Yesterday, I discussed a topic that has vexed me ever since long before I started this blog, namely the topic of how physicians are seduced by pseudoscience and ultimately embrace it whole-heartedly. The kinds of pseudoscience I’ve seen physicians embracing are many, including climate science denialism and creationism, but the ones that most interest me are ones that physicians should know better than to embrace. I’m referring, of course, to pseudoscience related to the medical profession, such as various forms of medical quackery (which, alas, have found all too cozy a home in medicine to the point of even becoming part of a specialty called integrative medicine) and antivaccine beliefs. Yesterday’s post addressed the question of antivaccine beliefs, but much of my discussion could have applied to many forms of pseudoscience that doctors all too frequently embrace.

The discussion after yesterday’s post was more voluminous and involved than I had expected. I love it when that happens, and, especially when such discussions are not invaded by our resident troll sockpuppet Travis Schwochert impersonating old commenters. It got to the point where I realized that I had left out one very powerful motivating factor for physicians. Well, there are actually two that I didn’t discuss that much. Money is one, but that one tends to apply only to physicians who have discovered that quackery can be lucrative. The second one is related, but not the same, as one that I discussed yesterday. Both flow from ego gratification.

You’ll remember that yesterday I discussed the case of Dr. Douglas Mackenzie, a plastic surgeon who has become very antivacccine, so much so that he’s now doing promotional work for the antivaccine propaganda movie VAXXED. I have no evidence that he makes any money off of antivaccine views, and from his interview I concluded that much of his motivation for “going antivax” flows from his self-image as a “maverick,” as someone who can “think for himself” and “do his own research,” and the sense of superiority that comes from viewing himself that way. In Dr. Mackenzie’s world, he is a free thinker, someone who doesn’t follow the rest of his sheeple colleagues, whom he contemptuously describes as having been “brainwashed” about vaccines. He brags about having read not just books by antivaccine “thought leaders” (if you can call it thinking) Andrew Wakefield or Suzanne Humphries but also having the “other side” in the form of books by Paul Offit. Of course, the very fact that he thought that Wakefield and Humphries trump Offit tells you all you need to know about his critical thinking skills (i.e., that they are very weak indeed), but there’s another reason he was drawn to people like Wakefield and Humphries. They speak his language. They view themselves as being apart from the “herd,” and therefore better than the herd, as well. Mackenzie saw that and it resonated with him. Against that shared arrogance, Dr. Offit’s low-key defense of the scientific consensus never had a chance right from the very beginning. It doesn’t matter whether Dr. Mackenzie makes any money off of antivaccine views,

But there’s another reward of bucking the scientific consensus besides feeding one’s egotistical view of oneself as being a better, freer thinker than one’s colleagues and the rest of the scientific community, and that’s adulation. Before I return to antivaccine physicians, let’s take a look at a cancer quack, Dr. Stanislaw Burzynski. He’s a trifecta of reasons for embracing pseudoscience in not only does he make a lot of money selling his antineoplastons, but he also clearly shares Dr. Mackenzie’s self-image of being better, more innovative, and more of a free thinker than the rest of the medical profession. It’s a character trait that he’s clearly had since he was very young. Then there’s the adulation. Burzynski’s patients (at least the few who survive) adore him. They believe that he’s curing cancer that can’t be cured, and their worship of him is such that they immediately react to any perceived threat to him. They did it in the 1990s when the FDA was prosecuting Burzynski, and they recently did it again when the Texas Medical Board brought action against him to strip him of his medical license. In the process, Burzynski has rubbed elbows with admiring celebrities and politicians. One fan, Eric Merola, became so enamored of Burzynski that he made not just one but two propaganda films about him. Clearly, Burzynski loves the attention and thrives on it, viewing criticism and legal actions taken against him as “persecution” that geniuses suffer as a result of their genius.

