Denialism: ‘Researching’ the case against vaccines

Some of the most error-laden claims coming from those who deny the safety and efficacy of vaccination are accompanied by the confidence of having done their ‘research’.

However there is no way one could properly research, evaluate or study the risks and benefits of vaccination, and ultimately conclude to deny their children the protection it offers. There is no way one could properly educate themselves on the topic and actively entertain the inaccurate mantras used by anti-vaccine lobbyists. Certainly this so-called research shows no sign of being properly guided or assessed for basics such as structure, source material or conclusion.

In fact that last sentence above could apply to many areas other than vaccination. David Dunning and Justin Kruger hypothesised and successfully demonstrated a cognitive bias linked to intellectual skill. Their conclusions are examined in a 2010 episode of The Science Show. The synopsis opens with: The dumb get confident while the intelligent get doubtful. Whilst the “Dunning-Kruger effect” quite rightly takes its place in examining and explaining the phenomena, it has been noted by great thinkers for centuries.

Take this mother interviewed in a masterpiece of false balance cobbled together by Today show reporter Lauren Ellis. It’s true that the ability to gauge risk is not a natural skill in the absence of education and contemplation. We’re hard-wired to choose being safe over sorry. But one cannot objectively or conclusively “look into” the ‘flu (or any) vaccine and decide against it on that basis. The certainty this woman “studied” misinformation and evidence denial is confirmed by the rest of her comment:

When I looked into the ‘flu vaccine it wasn’t proven to be 100% safe. I made a choice that I was going to do the best that I could do to build up their immune systems through whole foods, active exercise and having a loving and caring environment at home. We actually want to invite those kinds of sicknesses into the body because that’s the body’s natural way of boosting its defences.

Along with overestimating their own level of skill the Dunning-Kruger effect lists the failure of the cognitively-challenged to identify genuine skill in others. Our subject is right on cue, later adding; “I think what we do is we cheat a little bit and we listen too much to the doctors”.

Attempting to take more responsibility for one’s health is by itself a positive trend. However the reality is that through a combination of poor regulation, apathetic accreditation, unchecked claims and lucrative scams, an industry has grown from marketing “wellness” alongside denialism. A vital skill today is that required to recognise reputable sources and source material. There is so much specialty, knowledge and experience attached to individual areas of health and medicine that ascertaining expert advice is essential.

Such a skill – let’s call it a research skill – by no means only applies to the choices we make around health, medicine and alternatives to medicine. But the amount of information is so vast and varied that intellectual tools independent of the information presented are more than likely to serve us well. More so, we are all subject to cognitive biases such as pattern recognition or emotional resonance such that we may easily hijack our attempt at objectivity.

Thus a research skill that values evidence and source, based upon merit, helps keep both ‘researcher’ and material in check. Those fortunate enough to be familiar with the scientific method apply a more complex type of such thinking. Individual topics and subject matter can be quite complex but appreciating the scientific method itself and it’s impact on scientific consensus is well within the grasp of interested individuals. Enter Scientific Denialism, which I’ve already quite purposely mentioned alongside marketing (or promoting/defending aspects) of the “wellness” industry.

Diethelm and McKee presented a Viewpoint piece in the European Journal of Public Health in 2009 entitled; Denialsm: what is it and how should scientists respond? They cite the definition of Mark and Chris Hoofnagle:

The employment of rhetorical arguments to give the appearance of legitimate debate where there is none, an approach that has the ultimate goal of rejecting a proposition on which a scientific consensus exists

The Hoofnagle brothers identify five elements of denialism that are employed alone or together. All five can be found with numerous representations emanating from the anti-vaccination sector.

Conspiracy Theories are employed to dismiss scientific consensus arrived at via the peer review process. Granted, the conspiracies advanced by the bulk of anti-vaccination identities go well beyond this goal into rambling nonsense. The Big Pharma Monopoly conspiracy has become a monster of ludicrous proportion. There are examples of unacceptable conduct and flawed research by pharmaceutical companies, that if presented rationally and sparingly might help support criticism of vaccines or their method of use.

Continually serving to delight critics of the anti-vaccination movement in Australia is perpetual “PhD candidate”, Judy Wilyman of Wollongong University. Her thinking, and consequent tone of argument or demand levelled at government, appears crippled by belief in a vast web of conspiracies. Doctors will lie, research conducted by drug companies is by default corrupt, science advocacy groups are motivated to support this corruption – and by extension the member’s arguments are to be dismissed. The government assisted “crime against humanity” of vaccination is helped along by corrupt media and grieving parents relaying “anecdotes” of infant fatality. This is all designed to entrap the community (for whom Judy speaks) using fear and guilt.

Not surprisingly her supervisor is well known for his authorship of scientific denialism. A strident defender of the anti-vaccine and several conspiracy movements, Brian Martin (of Wollongong University) has written frequently on the topic of supposed scientific dissent. He validates the Hoofnagle brothers observation that the peer review process is to the conspiracy theorist a means to suppress scientific dissent. As I’ve noted before, Martin writes in Grassroots Science:

Dissent is central to science: the formulation of new ideas and the discovery of new evidence is the driving force behind scientific advance. At the same time, certain theories, methods, and ways of approaching the world – often called paradigms – are treated as sacrosanct within the professional scientific community. Those who persist in challenging paradigms may be treated not as legitimate scientists but as renegades or outcasts. [...]

For example, there are many individuals who have developed challenges and alternatives to relativity, quantum mechanics, and the theory of evolution, three theories central to modern science. [...]

Western medical authorities at first rejected acupuncture as unscientific but, following demonstrations of its effectiveness, eventually accepted or tolerated it as a practice under the canons of western biomedicine, rejecting its associations with non-Western concepts of the body. [...]

