Fake news and the spreading of measles

“Fake news” isn’t my favourite term for the disinformation spread by antivaccinationists. However it conveys a meaning that is usefully accurate when it comes to labelling deception spread with the aim of misrepresenting the facts about vaccines.

The narrator in the US video below asks the question, “Is fake news making people sick?”. He notes that the country has broken a 25 year old record for measles cases this year. At the time of making the video there were over 700 cases across 22 states since the beginning of 2019. In states where population density is high we can expect to see the impact of vaccine induced immunity and herd immunity (or the lack thereof) in their unmistakably predictable manner.

New York city has had over 400 cases since October 2018. Some – not all – members of the orthodox Hasidic Jewish community have been avoiding vaccines. The narrator tells us this is due to “rampant misinformation around vaccines”, even though the orthodox community “overwhelmingly” believes in vaccines. One woman seems to doubt vaccine safety and efficacy. She argues that “some people question why would I subject my three year old to toxins when it’s not going to protect him or her”.

There is an increase in insular socialising habits in close orthodox communities. This ensures the successful spread of misinformation by The Vaccine Safety Handbook. Packed with the most well constructed vaccine myths, it targets these communities with well debunked anti-vaccine conspiracies, codswallop and even commentary from rabbis, specific to Jewish religious law.

WhatsApp groups have been set up to push anti-vaccine disinformation further, with some orthodox members reporting that their only source of news is via WhatsApp.

If this reminds you of the Somali community in Minnesota in 2017 and 2011, you’re not alone. 80% of reported measles cases in 2017 were of Somali children whose parents had been convinced of the risk between autism and MMR. It was the largest measles outbreak for 30 years.

What’s this got to do with orthodox Jews in New York? Well I mentioned the insular nature of close communities. In an article headed Minnesota’s measles outbreak is what happens when anti-vaxxers target immigrants, it is noted some of these Somali Americans had concerns about higher than average rates of autism amongst their children. This entire episode is indicative of the impact that calculated disinformation can have. Particularly when provided in an area of uncertainty and despite the effort and funding from health experts and government authorities.

In 2008 Somali parents stressed that there appeared to be more 3-4 year old Minnesota Somali children enrolled in the public preschool special education program for Autism Spectrum Disorder, compared to the overall percentage of Somali children enrolled in public schools [page 4].

Also a couple of years before this time MMR vaccine coverage had started to decrease in Minnesota-born Somali children from 2006 at which time rates had been above 90% [Figure 2].

Cultural differences meant that the most genuine efforts to assist the Somali-American community with this issue proved difficult. There is no word in Somali for “autism”. Indeed there is no grey area as one Somali parent put it. Mental health is seen as either “crazy” or “sane”, and this leads to the fear that a child may be called an unhelpful name within the community. A name used behind the parents’ back [page 4].

The Minnesota Department of Health (MDH) worked to re-examine enrollment data for pre-school aged children in the special education program. The results were published in a report which tended to focus on participation rates only. The report [pp 4-5];

…did not attempt to measure the true occurrence of ASD in all children, and it did not attempt to identify possible causes or risk factors for ASD. Instead, the focus was on developing a better understanding of reported differences in program participation rates among preschool-aged children enrolled in this MPS program.

The three main findings in the report confirmed parent’s observations and also raised questions as to better outreach services to Somali children vs genuinely higher levels of ASD, compared to non-Somali children accessing ASD services outside of the MPS. The proportion of Asian and Native American children participating in ASD programs was significantly lower. The cause for this remained elusive. Participation rate differences between Somali pre-school children and pre-school children from other ethnic backgrounds decreased “substantially” over the three years studied. The basis for this final point remained unclear.

Following the 2009 MDH report advocates for the Somali community called for further research. The CDC, NIH and Autism Speaks provided technical assistance and funding to the University of Minnesota. The aim was to focus on ASD in Minnesota and within Somali vs non-Somali communities. The MDH and the University of Minnesota’s Institute on Community Integration added in-kind staff and funding.

Still, we need to remember that it was 2008 when Somali parents first raised their concerns about ASD with the Minnesota Department of Health.