Then there’s Andrew Wakefield. In the small, loony world of the antivaccine movement, he is the equivalent of a rock star. (Better to rule in hell than to serve in heaven, I guess.) Parents (particularly mothers) who believe that vaccines caused their child’s autism basically worship the ground he walks on. Whenever he attends a rally, an antivaccine meeting disguised as a medical meeting, or any antivaccine event, he is surrounded by sycophants, toadies, and lackeys, as well as adoring fans. Like Burzynski, Wakefield views himself as superior to the rest of the medical profession, as someone who doesn’t “follow the herd” and listens to parental concerns that the medical profession is ignoring. Never mind that the medical profession isn’t ignoring the concerns of parents who believe in the antivaccine pseudoscience that concludes that vaccines cause autism; it’s just that the message it is telling parents is not one they want to hear. Responsible physicians have to base their treatment and utterances in science, and science has come to a conclusion that these parents reject utterly. Wakefield, in contrast, panders to these parents’ views, and, because they view him as having suffered for his “apostasy” with respect to vaccines, they admire him. To show you how much antivaxers love Andy, I like to cite this article from over five years ago:

“To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one,” says J. B. Handley, co-founder of Generation Rescue, a group that disputes vaccine safety. “He’s a symbol of how all of us feel.”

Since losing his medical license, Wakefield has depended on his followers for financing and for the emotional scaffolding that allows him to believe himself a truth-teller when the majority of his peers consider him a menace to medicine. The fact that his fans have stood by him through his denunciation may seem surprising, but they may find it easier to ignore his critics than to reject their faith in him. After all, his is a rare voice of certainty in the face of a disease that is, at its core, mysterious.

Note that Handley was being utterly unironic when he said that, nor was he exaggerating. Many antivaxers view Andrew Wakefield just that highly, and over the last 19 years since he first burst onto the international scene with his case series linking autism with the MMR vaccine (which is now known to be fraudulent) Wakefield’s ego has grown in proportion to that worship.

Looking at cases like Wakefield and Burzynski (and several others not listed here), it can’t be overemphasized how much of a factor ego is in motivating physicians to become antivaccine (or quacks). Physicians in particular are prone to the Dunning-Kruger effect, in which they have far more confidence in their knowledge and mastery of a topic than is justified, and many physicians like to view themselves as superintelligent and able to master virtually any topic on their own if they just put their mind to it; e.g., Dr. Mackenzie. Alternatively, they discover something and can’t let it go when it becomes clear that it isn’t the breakthrough that they thought it was. Either way, embracing pseudoscience feeds not only the physician’s self-image as being open-minded and “apart from the herd,” but it can also bolster the physician’s self-image as a “healer” who takes his patient’s concerns more seriously than other doctors or who can do things for their patients that other doctors can’t. Add to that the fact that, in some cases, there’s a lot of money to be made, and it’s not surprising that physicians, particularly those with personality traits possessed by Wakefield and Burzynski (and many others) are attracted to quackery like moths to the flame.

Comments

  1. #1 Anonymous Pseudonym
    In Your Head
    April 21, 2017

    Arguably, due to a physicians extensive schooling and training, they are more susceptible to the Dunning-Kruger effect then most. Personally I’ve run into a significant percentage of people in my line of work with near the same experience, education, and training that think they know more then they do. I was likely guilty of the same hubris, but I have come to the belief that my knowledge is also only covering about 50% of the topic as is currently understood. I am out of date. How many physicians are willing to admit to others, much less themselves, that they are unable to keep up with the current body of knowledge, even in their own general specialty. Orac is a Breast Cancer surgeon and researcher. I’d be willing to bet that he would acknowledge gaps in his knowledge of his specialty. Wakefield, Carson, Burzynski, et al are unwilling to admit to not having all the answers, or that they are basing their conclusions off of faulty premises. Ego is a wonderful motivator.

  2. #2 Dorit Reiss
    April 21, 2017

    This level of arrogance also seems to correlate with stepping outside your area of expertise. I don’t know if it just takes this kind of arrogance to be willing to confidently reject expert consensus outside their area of expertise or if it’s easier to be arrogant when you do not know enough to understand the nuances. But note the lack of doctors of infectious diseases, virologists, etc’ among these doctors – with Dr. Obukhanych, Ph.D., the only immunologist, and she was young in her career, with little established credentials, and no clinical experience when she decided to reject her training and embrace pseudo-science.

  3. #3 MikeMa
    April 21, 2017

    Getting away with fraud for 12 years and hoodwinking the Lancet might count for something with Wakefield’s ego.

  4. #4 Michael J. Dochniak
    Minnesota
    April 21, 2017

    Does Orac’s use of pseudo-scientific language (i.e., ego) bring understanding?

    I submit that pseudoscience, in many forms, is an important aspect of our history and culture.

    As Orac has demonstrated, the language of pseudoscience can be a persuasive communication tool.

