Journal publisher retracted a study claiming poison oak could cure itching. Well done.

None of these plants will cure itching. 

Today I want to tell a positive story, where a science journal did the right thing.

I’ve written a lot over the years about bad science. A particular gripe of mine is when bogus scientific results, sometimes fraudulent, sometimes just sloppy, manage to sneak into the peer-reviewed scientific literature. This happens all too often, especially as the number of papers published each year has grown. These bad papers are then used by fraudsters and charlatans (and sometimes by innocent people who just don’t have the expertise to understand) to “prove” an unscientific claim.

Fortunately, a growing number of journals–the better ones, in general–are showing more concern than in the past, and taking actions (sometimes) to retract papers, even over the objections of the authors.

Before I get to the good news, a reminder about the most notorious scientific paper in recent memory: Andrew Wakefield’s fraudulent study in The Lancet, published in 1998, which claimed to find a link between vaccines and autism. The Lancet, to its everlasting shame, failed to retract the article until 2010, despite an avalanche of evidence that began appearing in 2002. Ten of the original 13 authors even published their own “Retraction of an Interpretation” in 2004, but The Lancet still refused to retract unless all the authors agreed. Wakefield, who was already leading the anti-vaccine movement and is now adored by anti-vaxxers, refused.

That article has probably contributed indirectly to the deaths of thousands of people from vaccine-preventable infectious diseases. And given what we knew about it by 2002, The Lancet had no excuse for delaying retraction until 12 years after publication.

But I digress. Today I want to highlight an article whose retraction I called for a few years ago, one that the journal, Scientific Reports (published by Nature Publishing Group) did indeed retract, about 9 months later.

The paper I called out was a study that claimed that an extract of poison oak can be used to treat pain. If that sounds kind of ridiculous, that’s because it is. The actual paper sounded very science-y, as I pointed out in my original column. It was titled “Ultra-diluted Toxicodendron pubescens attenuates pro-inflammatory cytokines and ROS-mediated neuropathic pain in rats.”

Toxicodendron pubescens, in case you’re wondering, is poison oak. It’s not a tree and it has nothing to do with oaks–it’s a cousin of poison ivy, and both plants contain oils that can cause extreme itching and painful rashes on contact.

How on earth could poison oak be used to treat pain? Well, it can’t. The paper was actually about a homeopathic treatment. One of the core tenets of homeopathy is that “like cures like,” as long as you dilute it sufficiently. So the poison oak paper started with the premise that since poison oak causes pain and itching, you can also use it, after you dilute it, to treat pain and itching!

Homeopathy, as I’ve written before, is a highly implausible and easily disprovable set of beliefs about medicine. I use the word “belief” intentionally here, because homeopathy really has no claim to be a type of medicine, or even a hypothesis. It’s just a 200-year-old collection of beliefs that turned out, long ago, to be wrong.

If this sounds absurd, well, selling these products is a highly profitable business. For example, check out Boericke & Tafel’s Oral Ivy Liquid ($15 for a 1-ounce bottle on Amazon.com), a homeopathic product that is made from poison ivy, poison oak, and poison sumac. It claims to be “for the prevention and temporary relief of contact dermatitis associated with poison ivy, poison oak or poison sumac.” What’s in it? Poison oak, at very low levels. (Actually this product isn’t really diluted to homeopathic levels: the packaging says it contains 0.02g of poison oak in each drop. So it might actually cause an allergic reaction–I’d stay far away from this stuff.)

Back to the study: in the paper, the authors diluted a preparation of poison oak down to levels as low as 10-30, a common practice in homeopathy. The problem is, at that level of dilution, not even a single molecule of the original substance would remain. There’s simply no possibility that such a dilution could have any therapeutic benefit, but somehow they found an effect. Hmm.

A number of scientists wrote to the journal complaining that this result was extremely implausible, and that the experiments didn’t support the conclusions. To their credit, the journal editors took the complaints seriously and investigated. The retraction notice (read it here) pointed out another major problem as well: some of the figures were duplicates! Each figure is supposed to represent a different experiment, so duplication is a big problem, added to the fundamental implausibility of the study.

As is often the case when fraud is detected, the authors did not agree with the retraction.

When I wrote my column complaining about this study, I said the “the right thing to do would be to retract this paper, because its results are simply not valid. We'll see if that happens.” Well, about 9 months later, that’s exactly what happened.

A few years ago, I was in direct contact with the Editors-in-Chief at both Scientific Reports and PLoS ONE (about different papers than the one I’m discussing above), and they expressed genuine concern about fraudulent research, as well as a determination to do better at rooting it out. When journals do the right thing, we should applaud them. So here’s to Scientific Reports, who got it right this time.

Europe's pause on the AstraZeneca COVID vaccine plays right into anti-vaxxers' hands

Last week, more than a dozen European countries suspended the AstraZeneca Covid-19 vaccine. They claimed it was out of an excess of caution, but instead they played right into the hands of those who continue to spread anti-vaccine misinformation.

On Thursday, the European Medicines Agency announced that there was nothing to worry about, that the AstraZeneca vaccine was safe, and that all countries should resume using it.

Too late, I fear. The harm has already been done.

I’ve been fighting the anti-vax movement for years, as have many other scientists, doctors, and science bloggers. We’ve seen their strategies, and they don’t play fair. They don’t care about facts, and they love to scare people. This latest incident gives them plenty of fodder.