At the same time, some mainstream medical practitioners and researchers are hostile to alternative health. This is apparent in pronouncements that taking vitamin supplements is a waste of money or in police raids on alternative cancer therapists, the raids being encouraged by mainstream opponents.

Many proponents of alternative health say that mainstream medical science is distorted by corporate, government, and professional pressures. In this context, grassroots medical science presents itself as being truer to the ethos of science as a search for truth unsullied by vested interests.

Brian Martin also happens to excel at that exceptional variant of conspiracy theory known as inversionism. Here one’s own tactics and motivation are attributed to critics or those who can justify the antithesis of one’s argument. In Suppressing Research Data: Methods, Context, Accountability, and Responses Martin writes:

Censorship, fraud, and publication biases are ways in which the availability of research data can be distorted. A different process is distortion of the perception of research data rather than distortion of the data itself. In other words, data is openly available, but efforts are made to shape people’s perception of it.

Although this perfectly describes tactics of the anti-vaccination lobby, Martin is writing about what he argues is a regular process in legitimate science and the peer review process.

Diethelm and McKee note that whilst the proper avenue to validate supposed suppression of dissent is ignored by conspiracy theorists, denialism can and does exploit genuine concerns. For our purposes we may note that unethical and dishonest conduct by pharmaceutical companies has indeed occurred. Also the 2006 CSL trial of Fluvax resulted in just one adverse reaction. “Not usually regarded as an adequate signal of a major safety problem”, according to a TGA spokesperson. That single febrile seizure was equal to 0.37% of the study sample. In hindsight a valid predictor of the 0.33% rate of febrile seizures W.A. experienced in April 2010.

Health authorities and practitioners take evident problems with the pharmaceutical industry very seriously. In the case of vaccination it’s perhaps testament to the addition of truly absurd conspiracies and the overlap with New World Order themes that has seen the anti-vaccination lobby squander a potentially effective means to sew their false doubt.

A second feature of denialism is the use of Fake Experts. An excellent example of this is the appalling HIV/AIDS Rethinkers list. If subject to the criteria of listing individuals actually working in the field of HIV from which the theory being “rethought” is sourced, the list would disappear. So it is with the academic integrity of vaccine denialists.

Some such as Meryl Dorey of the Australian (anti) Vaccination Network simply append the title of expert to themselves. All that’s needed is the familiar claim of having “researched” the subject for “twenty years”, whereas doctors (Meryl assures us) study vaccines for only six hours. Few can validate the Dunning-Kruger effect better by insisting smallpox and polio were merely renamed (part of a conspiracy), vaccines certainly cause autism (thousands of documented cases), SIDS, death, shaken baby syndrome and more.

The use of so-called experts who argue in opposition to established knowledge is spread across a diverse field in the case of vaccine denial. Micropalaentologist Viera Scheibner makes much of her title of “doctor”, deceitfully selling herself as a natural scientist who worked for a state authority. A host of chiropractors already in denial of science based medicine see fit to both parrot the standard anti-vaccine rhetoric whilst arguing the immune system can be specifically modulated by chiropractic.

Anti-vaccine groups pay great attention to scam artists such as Dr. Joe Mercola, Mike Adams and Barbara Loe Fisher of the official sounding National Vaccine Information Center. Father and son team Mark and David Geier promote both the belief vaccines cause autism and an abusive hormonal ‘treatment’. They have authored and co-authored a number of papers attempting to link vaccines to autism. Mark Geier has lost his licence to practice in at least 10 USA states.

Sites such as SaneVax or Age of Autism with Dan Olmsted and Mark Blaxill seek to continue the attack on reputable scientists and research. In Australia the new AVN president Greg Beattie describes himself as an author having produced bogus claims, misleading data and irrelevant mortality graphs whilst the universally condemned Melanie’s Marvellous Measles was written by anti-health zealot, Stephanie Messenger. Any of these, or similar identities along with the nonsense they write may be produced by anti-vaccine lobbyists to ‘refute’ genuine evidence-based knowledge on vaccination.

Cherry Picking or Selectivity is a practice the anti-vaccination lobby relies heavily on. Sadly, their harvest is so woeful that we are continually treated to Andrew Wakefield’s discredited and withdrawn Lancet paper, from which the fallacious association with autism is fuelled. Additionally an unproven handful of purported dishonesty levelled at his most effective critics or their careers hovers about regularly “vindicating” Wakefield. This by extension proves vaccines do cause autism, a conspiracy rages against Wakefield and the fake experts have been right all along.

Of course selective use of material and events can have enormous impact. Imagine the magazine Mothers For Moonbeams publishes a piece on the W.A. Fluvax episode and the impact on Saba Button presented selectively with concerns about the increase in the number of childhood vaccinations. Add the type of nonsense written by Natasha Bita in August 2012 falsely “linking” ten deaths to Australia’s influenza vaccine, to “PhD candidate” Judy Wilyman’s claim that vaccines are full of lethal “toxins”, and readers’ confidence in influenza vaccination can fall.

We constantly hear of vaccine-injury compensation cases involving autism-like symptoms, misrepresentation of the Bailey Banks case or a finding from an obscure Italian court as evidence vaccines really do cause autism. Similar selections can be made for a range of conditions unrelated to vaccination.

Similarly, alternatives to medicine used to “boost immunity” rely on sparse and often irrelevant research into (for example) St. John’s Wort or vitamin deficiency. It will come as no surprise to those familiar with vaccine denialists that Diethelm and McKee note that the towering isolation of the denialists position does not perturb them. Rather they see this as reason to liken themselves to Galileo.