    In the complicated world of medicine, it may be healthy to practice science and pseudoscience in an effort to “DO NO HARM”.

  5. #5 Jazzlet
    April 21, 2017

    As a someone who studied biology I think it’s a shame these medics who want to be apart from the herd don’t suffer the natural consequences of that, namely getting taken down by predators.

  6. #6 Eric Lund
    April 21, 2017

    This level of arrogance also seems to correlate with stepping outside your area of expertise. I don’t know if it just takes this kind of arrogance to be willing to confidently reject expert consensus outside their area of expertise or if it’s easier to be arrogant when you do not know enough to understand the nuances.

    As a Ph.D. physicist, I resemble that remark. Like most physicists, I tend to approach problems using the simplest model that works, and only add complexity when it is shown to be necessary. There is a reason we tell jokes about spherical cows: that’s only a slight exaggeration of how many physicists operate.

    However, a good physicist has to understand the limitations of that approach, especially when venturing into a different field. I find it helpful for gaining a layman’s understanding of many topics, but I am also aware that there are lots of nuances I am not aware of until I get something wrong by ignoring them. I will admit that there are too many physicists who don’t get this.

    At least physicists are taught the notion that they might be wrong because of some nuance they have overlooked. Many doctors never get that training in the first place, and they graduate into a culture where doctors are considered authority figures (much more so than Ph.D. holders),

    Engineers, too, have a strong susceptibility to the Dunning-Kruger effect, and for similar reasons as physicians.

  7. #7 Elliott
    April 21, 2017

    Ego gratification was basically what I was trying to get across with my comment yesterday. Having a great deal of confidence is necessary if you want to make a discovery, but it leads you astray when you go outside your expertise. (See Nobel disease).

    I’ve seen experience go both ways in science. Sometimes having lots of it can lead to overconfidence but it can also give you an appreciation for what you don’t know. I think it depends upon your ego.

  8. #8 Narad
    April 21, 2017

    with Dr. Obukhanych, Ph.D., the only immunologist, and she was young in her career, with little established credentials, and no clinical experience

    I’m not sure how Tetyana could ever have gained “clinical experience” – she’s not an M.D. who specialized in immunology, just some random Ph.D.

  9. #9 Johnny
    127.0.0.1
    April 21, 2017

    One good example of the Dunning-Kruger effect is Marilyn vos Savant, the holder of highest recorded IQ according to the Guinness Book of Records.

    She took a job writing a question and answer column, and while she had some great hits, she had some serious misses. Back in the day, a bunch of the worst were gathered up here –
    http://www.wiskit.com/marilyn/

    I would hate read her column* up until sometime around 2010, and noted that she had pretty much given up on factual Q&A and moved on to brain teasers and opinion questions. Dunno what she’s done in the last few years – I don’t get her column and frankly don’t miss it.

    vos Savant isn’t a specialist in any particular field, so, in this case, anyway, being an expert isn’t necessary to suffer from DK. It can strike generalists as well.

    *I’d made a few minor contributions to documenting her wrongness in a couple forums, and was looking for more.

  10. #10 Narad
    April 21, 2017

    I don’t get her column and frankly don’t miss it.

    Her site seems to be moribund (at least, nobody has bothered to change the copyright footer since 2014). but this wishy-washy defense of “GMO labeling” failed to impress me. I’ve heard the name, but it must have been quite some time ago.

  11. #11 Denice Walter
    April 21, 2017

    re DK and vicinity

    I’ve heard that a new book, Illusion of Knowledge ( or suchlike) discusses how those who know little believe in themselves ( concerns access to computers and lack of reflection as being indicative).
    I haven’t seen it but saw an interview with the authors.

  12. #12 Narad
    April 21, 2017

    Illusion of Knowledge ( or suchlike)

    Is it The Knowledge Illusion? The subtitle raises a red flag for me, although it certainly can be hell to be psychologically alone.

  13. #13 viggen
    Boulder
    April 21, 2017

    At least physicists are taught the notion that they might be wrong because of some nuance they have overlooked.

    Only a tiny decision to decide when that doesn’t apply; that’s why there are so many good physicists who are also biology cranks.

