Vaccine fearmongers versus Steve Novella

I'm envious of Steve Novella. Well, just a little, anyway. The reason is that he's somehow managed to annoy David Kirby and the anti-vaccine contingent enough to provoke what appears to be a coordinated response to his debunking of anti-vaccine propaganda. For that alone he deserves some serious props.

You may have wondered why I haven't written much about Amanda Peet giving an interview in which she pointed out that she had looked into the matter and had found no reason to believe that vaccines caused autism or were unsafe. In the same interview, she referred to parents who don't vaccinate their children as "parasites." True, she did later apologize for using the term "parasites" (although arguably it is not that overblown a term to use), but she stood firm in her support of vaccination and pointing out that decreasing levels of vaccination will inevitably lead to the return of vaccine-preventable diseases. Peet's remarks were intelligent and scientifically accurate, in marked contrast to those of another celebrity mother, Jenny McCarthy, whose output of stupid and scientifically ignorant anti-vaccine propaganda is enough to risk an IQ drop of 10 points in just about anyone subjected to her malignant pseudoscientific nonsense.

Enter (predictably) David Kirby. Not suprisingly, he couldn't resist writing a piece for that highly-trafficked repository of anti-vaccination propaganda since day one, The Huffington Post, entitled Amanda Peet vs. the Medical Establishment, that was so hilariously full of logical fallacies and irrelevant comparisons that were so amazingly off-base that arguably Kirby set a new level of dumb even for him. I had ignored it because, well, these days I have to be in a very special frame of mind to be willing to dissect Kirby's blather in detail. Usually that frame of mind involves alcohol.

Steve Novella noticed, and that's when the fun began. His takedown of Kirby's unctuous, self-righteous claim that Amanda Peet was speaking against the "medical establishment" was a joy to behold, especially how he pointed out that David Kirby had a truly--shall we say?--unorthodox definition of what constitutes the"medical establishment." He also pointed out something that would escape most people with only a passing knowledge of this issue, namely how utterly disingenuous Kirby was when he mentioned that "some members" of the IACC (the Interagency Autism Coordinating Committee) want "specific objectives on vaccine research" regarding a possible link between vaccines and autism. Of course, what Kirby left out of that statement was that Lynn Redwood, president of the Coalition for Safe Minds, and Lee Grossman, president of the Autism Society of America (Kool Aid drinkers both who believe that vaccines cause autism), had, in a foolish and ham-handed attempt on the part of the NIH to be "inclusive" (and possibly to coopt antivaccinationist), been appointed to the IACC, as I wrote about last year. Moreover, what Steve didn't know but I did was that this was not the first time Kirby had been deceptive in using their presence on the IACC to imply that the committee supported the view that there might be a link between vaccines and autism, even asking, "If the debate over vaccines and autism is over, then why did the Feds appoint two people to this important new panel who will relentlessly push for more taxpayer dollars going into research of vaccines and autism?"

Steve also mentioned the Hannah Poling case, which is apparently what got the antivaccine brigade's attention enough to provoke a response.

It began with Dr. Jon Poling, father of Hannah Poling, showed up in the comments of Steve's blog with a long comment complaining about Steve's post, a comment that was reposted at Age of Autism. Then, David Kirby piled on with more of his trademarked brand of ooze.

I smell a coordinated attack.

Indeed, I think I know what's going on here. Antivaccinationists can dismiss me, for example, when I post about mitochondrial disorders because I'm a cancer surgeon and researcher, and autism and vaccines are not my primary area of expertise. They also like to point to my use of a pseudonym to try to tear down my credibility, mainly because in their eyes that frees them from actually addressing my arguments. In particular, certain of them like to act all wounded after I apply my special brand of not-so-Respectful Insolence to them and try to dismiss me because I'm so "mean" and "angry." (What's not to be angry about when pseudoscientists endanger the cornerstone of public health efforts, the vaccination program? Yeah, I get a little peeved when I think about vaccine-preventable diseases coming roaring back because of anti-vaccine activists.) Witness Dr. Jay Gordon showing up in the comments and trying to do just that yet again. Meanwhile other bloggers who have written critically about the abuse of the Poling case by anti-vaccine activists are for the most part not medical professionals, making it even easier for the mercury militia to dismiss them. Recently, the vaccine-autism conspiracy crowd has been frequently and proudly pointing to Dr. Poling, who is a neurologist, as an actual authority giving credence to their beliefs. Personally, I think Dr. Poling should know better and may indeed know better, but he wouldn't be the first physician or scientist whose objectivity has been adversely affected by having a child with severe medical problems. Be that as it may, Dr. Poling rapidly became a new hero to anti-vaccine advocates, because he had not just an M.D., but a Ph.D. too, and he was saying things that gave aid and comfort to them.