Impossible Expectations from research are used often to create the illusion of doubt or bias. The infamous cry for a study of unvaccinated vs vaccinated children both suggests the efficacy of vaccines has never been properly established, whilst hinting that the unvaccinated are healthier due to the absence of artificial immunity and vaccine toxins. Not only is this absurd from an ethical viewpoint, methodologically it is nonsensical.

In order to correct for the variable of herd immunity, the unvaccinated sample would need to be isolated. In doing so the sample is rendered entirely unrepresentative of the qualities that supposedly need to be tested. More so this research need not be done. The impact of mass vaccination is clear – particularly with the return of diseases following a drop in vaccine uptake.

Gradually the ‘demand’ that vaccines show a 100% rate of safety and efficacy has emerged in more unreasonable quarters. Combined with the inability to acknowledge that as herd immunity drops, both vaccinated and unvaccinated are at increased risk, this impossible expectation ensures the anti-vaccine lobby can ignore basic community responsibility.

Again with alternatives to medicine or seemingly magical ways to fight disease and boost immunity, it is expected that science – or better yet, quantum science – will explain the mechanism behind promises and testimonials.

Finally Misrepresentation and Logical Fallacies are essential tools of the denialist. A very simple, yet highly effective means of misrepresenting the irresponsibility of vaccine denial has been use of the term “pro-vaccinators”. This conveys the impression that not only does a legitimate debate exist but that those unburdened by the delusion vaccination is harmful, may be motivated by ideology or some other non-evidence based reason.

Meryl Dorey of Australia’s AVN frequently insists to have a database listing death and disability from vaccine injury. This same theme of having a vaccine-injured child is presented by individuals both as a reason to attack vaccination and unleash abuse on those who accept vaccine safety. Indeed the correlation as causation fallacy is a primary of the anti-vaccination movement.

Slippery slope, appeal to authority, straw man arguments, inconsistency and more. Logical fallacies abound. Reductio ad absurdum is favoured commonly in explaining that conventional scientists or medical practitioners will defend vaccination because of their position and not the efficacy and safety of vaccines. On the other hand as Judy Wilyman argues, because areas of some affluence may have low vaccination rates this is proof that doctors do not vaccinate their children. Therefore, they are withholding information.

An example of misrepresentation through inconsistency and non-sequiter is the claim that vaccine preventable diseases were under control before mass vaccination. Heavily doctored graphs using the variable of mortality – not incidence or morbidity – peddle the falsehood that vaccines had no effect on disease whilst improved living standards led to their demise.

Bereft of evidence, vaccine denialists place significant energy in convincing their unfortunate devotees that the very fabric of democracy and the right to “health freedom” is under threat. Donate enough money to the AVN and you can save free speech and ensure looming mandatory vaccination is kept at bay. Evoking anger, disgust and suspicion toward those who challenge vaccine denial is a staple of anti-vaccine groups.

♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

It takes little work to find anti-vaccine articles or identities that present all five aspects of denial in the one argument. Conspiracy theories and fake experts have carved out their own canyon sized themes over the years. Meryl Dorey’s obsession with “real scepticism” and her website aiming to mock scientific skepticism reinforces how effective evidence based deconstruction of her denialism has been.

Ultimately, understanding these tactics and how denialists use them reinforces the argument that accepting to debate a certain topic can be counterproductive. The debater who holds to evidence and argues within the constraints of the scientific method or present consensus, must face an opponent with no regard for truth, logic or bipartisan discourse.

Rather than focus on the topic at hand an effective technique would be to expose the tactics used in vaccine denial. Those engaged in denialism do not deal in evidence or seek to bring about a greater good through the application of truth.

Therefore it’s important that scientific skeptics and health professionals continue to expose vaccine denial for what it is.

As for budding ‘researchers’. They can be rightly satisfied with skills that lead one to reputable source material.

The anti-vaccination lobby’s long history

Hat tip to @BadScienceWatch.

From Jenner to Wakefield: The long shadow of the anti-vaccination movement


From YouTube Description:

In 1998 a medical furore broke out when The Lancet published an article by Andrew Wakefield questioning the benefits of the MMR vaccination which was being given unquestioningly to children throughout the UK.

Coming 202 years after the first vaccination by Edward Jenner, which led to the eradication of smallpox throughout the world, this recent incident is only the latest in a long history of questioning the benefits of vaccination.

From early irrational fears born of outdated medical understanding through to the latest medical research and findings, Professor Gareth Williams traces the history of the anti-vaccination movement and its long tail, reviewing the social settings in which the fears were found and offering a balanced assessment of vaccination as we find it today.

The transcript and downloadable versions of the lecture are available from the on the Gresham College website:

http://www.gresham.ac.uk/lectures-and…

Gresham College has been giving free public lectures since 1597. This tradition continues today with all of our five or so public lectures a week being made available for free download from our website.

http://www.gresham.ac.uk

Climate science infographic

Of 13,950 peer reviewed papers on climate published between 1991 and 2012, only 24 reject global warming.
Climate change infographic

Thus, it’s a safe bet that denial of global warming is not based on science.

Cannabis misinformation and the anti-drug lobby

The most dangerous aspect of drug use is that the chemical becomes the centre of life, leads to physical debilitation after tolerance is reached, and no amount of drug produces the necessary euphoria – only coma or suicide are left

- Herschel Mills Baker (Drug Free Australia)

“Suicide/Schizophrenia: Consequences of acute and chronic cannabis use” -

A recent thread on Facebook gave me cause to reflect upon the impact that the anti-drug lobby has had upon community perception of evidence specific to cannabis, its use, abuse and potential.