  14. #14 Richard
    The Netherlands
    April 21, 2017

    I think that strong human emotions play an even bigger role in antivaccine and woo circles than already sketched here. The problems with emotions as a driving force is that they’re powerful, appeal to almost anyone (contrary to scientific arguments), and are largely immune (pun intended) to rationality and common sense. These doctors-gone-antivaccine may be so completely addicted to the warm bath of adulation of their fans and their own feeling of rogue power that they are no longer capable of objective thought and proper functioning, at least with respect to the subject at hand; in a way, they have a similar problem as doctors who become addicted to prescription medicines: they think they know what they’re doing, but in reality they’re way down the wrong path.
    Then again, the antivaccine movement has little else but emotion to support its message; they sure as hell don’t have facts or science on their side. Unfortunately, an appeal to emotion is as already said a powerful means of convincing and manipulating people. When parents of an autistic child believe that vaccinesdidit, and you say that you disagree with them, an often heard accusation is that you’re a heartless person, without any empathy for those poor suffering people… Which of course is untrue, but somehow it is still difficult to get rid of this emotional smear, and convince people that you absolutely care about their plight, but just disagree about the cause.
    And I’m afraid that rational education isn’t enough to solve this very human problem.

  15. #15 Eddie Mercury
    April 21, 2017

    Then there’s Andrew Wakefield. In the small, loony world of the antivaccine movement, he is the equivalent of a rock star. (Better to rule in hell than to serve in heaven, I guess.) Parents (particularly mothers) who believe that vaccines caused their child’s autism basically worship the ground he walks on. Whenever he attends a rally, an antivaccine meeting disguised as a medical meeting, or any antivaccine event, he is surrounded by sycophants, toadies, and lackeys, as well as adoring fans.

    Yes. Andrew Wakefield is the Jimmy Page of the antivaccine movement. Very much so. Every rally that I’ve gone two I’ve seen at least three pairs of knickers thrown in his general direction.

  16. #16 yvette
    April 21, 2017

    This is basically a repeat from my comment yesterday, but anti-vaccine doctors, at least those who see patients at all, cater to a high-selected form of patients. None that I know of work in an ER or ICU where they ever might encounter a child with a vaccine-preventable illness. As such, they rarely have any corrective for their quackery.

    If ORAC decided to “think for himself” with breast surgery, unless he was very good or very lucky, reality would soon correct him. In contrast, anti-vaccine doctors spend most of their time on stage and making movies patting themselves on the back for being “awake.” The consequences of their woo are dealt with by anonymous docs who “follow the herd.”

  17. #17 Lawrence
    April 21, 2017

    @Yvette

    Unfortunately, there are bad apples in every profession. Some are much better at routing out the charlatans than others.

    I find the medical profession, especially in some of the more “high-priced” areas, like plastic surgery, not the best when it comes to policing their own…..

  18. #18 sadmar
    April 21, 2017

    Human behavior and ‘mindsets’ are complex as hell, and simple models – including ‘modified Dunning-Kruger’* or even “ego gratification” – don’t get you very far. They just refine the question a bit. E.g., why would physicians find themselves in a state where the drive for ego gratification leads to promoting rank anti-vax pseudoscience or cancer quackery? There are a number of ways to be ‘brave maverick doctor’. Why these? OK, there are fewer ways to gain ‘rock star’ status. Why then, do these folks have a need so strong they’ll descend into that particular hell, not just to go beyond being a valued skilled session musician in heaven, or even a mere ‘rock star’, but all the way to Elvis – not just a superstar, but a King.

    Note that divergence from something Orac takes as a base assumption is implicit in my questions. I don’t think “physicians are seduced by pseudoscience” at all. First, it’s not ‘seduction’, coming from the outside in. It’s pursuit of some perverted version of basic, ‘normal’ human need, proceeding from what is likely some form of ‘lack’ linked to something listed in the DSM. Second, the pseudo-science is just coming along for the ride. In and of itself, the particulars of it’s wrongnesses have no seductive appeal, except perhaps as markers of the power displayed in getting around them.

    I think the appeal, such as it is, is more generic: If you have a background education in something like medical science that claims a sort of universal, depersonalized, ‘objective’, hard-fact special knowledge, then that’s what you have to challenge and overthrow to exult and distinguish yourself in terms of your own ‘will’ – or perhaps compensation for your sub-conscious desperate weaknesses. If that’s the case, we would expect physicians to be more susceptible to the depths of this particular woo, and rather than the sort of DK that may infect engineers or physicists stepping away from their fields – the proximity of the woo to the woo-ists field of expertise would be key to the display of authority, of both exceptional knowledge/ability and indomitable will.