First let’s talk about the “fear” part. A very, very small number of cases were reported in which people had blood clots soon after getting the vaccine. This sounds scary.

But wait a minute. We are giving the vaccine to millions of people. If you look at a group that large, how many of them will have blood clots in a given week? The answer, not surprisingly, is greater than zero.

So the first thing that public health authorities should have asked is, obviously, are we seeing more blood clots than expected? But no, they didn’t do that. Instead, out of an excess of caution (so they claimed), they halted the AstraZeneca vaccine while they investigated. This meant that literally millions of vaccine doses were not administered.

Fortunately the investigation took only a few days. What did they find? Well, here’s the answer, directly from the European Medicines Agency itself:

“the number of thromboembolic events reported after vaccination ... was lower than that expected in the general population.”

In other words, the vaccine clearly doesn’t cause blood clots. If anything, it might even prevent blood clots, because the number observed was lower than expected. (No one is claiming that it actually prevents blood clots; I’m just pointing out how wrong the decision to halt the vaccine was.)

Now the unfounded fear of vaccine-induced blood clots has spread through Europe and beyond. You can’t “unsay” something like this, and anti-vax websites and social media groups are already using it to scare more people. (I won’t link to any of them because I don’t want to give them the traffic.) Indeed, several northern European countries still haven’t resumed use of the vaccine, and Germany, France, and Italy are including a warning (an incorrect one) that the vaccine might cause blood clots. This is just wrong.

Halting the AstraZeneca vaccine without doing some very basic number-checking was a huge blunder. Let’s just hope this decision doesn’t cost too many lives.

Should we pay people to get vaccinated? Well, maybe.

This past week, a major US retail company, Dollar General, announced that it would pay its employees the equivalent of four hours’ salary if they would get the Covid-19 vaccine. That’s about $40, based on the average pay at Dollar General. The idea is to give employees an additional incentive, and also to cover the time they might need to take off work to get vaccinated.

This is an excellent idea. Let me explain why.

First, though, I should point out that several prominent economists, including Harvard’s Gregory Mankiw and the Brooking Institution’s Robert Litan, have already proposed paying people to be vaccinated–but their proposal is, frankly, terrible. So let’s start with that.

Now that we have two vaccines, from Moderna and Pfizer/BioNTech, with more on the way, we can finally see an end to this awful pandemic. At the moment we have a supply problem: there aren’t enough vaccines to go around. But soon, perhaps in a few months, we’ll have plenty of vaccines. Then the problem becomes getting enough people vaccinated to create “herd immunity.”

(Aside: herd immunity has been discussed ad nauseum this year, so I won’t get into any details, but it essentially refers to the situation where so many people are immune to the virus that it doesn’t spread any more. We probably need 60% of the population to be immune (estimates vary) in order to reach herd immunity.)

A well-informed person might think this won’t be a problem: billions of people are desperate to get the vaccine right now. But the anti-vaccination movement has been spreading misinformation about Covid-19 vaccines since the beginning of the pandemic, long before we even had a vaccine. (Yes, I know it’s patently ridiculous to make claims about a non-existent vaccine, but they did, aplenty. I’m not linking to any of their claims here because I don’t want to give them the traffic.)

As a result of the relentless anti-vax propaganda campaign, a substantial portion of the population is at least “vaccine hesitant,” meaning they’re not sure if they want the vaccine. They are worried primarily about safety, even though the data is very clear that these vaccines are remarkably safe. (It’s true that a tiny number of people have had allergic reactions, but this data is public and no one’s hiding it.)

So we need to convince some people that it’s in their own best interests to get vaccinated. A small number of deeply confused anti-vaxxers, such as the people behind the mis-named NVIC, are probably unreachable. They simply won’t listen, preferring to believe their own misinformation and conspiracy theories. But for the large number of people who are merely hesitant, a positive incentive might be just the thing to convince them to get vaccinated.

Enter the economists. Robert Litan first proposed paying people to take the vaccine back in August, and Gregory Mankiw strongly endorsed the idea, writing:

“what’s the best way to achieve herd immunity? Again, simple: Once a vaccine is approved, pay people to take it.”

Such confidence! Actually it’s quite a good idea in principle. But Litan and Mankiw then went off the rails, proposing that we pay everyone $1000 each to get the shot. Litan admitted that he didn’t have any data to support this particular amount, but he called it a “strong hunch.”

That’s a $300 billion program. Neither Litan nor Mankiw was bothered by this.

There are some gigantic problems with this proposal. First, because it’s such an enormous amount, it’s extremely unlikely that it will ever happen. It’s just the kind of hypothetical, pie-in-the-sky proposal that gives academics a bad name. Because it will never happen, Litan and Mankiw will never have their idea tested in real life, and no doubt they will continue to claim it would have worked.

Second, though, is a much bigger problem, as pointed out by economists George Loewenstein and Cynthia Cryder in the New York Times, and by medical ethicists Emily Largent and Franklin Miller in JAMA. The problem is that if you offer to pay a lot of money to do something, then people conclude “this is something you would not want to do without compensation.” In other words, it’s dangerous or somehow bad.

Thus a large payment may merely heighten people’s suspicions that the government (or “Big Pharma”) is up to no good, and that’s why they have to bribe people to take their suggestions. The last thing we need right now is to increase people’s mistrust of vaccines.