Enter disgraced fraud, data falsifier and ex-gastroenterologist, Andrew Wakefield, who was struck off the U.K.’s General Medical Council 21 years ago and the many-faced Organic Consumers Association. Wakefield targetted and set about convincing Minnesota’s Somali Community that MMR could not be trusted as health authorities claimed. It caused autism he lied. The rumour spread through the community. During the 2017 measles outbreak Wakefield insisted he didn’t feel responsible at all.

In short Wakefield and fellow antivaccinationists spread his anti-vaccine lies with the result that MMR vaccination fell in the Somali community for a number of years. Immigration status can be a risk factor with respect to immunisation status and this fact played very well into the hands of antivaccinationists.

Nonetheless, no vaccines cause autism.

It’s important to remember, and realise, how much damage antivaccinationists can do to public health. Yes, “fake news” is making people sick. Cities with high density and insular communities that are convinced to skip vaccination will constantly face the possibility of outbreaks. The anti-vaccine lobby and their minions will continue to spread misinformation and where possible it must be refuted.

I read a comment recently dismissing the need for any vaccine and contending that only three people had died since 2000. Forgetting that this US citizen is ignoring the rest of the world, it is just such complacency that helps drive the luxurious nonsense that vaccines are more harmful than the diseases they prevent.

Because after all, in the developed world vaccines are a victim of their own success.

 

 

Seven Ways to Identify Pseudoscience

Original seven ways – © Relatively Interesting

  • The use of psychobabble – words that sound scientific and professional but are used incorrectly, or in a misleading manner;

Self-help books, folk and pop psychology, and motivational seminars often use psychobabble.  Deepak Chopra is a name that comes to mind at present. Nothing more than a fraud according to Professor Jerry Coyne, one may delight in the Wisdom of Chopra which is a Twitter stream made up of seeming quotes that are randomly generated by words that can be found in his genuine Twitter stream. If anybody breathes prescient life into the words of the late Carl Sagan it is the scoundrel and intellectual mobster Deepak Chopra.

Sagan proffered;

I worry that, especially as the Millennium edges nearer, pseudo-science and superstition will seem year by year more tempting, the siren song of unreason more sonorous and attractive.

  • A substantial reliance on anecdotal evidence;

Without a doubt the alternatives to medicine behemoth would be lost without dramatic tales of self-limiting illnesses merely running their course, or completely false or hugely exaggerated stories of serious, disabling or terminal disease executing an about face due to the power of some wonderful concoction. The frustrating hurdle here for those who promote reason is that almost all work undertaken to convince the patient occurs in their own mind. Scam artists from peddlers of herbs to chiropractors, Baptist religions and indeed even the Catholic Church are swift to take credit if they have been involved.

  • Extraordinary claims in the absence of extraordinary evidence;

From 9/11 being an inside job to images of the apparent exhumation of giant skeletons to alien autopsy videos and shaky vision of UFOs drifting across a grainy background it seems all these and other extraordinary claims have one thing in common. A powerful need to believe in their truth by those that ensure certain – in fact sometimes many – conspiracy theories indeed exist. Now thanks to Netflix we can wander through a range of delightful titles that offer everything from reasonable special effects to WW2 era reports and “experts” convinced our governments expect us to believe the laws of physics have been broken.

  • Claims which cannot be proven false;

Insisting oneself or perhaps a number of people in the world have communicated telepathically at infrequent and random intervals with aliens from a distant star is impossible to disprove on face value. The claimant can continue to insist he/she is unaware of who the other telepathic human recipients are, or when he/she will receive or has received a communication. The communication may be quite benign such as, “Happy Birthday Deepak”.

Ideally the burden of proof should be placed on the party making the claim.

  • Claims that counter established scientific fact;

Often going hand in hand with claims that rely on anecdotal evidence are those that defy scientific fact. Homeopathy stands atop the podium in this regard. Not only is it absolutely certain to not work but its adherents may insist on relaying impossible tales – often knowing they are outright lies – to besmear evidence based medicine and promote junk, bogus cures. For example pertussis (or Whooping Cough) is sometimes referred to as “the 100 day cough”. Prominent Australian antivaccinationist Meryl Dorey claimed on national TV both her vaccinated and unvaccinated children “got it”. She treated it homeopathically and “none of us were sick for more than two weeks and it was nothing worse than a bad cough”.