  19. #19 JustaTech
    April 21, 2017

    Eric Lund, I could tell you some stories about spherical cows on frictionless planes, or more pointedly, someone who said it was perfectly reasonable to model red blood cells as spheres (in a moving fluid!).
    But at least the models physicists use make more sense than the engineering lab that was described as “model a bridge as a spring and go hit it with a hammer”.

  20. #20 JustaTech
    April 21, 2017

    Johnny @9 Marilyn vos Savant’s column still runs in Parade magazine, that thing that comes free with the Sunday paper, bundled in with the ads and coupons.
    Talk about lowest common denominator.
    I used to like her column, but I can’t decide if I got smarter (and older) or if it got dumber.

  21. #21 sadmar
    April 21, 2017

    @ Yvette:

    In writing my comment above, I was actually thinking of an MD who had gone to a very good med school, and practiced as an ER doc at a big urban hosp[ital before turning to homeopathy full-time, and ultimately attemping (rather comically) to market an iPhone app that would cure Ebola with sound waves. The sort of “correctives” you describe – the human tragedies that routinely show up in ERs and ICUs may cut too close the bone for some docs (not necessarily as direct experience, but perhaps as ‘resonance’), and be exactly the truthg they’re running away from. That probably wouldn’t apply to someone like Bob Sears, who’s basically just following the vocation of his whole family – I doubt there’s one pathology that covers the terrain. But I’m betting what we’re looking at in general is closer to some form of ‘mental health issue’ than ‘stupidity’, ‘ignorance’ or the other usual skeptic epithets. Which is not to say I’m suggesting die-hard woo-ists meet the threshold criteria for some sort of personality disorder. My guess is just that if we reconceived these as spectrum conditions, we’d find woo-ists average out distinctly some degree in such directions over the general population.

  22. #22 sadmar
    April 21, 2017

    @ JustaTech

    You got smarter. Her column was always dumb.

  23. #23 Chris Hickie
    April 21, 2017

    My 0.02 FWIW…My sense for science was learned the hard way in undergrad (an oral exam in front of 3 professors was required for graduation in physics, all was fair game) and grad school (not passing my candidacy exam the first time) how hard actual research can be, especially when critically reviewed by one’s superiors. This was before I became a physician. Even if you’re an “expert” in an area, it’s darned hard to be “the expert”. But for many of these AV physicians, they think all they have to do to be “the expert” is read some articles and then put out a non-peer reviewed book or web site. I’m pretty sure most 5th grade science fair projects would stump Bob Sears or Jay Gordon with their complexity.

  24. #24 jrkrideau
    At the bottom of the lake (the bottom end that is)
    April 22, 2017

    # 12 Narad

    it certainly can be hell to be psychologically alone

    Just from the various blurbs about the book, I think you are misinterpreting that title. It is The Knowledge Illusion: Why We Never Think Alone. It seems to be about the “group” nature of cognition and knowledge. It does not seem to have anything to do with “loneliness” or “social isolation”, etc. The book looks like it is relevant to a discussion of the Dunning-Kruger effect.

    From the blurbs and a quick look at the authors’ C.V.s they may know what they are talking about. They really are cognitive scientists! Not a plastic surgeon talking about vaccines or a cardiologist writing about gluten-free diets.

  25. #25 Julian Frost
    Gauteng East Rand
    April 22, 2017

    @Yvette #16:

    The consequences of their woo are dealt with by anonymous docs who “follow the herd.”

    Or by the children of the antivaxxers.
    Yesterday I read that a teenager in Portugal died from measles. Her mother (the father wasn’t mentioned) was an antivaxxer.

  26. #26 Dangerous Bacon
    April 22, 2017

    One other motivation that drives some predominantly antivax physicians is the desire to be seen as a virtuous compromiser.

    Thus we have pediatricians like Bob Sears, Paul Young and Jay Gordon who stroke their egos by telling us they are not like those hardcore antivaxers or “extremist” pro-immunization advocates.

    No, they’re reasonable guys* who are only interested in the welfare of their patients, doncha know, and not beholden to the dogma of the CDC or antivax zealots.