Then along comes Steve Novella. Not only is he a neurologist, too, just like Dr. Poling, but he's also an academic neurologist-just like Dr. Poling. Not only that, but he's an academic neurologist at Yale, which is on par with Johns Hopkins, which, if I remember correctly, is where Dr. Poling was once on the faculty. Not only that, Dr. Novella doesn't buy the whole vaccines-cause-autism myth, and he knows how to argue against it, having spent considerable time studying the issue. He even understands quite a bit about mitochondrial disorders and can state clearly the reasons demonstrating that antivaccinationists are misusing the science there and how Dr. Poling is allowing them to do so, for whatever reason. Consequently, Dr. Novella is seen as a much more serious threat than I or many of the other bloggers who have criticized the whole claim that vaccines somehow "trigger" autism in children with mitochondrial disorders. He had to be countered; he couldn't be ignored. A counterattack had to be launched.

And so, apparently, it was.

Sadly, as part of that counterattack Dr. Poling lowered himself to a pretty low level, in essence accusing Steve of "attacking mothers":

Jenny McCarthy is an Autism Mom looking for answers and rattling some cages--good for her. Amanda Peet is a new mom who believes in the importance of vaccines to protect her baby--good for her too. Don't attack the moms, listen to them.

Even worse:

Rule number one of pediatrics though is "LISTEN TO THE MOM." Are 10s of thousands of autism moms over the last decade suffering from mass hysteria induced by Hollywood? Not likely.

Nice straw man. No one said that autism moms are suffering from mass hysteria induced by Hollywood. I challenge Dr. Poling to find anyone who did. I'll wait. Indeed, on a temporal basis alone, Poling's strawman is ridiculous. The thimerosal scare started in the late 1990s; Jenny McCarthy didn't jump on the anti-vaccine bandwagon until last year. As for "listening to the Mom," that's good advice--up to a point. Mothers do indeed have a lot of observations and information that a doctor can't get from any other source. The problem is that the emotional connection between mother and child makes it very difficult for a mother to be objective. Closeness does not necessarily mean accurate reporting. Couple the emotional bond between mother and child with the normal human tendency to see patterns were none exist, and a mother's observations, more specifically her interpretations of those observations, are, at best, no more reliable than anyone else's and often less so. Pointing this out is not "attacking" mothers; it's mentioning an aspect of normal human psychology and behavior that is so basic and overarching that it is one of the reasons that physicians have known since time immemorial that it is generally a bad idea to treat one's own close family, except for only the most minor of problems. It's impossible to be sufficiently objective. It's also the reason why medical science relies so heavily on objective measurements, wherever possible. It's very easy to be deceived by anecdotes and personal observations, particularly if those personal observations are of a loved one.

I also have to wonder if Dr. Poling read the--sorry, I can't resist--tsunami of nasty invective directed at Amanda Peet after her comments about vaccines, complete with insinuations that she is a "shill" for big pharma and threats. I'd like to think he didn't see that. However, more likely he did and saw nothing wrong with it. I hope after he's done insinuating that Steve Novella is somehow "attacking mothers," he turns around and tells his new friends to stop attacking Amanda Peet as well. Be that as it may, It disturbs me that Dr. Poling was almost as crass about using the "mommy gambit" as, for example, Robert F. Kennedy, Jr. was a year ago. In both cases, it was the same message: Being a mother, especially a mother of an autistic child, should somehow inoculate a woman against criticism even when she is spouting pseudoscientific anti-vaccine nonsense that has the potential to endanger public health if enough parents listen. The "mommy gambit" is an argument based on pure emotion, not reason or science. From my perspective, mothers of autistic children deserve admiration and support for doing the difficult task that they do raising their children. However, our support does not and should not extent to remaining silent when they spout dangerous pseudoscience, as I pointed out before when discussing RFK, Jr.:

As much as I might sympathize with how difficult it is for these parents to deal with their autistic children, as much as I might admire their fortitude, such sympathy does not, nor should it, translate into tolerance when they play on that sympathy to advocate pseudoscience.