This perception of course can be traced in part to sensational media headlines following the release of research into the effects of chronic cannabis abuse. Yet the anti-drug lobby has been willingly involved in the perpetuation of self serving and frequently egregious falsehoods that have left inhumane policy sabotage and damaged individuals in their wake. Worse, the very real and well understood problems associated with cannabis abuse have been scattered by the gale of “cannabis psychosis”.

I should stress this is not a pro-drug nor pro-cannabis post. If anything it is a pro-evidence post and I would hope readers can reflect upon the value of evidence in a human rights manner, much as we do in a consumer rights manner. As I suggest under my “About” tab, skeptics make excellent agents of morality because they are agents of evidence. This isn’t to suggest one is endowed with superior morale. Rather, one is bound to reject subjective and predisposed constraints in favour of evidence.

An effective informed policy on cannabis use should not slant only toward the harms caused by its use but also by the harms caused by the social measures/existing policies designed to control or prevent its use. Cannabis is not a hard drug. Cannabis is not a soft drug. Cannabis is a drug, and as such deserves the respect that science and apolitical critiques can bring.

The nonsense above was originally written in 1988 and has been continually polished and rephrased over the years. Its most recent incarnation was Cannabis – suicide, schizophrenia and other ill effects, uproariously tagged “First Edition, March 2009″. Subtitled A research paper on the effects of acute and chronic cannabis use, it is in fact a biased selection of literature. Not research, nor literature review.

Cannabis “potency” is a key driver of fear and a launch pad for ongoing misinformation. This area is fraught with notable disrespect for variables involved. Is “potency” THC content per volume? If so, what strains grown under what conditions provide conclusive answers? Or does one compare the hashish and hash oil of the 1970s and 1980s (at around 20% THC content) with todays plants? If so, what of the famed sinsemilla grown for decades?

DFA choose to refute Australia’s peak illicit drug body, the ANCD, and their “Evidence-based answers to cannabis questions: a review of the literature” (2006), which concluded no significant increase in THC content had occurred. This was challenged by the unqualified lobbyists with a preposterous figure of 30% THC content from an apparent – and unsourced – 1993 Australian Bureau of Criminal Intelligence claim. Readers were to be very afraid as the equally preposterous and unsourced joint potency from the 1960s was 0.5%

Could this even be true?

In THC content of cannabis in Australia: evidence and implications, Wayne Hall and Wendy Swift reported in 1999:

The major obstacle to testing these claims is that the THC content of cannabis products has not been systematically tested by any Australian police force over the period in which average THC content has been claimed to have increased.

Well, no it appears to be fiction.

So why are DFA misleading the public this way? A primary area of community confusion and angst is the poorly reported association between psychosis and cannabis. The most fallacious is the “puff-puff, go mad” claim. It terrifies parents and this fear can persist in the absence of evidence. I must stress that negative experiences associated with ingesting THC can certainly be exacerbated by ingesting a volume of cannabis that contains more THC than a user is accustomed to. I’m not attempting to refute this possibility. I would add however, that user titration gives control to the cannabis user over the amount ingested. In this light a number of claims pushed by DFA demand criticism.

Primary is that DFA claim that the introduction of hydroponic cannabis (itself a spin-off of prohibition’s failure) brings with it [page 11]:

…a well demonstrated dose-response relationship between cannabis and its related drug-induced psychosis, where the greater amount of cannabis consumed correlates to a higher degree of risk of psychosis any three to fourfold increase is absolutely critical in any assessment of cannabis harms. When it is further considered that changed usage patterns, whereby users smoke only the multiple potent heads of the cannabis plant… the ANCD paper’s approach to potency is of concern.

Again, as we shall see below, this is not backed by evidence. What is drug-induced psychosis in this context? Sure, hydroponic production has provided the equivalent of sinsemilla-type product to users. Yet DFA then go on to cite the ANCD paper which confirms a tripling of THC figures in the USA. Quite correctly there is no reason to suggest this hasn’t occurred here, yet as the paper notes:

…the majority of THC levels in studies of [USA] cannabis seizures have remained under 5%.

So the ANCD conclusion that no evidence exists for huge THC increases in recent decades is valid. If anything users have more of the THC rich component of the plant, and less of the THC poor component. Hydroponics ensures rapid maturation and more flowering (head). Per plant there is more THC rich matter. But that matter is not notably more THC potent.

I hate to excessively mull this over, so to speak, but once again prohibition has placed better drugs for the same price into the hands of Aussie kids.

Let’s consider DFA’s claim that, “users smoke only the multiple potent heads of the cannabis plant”. They are challenging figures from 1970 to 1997. Returning again to Hall and Swift 1999, we see on page 8:

HallandSwift_type of cannabis smoked

So consumption of “skunk” or “super-skunk” that DFA claim is driving kids insane increased as much as leaf in the 14-19 year old group, from 1995-1998. Yet head seems to be the main product. Nonetheless users are not “smoking only multiple potent heads”. Which sounds more scary than just “heads”, one presumes.

Under Changing Patterns of Cannabis Use, Hall and Swift write on page 7:

The media preoccupation with the THC content of cannabis has distracted attention from other causes for concern about changing patterns of cannabis use among Australian adolescents and young adults. These patterns of cannabis use, which may encourage younger users to use more potent forms of cannabis, may also increase their chances of developing problems as a consequence of their cannabis use.

This is of course, exactly the point. By pursuing sensationalism, co-morbid health problems and negative lifestyle changes are frequently ignored. That this has been willingly and eagerly encouraged by groups such as DFA as part of their agenda to encourage blanket illicit drug zero tolerance and the public health damage this brings, is deeply concerning.