    I’m reminded of a classic political cartoon from 1864, when the compromiser/appeaser George McClellan ran for President of the U.S., portraying both Lincoln and Jeff Davis as extremists who wanted to tear the country apart, while McClellan was the virtuous man trying to hold the nation together. Not many bought this self-serving claptrap.

    https://hsp.org/sites/default/files/2189-3133_b5f20_1.jpg

    Nor should anyone believe the physicians who claim to have studied both sides, and exclaim how they are pro-vaccine (within limits, of course) even while giving support to typical antivax nonsense.

    *Speaking of reasonable guys, Jay Gordon recently tweeted that “ALL” children aged 3 and over should get the MMR. Maybe that’s progress from the days when parents had to talk Jay into giving their kids the shot, but it also overlooks that the first MMR shot is recommended for children aged 12-15 months, who are more vulnerable than older kids to serious disease complications (not to mention their younger siblings and immunologically comprised contacts of all ages). And it sends a nice antivax dog whistle to those who believe that giving the MMR at 12-15 months causes autism.

  27. #27 Troels
    April 22, 2017

    #25,
    Euronews’ article says the girl wasn’t vaccinated against measles “due to allergic conditions on the advice of a doctor”.

  28. #28 Dangerous Bacon
    April 22, 2017

    The CDC says “Anyone who has ever had a life-threatening allergic reaction to the antibiotic neomycin, or any other component of MMR vaccine, should not get the vaccine.”

    If the “allergic conditions” referenced by Euronews didn’t fall into that category, it’s hard to see how they justified not getting the shot.

    The Portuguese outbreak has been linked by government officials to children unvaccinated by parental wishes:

    http://outbreaknewstoday.com/measles-cases-rise-portugal-teen-death-reported-96432/

  29. #29 The Very Reverend Battleaxe of Knowledge
    April 22, 2017

    See, you brainwashed pro-vaxers? Troels @ 27 brings the truth! The teenager in Portugal was just one of those unfortunate, inferior offscourings of evolution that were left vulnerable to measles by a decline in herd immunity. That makes it all right! Lighten up!

    (In these Travis-infested days I guess I need </sarcasm> tags.)

  30. #30 Troels
    DKC
    April 22, 2017

    #29,

    Troels @ 27 brings the truth!

    No, in order to bring truth, I would need to know what it is to begin with. All I know is according one news outlet the parents claims to have a valid reason for not vaccinating against measles.

    (In these Travis-infested days I guess I need tags.)

    Not Travis.

  31. #31 Brian Deer
    April 22, 2017

    Not sure that you’re right about Wakefield’s “Dr”, but I’d like to hear the argument.

    As I understand it, in British medicine, “Dr” is a courtesy title for a medical practitioner. It’s not a courtesy title for someone who has graduated medical school.

    As I’m sure most people know, in Britain and various other countries taking it’s lead, medicine is an undergraduate degree, not a doctoral degree. An American MD, on the other hand, will not only be a medical practitioner, but will actually have a doctoral level degree, on top of an undergraduate degree (usually in science).

    So, given that Wakefield isn’t (and never will be again) a medical practitioner, and has no doctorate, on what basis do you say he’s entitled to the courtesy title?

    I’m rather interested in that, not least since I acquired a doctoral degree, albeit honorary (which in any event are generally harder to earn, and are certainly more fun on the day).

  32. #32 Johnny
    127.0.0.1
    April 22, 2017

    All I know is according one news outlet the parents claims to have a valid reason for not vaccinating against measles.

    More telling, the same report says that both their younger and older child are vaccinated. Given that measles is very infectious, and there are no reports that those other kids were infected, it sounds plausible that the teenager may well have had a valid medical reason to not be vaccinated.

  33. #33 brian
    In a country where surgeons are addressed as "Doctor"
    April 22, 2017

    @31 (Brian Deer)

    Doctor Deer,

    Ah, Orac hates this sort of stuff, but here’s what the World’s Greatest On-Line Compendium of All Knowlege says on the subject:

    “In the United Kingdom . . . the title Dr is generally used both for those who hold doctoral degrees and for registered medical practitioners. History has dictated the use of the courtesy title Dr by physicians and general practitioners. However, surgeons do not use the title of Dr but, due to the origins of surgery with the barber surgeons, instead use Mr, Mrs, Ms, Miss, etc. This custom applies to surgeons of any grade who have passed the appropriate exams and is not the exclusive province of consultant-level surgeons. . . . Physicians, on the other hand, when they pass their “MRCP(UK)” examinations, or equivalent, do not drop Dr but retain it, even as consultants. The status and rank of consultant surgeons, addressed as “Mister”, and consultant physicians, addressed as “Doctor”, is equivalent.

    https://en.wikipedia.org/wiki/Doctor_(title)#Usage_by_medical_practitioners_in_the_UK_and_culturally-related_countries

    But of course we’ve been through this before.