In addition, paying so much money for each shot is, as Largent and Miller point out, a bad investment. Sure, $300 billion is much less than Covid-19 is costing us right now, but it’s still a huge sum, and those funds could be better spent on many other things, such as helping to support states that are still struggling to set up facilities to administer the vaccine.

Now let’s go back to the Dollar General plan. Dollar General is paying the equivalent of four hours’ worth of salary, about $40 on average, to each employee who gets vaccinated. As I said above, this is an excellent idea.

Why is this better than the $1000 per person plan from the economists? First of all, it costs far, far less than the economists’ plan, which makes it far more likely to happen. Second, Dollar General is paying people to defray the actual costs–in time–that they will incur in order to get the vaccine. So it’s not so much a bribe as it is a modest reimbursement. Third, by providing a modest payment, they provide a relatively bigger incentive to low-income groups, and they avoid paying billions of dollars to high-income people who are already highly motivated to get the vaccine.

I suggest we adopt a version of Dollar General’s plan for the entire U.S. population. Why not offer a cash payment of $20 to everyone who gets the vaccine, and pay it immediately? Obviously there would be some logistical challenges to this–we’d need security procedures to make sure the $20 payments were actually handed out and not stolen–but it would be far simpler than arranging the $1000 payments so blithely proposed by the academic economists. And it would only cost $6 billion rather than $300 billion.

A payment of $20 provides a small positive incentive, and it can be justified as paying people for the time they spend getting the shot. Because it won’t seem like a bribe, it will be much less likely to raise suspicions that the vaccine is harmful (which it isn’t, I hasten to add).

So Litan and Mankiw were sort of right: paying people might encourage more people to get vaccinated. But they’re wildly wrong about the size of the payment, which other economists and bioethicists have pointed out would likely create distrust. Dollar General is getting it right: let’s offer everyone a small cash payment if they’ll take the time to get the vaccine. It might just work.

Would you trust your kids with this man? No? I didn't think so.

Today I want to shine a bit of light on the conspiracy theorist behind the film "Vaxxed" and its recent sequel, "Vaxxed II." I'm not going to provide any links to the movie, or to describe it, except to say that it's a slickly-produced conspiracy theory masquerading as a documentary. Don't watch it.

Anti-vax activists often use conspiracy theory tactics, which work like this: they simply make up a claim, out of thin air, that a secret cabal of doctors (or government scientists, or pharma companies) is out to harm patients by giving them vaccines, and is hiding the "truth" about the risks of vaccination. Never mind how irrational this is, and never mind that there's not a shred of evidence behind it: if you try to argue with the anti-vaxxer, you're part of the conspiracy.

So rather than try to disprove something that was never proven in the first place, let's look instead at the source of the anti-vax propaganda film, "Vaxxed." The source is one man: Andrew Wakefield. Who is this guy, and why is he so obsessed with vaccines?

Wakefield was once a doctor, before he had his license revoked a decade ago. In his former life, he was a gastroenterologist, with no special training in vaccines or infectious diseases. He first gained fame–a lot of fame–for a 1998 paper in a medical journal, The Lancet, in which he claimed to have discovered a link between the MMR vaccine (that's the one that covers measles, mumps, and rubella) and autism.

Here are some things you need to know about Wakefield before watching his movie:

1. Wakefield's 1998 paper, it eventually turned out, was "an elaborate fraud." Wakefield defrauded the public, his patients, and even his own co-authors on the paper, most of whom were unaware of his elaborate conflicts of interests.
2. Before he published his 1998 study, Wakefield was hired by a lawyer, Richard Barr, who was trying to build a lawsuit against vaccine makers. Barr paid Wakefield £435,000 (equal to $750,000 US dollars at the time) to help him build his case. Wakefield's co-authors were unaware of this contract.
3. The study claimed that 8 out of 12 children had been diagnosed with autism soon after getting the MMR vaccine. It described these children as "a consecutive series" of admissions to the hospital where Wakefield worked. That was a lie. It turned out, as investigative journalist Brian Deer revealed, that all 12 children and their parents were referred to Wakefield by Barr–the lawyer who was paying Wakefield to conduct the study, and who was trying to sue vaccine makers.
4. Wakefield also falsified data on all 12 of the children in his original study.
5. Wakefield conducted "invasive and distressing procedures" on the children without approval from his hospital's ethics board.
6. After learning some of the back story, 10 of his 12 co-authors tried to retract the paper in 2004. Wakefield refused to join them, so they published a partial retraction, signed by the 10 co-authors. The Lancet itself later fully retracted the paper (over Wakefield's objections), but it took until 2010 for them to act. By then, the anti-vax movement had spread widely.
7. Prior to publishing his paper, Wakefield filed a patent claim for a "safer" vaccine for measles, one that would have profited him greatly once he discredited the (perfectly safe) MMR vaccine.
8. After losing his license in the UK, Wakefield moved to Austin, Texas where he ran an organization called Thoughtful House, through which he paid himself a salary of $280,000. (Perhaps coincidentally, Austin is now a hotbed of anti-vaccination activism.)

For more than 20 years, Andrew Wakefield has made money off false claims that vaccines cause autism, first put forth in his discredited 1998 paper. He gives talks, writes books, conducts seminars, and now makes movies, of which make him money. Since the publication of his paper, dozens of studies involving literally millions of children have shown, time and again, that vaccines do not cause autism. Wakefield has denied every one of those studies, and continues to push his bogus claims.