In 2009 this manuscript of misinformation was used to lobby independent conservative QLD MP, Peter Wellington to push for the old DFA staple of School Drug Testing. Such tactics are typical of the evangelical crusade waged by this conservative Christian group. The Australian National Council on Drugs concluded in 2007 that SDT was technically unreliable, cost prohibitive, morally and legally problematic, prone to exacerbate problems faced by at-risk children, designed to normalise punitive measures and fraught with false positives.

You can read more here about Drug Free Australia and their campaign against evidence. Or just marvel at a school kid’s drawing of God espousing “be drug free and you’ll be with me”. It isn’t just punitive policies DFA seek but a quite inhumane roll back of Harm Minimisation strategies, particularly those involving harm reduction. Whilst it is unacceptable for young Aussies to be under the impression cannabis is entirely safe, we can see without much effort how a spike in reports on cannabis and psychological harm has been exploited.

Claims that cannabis is supposedly endowed with benign or even beneficial properties because it is “natural” are equally concerning. The notion that if something comes from the earth it’s therefore by default superior to a manufactured pharmaceutical analogue is certainly not backed by evidence.

In fact this point is ripe for confusion about the role of evidence, its import and what might be termed insults from intuitive reasoning. Cannabis use as a recreational drug is defended at times with argument from antiquity. Combined with the “mother earth” line it may sound quite compelling. Like many alternatives to medicine (such as TCM), cannabis is also subject to further defence with argument from antiquity. According to The Mayo Clinic medicinal use can be traced back 5,000 years. Yet a crucial distinction is made here.

Research into the medicinal benefit of cannabinoids or their application as medication is quite different from inhaling cannabis smoke and expecting better health. There is quite a lot of rot about cannabis being medicinally magical. Whilst there is some potential for a rather large range of symptoms and side effects, grasping impact on actual pathologies demands extensive investment in research.

As abundantly hinted at above, perhaps the most alarming and challenging theme I’ve faced in recent years is the media construct that cannabis “causes” psychosis or schizophrenia. The primary reason this created so much angst in the illicit drug policy and discourse deconstruction fields was the immediate negative impact on management of the many known psychological issues. The 2007 meta-analysis by Moore et al published in The Lancet was seized upon as conclusive evidence.

It remains an excellent review, and fortunately drew much needed explanation about the nature of meta-analyses and in particular that of Moore et al. Amidst the frustrating and very disappointing bad science reporting to follow (including one of the worst by Australia’s own Jonica Newby on ABC’s Catalyst), were calmer voices such as that found on Storied Conduct: Resources and News in Psychology.

Correlation, as our basic research theories tell us, can never prove causation. All of the studies examined by Moore et al. (2007) were correlational in nature. Further, the additional use of meta-analytic grouping techniques cannot turn correlational data into experimental data no matter how sophisticated the statistics. This means that, while the trends and the thrust of the data seems to make marijuana a very promising explanatory causal factor in the development of some of the psychoses that these research participants developed, such a link has not been conclusively demonstrated. And, while the gross odds ratio speaks of a 41% increased risk, the authors themselves acknowledge the impact of confounding and other variables in lowering the risk percentage in the studies they examined. Hence, we are left without a good estimate of what the actual increased risk might be.

The number of media articles poorly reporting findings grew steadily over three to four years. Diligently a steady number of D&A workers, bloggers and independent media contributors used a dual method of exposing predetermined agendas and explaining the results in proper context. Generically speaking – and I stress generically – the headline “Cannabis induced psychosis increases 300% in two years scientists find”, might pop up. On examination it reflects that a sample with 0.2% predisposition to psychotic episodes had two years later, under different methodology, been found to present a 0.6% prediction to experience the transient psychosis they are genetically predisposed to, had they continued to smoke cannabis heavily for another decade.

One of the sadder developments was the establishment in 2008 of the National Cannabis Prevention and Information Centre. The NCPIC. Coined the National Cannabis Propaganda and Infotainment Centre by a contributor to a professional e-list, it regretfully offers themes well documented as not being efficacious in reducing cannabis abuse. In 2009 NCPIC head Jan Copeland was pulled up by the same publication for dodging the need to publish bipartisan research.

The NCPIC is in the habit of presenting the style of faux science we see above from DFA and also using alarming distortion of facts in their supposed quest to “prevent”. The public is seemingly deemed at risk from balanced information which is substituted with bias and deception. In view of the documented harm this approach leads to it is not good enough for a tax payer funded organisation.

One of the best papers I’ve read is Continued cannabis use and the risk of incidence and persistence of psychotic symptoms: 10 year follow up cohort study, by Kuepper et al. This paper controlled very well for baseline incidence (Eg: self medication of psychosis/schizophrenia, supplementation of low cerebral anandamide [thus proposed alleviation of psychotic symptoms] via cannabis, cumulative effect of CBD’s anti-psychotic properties, other drugs, unstable lifestyle, etc.

In doing so, they thus also controlled for the host of suspected [exact cause remains unknown] causes of psychosis (stress, genetic predisposition, changes at puberty, assault, major life changes, biological causes, neuroses etc). This was itself arguably misused by Professor Jan Copeland who we’ve just met.

Wayne Hall and Louisa Degenhardt contributed an excellent review [BMJ 2011;342:d719] at the time. They noted the superior methodology and also that:

In the light of these findings and those of earlier studies, it is likely that cannabis use precipitates schizophrenia in people who are vulnerable because of a personal or family history of schizophrenia… A modelling study suggests that we would need to prevent 2018-4530 young people in the United Kingdom from becoming regular cannabis users to prevent one case of schizophrenia, or to prevent four to five times as many (10,000-23,000) from light cannabis use to achieve the same result.

Of course schizophrenia is a disease with a clear diagnosis. Psychosis is a transient symptom with a much less clear delineation. What’s certain is that the term is misused and frequently in the manner suggesting cannabis use/abuse leads to a permanent state of psychosis.