    Dr. brian

  34. #34 Panacea
    April 22, 2017

    Sorry Orac. Got to weigh in.

    In the United States the word doctor is synonymous with physician, even though it actually has little to do with medicine (doctor is an academic title, not a professional one).

    When Andrew Wakefield lost his medical license in the UK, he didn’t stop being a physician. He’s still one. He’s just not licensed and can’t actually practice medicine anymore. So for him to refer to himself as Doctor Wakefield simply reflects what he is: a trained physician. In the eyes of the public, that’s enough. To many health care practitioners, that’s enough (whether that’s true for Orac I won’t guess; I’m not a mind reader).

    Whatever the reason, it doesn’t ruffle my feathers to refer to Wakefield as “Doctor.”

    Honorary degrees are a bit different. They were supposed to recognize important contributions from people who didn’t pursue an academic career path, but they’ve gotten to be fluff handed out to famous people to entice them to speak at commencement events.

    But Brian, I’ll happily call you doctor. You do good journalism. I’m a fan of your series on Septra as much as your work on Wakefield.

  35. #35 Narad
    April 22, 2017

    Just from the various blurbs about the book, I think you are misinterpreting that title. It is The Knowledge Illusion: Why We Never Think Alone. It seems to be about the “group” nature of cognition and knowledge. It does not seem to have anything to do with “loneliness” or “social isolation”, etc.

    No, this is what I suspected. The disclaimer wasn’t even needed, but I failed to attend to the subtitle.

  36. #36 Narad
    April 22, 2017

    In the United States the word doctor is synonymous with physician, even though it actually has little to do with medicine (doctor is an academic title, not a professional one).

    Y’all are really making my head hurt.

  37. #37 Eric Lund
    April 23, 2017

    In the United States the word doctor is synonymous with physician, even though it actually has little to do with medicine (doctor is an academic title, not a professional one).

    A few years back there was a New Yorker cartoon with the caption, “Are you a real doctor, or merely a Ph.D.?”

    In practice, dentists and veterinarians are also addressed as “Doctor”. They go through analogous post-graduate training programs (at least in the US), so if an M.D. can be called “Doctor”, I have no problem with these others being called “Doctor”.

    Conversely, I know at least one person who often travels internationally who has a Ph.D. but never admits to the airlines both that and his occupation. He is afraid that some flight attendant will see “Dr. [redacted], research physicist” on a flight manifest and incorrectly assume he’s a physician. Which implies that the issue is hardly limited to the US.

    However, there is an important difference between the M.D. and comparable degrees on the one hand, and Ph.D. and the equivalents on the other. To earn a Ph.D. you must perform a substantial piece of original research. The M.D., et al., have no such requirement. This is why many who want to go into medical research, including Orac, earn both degrees.

  38. #38 Brian Deer
    April 23, 2017

    # 33 (brian)

    That’s what I thought. In this context, “Dr” is a courtesy title for a medical practitioner (your source adds ‘registered’), which, on this authority, means that Wakefield isn’t a doctor. I suppose I could ask the General Medical Council, but I’m not that bothered.

    Wakefield is no longer “Dr Wakefield”

    Thanks

  39. #39 sadmar
    April 23, 2017

    @ Eric

    “To earn a Ph.D. you must perform a substantial piece of original research.” I have long been irritated by the use of “research” as a general descriptor of academic work. IMHO, the term should be “scholarship”. I know they’re used as synonyms now, and people refer to the kind of academic work I did as “research” all the time, but I think that hides an unfortunate bias, in both directions.

    What I did was ‘theory and criticism’. The task wasn’t ‘develop original knowledge’ but ‘develop original thought’. I always felt, first, sheepish toward lab/field/archive researchers that anyone used a term that rightly belongs to them for my ‘think pieces’ about the ideologies in Schwarzenegger action films or 80s music videos. At the same time, though, I felt more purely philosophical inquiries like mine were being inappropriately delegitimated. I mean, how is that ‘think pieces’ become discounted or not-counted for a degree titles “Doctor of Philosophy’. Especially when “substantial original research” can be valued, and rightly so, even if the authors pull no useful philosophy from their findings?

