himself a surgeon, summed up what he knows about the AAPS in a helpful blog post. The short version is that the organization stands at direct odds, in myriad ways, with some of […]

  101. #106 sadmar
    December 2, 2016

    @ Orac #103

    You don’t walk and chew bubblegum; you kick ass and chew bubblegum.*

    collins was discussing people channeling suspicion of government into moon-hoax CTs instead of the “real conspiracies” of “The Patriot Act, the Iraq war, the financial industry bailouts, and the right to indefinite military detention without charge.” Thus my analogy is people channeling suspicion of the pharmas into ‘holocaust scenario’ CTs instead of the real conspiracies to boost prices, slash regulation, privatize healthcare etc. by placing policy in the hands of copperative pols with large holdings of the pharma stocks that will rise accordingly, or indebted to pharma funding for their campaigns. Which I offered for ‘fun’ since I don’t actually think pharma suspicions are at the root of AV itself, just the CTs built out from fear and loathing at having given birth to ‘freaks,’ who then become inescapable millstones around the necks of upper-middle-class-striver life ambitions.

    Regardless, the AVs have spit out all their bubblegum, and stepped in it so thoroughly their shows are stuck to the floor So they can’t chew OR walk. gotten their shoes

    To the extent that focusing critique on the CTs also pushes the real dirt to the backseat, I’d just say that sometimes the proper respective targets for gum-chewing and ass-kicking get switched around.
    _______
    * The reference, for those unfamiliar, is to John Carpenter’s CT satire filmThey Live, subject of a celebrated video analysis by Slavoj Žižek:

  102. […] But he also belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons (AAPS). Among other things, this group decries evidence-based medicine, Medicare, and Medicaid, […]

  103. […] But he also belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons (AAPS). Among other things, this group decries evidence-based medicine, Medicare, and Medicaid, […]

  104. […] But he also belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons (AAPS). Among other things, this group decries evidence-based medicine, Medicare, and Medicaid, […]

  105. […] New secretary of Health and Human Services is a member of a fringe medical organization. Here’s what that means. (scienceblogs) […]

  106. […] But he also belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons (AAPS). Among other things, this group decries evidence-based medicine, Medicare, and Medicaid, […]

  107. […] But he also belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons (AAPS). Among other things, this group decries evidence-based medicine, Medicare, and Medicaid, […]

  108. […] The new Secretary of HHS is a member of a fringe medical org. Here’s what that means. […]

  109. […] But he also belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons (AAPS). Among other things, this group decries evidence-based medicine, Medicare, and Medicaid, […]

  110. […] But he also belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons (AAPS). Among other things, this group decries evidence-based medicine, Medicare, and Medicaid, […]

  111. […] a position against requiring them — a position that many mainstream medical organizations find alarming. “Our children face the possibility of death or serious long-term adverse effects from mandated […]

  112. […] a position against requiring them — a position that many mainstream medical organizations find alarming. “Our children face the possibility of death or serious long-term adverse effects from mandated […]

  113. […] in opposition to requiring them — a place that many mainstream medical organizations discover alarming. “Our kids face the potential for loss of life or critical long-term adversarial results from […]

  114. […] But he also belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons (AAPS). Among other things, this group decries evidence-based medicine, Medicare, and Medicaid, […]

  115. […] But he also belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons (AAPS). Among other things, this group decries evidence-based medicine, Medicare, and Medicaid, […]

  116. […] a position against requiring them — a position that many mainstream medical organizations find alarming. “Our children face the possibility of death or serious long-term adverse effects from mandated […]

  117. […] a position against requiring them — a position that many mainstream medical organizations find alarming. “Our children face the possibility of death or serious long-term adverse effects from mandated […]

  118. […] said Dr. David Gorski, a surgeon and the managing editor of the blog Science-Based Medicine, who wrote a blog post about his concerns last week. “[The AAPS has] an almost Ayn Randian view of medicine where […]

  119. #124 RJ
    December 9, 2016

    Finally, someone who can stop this vaccine madness. Conventional medicine is in denial, but the autism problem is not going away. 2,000,000 kids and counting? Vaccines cause autism. The studies are obviously wrong. They are just today’s “tobacco science”.

    YouTube has a channel of parents describing exactly how their child was vaccine injured immediately after receiving shots. Talk to ER room nurses. Try to convince the parents that vaccines didn’t cause their infant’s autism – good luck.

    I’d like to see one of these pro doctors take 100 vaccine shots at once if they’re so safe.

    Vaccines cause autism, SIDS, and peanut allergies and set the child up to be sick the rest of their life.