Copeland is quoted in an article for The Drum by Quentin Dempster:

Professor Jan Copeland, director of the NCPIC  a government-backed preventative agency, told 7.30 NSW that if cannabis was taken out of the picture the incidence of schizophrenia in Australia could be reduced by 8 to 14 per cent. She could not be more specific. That guesstimate was based on overseas studies. There have been no studies in Australia. This is revealing.

I had seen the report and was stunned. Copeland had failed to grasp the import of incident cannabis use to incident psychotic symptoms. More so she had failed to appreciate the basics of the different time periods. What she had messed up re 8% and 14% from the Kuepper et al study came from this line in the Abstract under Results:

The incidence rate of [sub threshold] psychotic symptoms over the period from baseline to T2 was 31% (152) in exposed individuals versus 20% (284) in non-exposed individuals; over the period from T2 to T3 these rates were 14% (108) and 8% (49), respectively.

The paper cited mentions “schizophrenia” twice. Once in describing instruments used to collate data and again under “methodological issues”.

I wrote to Jan and rather comprehensively outlined the incident specific nature of the results, to seek clarification. I received no reply. For the record here is the conclusion from this sterling study.

Cannabis use is a risk factor for the development of incident psychotic symptoms. Continued cannabis use might increase the risk for psychotic disorder by impacting on the persistence of symptoms.

It’s important to realise that this association is emerging as a very small but very significant issue for individuals predisposed to psychotic episodes. “Cannabis induced psychosis” is thus better viewed as schizophrenia. To date new trends and good research has been seized or sabotaged for political gain. There are areas in need of research dollars wherein we should despise bad science or exploitation of good science. Illicit drug policy is one of them.

As I mentioned way above this is not a pro-cannabis post. There are a host of reasons including psychological, physical and social to not use cannabis. Although I note it is Australia’s most popular illicit drug.

Which reminds me. There are no reasons to not use and respect evidence.

Complementary medicines’ problem with evidence

Evidence aplenty for complementary medicines-by ex-head of the AMA-Take THAT Friends of Science-enemies of truth!

Anti-vaccine lobbyist Meryl Dorey seizing legitimacy from Dr. Kerryn Phelps

Last week Dr. Kerryn Phelps wrote an article for The Australian defending the view that alternatives to medicine are in fact, a type of medicine.

The article’s heading, Evidence aplenty for complementary medicines itself touched on a unique feature of the massive Wellness Industry. Semantics. We have witnessed natural medicine become alternative medicine become complementary medicine become integrative medicine or more frequently complementary and integrative medicine. These are semantic costume changes designed to market integrity. To divert attention away from the fact that evidence for the efficacy of alternatives to medicine is lacking. Simply put, this is not medicine.

Dr. Phelps criticised Friends Of Science In Medicine [FSM], suggesting their “agenda was a declaration of war”. Yet I would conclude FSM are providing a long overdue and organised response to the rise of demonstrably non efficacious and potentially dangerous practices gaining undeserved academic credence. These have always shared a hostility toward evidence based medicine and science itself.

FSM president Professor John Dwyer writes:

We strongly support sound research to determine the effectiveness or otherwise of any biologically plausible areas of ‘alternative’ interventions. We do not seek to prevent consumers from making informed choices about alternative interventions, but wish to see the public better informed and therefore protected from false claims.

I do not doubt for a moment that Dr. Phelps and many other GPs who support alternatives to medicine are above reproach. Nor am I suggesting that all naturopaths and chiropractors (for example) are incapable of establishing a meaningful patient-focused reciprocal relationship with conventional medicine. What I am suggesting is that they are a minority and it is thus in error to suggest alternatives to medicine are generally based on evidence. Dr. Phelps’ insistence that these practices “compliment” or effectively “integrate” with conventional medicine is simply wishful thinking.

I strongly agree with Kerryn Phelps in that individuals taking more responsibility for their health is positive. I support and defend the right of patients to have more choice in managing their health. What I find deeply troubling is that once these two conditions are met, patients and wellness consumers are faced with bogus claims, unnecessary expense and a cornucopia of charlatans. That this is in no small part due to paper tiger regulation reflects that the system itself is broken and failing Australians.

That 19 of Australia’s 39 universities offer courses in scientifically implausible practices is alarming. The role of FSM in highlighting the perils of affording academic credibility to these practices is vital. It can be argued, as Dr. Phelps has previously, that universities will ensure rigid standards are met. Or as now, that FSM should support “an increase in university-based education for practitioners”. Sound reasoning to be sure. Until one considers that these very practices depend upon denial of the scientific method and graduates often emerge highly defensive of an ideology.

There is also an inescapable convolution of practice, integrity and accountability. A belief system associated with one modality may open the way for increasingly absurd practices. The anti-science, anti-medicine, post modernist culture so crucial to new age chiropractic is conducive to opposition, not integration.

This convolution raises the question of where the line is drawn. Few understand what constitute homeopathic principles beyond assuming they provide a “natural” therapy. Yet I would be surprised and disappointed if Dr. Phelps agued it had a role in medicine beyond placebo. Basic chemistry confirms there is no ingredient at all in homeopathic products, beyond expensive sugar. For those who seek to understand more about this “informed choice” there await increasingly bizarre claims most often concluding quantum physics will one day reveal all. This is the same mechanism behind theta healing – even remote theta healing.

For the purposes of this post it’s important to focus primarily on Dr. Phelps’ defence of chiropractic. But what type of chiropractor? John Reggars is past president of the Chiropractors Registration Board of Victoria and present vice president of the Chiropractic and Osteopathic College of Australasia. Focused on science, he is concerned by the rise of “ideological dogma” and the anti-scientific fundamentalist training that FSM have identified as problematic. In a paper by Reggars published in May 2011 he notes that in Australia the 1990s saw a resurgence of “chiropractic philosophy” and with it the belief in VSC, or Vertebral Subluxation Complex.