    As to humanities Ph.D.s using the title “Doctor”. My take was the any individual or academic institution that insisted on using the title was strictly second-rate. At ‘good schools’ you just assume all the professors have the highest credentials, and the non-Ph.D.s (MFAs for example) are so well qualified in what they do it would be silly to use some lower-status title. So no one is ever called ‘Dr. Soenseau’ just ‘Prof. Soenseau’, or by their first name. lest they be seen as doth protesting their mere degrees too much.

    The one exception was one of my former flat-mates, who had “Dr.” before her name on her checks because she’d just come out of a personal bankruptcy, and it helped her get the checks accepted at local stores.

  40. #40 Brian Deer
    April 23, 2017

    If you haven’t seen many already, some of the PhDs awarded in relation to the MMR issue in the UK are just scary in their thinness. Most often its doing various calculations on newspaper articles as the contribution to knowledge. Seemed to me that what was being marked was how the thesis was set out and referenced.

  41. #41 Narad
    April 23, 2017

    Although I disagree with Orac’s position, this general exchange has been more than enough to convince me of the wisdom of shіtcanning the entire topic.

  42. #42 Chris Hickie
    April 23, 2017

    Most of my patients couldn’t call me doctor even if they wanted to 😉

  43. #43 dingo199
    April 23, 2017

    In the UK, anyone who has passed the medical degree qualification (MBChB, MBBS, BM or MBBCh) is entitled to call themselves or be called “doctor”.
    Those who pass the degree will be provisionally registered with the GMC, and only achieve full registration when they succesfully complete their pre-registration “internship” which is one year in duration.

    Having registration (or being “licensed”) allows a doctor to practice medicine. Without registration they cannot do this.

    Wakefield is still a “doctor”, but since he was stripped of his registration by the GMC he no longer has a license to practice.

    Doctors who have retired, and have had their registration lapse, are still lallowed to call themselves “doctor”.

    Confusion also arises because “doctor” is not what is legally termed a “protected title” in the UK. Certain professions have what is called a “protected title” (eg “pharmacist”, “chiropractor”) and no-one is allowed to use those terms unless they are qualified in that profession. But not only medical doctors are “doctors” (dentitsts, veterinarians, PhDs) so the term does not have a protected status, which can lead to other quack types usurping the title.

    The term “Doctor of Medicine” does however have protected status, and cannot be used by anyone else. Unfortunately Wakefield is still a “doctor of medicine”.

  44. #44 Dangerous Bacon
    April 24, 2017

    “Come, come, we are not so far wrong, after all,” said Holmes. “And now, Dr James Mortimer —

    “Mister, sir, Mister — a humble M.R.C.S.”

    “And a man of precise mind, evidently.”

    “A dabbler in science, Mr Holmes, a picker up of shells on the shores of the great unknown ocean.”

  45. #45 Denice Walter
    April 24, 2017

    test

  46. #46 Denice Walter
    April 24, 2017

    @ Narad :

    I liked what I saw ( on television- I didn’t read the book) because the researchers addressed how those with little knowledge believed that they knew much more than reality merited. They asked subjects to explain how things worked which was often revelatory of their dearth of knowledge. In addition, they found that access to computers might accelerate the effect and that ( self) reflective inhibited it.

    OBVIOUSLY we at RI are painfully aware of the phenomenon.

  47. #47 Denice Walter
    April 24, 2017

    @ Chris Hickie:

    Take a peek at Kim’s article today @ AoA.

  48. #48 Calli Arcale
    http://fractalwonder.wordpress.com
    April 24, 2017

    My brother, who rarely uses his title (PhD) on letters, did so once in an effort to gain a little more access when asking questions about our grandmother’s health on one occasion. He never actually *said* he was an MD, just called himself “Doctor” and used Cleveland Clinic letterhead and allowed the obvious confusion to happen. 😉 (He’s a physicist. At the time, he was doing research on fMRI.)

  49. #49 MI Dawn
    April 24, 2017

    @Calli Arcale: I went over to the scum hive and now I’m depressed. Paul Thomas, the so-called pediatrician, should have his license yanked since he’s certainly not practicing medicine. He can go ahead and be a quack, just not make all science-based providers look bad.

    My only happiness is knowing that I raised 2 healthy, fully UTD children who will make sure *their* children, if they should have any, will also be fully vaccinated, barring medical reasons not to be so.

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