Countering established fact may be said of an enormous number of claims made about pseudoscientific “cures” for many ailments. Some treat energy meridians or “chakras” that don’t actually exist. These involve peddling herbs, acupuncture, acupressure, chiropractic, osteopathy, chanting, cupping, aligning activities with moon cycles, astrology and more.

Without a doubt denial of anthropogenic climate change should be mentioned here and we might again reflect upon to Carl Sagan’s worrying prediction.

  • Absence of adequate peer review;

In 2015 antivaccinationist and critic of vaccine science Judy Wilyman, under the auspicies of antivaccinationist and conspiracy sympathiser Dr. Brian Martin, finished her PhD at the University of Wollongong. The controversy surrounding inadequate peer review between 2012 to 2016 and indeed until today is a function of the copious inaccuracies in her thesis. Entitled “A critical analysis of the Australian Government’s rationale for its vaccination policy”, it was an immature an inaccurate antivaccination conspiracy rant. The fact that it was accepted, and indeed accepted with its discredited bibliography, indicates a clear absence of adequate peer review.

Tragically this eventuality has emboldened Wilyman to demand respect from academics and to level outrageous personal claims at her critics, rather than attempt to publish respectable material.

  • Claims that are repeated despite being refuted;

Whilst a great deal of the above intellectual repugnance deserves a slice of this pie, the authors at Relatively Interesting have populated it with the anti-vaccination obsession with the globally damaging claim that vaccines cause autism. Originally at a 1998 media conference designed to reassure parents, head author of the now rejected paper Andrew Wakefield proffered the baseless claim that rather than use the MMR trivalent vaccine, parents should consider choosing single shot vaccines. The “vaccines cause autism” claim has not only been shown to be false and cannot be replicated, but it is now well established that Wakefield acted with the sole aim of making tens and probably hundreds of millions of pounds via his plan to establish immuno-analysis laboratories for the new condition he was calling autistic enterocolitis. He also held patents for single shot measles, mumps and rubella vaccines.

A five member General Medical Council panel found Wakefield guilty of over 30 charges including 12 of causing children to endure “clinically unjustified” invasive testing procedures, buying blood at children’s birthday parties and managing four counts of dishonesty. Then, his “continued lack of insight” into his conduct, and consequences thereof, meant that only “total erasure” from the medical register was warranted. Today on the back of countless refutations of Wakefields claims he now pushes the fraudumentary Vaxxed full of false information and complete with the tampered audio of phone conversations.

Regrettably today more than in recent years we can benefit from keeping an eye out for these seven markers of pseudo-science.

Anti-vaccine Zika virus conspiracy fails to surprise

It was an event so impossible to predict it is absent from the highly respected Before It’s NewsWhat Did Nostradamus Predict For 2016? Or the Top 10 Nostradamus Predictions for 2016. Yet anti-vaccine conspiracy theorists reckon neonatal microcephaly associated with maternal infection with the mosquito-borne Zika virus, is actually due to… a vaccine.

It’s not spread by the Aedes aegypti mosquito they warn. This truth of course, is being suppressed by a conspiracy.

A few days ago I wondered what potions, cures or other nonsense homeopaths might be selling to save the world from Zika. As it turned out I happened upon an article entitled Zika Virus. Are we being told the truth? The hosting blog, Homeopathy Safe Medicine is concocted by Steve Scrutton. Steve is also upset that the BBC aren’t playing ball with the CDC whistleblower fallacy that there is indeed a link between MMR and autism (also suppressed by a conspiracy)  – “particularly with black children”, and is happy enough to publish a final email exchange.

A little more searching would save Steve ample time on this point. For example Orac at Respecful Insolence, Rene’ Najera at Science Based Medicine and an even earlier article at SBM yield facts.

Or of course one may visit Snopes.

CDC_whistleblower_snopesSo Steve’s a conspiracy theorist. Anyway, to get back on track, you may have already guessed Steve’s answer to that title question above on Zika virus. From there we’re introduced to a fine upstanding crock of a site named The Unhived Mind III.