(Why, you might ask, have scientists conducted studies looking for a link between autism and vaccines, if there was never any evidence for such a link? The answer is simple: anti-vaxxers have been so successful at scaring people about a nonexistent threat that scientists and public health experts felt it necessary to conduct those studies, in order to reassure people. Literally millions of dollars have been spent to prove something we already knew.)

Meanwhile, measles outbreaks have appeared with increasing frequency in the U.S., the UK, other European countries, and around the world, including the deadly outbreak in Samoa late last year, which caused 5,700 infections and 83 deaths in a population of just 200,000. Wakefield's new movie was released in the middle of that outbreak.

So to anyone who watched the movie Vaxxed and is now having doubts about vaccines, I ask: would you trust your children with this man? I wouldn't.

Let the 2010s be the end of the post-truth era

The 2010s are over, and the double-20s are about to begin. One phrase that I'd like to never hear again is "post-truth era," an idea that has gained prominence during the past decade, especially the last few years.

One dominant theme of post-truthery is that every person has a right to his/her own interpretation of the facts, and that these alternative interpretations–or "alternative facts," as Trump adviser Kellyanne Conway famously called them–deserve to be taken seriously. They don't.

And yet, like most of the pseudoscience that I've been writing about for years now, we have to continue calling out nonsense for what it is, because some of it is harmful, and even deadly. Politics is a never-ending font of post-truthery (or truthiness, as Stephen Colbert defined it in 2005), but here I'm concerned about science. Today I'll highlight three anti-truth campaigns that have caused great harm over the past decades, in the hope that they will soon fade away.

Among serious scientists, truth is not being questioned. Indeed, the essence of science is the search for objective truth. Sometimes, though, a scientific discovery threatens to undermine the power or profits of an influential industry, and that's when industry resorts to denialism (which is essentially the same thing as post-truthiness).

Perhaps the most well-documented example of organized science denialism dates back to the 1950s, when accumulating evidence made it clear that smoking causes cancer. The tobacco industry didn't want to admit this, even though their own internal research supported it, because it meant that their main product was killing their customers, which in turn was terrible news for their business. In response,

"the tobacco companies helped manufacture the smoking controversy by funding scientific research that was intended to obfuscate and prolong the debate about smoking and health." (Cummings et al. 2007).

Eventually, after decades of lawsuits and literally millions of smoking-related deaths, the industry was forced to admit the truth and pay out billions of dollars in settlements in the U.S. Nonetheless, many people still smoke, and even as recently as 2016, the largest tobacco company in the U.S., Philip Morris, was still trying to deny the science about cigarettes.

My second example is more recent, and potentially even more harmful to the human species. You might have already guessed it: I'm talking about climate change denialism. For several decades, the evidence has been building that the planet is getting warmer. A series of reports from the Intergovernmental Panel on Climate Change (IPCC) warned, in increasingly confident terms, that humans were the primary cause of recent warming, mostly due to our use of fossil fuels and the carbon they emit into the atmosphere.

The current IPCC report states unequivocally that humans have already caused 1° C of warming, and that the warming will increase rapidly over the next several decades.

Scientifically, these facts are not in dispute. The world is already experiencing more severe storms, unprecedented floods and droughts, and die-offs due to warming oceans (such as the massive and tragic die-off of coral in Great Barrier Reef).

However, the fossil fuel industry sees global warming as a threat to their profits. Rather than invest in new, cleaner forms of energy, large companies such as Exxon-Mobil and billionaire coal magnates such as the Koch brothers have poured countless millions of dollars into disinformation campaigns to cast doubt on the science of climate change. Prominent among these efforts is The Heartland Institute, a fossil-fuel-funded organization whose main mission is to cast doubt on the science of climate change. (Heartland has also worked to cast doubt on the link between smoking and cancer.)

Climate change denialists learned from the tobacco companies that it was possible to delay government action by decades, simply by casting doubt on the science. Unfortunately, their campaigns have been working. For years, many U.S. politicians denied that the planet was getting warmer. As that argument has become increasingly harder to make with a straight face, they've changed their strategy, and now they might admit that the planet is heating up, but deny that human activities are responsible. They're still wrong.

The goal of this denialism is, simply put, to protect the profits of fossil fuel industries. However, truth doesn't care if you believe it or not. The world is getting hotter. Australia just had its four hottest days in recorded history. The unprecedented heat wave has led to hundreds of fires through much of the country, threatening every major city on the continent. There's no reason to think this won't keep happening.

Climate change denialists are only fooling themselves–after being duped by oil and coal companies.

My third and final example is one that has frustrated me for 15 years now, and it's one that just won't go away: the anti-vaccination movement. This is one of the most frustrating examples of post-truth wrongheadedness, in part it seems so unnecessary, and because so many children have been harmed as a result.

First, let's be clear about the facts: vaccines are one of the greatest boons to human health in the history of science and medicine. People used to die by the millions from smallpox, polio, and a dozen other infections that are now almost completely preventable by vaccines.

Smallpox was 100% eliminated from the planet in 1980, in one of humankind's greatest public health triumphs. Polio has now been eradicated from nearly all countries, and a campaign that started in 1988 has now reduced polio to just a few countries and fewer than 100 cases worldwide. Both of these successes are due to vaccines.

