Novella on Dr Gordon (LONG!)
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|Mon, 12-08-2008 - 4:40pm|
Dr. Jay Gordon is a pediatrician and one of the stars of the anti-vaccinationist movement. (Dr. Gorski wrote an exellent criticism of many of his claims recently on SBM.) He is, in fact, the pediatrician to Jenny McCarthy’s son, Evan (who she claims was injured by vaccines). Several months ago he published an “open letter on vaccinations” which is now making the rounds on anti-vaccine websites. The letter is a work of pure arrogant pseudoscience – a crafted piece of anti-vaccine propaganda. He begins:
I don’t give a lot of vaccines.
I still give DPT vaccinations to some children, chicken pox shots to kids who haven’t been able to acquire natural immunity by age ten years or so, and I give polio vaccines very infrequently. The polio vaccines are given for what I call “emotional” reasons because my exposition of the “numbers” (2000 cases of polio out of six or seven billion people) doesn’t counteract the very strong memory of a beloved aunt or uncle who had polio in fifties or sixties. And many parents feel much more comfortable traveling to India or parts of Africa with updated polio immunity for their children and themselves. By the way, 2007-2008 statistics don’t support that discomfort, but I don’t argue much.
In 2007, there were 1314 cases of polio on the planet and 127 of them were in “endemic” countries: 873 in India, 285 in Nigeria, 41 in the Congo, 32 in Pakistan and 17 in Afghanistan.
As of July 1, 2008, halfway through the year, we’re running a similar pace with 714 cases of polio reported worldwide. Nigeria has had 353 cases, India 287.
His argument is that because the risk of catching polio is so low, the benefits to the individual child are not balanced by the risks of the vaccine. His argument, however, is bogus on many levels. First, the benefits of the vaccine to the individual child do outweigh the risks. That is largely due to the fact that the polio vaccine is very safe. Serious complications are extremely rare.
Also – Gordon is not thinking clearly about the risks of contracting polio. He is basing his argument on the fact that 2000 out of 6 billion is a very low risk (equal to one in 3 million). But that is the wrong statistic to use, because it includes those who are vaccinated, which is most people. The real risk that should be considered is the risk of contracting polio among the unvaccinated only. This risk is much higher. Almost all cases of polio occur among the unvaccinated.
He also fails to point out that “endemic” countries are endemic because of low vaccination rates. In fact, the World Health Organization was on the brink of eradicating polio from the earth through an aggressive vaccination schedule. But these efforts were thwarted by vaccine fear-mongering in Nigeria. This led to an outbreak of polio in Nigeria that spread to other vulnerable countries.
Gordon also displays incredibly sloppy thinking when discussing the risk/benefit calculation of vaccines. He acknowledges that vaccines work (unlike some in the anti-vaccine movement), and pays lip service to public health when he writes : “Public health is an important topic and ignoring that aspect of the discussion is irresponsible.” However, he then irresponsibly ignores public health.
It is unavoidable that as vaccines do their job they render the diseases they protect against increasingly rare. If we are ever going to eradicate another vaccine-preventable disease (like we did with small pox) then we necessarily must pass through a period where the risk of contracting the disease is extremely low. At some point, the risk of contracting the disease must be lower than the risk of the vaccine – even for extremely safe vaccines (because no intervention has zero risk).
If Gordon had his way, however, as soon as we got close to eradicating any disease we should back off on vaccinations for that disease, which would inevitably lead to its resurgence. We would forever be playing “whack a mole” with the disease, never eliminating it completely.
To be clear, we are not at this point with polio. The advantages to the individual still outweigh the risks. If we can maintain an aggressive vaccination program, the time period during which we would need to give the vaccine even when the risk of the disease approaches zero would be very brief, long enough to make sure it is completely gone. It depends on how sure we want to be.
Some might argue that we only need to give the vaccine in endemic areas. However, we live in a global community. Travelers bring diseases from other parts of the world every year, or unvaccinated travelers abroad can become infected. The only reason they do not spread and form a local epidemic is because of herd immunity – because of the vaccine schedule.
Even if we set aside the possibility of eradication – keeping infections isolated and preventing epidemics depends upon herd immunity, which is only as effective as the thoroughness of the vaccination program. Every parent who takes Dr. Gordon’s advice weakens herd immunity, and risks not only their child but their community.