I've written about the Hannah Poling case and the claim that mitochondrial disorders are a mechanism of vaccine-induced autism before; so I don't need to rehash all of that again--especially since Steve has partially answered Dr. Poling as well and has also written about his daughter's case. However, there are some observations to be made. First, Dr. Poling appears to have revealed more about his daughter's medical condition than he has seemed willing to reveal before. Of course, he's always been careful to reveal just enough to give the anti-vaccine crowd a bit of seeming plausibility when they point to his daughter's case as "evidence" that vaccines somehow cause autism through mitochondrial disorders but seemingly never enough to allow a more rigorous scientific evaluation of whether that possibility is likely to be true or not. At least, he doesn't do so in public, but that begs the question: If Dr. Poling is willing to disucuss some of his daughter's case as "evidence" that vaccines can cause autism in children with mitochondrial disorders, why not discuss more?

I'm also very curious where Dr. Poling gets the "5-20%" figure for the percentage of autistic/ASD children with mitochondrial disorders. Where is the data? What study? From my reading of the literature, that figure seems way high. The highest somewhat plausible estimate I've been able to find in the literature comes from Oliveira et al in Portugal from last year, which found 4.6%. The only source of the 20% figure that I've ever been able to find is from an article by antivaccine apologist David Kirby, who referenced a "study" from the Kennedy-Krieger Institute that at the time I couldn't locate on PubMed. Of course, KKI sees a skewed population because of its expertise in mitochondrial disorders, and likely many children are referred there specifically because there is clinical reason to suspect that they might have mitochondrial disorders. Even if the study does show numbers that high, it's likely to be due mostly to selection bias. I suspect that Dr. Poling knows that. Moreover, there is the question of whether mitochondrial disorders are a cause of autistic symptoms or an epiphenomenon associated with autism; antivaccinationists jump to the conclusion that they are a cause, coupled with vaccines, because to them it is always, first and foremost, all about the vaccines. Finally, Dr. Poling's also apparently lost his ability to recognize good scientific studies, as the study that he references is not particularly impressive. Indeed, I'm half-tempted to look it over in more detail and do a post about it. (Doing so here would render this already long post too long even by Orac standards.)

While it's disappointing and disturbing to see Dr. Poling apparently sinking slowly into the anti-vaccine slime and participating in what certainly seems to be a coordinated counterattack against a colleague, it's just exasperating--as usual--to see the level of stupid to which David Kirby willingly--nay, gleefully!--descends, once again on The Huffington Post. He begins with a typical gloat:

I write my Huffington Post blogs in order to spark debate and commentary from other quarters about what has become -- like it or not -- the biggest medical controversy of our time: the potential link between vaccine ingredients and autism.

In that sense, my last piece, "Amanda Peet vs. the Medical Establishment," has done its job.

Reaction was predictably swift and furious to this opinion essay -- and that's what blogs are: this is not news reporting.

The potential link between vaccine ingredients and autism? The biggest medical controversy of our time. (Rolls eyes.) Yeah, right. David. Only in the minds of anti-vaccine activists. Of course, it's fun to point out how assiduously Kirby avoids mentioning that former vaccine bogeyman to rule all bogeymen, mercury. It's now "vaccine ingredients." What happened to the title of Kirby's book, I wonder? You remember what that was, don't you? Evidence of Harm: Mercury in Vaccines and the Autism Epidemic, A Medical Mystery. Funny how David Kirby seems to have forgotten the book that made his reputation, such as it is. Perhaps he finally realized just how ridiculous blaming mercury from crematoria in California and drifting over from China as the reason that autism prevalence in California hasn't decreased in the six years since thimerosal was removed from nearly all childhood vaccines made him look.

In any event, clearly Kirby's purpose isn't (nor has it ever been) to convey scientifically accurate information or reporting. I'm glad he cleared that up right from the start in his article. I've been waiting for three years for him finally--finally--to admit that what he writes and does with regard to the vaccine-autism manufactroversy has absolutely nothing to do with news reporting. Now he finally has. Maybe there is hope for him.

And, then again, maybe not, if this passage is any indication:

Many took issue with the title (of all things), not realizing it was a tongue-in-cheek, somewhat satirical, and deliberately provocative headline meant to spark the indignant outrage that it obviously did, (It worked for Jonathan Swift and that New Yorker cartoonist, too).