    The CDC is morally bankrupt, hope he overhauls it. You can dismantle it for my money. The story will come out.

    New book out on fraud at the CDC https://www.amazon.com/Master-Manipulator-Explosive-Embezzlement-Government/dp/151070843X

    Julie Gerberding should be tried in the Hague for what she’s done to children.

  120. #125 rs
    December 9, 2016

    “The studies are obviously wrong.”

    Yet no sensible person sees it. If it’s so obvious show it. Citations to garbage only demonstrate your credulity.

  121. #126 Woo Fighter
    December 9, 2016

    Master Manipulator: The Explosive True Story of Fraud, Embezzlement, and Government Betrayal at the CDC
    by James Ottar Grundvig (Author),
    Robert F. Kennedy Jr. (Introduction), Sharyl Attkisson (Foreword)

    Say no more.

    What, they couldn’t get Wakefield himself to toss out a few words too and complete the unholy trinity?

  122. #127 Woo Fighter
    December 9, 2016

    I think I left the bold HTML tag open…sorry Mr. Internet…

  123. #128 shay simmons
    December 9, 2016

    The studies are obviously wrong.

    All 24k of them?

  124. #129 JustaTech
    December 9, 2016

    RJ @124: “There’s a YouTube channel” is probably the worst piece of supporting evidence I’ve seen in a long time.
    There are YouTube channels that have videos of aliens, and Bigfoot and Elvis. You know just the other day I saw a YouTube channel filled with videos about this poor man trapped on a space station with some robots, forced to watch terrible movies. That poor man!

  125. #130 sullenbode
    December 9, 2016

    just the other day I saw a YouTube channel filled with videos about this poor man trapped on a space station with some robots, forced to watch terrible movies. That poor man!

    Mystery science theatre bla bla bla — You are doing it wrong:

  126. […] supposed to head. For instance, to head the Department of Health and Human Services, he picked an orthopedic surgeon who belongs to an organization utterly opposed to any role of the federal government in health care and who himself looks poised to dismantle as […]

  127. […] belongs to a professional organization that pushes discredited anti-vaccine theories and suggests it is “evil and immoral” for doctors to participate in Medicare and […]

  128. […] Member of the right-wing Association of American Physicians and Surgeons, an anti-Medicare & Medicaid, anti-choice, anti-organ donation political group that claimed that President Obama won the election by hypnotizing voters […]

  129. […] many times more people than my usual daily brain droppings usually do was that Tom Price belongs to one of the wingnuttiest of wingnut medical groups I’ve ever encountered, the Association of American Physicians and Surgeons (AAPS). […]

  130. […] change the fact that Trump appointed a man to run the Department of Health and Human Services who belongs to the premiere crank medical “society” in the US, the Association of American Physicians and Scientists (AAPS), which is still cranking out […]

  131. […] DOAJ’s recent reset. The journal has no stated editor, publishes only in PDFs, and has articles arguing against evidence-based medicine and vaccination. Yet, its existence provides a hint about some of the options the incoming administration may have […]

  132. […] DOAJ’s recent reset. The journal has no stated editor, publishes only in PDFs, and has articles arguing against evidence-based medicine and vaccination. Yet, it provides a hint about the options the incoming administration may have if it decides to […]

  133. […] Price may not espouse this group’s every quack theory. But as oncologist and science blogger David Gorski pointed out, it’s hard to imagine how an orthopedic surgeon who believes in science could buy […]

  134. […] Price may not espouse this group’s every quack theory. But as oncologist and science blogger David Gorski pointed out, it’s hard to imagine how an orthopedic surgeon who believes in science could buy […]

  135. […] meeting with antivaccinationists like Andrew Wakefield and Robert F. Kennedy, Jr., appointing a member of a crank medical organization as Secretary of Health and Human Services, and considering for the position of FDA commissioner […]

  136. […] dogma is “pseudoscience,” wrote oncologist and blogger David Gorski at Science Blogs in November. The AAPS is hostile to […]

  137. #142 jack
    United States
    February 15, 2017

    Amazing all of the attack comments on this site, presumably from non-members. What happened to the tolerance of diverse opinions? What happened to the freedom of association? Most of you commenters sound like Torquemada supporters rooting out and punishing those who think differently than progressive group think dogma. I can just imagine all the vitriol this comment will engender.

  138. […] AAPS organization stands at direct odds, in myriad ways, with some of very foundational beliefs of evidence-based modern public-health […]

  139. […] in the Association of American Physicians and Surgeons (AAPS), an organization that is basically an Ayn Rand-worshiping John Birch Society disguised as a medical professional society that routinely publishes antivaccine misinformation in its journal, as well HIV/AIDS denialism and […]

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