Many other diseases, including measles, chicken pox, and bacterial meningitis, have been reduced so dramatically by vaccines that physicians in the U.S. and Europe almost never see a case. This graph shows the dramatic effect of the measles vaccine, which was introduced in the U.S. in the early 1960s:

Measles cases in the United States by year, 1954-2008. Source: CDC.

The graph shows the number of reported cases, but actual cases were much higher, likely around 4 million cases per year by one estimate. These are the facts.

So what happened? The modern anti-vax movement, led by a small number of extremely vocal, extremely self-confident individuals, began in 1998 with the publication of a fraudulent study (later retracted when the fraud was uncovered) claiming that vaccines caused autism. The study was led by former physician Andrew Wakefield, who later lost his medical license because of his fraud, which included misleading his co-authors and mistreating patients.

Nonetheless, this study was picked up and amplified by several celebrities with large followings, including former Playboy model and MTV host Jenny McCarthy and political activist Robert F. Kennedy Jr, the nephew of former US President John Kennedy. RFK Jr.

Anti-vax activism is all over the web today, despite many efforts to quash it. Countless claims of "my child got sick after his vaccine jab" are presented as proof that vaccines cause harm, and under post-truthism, we're supposed to take such claims seriously.

These stories can be especially difficult to respond to, because many parents are dealing with children who have genuine health problems–including autism–and the parents often truly believe what they are saying. Thus it won't do to tell them to be quiet and go away: their children really do need medical care. They're simply wrong in believing that vaccines have anything to do with their childrens' problems. Their beliefs are amplified by Facebook groups and websites whose sole purpose is to echo and amplify the mistaken claims of anti-vaxxers.

Even though there was never any good evidence that vaccines cause autism, scientists have conducted dozens of studies involving literally millions of children to answer precisely that question, and the evidence is very, very clear: vaccines do not cause autism, nor do they cause any other systematic neurological or behavioral problems. Vaccines do prevent diseases, though, and unvaccinated children can and will get sick. Recent experience has also given us, tragically, many examples of children who died from entirely preventable infections, because their parents didn't vaccinate them. These tragedies didn't have to happen.

Every era is the age of truth. The idea that we're in a "post-truth era," despite being repeated thousands of times in articles, essays, and op-eds over the past decade, is a commentary on people's ability to fool themselves, not on the state of the world. Truth describes the world as it is, and those who choose to deny it might win a short-term argument, but in the long term, they will always lose.

Finally, on a more positive note, I'm somewhat heartened by efforts to educate college students on how to recognize and counter bogus ideas, such as the University of Washington course, Calling Bullshit, created by Carl Bergstrom and Jevin West. (Yes, that really is its title.) As the professors wrote,

"The world is awash in bullshit.... We're sick of it. It's time to do something, and as educators, one constructive thing we know how to do is to teach people." 

If you're interested, they've made the lectures available as free videos on YouTube.

Labelling an era as post-anything has always, to me, suggested a lack of substance, as if the era is defined only by what came before it. The use of "post-" also ignores that fact that the next era will need a name too. Should we expect "post-post-truth" to come next, and what would that look like? Let's hope that the 2020s will give us a return to simple respect for truth. The future of civilization might very well depend on it.

$545 million wasn't enough for chiropractors. Now they're lobbying Congress for much more.

Medicare currently wastes more than $545 million a year on chiropractors, as I revealed in an article last year. Wasteful as this is, it's not enough for chiropractors, who have successfully lobbied to have two Congressmen propose a new bill, HR3654, that will require Medicare to pay chiropractors for the full range of services that real doctors offer.

The American Chiropractic Association is practically rubbing its (metaphorical) hands together with glee. As they proudly point out, this endorsement of quackery is bipartisan: the bill is sponsored by two New York Congressman, Democrat Brian Higgins and Republican Tom Reed.

The idea of having chiropractors function as regular physicians is very troubling. Chiropractors do not receive proper medical training: they get their Doctor of Chiropractic (D.C.) degrees from one of a very small number of special chiropractic schools, which do not provide the full medical training that real medical schools do. Their curriculum also includes a heavy dose of pseudoscience, especially the training around subluxations.

For a detailed discussion of why chiropractors are not competent to be family physicians, I recommend this article by an experienced physician, Dr. Harriett Hall, titled "Chiropractors as family doctors? No way!" Dr. Hall goes into considerable detail explain why many of the medical practices of chiropractors are non-standard, not evidence-based, and possibly harmful. Or see this lengthy takedown of chiropractic subluxations by Sam Homola, a former chiropractor.

Many chiropractors are also anti-vaccine, unfortunately, as documented just two weeks ago in this article by attorney Jann Bellamy. Among other things, Bellamy points out that a major chiropractic conference this fall will feature a keynote talk by anti-vaccine activist Robert Kennedy Jr. (about whom I've written before).

Even more alarming, as I've explained before, is that chiropractic neck manipulation has been shown to carry a small but real risk of stroke, because it can create a tear in your vertebral arteries. For example, this report from 2016 documented a case of cerebral hemorrhage apparently caused by chiropractic manipulation. The patient in that case was a 75-year-old woman, which puts her squarely in the class of patients eligible for Medicare.