These critics balk at considering the US President, or Senate health committee members, or the Chairman of a House science subcommittee, or appointed members of the federal Interagency Autism Coordinating Committee, or many others like them, as part of the "medical establishment."

Fair enough. These are the people who, in a democratic society, control the medical establishment. They are not part of the establishment, in that sense, they are above it. They put the "over" in oversight. As a journalist, I value their opinion. As a citizen, I cannot imagine what this country would be like without them.

The stupid, it burns with the intensity of of a supernova.

By Kirby's standard, then politicians must represent the engineering establishment too, because they write guidelines and regulations over the construction of buildings. Or maybe politicians or committee members represent the astronomy establishment, because of how heavily the government funds and regulates NASA. Or maybe politicians are part of the chemical establishment, given how the government "controls" the chemical industry.

Of course, what really annoyed David Kirby was that Steve Novella characterized him so well:

In his piece, "Celebrity Smackdown: Amanda Peet vs Jenny McCarthy," Dr. Novella refers to me as "that reporter who has made a career out of spreading misinformation about vaccines and any nonsense he can think of." In the same breath, he dismisses vaccine-related statements made by CDC officials because, "they were given in a political and not purely scientific context."

Now, there's the real reason Steve has earned the wrath of the antivaccinationists. He dissed David Kirby--big time. Of course, any science-based person who's been following Kirby for the past three or four years will immediately recognized that Steve's description of Kirby is about as spot-on accurate a characterization of him that I've ever seen. Better yet, it clearly irritated Kirby, which is almost certainly why Kirby made it a point to mention this aspect of Dr. Poling's article:

Now, Hannah's father, Dr. Jon Poling, a respected neurologist and clinical assistant professor of the Department of Neurology, Medical College of Georgia, has responded to Dr. Novella, including his, "criticizing the journalism of Mr. David Kirby."

Raw petulance doesn't get much more naked than that. Does anyone want to take any bets about whether David Kirby put Dr. Poling up to writing that "letter" to Steve? That's my guess how it went down. In any case, Kirby, quite predictably, failed to note that Dr. Poling appears to have drifted far outside the mainstream, as John Shoffner, a mitochondrial disease expert, says:

Jon Poling, says Shoffner, has been "muddying the waters" with some of his comments. "There is no precedent for that type of thinking and no data for that type of thinking," Shoffner says.

Indeed, there isn't, and it's quite depressing to see a once promising neurologist fall in with pseudoscience.

Amusingly, Steve has struck back, and his longer characterization of Kirby is even more scathing:

What Kirby is primarily doing here is exactly the same thing that the Discovery Institute (an anti-evolution group) tries to do with intelligent design (ID) and evolution. They promote the idea of a scientific controversy of evolution and ID where none exists. They then use propaganda and political mechanisms to create a public and political controversy. They then present the public controversy they manufactured as if it were a scientific controversy, and then scream for academic freedom to "teach the controversy." Meanwhile they desperately claim that there must be something wrong with evolution or else why would there be such a controversy.

Kirby and the anti-vaccination crowd have created a false controversy over vaccines and autism. They then promote this controversy as if it were a legitimate scientific controversy. They then demand that their claims be investigated, that they are represented on the IACC, and they sue the government over alleged vaccine injury - and claim that the resultant controversy they manufactured is evidence for a legitimate scientific controversy and that they should therefore be taken seriously. There must be something to this controversy we manufactured because there's a controversy - it's nothing more than an elaborate and deceptive self-fulfilling prophesy.

Kirby is now using a strategy also familiar to the ID crowd - say something scientifically outrageous, and then use the backlash of scientific outrage to say - well at least I got them talking about it and taking the controversy seriously. Mission accomplished. It's must more self-fulfillment.

Yes, Kirby has clearly descended into Discovery Institute territory. Maybe he and Casey Luskin can get together with Dr. Michael Egnor to talk strategy. My only request to anyone else discussing the vaccine-autism issue from a science-based perspective is this: Don't call it a controversy. Don't fall for the antivaccinationists' "frame." The myth that vaccines somehow cause autism is not a scientific or medical controversy, no matter how desperately they try to frame it that way. It just isn't. Call it a manufactroversy instead, because that's what it is.