Reggars is highly critical of such chiropractic pseudoscience, pointing out misuse of diagnostic treatment, schemes to “double your income”, selling the notion of lifelong chiropractic care “to an ignorant public” and locking patients into contract plans. He also writes:

For the true believer, the naive practitioner or undergraduate chiropractic student who accepts in good faith the propaganda and pseudoscience peddled by the VSC teachers, mentors and professional organisations, the result is the same, a sense of belonging and an unshakable and unwavering faith in their ideology.

Belief in the unseen VSC is accompanied by the insistence all disease – including infectious disease – has its origin or cure in the spine. Chiropractic is the invention of 19th century magnetic healer Daniel David Palmer. Perhaps nothing reinforces the value of Friends Of Science In Medicine better than this modern scam of chiropractic. Represented in Australia by the Chiropractor’s Association of Australia [CAA] its aim is:

To achieve a fundamental paradigm shift in healthcare direction where chiropractic is recognised as the most cost efficient and effective health regime of first choice that is readily accessible to all people.

In other words they seek to displace the GP as the primary care physician. It is impossible to broach the many areas of medicine or do the same with the many pseudosciences chiropractic endorses to elaborate on this. Yet from vitamin therapy to homeopathy new age chiropractors have a positive word. Efficacy matters not. The CAA seem to instill fear and confusion about conventional medicine as a key mechanism in their “fundamental paradigm shift in healthcare direction”.

When we understand what seeking to usurp the family doctor entails, we can see that FSM can scarcely be accused of declaring war. The article Recent Controversies in Chiropractic and RMIT courses/clinic provides exceptional insight into the very concerns FSM seek to address with quackery in universities. Palmer argued humans have “a god-given energy flow” which when disrupted leads to illness. Exhuming such nonsense and contending that the doctrine is “evidence-based education and practice”, as suggested by Dr. Ray Myers, head of RMIT University’s School of Health Sciences is shameful.

One area the CAA has chosen to immerse itself in is the anti-vaccine movement. Many graduates emerge convinced that vaccination is a toxic medical trick. As one put it, raging on Meryl Dorey’s anti-vaccine Facebook page; “Of course we don’t support vaccination, it’s the biggest medical sham since bloodletting!”. The reason for his outburst was the article Doctors accuse chiropractors of selling anti-vaccination message.

To understand why we must travel back over 100 years. In 1909 Palmer wrote:

If we had one hundred cases of small-pox, I can prove to you where, in one, you will find a subluxation and you will find the same conditions in the other ninety-nine. I adjust one and return his functions to normal… . There is no contagious disease… . There is no infection… .

Herein lies a major problem for Dr. Phelps who is under no such illusions about vaccination. As seen above Meryl Dorey has hitched a ride on Dr. Phelps’ reputation. On another email list Dorey simply copied the entire article and sent it off with the opening line, “If only we could get her to look at the vaccination issue as well… <sigh>”.

As well?! Dr. Phelps opined in The Australian about the “us and them” attitude. Yet these two words reflect just how rusted on and integral to many who entertain alternatives to medicine the “us and them” mindset is.

Some months back Dorey was also using Phelps’ prior role as AMA president, in the AVN attack on all conventional medicine. I wondered if Dr. Phelps knew of her unofficial patronage.

Past president of the CAA, Simon Floreani, has promoted homeoprophylaxis, showcasing Isaac Golden. Anti-vaccine activist and “paediatric chiropractor” Warren Sipser went as far as testifying in the family court against the immunisation of a five year old girl. Sipser informed reporters at the time “there is credible evidence they [vaccines] may do more harm than good”. Nimrod Weiner of Newtown Chiropractic ran anti-vaccine workshops using information garnered from the same AVN to whom Dr. Phelps is “diametrically opposed”.

Weiner informed pregnant mothers at a public talk that homeopathic immunisation (water) was superior to regular immunisation. That Andrew Wakefield’s fraudulent paper attempting to causally link MMR to autism was “scientifically good”. Last July Dr. Phelps tweeted:

WIN News Wollongong recently aired a comment from Meryl Dorey claiming that “all vaccines” are linked to autism in the medical literature. This is complete opportunistic nonsense and is now quite properly the subject of a complaint to ACMA. As Jonathon Holmes observed on Media Watch “there’s evidence and there’s bulldust” and that “Dorey’s claim about the medical literature linking vaccination and autism is pure, unadulterated baloney.”

Quite right. Which raises my point on convolution again. Where do we draw the line? Of the 222 listed professional members of Dorey’s anti-vaccine group over 60%, or 135 are chiropractors. The next largest is homeopaths with 16 members, or a comparatively small 7%. Naturopaths number 15 members. Then kinesiologists, then acupuncturists with 5 and 4 members respectively. Aside from one physiotherapist and one occupational therapist, all “professional members” sell alternatives to medicine of some description.

A US study published in Vaccine showed that parents who deny their children vaccination are four times more likely to see a chiropractor as the primary care physician. When Floreani was CAA president his chiropractor wife wrote of their newborn son’s pertussis. Including [bold hers]:

We performed chiropractic checks on our baby daily and utilised a whooping cough homeopathic. I dosed myself with an array of vitamins to boost his immunity via breast milk and kept him hydrated with constant breastfeeding. Whooping cough is often slow to develop and may respond well to conservative management, including chiropractic, osteopathy, homeopathy, herbs, acupuncture or acupressure.