And to those chiropractors who've read this far: I'm sorry that you were hoodwinked into spending 3-4 years in a chiropractic school, paying nearly $200,000 in tuition and fees, with the promise that you'd be a legitimate medical professional. You were scammed, and I'm sorry about that. And I understand that most (perhaps all) chiropractors want to help their patients. The problem is, the training offered by chiropractic colleges is far short of a proper medical degree.

If the chiropractors' lobbying association get its way, this $545 million (annually) in wasted Medicare dollars will soon become a far higher amount–to the detriment of patients. The bill will allow chiropractors to bill Medicare for pretty much any service that a bona fide physician offers.

It's also worth noting that in 2018, Medicare's Inspector General issued a report titled "Medicare needs better controls to prevent waste, fraud, and abuse related to chiropractic services," which revealed that almost half of Medicare spending on chiropractic care from 2010-2015, between $257 million and $304 million per year, was likely wasted or fraudulent. One wouldn't think this is a time to expand Medicare's coverage of chiropractic.

Congress, don't be fooled by arguments that this proposed new law will lower medical costs, or give patients what they need: it won't. Instead, it will dramatically increase the amount of funds wasted on ineffective treatments. The U.S. does need a better health care system, but this bill would be a big step in the wrong direction.

Donald Trump shows his anti-vaccine craziness, and Ben Carson's response is worse

Donald Trump used the latest Republican debate as an opportunity to express wildly inaccurate anti-vaccine claims, embracing the thoroughly discredited position that vaccines cause autism. This claim has been exhaustively debunked, by countless scientific studies and by reports from the Institute of Medicine and the CDC. It started with a now-retracted 1998 study by one of the great villains in medicine, Andrew Wakefield, who continues to push his fraudulent views despite having lost his medical license.

Trump's comments were nutty and dangerous, but Ben Carson's response was, in some ways, worse. Carson had the chance to set the record straight, and because of his medical credentials, he could have been effective. He failed.

Trump has been an anti-vaxxer for years, so his comments were not surprising. Science blogger Orac posted a 2007 Trump quote that almost exactly mirrors what he said in the debate.

What was much more surprising, and deeply disappointing, was the response of candidate Ben Carson, who until last year was a pediatric neurosurgeon at Johns Hopkins School of Medicine. (Note that although I too work at Hopkins Medicine, I've never met Dr. Carson.) Carson did point out vaccines don't cause autism, but then he made a series of false claims that come right out of the anti-vax playbook.

When the moderator asked Carson to respond to Trump's anti-vaccine rant, Carson had a golden opportunity to do some real good: he could have corrected the record and pointed out the real harm that comes from anti-vaccination misinformation. Instead, he said things like this:

“Vaccines are very important, certain ones, the ones that would prevent death or crippling. There are others, a multitude of vaccines that don’t fit in that category, and there should be some discretion in those cases.”

Forbes bogger Tara Haelle has already explained the grievous error here: all our vaccines prevent death.  Carson's claim is simply false, and it's shocking that a highly trained physician would make this statement, on a national stage, without knowing the facts. What Carson should have said–but didn't–was this, from the Every Child By Two organization:

"Each and every vaccine added to the list of recommended immunizations will save the lives and/or reduce the number of disabilities of children in the United States. With the introduction of every new vaccine, rates of both disease and deaths have fallen across the country."

Carson then dug himself even deeper into the anti-vaccine camp with this claim:

"But it is true that we are probably giving way too many in too short a period of time."

This claim is right out of the anti-vaccine playbook: it was the basis of the "too many, too soon" campaign launched by Jenny McCarthy's Generation Rescue, the country's leading anti-vaccine activist group. In fact, the vaccine schedule is very safe, and misinformation like this trope leads to parents withholding vaccines from their children, which in turn can cause sickness, disability, and death.

Let me show you what Carson could have done. Six years ago, Bill Maher–one of the most left-wing talk show hosts in the media, and an anti-vaxxer himself–was interviewing former Republican Senate majority leader Bill Frist, who is also an M.D. Here's what happened:

Dr. Frist interrupted Maher and said "wait, this is important," and proceeded to school Maher on how vaccines save lives. I wasn't a big fan of Frist, but he did a fantastic job here. Carson, in contrast, just pandered to the audience, and to Trump.

The moderator also asked Rand Paul, the other M.D. among the candidates, to respond to Trump's anti-vax claims. He too repeated the anti-vaccine trope that he "ought to have the right to spread my vaccines out a little bit." This is nonsense as well: Paul does have that right, and no one has ever proposed taking it away. It's bad medicine, though, and as doctor, Paul should know better. He failed as well.

It's far more harmful to the public when a high-profile doctor makes anti-vaccine statements than when a blowhard like Trump makes them. Dr. Ben Carson and Dr. Rand Paul should both know better.

California passes pro-vaccine bill, protects children

In a victory for children’s health, California passed a new law this week removing the “personal belief” exemption from the state’s vaccine requirements for children. Assuming that Governor Jerry Brown signs the bill this week–which no one is certain about–California will be transformed from a haven for anti-vaccine demagoguery to a state that protects children instead.

How this came to pass is a long tale, but the immediate impetus was the outbreak of measles in Disneyland in January–the worst outbreak in 20 years–which spread mostly through unvaccinated children. During that outbreak, we learned that in some areas of California, anti-vaccination hysteria had grown so widespread that more than half the children in some schools were unvaccinated.