Dr. Gordon also likes to pretend that he is the only one concerned about vaccine safety, or honestly and openly examining vaccine risk. This is pure hubris. Vaccine risks and benefits are carefully considered. For example, in the US the oral polio vaccine (OPV) was given rather than the inactivated polio vaccine (IPV) because OPV is more effective. Widespread use of the OPV is essentially what eradicated polio from the Western hemisphere.
In 2000, however, the US changed over to IPV. This was due purely to the constant assessment of risks vs benefits. While OPV is more effective is also carries a 1 in 2.4 million risk of contracting polio from the vaccine. IPV is less effective, but does not carry this small risk. It was decided, however, that IPV would be adequate to protect against importation of the polio virus back to the US, without the small risk of the OPV.
Gordon then launches into his reasons for believing that vaccines are not safe. You would think that a doctor defending a minority opinion on an important public health issue would reference published research to defend his position. Nope – Dr. Gordon just gives us his personal anecdotal experience, and some tired rhetoric.
In 1980 I abandoned the recommended vaccine schedule. I received dozens and dozens of phone calls from moms and dads reporting that their child had received shots a couple of days ago and they were acting “a little different.” They couldn’t quite put their finger on it but their child was just not acting quite the same as before I gave the shots. They’d ask if this was okay…was it normal? Initially, as I was trained to do, I replied “yes.” After dozens and dozens and dozens of phone calls, I decided that I had better listen to these moms a lot more.
Ugh! The “mommy” gambit. RFK Jr. and David Kirby have played that card to death as well. Gordon is telling us to listen to his uncontrolled gut feelings – not the growing body of carefully collected published data which clearly indicates that vaccines are safe, that they are not associated with autism or other neurological disorders. He tries to make this scientifically bitter pill go down easier by implying that doctors claim vaccines are safe because that is how they are “trained” (like dogs are trained) – not because they can think for themselves and perhaps have a better understanding of the published literature than he does.
He also implies that it is out of compassion and open honesty that he is willing to listen to mommies, and other doctors are not. This is nothing but supreme arrogance in logical fallacy form. This issue is determined by the best scientific evidence. Gordon does not have that on his side, however, so he tries to distract with a bit of misdirection. This is a maneuver familiar to any illusionist, or creationist.
But it gets worse. He writes:
Now, when you discuss this topic with your pediatrician, he or she will clobber my ideas and me. So be it. I have watched children getting or not getting vaccines for thirty years. I won’t publish my data because I have none suitable for “peer review.” I can tell you that my very strong impression is that children with the fewest vaccines, or no vaccines at all, get sick less frequently and are healthier in general. I truly believe they also develop less autism and other “persistent developmental delays.”
First he tries to perform a preemptive strike against his critics, anticipating that they will “clobber my ideas and me.” This is clearly meant to portray himself (more arrogance) as an abused whistleblower. Maybe, just maybe, criticism of Dr. Gordon is legitimate because of his dangerous and incorrect anti-vaccine misinformation.
He reassures us that he has the data to back up his controversial claims, however. But nothing he can publish. We’ll just have to trust him. Notice the quotes around “peer review.” What does that mean? Is he denigrating all peer-review? This is not surprising. He is telling the public not to listen to science. Do not listen to the consensus of scientific opinion built upon published “peer-reviewed” data. Listen to his “very strong impressions.” He’s the guru. He knows best.
He has the audacity of reassuring us not once but twice that he is not “anti-vaccination.” This is contradicted by his “very strong impression” that children who received “no vaccines at all” are “healthier in general.” His reassurances are just more misdirection.
Next on his list of standard anti-vaccine propaganda is the toxin gambit. Even though mercury in vaccines as a cause of neurological disease has been thoroughly refuted by the data, Gordon still clings to this failed hypothesis. He writes:
Mercury has not been removed from all vaccines. Most flu shots still contain 25 micrograms of mercury as do the tetanus boosters. This represents 30-60% of the dose a baby or child would have gotten in the “bad old days” and completely invalidates the argument that “we’ve gotten thimerosal out of shots and autism has not gone down.”
This is just absurd. Mercury-based thimerosal was completely removed from the routine vaccine schedule by early 2002. Prior to that children received thimerosal in many vaccines, including the occasional flu and tetanus booster. Now, they are only exposed to thimerosal if they get optional vaccines that include it. And – many flu vaccines do not contain thimerosal (and fewer and fewer do) and some states, like California, have banned thimerosal completely.