Magically, it resolved within two weeks. Which means it wasn’t pertussis but a self limiting infection and all that woo did nothing but correlate to the illness. But I am sure Dr. Phelps would be the first to agree herbs, acupressure, homeopathy and so on would do nothing to manage pertussis. It is very dangerous misinformation with potentially fatal consequences.

So not only are unvaccinated children more likely to see a chiropractor and be subject to such abuse, but by not seeing a GP they are unlikely to become a recorded notification. Officially whilst only 5% of 0-4 year olds in Australia are not fully vaccinated for pertussis they make up 27% of cases. Thus, this figure may well be conservative. Dr. Phelps must ask herself; If vaccine deniers will choose chiropractors, might chiropractors influence parents to reject vaccination? The above rubbish is by Dr Jennifer Barham-Floreani – B.App.Clin.Sci, B.Chiropractic after all.

Australian Doctor wrote in part about the study in Vaccine:

Are naturopathic and complementary healthcare providers reinforcing parental concerns and ‘anti-vaccine’ opinions or promoting exemptions, or are they providing healthcare without emphasizing vaccinations?

I hope Dr. Phelps is asking herself that question also. As I stress above I’m sure Dr. Phelps and her colleagues are above reproach. But that’s not the point. The larger message being advanced here is that alternatives to medicine not only complement but “integrate” with conventional medicine. Not only does available evidence show this is not true but to generalise is to lend credence to dangerous charlatans.

This post has focused primarily on chiropractors, because they not only serve as a hub for health focused pseudosciences, but also seek to replace the family GP. I will contend that my point on convoluted overlap is valid. Once a patient is referred to one pseudoscience how does the referring GP control for pollution as it were? More material on the dubious ethics of new age chiropractic, including catastrophic neck injury and paediatric “improvement” by parental proxy can be found here.

St. John’s Wort seems to be trotted out in almost every article claiming alternatives to medicine have an evidence base. What is forgotten is that hyperforin, the antidepressant extract of St. John’s Wort, and other extracts are both inducers and inhibitors of P450 cytochrome enzymes. These liver cytochromes are involved in the metabolism of over 50% of marketed medication.

In the case of opioid pain relief studies have demonstrated a decrease of blood plasma levels of oxycodone of up to 50% and reduced half life of 27%. In the case of alprazolzm (a benzodiazapine), prescribed for anxiety and panic attacks a doubling of clearance rate has been documented.

Chronic pain is associated with depression and depression with anxiety. Opioids and benzodiazapines are causally linked to respiratory depression overdose death. Hence the clinical significance of any “integration” of serious pain management with a herbal choice for the depression it may cause is likely to be anything but “complementary” for the patient. Many patients choose not to inform their GP of herbal supplements.

Proper diagnosis following treatment with medication will be hampered by St. John’s Wort. Excessive doses of actual medication may be prescribed. Should a patient cease St. John’s Wort whilst on opioid, benzodiazapine or both medication regimes a spike in blood plasma of the active metabolites will ensue. More likely, as St. John’s Wort is improperly regulated and dose concentration varies widely a patient may unwittingly expose themselves to respiratory depression and possibly death with no change in their daily medication/St. John’s Wort routine.

In short whilst the concentration (dose) of actual medication is stable, the drug interaction outcome due to St. John’s Wort mimics an unstable medication dose. Patients may easily find themselves unsuitable to drive, work, operate machinery, bathe or sleep without potential for disaster. Consequently many medication regimes may be deleteriously effected by St. John’s Wort.

Thus the wider picture of evidence pertaining to St. John’s Wort is not quite the basis for “integration” proponents of alternatives to medicine would have us believe.

My response to the ongoing insistence that placebo effects derived from acupuncture constitute evidence is likely to be here in Acupuncture: essential facts about a major scam. Over and again it emerges that subjects who think they are receiving acupuncture, whether they are or not, demonstrate a response.

Findings aside, how would Dr. Phelps explain meridians, invisible forces, chakra or vital energies? It is too easy to point to apparently positive findings when the mechanism by which they arise is implausible, unknown or assumed to be related to endorphin release. The technology to manufacture acupuncture needles did not exist until the 1600s and the only nation to seriously try to ban acupuncture was China under the Chinese Nationalist Government. Western marketing has done much for this “traditional” Chinese medicine.

What of naturopaths who insist on Black Salve [2]? Or who use herbal balls from China with high levels of elemental mercury, arsenic and lead? What of poor hygiene and bacterial infection from acupuncturists or masseurs? The astonishing story of Monika Milka and non-sterile syringes used in biomesotherapy, leaving her patients seriously infected with mycobacterium chelonae?

Tragic cases like Penelope Dingle and Isabella Denley indicate that the notion of integration or proper supervision is seriously flawed. One point raised repeatedly by FSM is that whilst ill patients waste time being exploited by pseudoscience acting as a health choice, the chance of genuine care, full recovery or even survival is lost.

These are the real issues Dr. Phelps could constructively help Aussies understand before raging at FSM. How is it that so many various practices have come to exist that are beholden to ideology, not evidence? How is it they can convince parents to withhold treatment from their children and in doing so undermine the health of our entire community?

FSM exists to address an unacceptable situation in our educational institutions. They have taken a stand because those in a position to defend academia seemingly chose to act unethically. When it comes to “informed choice” there is an excess of non evidence based, expensive pseudoscience. It is pervaded by a combative, arrogant anti-science and anti-medicine mindset. It is amply equipped with scams.

This madness must stop and Dr. Kerryn Phelps is most welcome to clearly state just what aspects of non conventional medicine are high risk ideology and what is safe, effective and backed by evidence. Real evidence that can be trusted alone.

Presently, there appears to be a scarcity.

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