And just three years ago, California had the worst whooping cough epidemic in 70 years, thanks to the anti-vaccine movement.

After the recent measles outbreak, California state Sen. Richard Pan, who is also a pediatrician, introduced SB 277 to remove personal and religious exemptions from vaccines in the state. In February, he and I were guests together on an episode of NPR's On Point with host Tom Ashbrook discussing this issue. Senator Pan spoke passionately and from direct experience about the need to protect children from disease. 

All states in the U.S. require children to be vaccinated in order to attend public schools, a policy that has been the foundation of our national effort to control infectious diseases. Under California’s current law, parents can opt out of vaccines for their children for almost any reason, simply by claiming a “personal belief” exemption. Anti-vaxxers have encouraged parents throughout the state to use this law to withhold vaccines from their children.

With this new bill, California moves back into the modern age. Without vaccinations, hundreds of thousands of children in the U.S. would get sick every year with measles, mumps, whooping cough, chicken pox, and other diseases. Thousands would die, and tens of thousands would be permanently injured. School-based vaccination policies have essentially eliminated these diseases from the U.S. in recent decades. I should add that SB 277 still allows medical exemptions, for those (rare) cases where a child has a legitimate medical reason (for example, because he/she is undergoing chemotherapy to treat cancer) to forego vaccination.

Ironically, vaccines’ very success has allowed anti-vaccine propaganda to spread. Vaccines have been so successful that most people don’t even remember the era when these diseases were a constant fear of childhood. Thus when anti-vaxxers spread (erroneous) claims that vaccines cause harm–most notoriously, that vaccines cause autism–new parents sometimes become convinced that the potential harm isn’t worth the benefit. Vaccines are safe, as the Institute of Medicine explained in a detailed report not long ago, and they are enormously beneficial.

Anti-vaxxers will continue to make extreme, and erroneous claims about vaccines. Just two months ago, the noted anti-vaxxer Robert F. Kennedy Jr. was in California campaigning against SB 277, calling vaccines a “holocaust” – perhaps the most extreme scaremongering I’ve seen on this issue. An anti-vax group called A Voice for Choice announced Thursday, after the vote, that they are “pulling out all the stops” and will try to challenge the new law in court.

Let’s hope that reason wins out–that Gov. Jerry Brown signs the bill and that California’s children are once again protected from vaccine-preventable diseases. We shouldn’t need another measles or whooping cough outbreak, or any more children dying of preventable diseases, to convince people once again that vaccines save lives.

MMR vaccine (still) doesn't cause autism, new study finds

Nope.

We’re still spending vast amounts of time and money trying to counter the ill effects of a discredited, retracted paper from 1998 that claimed to find a link between the MMR (measles, mumps, and rubella) vaccine and autism. Even after the The Lancet retracted the study, and even after the British Medical Council revoked the medical license of its lead author, Andrew Wakefield, many people continue to withhold vaccines from their children because of a fear that somehow, despite all the evidence to the contrary, vaccines might cause autism. Vaccines, I hasten to add, have saved millions of lives and are probably the greatest medical advance of the past two centuries.

Now another study has appeared to add more weight to the evidence about the safely of the MMR vaccine. The new study by Anjali Jain and colleagues, just published in the Journal of the American Medical Association, looked at a huge number of children–95,727–for evidence of any link between autism and the MMR vaccine.

The results were not surprising, to those who have been following the science. To quote the conclusions directly: 

“Receipt of the MMR vaccine was not associated with increased risk of ASD [autism spectrum disorder], regardless of whether older siblings had ASD. These findings indicate no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD.”

That should settle it, right? But then, dozens of previous studies should have already settled this question. Unfortunately, due to the ongoing activism of anti-vaccine groups such as Age of Autism, (who already attacked this new study) and to conspiracy theorists such as Robert F. Kennedy Jr. (whom I wrote about last summer, and who was campaigning against vaccines in Vermont just last week), misguided claims that vaccines cause autism or neurological problems persist.

Here are the numbers from the new study. The authors compared vaccinated children to unvaccinated children, using a huge database of medical claims that included at least 5 years of followup. (This was an "observational" study, by necessity–it would be unethical to withhold vaccines from children on purpose.) The relative risk for autism in children who had 2 doses of the MMR vaccine (the recommended amount) compared to unvaccinated children was 0.74. In other words, a child was somewhat less likely to be diagnosed with autism if he or she were vaccinated. 

Even more surprising was the relative risk among children who had an older sibling with autism: in this smaller group, children with 2 doses of MMR were just 44% as likely to be diagnosed with autism as unvaccinated children. This statistically significant finding indicates, unexpectedly, that vaccines might actually protect children from autism.

The authors were quick to note that there are other good reasons for this apparent protective effect of vaccines: in particular, if parents of autistic children withheld vaccines from their younger children, this could explain the effect. Why? Because we know that autism has a genetic component, and that if one child has autism, his younger sibling is more likely (because they share many genes) to have autism as well. Jain and colleagues explained that if these parents withheld vaccines–because of fears spread by the anti-vaccine movement–then their children could contribute to the apparently lower rate of autism in children who were vaccinated. The authors couldn’t rule out a protective effect of vaccines, but scientifically it seems unlikely, and they wisely offered an alternative explanation.