This represents a significant decrease in thimerosal exposure. The original argument of the “mercury militia” who blamed autism on vaccines was that as the total thimerosal dose increased (mostly over the 1990’s) so did the incidence of autism. Well – if that were true then as the thimerosal dose decreased after 2002 so should have autism. However, autism rates continued to increase at the exact same rate as prior to 2002.
So, Dr. Gordon���s position is that as mercury increased, autism increased, Then, as mercury decreased, autism continued to increase. And this is because mercury was not completely removed from all vaccines (even though it was in some states, like CA, where autism diagnoses have also continued to increase).
This argument is so brain-dead I have a hard time with the idea that Dr. Gordon believes it himself. I guess he could be so invested in his media persona as the vaccine-skeptic to the stars that he can compartmentalize as needed. But seriously, this argument is so demonstrably absurd that by itself it establishes Dr. Gordon as a hard-core antivaccinationist.
He backs up this bit of nonsense with further coy implications:
The CDC says that one out of five children have learning disabilities. I do not know why we have so many injured children now.
One of the hallmarks of propaganda is subtly loaded language. First he cites the CDC as a reference, to make it seem as if his next statement is backed by an appropriate authority. He then makes the coy statement that he does not know why “we have so many injured children now.” Notice the assumption (without reference or justification) that children with learning disabilities are “injured.” He makes this bold claim without making it seem as if he is making a claim at all – it’s just slipped in there as an innocuous statement, which he falsely implies is backed up by the CDC.
There is no evidence to support the claim that many, most, or all of children with learning disabilities have been “injured.”
Also notice the little word at the end of the statement – “now.” Why are there so many injured children “now”. This implies that there are more than before. Therefore something must be going on.
I did acknowledge that autism diagnosis rates are increasing. However, the data supports the conclusion that this increase in diagnoses are due to a broadening of the definition of autism (casting a wider net) and to increased efforts at surveillance (we are looking for it more). There is no evidence that true autism rates are increasing. A small real increase cannot be ruled out by the data – but that is just a generic limitation of the amount and quality of the data that we currently have.
Dr. Gordon hedges his bets, however. He doubles down on the toxin gambit with the next target for the anti-vaccinationists – aluminum. He declares that there is too much aluminum in vaccines.
Aluminum is added as an adjuvant – it makes the vaccines work better. There is no evidence that the level of aluminum currently in vaccines poses any risk. And remember, vaccines and the vaccine schedule are tested and monitored for safety. There are rare cases of harmful reactions to vaccines, nothing is risk free. But the risks are very low and far outweighed by the benefits.
What evidence does Gordon have for his claim of too much aluminum? An article in Mothering magazine – he apparently does not want to taint his arguments with anything peer-reviewed.
Wait – maybe he does. He also claims (again, against the consensus of opinion built upon actual evidence) that delaying some vaccines is safer. He writes:
Some vaccination problems are completely verifiable and a strategy of delaying vaccines is, in some small way, supported by this recent article:
Delay in diphtheria, pertussis, tetanus vaccination is associated with a reduced risk of childhood asthma.
J Allergy Clin Immunol. 2008 Mar;121(3):626-31. Epub 2008 Jan 18.
That is some mighty fine cherry-picking, Dr. Gordon. Of course, this is one preliminary study. The implications of this have yet to be worked out. There is also a suggestion in the literature that more infections as a child reduces overall asthma risk. A relatively unchallenged immune system may predispose to asthma. Or there may be some other factor at work. So are we ready to abandon personal hygiene as well? Not quite yet.
It may turn out that the vaccine schedule needs to be tweaked to optimize benefit to risk as new data comes in. No one claimed the current schedule is perfect and written in stone. But this small slice of data in no way justifies a broad program of eliminating and delaying vaccines, as Gordon implies.
From a scientific point of view his arguments are just plain lousy.
There is so much more, but Gordon has perfected the “Gish Gallop” as it applies to anti-vaccine propaganda. It takes far less space and time to generate misconceptions than it does to correct them. This will have to do for now.
One thing is clear. When Dr. Gordon repeatedly claims that he is not anti-vaccination, “methinks he doth protest too much.”