So: once again we have a large, carefully conducted study showing that the MMR vaccine does not cause autism, and even finding evidence that vaccinated children have lower rates of autism. Let's hope this study helps to end the anti-vax movement, so that we can soon stop spending time and money trying to refute their long-discredited hypotheses and instead focus on trying to understand the true cause.

“Shocking Report” on flu vaccines is neither shocking nor correct

Flu season is coming, and once again it’s time to get your flu shot (or snort, if you prefer FluMist). It’s not perfect, but the vaccine is your best protection against the influenza virus.

So I was surprised to stumble upon an article titled “Johns Hopkins Scientist Reveals Shocking Report on Flu Vaccines,” which popped up on an anti-vaccine website two weeks ago. Johns Hopkins University is my own institution, and I hadn’t heard any shocking new findings. I soon discovered that this article contained only a tiny seed of truth, surrounded by a mountain of anti-vaccine misinformation. Most of it focused on a report published in early 2013 by Peter Doshi, a former postdoctoral fellow at Hopkins.

First, as Snopes.com has already pointed out, Doshi is not a virologist or an epidemiologist, but rather an anthropologist who studies comparative effectiveness research. He never conducted influenza research at Hopkins. (He’s now an Assistant Professor at the University of Maryland’s School of Pharmacy.) Second, Doshi’s 2013 article was an opinion piece (a “feature”), not an original research article, and it did not report any new findings. Third, it is highly misleading to suggest (as the anti-vax article’s title does) that Doshi somehow represents Johns Hopkins University. At Johns Hopkins Hospital, the flu vaccine is required of all personnel who have contact with patients, as a good-practices effort to minimize the risk that a patient will catch the flu from a caregiver.

But what did Doshi’s article say? Even though it isn’t new, why are the anti-vaccine sites recycling it? His central argument is this:

“The vaccine might be less beneficial and less safe than has been claimed, and the threat of influenza appears overstated.”

Let’s look at this statement. It’s almost obviously true: one only has to find a few overstated claims about the risks of flu, which isn't hard to do. But it’s also completely consistent to state that the vaccine is enormously beneficial and that the threat of influenza is very serious. See how that works? 

Doshi uses this slight-of-hand to suggest that the vaccine may not be beneficial at all. He never says this outright—instead, he just questions, again and again, whether the precise percentages reported in published studies are accurate. For example, he makes a big deal of a CDC announcement in 2013 that the vaccine’s effectiveness was only 62%. He casts doubt with phrases like 

“the 62% reduction statistic almost certainly does not hold true for all subpopulations”

which is almost certainly true, but is meaningless from the point of view of public health. Of course the vaccine doesn’t have the same effectiveness in everyone. The point is that it works most of the time. 

Doshi cites another study that showed a clear benefit for the flu vaccine, only to cast doubt on it with this argument: 

“No evidence exists, however, to show that this reduction in risk of symptomatic influenza for a specific population—here, among healthy adults—extrapolates into any reduced risk of serious complications from influenza such as hospitalizations or death in another population.”

Again, Doshi’s argument doesn’t prove that the original study was wrong, only that it doesn’t apply to everyone. But Doshi’s motivation, as evidenced by the relentlessly negative slant of his entire article, seems to be to convince people that the flu vaccine is bad.

Not surprisingly, the anti-vaccine movement has embraced Doshi (for example, here and here). And unfortunately, he seems to have accepted their acclaim: in 2009, he spoke at an anti-vaccine conference hosted by NVIC, a notorious (and misleadingly named) anti-vaccination group.

Perhaps even more disturbing is that Doshi signed a petition arguing that the HIV virus is not the cause of AIDS, joining the ranks of HIV denialists. He signed this statement while still a graduate student, so I contacted him to ask if he still doubted the link between HIV and AIDS. I also asked him if he supports flu vaccination, if he agrees with the anti-vaccine movement's use of his statements, and if he believes the flu is a serious public health threat.

On the question of signing the HIV/AIDS petition, Doshi responded that "Seeing how my name was published and people have misconstrued this as some kind of endorsement, I have written the list owner and asked for my name to be removed." (He declined to state directly - and I gave him the chance - that he agrees that the HIV virus causes AIDS.)

As for the flu itself, Doshi says "I don’t agree with CDC’s portrayal of influenza as a major public health threat." So he and I have a serious disagreement there. I asked if he agrees with the anti-vaccinationist who are using his writings to claim that the flu vaccine is ineffective, and he replied that while "ineffective" is "too sweeping," he has found "no compelling evidence of hospitalization and mortality reduction in [the] elderly."

Doshi’s argument against the flu vaccine boils down to this: the vaccine is much less than 100% effective. This is undeniably true, and the research community makes no secret of it. In fact, many of us have repeatedly called for more research into better vaccines, in the effort to create a vaccine that is not only more effective, but that (like most other vaccines) only needs to be taken once for lifetime immunity. We’re just not there yet. Meanwhile, though, the annual flu vaccine is usually effective: a recent study showed, for example, that it reduced children’s risk of ending up in a pediatric intensive care unit by 74%.

So get your flu shot (or snort) now, before flu season hits, because it takes a couple of weeks for your body to develop immunity. By getting immunized, you’ll not only increase your chances of getting through the winter flu-free, but (because you won’t spread the flu to others) you might also save someone whose immune system would be overwhelmed by influenza.