Here Steve alerts us to the delicate title Brazilians not buying Zika excuse for babies with shrunken brains. Charming, no? The author of this article, Jim Stone, applies the Judy Wilyman theme of logic. Namely that morbidity and mortality are not high enough for all this fuss. Jim quotes the BBC:

Zika is generally mild and only causes symptoms in one in five people. It is spread by the Aedes aegypti mosquito, which also spreads dengue and chikungunya.

And adds himself:

My comment: Ok so a do nothing virus is going around that only makes one in five people get mildly sick, with no symptoms in 4 out of 5 people.

Had he continued quoting the BBC we’d have read more on this “do nothing virus”:

Brazil is experiencing the largest known outbreak of Zika.

President Dilma Rousseff, visiting Recife in the worst-affected north-east of the country, said Brazilians needed to engage in the fight against the virus. […]

Forty-nine babies with suspected microcephaly have died, Brazil’s health ministry says. In five of these cases an infection with Zika virus was found.

Jim Stone has his own tortuous conspiracy ramble site including an utterly ridiculous piece on the Zika virus. Jim advises his poor readers:

The claim is that a mosquito naturally carried this disease across almost all of South and Central America in only six months. This defies all logic because mosquitoes have a life cycle that is too long for immediate propagation and won’t fly more than a mile from where they hatch, which would limit the movement of a totally new disease to a mile or so a month, not 30 miles a day.

Jim gets pretty worked up about reports on the Wikipedia Zika virus page suggesting the carrier can “just rip across continents to all corners in months, faster than a bush tribesman could travel. It really is that way, Wikipedia said so!”. Well, no not really. What Wikipedia did note but Jim didn’t is:

The global distribution of the most cited carrier of Zika virus, A. aegypti, is expanding due to global trade and travel. A. aegypti distribution is now the most extensive ever recorded – across all continents including North America and even the European periphery. […]

Jim has also conveniently ignored the impact of human travel. Like many who seem happy to blame the Tdap vaccine, Jim is worried that the association between microcephaly and Zika virus has not been made before. It was initially identified in rhesus monkeys in 1947 then in humans in 1952, in Uganda.

Conspiracy theorists fail to grasp that the first documented outbreak of Zika virus in a human population was in 2007 and 2013 in the Pacific (Yap and French Polynesia, respectively), and later in the Americas in 2015 (Brazil and Colombia) and Africa (Cape Verde) [WHO Zika Fact Sheet]. ( Edit: The possibility of sexual transmission {2} is being investigated ). It is believed to have arrived in Brazil in 2014, and spread slowly. The outbreak in Columbia was reported by the WHO on October 21, 2015.

These relatively recent initial outbreaks are exactly why little is known about complications associated with the disease. Experts, including the WHO are not yet certain a causal link has been established between microcephaly and Zika virus. However health officials are operating under the assumption there is one.

Should this be the case it appears that infants born to mothers who had the virus during the first trimester are at an increased risk of microcephaly. The failure of the Tdap conspiracy theorists is partially evident in their inability to produce any data beyond a crude correlation. The Tdap vaccine is being offered in the third trimester (28 to 32 weeks). In the US and UK when there is a suspicion of foetal microcephaly where pregnant women have returned from Latin America, ultrasound screening will be offered from 20 weeks every 2 to 4 weeks.

Thus foetal microcephaly due to maternal infection with Zika could be evident 2 – 3 months before the vaccine is even offered. Essentially the conspiracy coincidence is vanishingly small and demonstrably false.

It would thus seem there is an opportunity to identify the time of malformation or the absence of genetic material of the Zika virus in placental tissue, to advance the case of the conspiracy theorists. Their case could do with real hard evidence as opposed to yet another vaccine timing coincidence.

The Internet is of course teeming with rubbish sites pushing the lie of vaccine induced birth defects. The Zika virus gives them something to exhaust the correlation gambit on. A nice twist that appears on No Vaccines Australia evokes The Bill and Melinda Gates Foundation.

The release of genetically modified Aedes aegypti mosquitoes by a British biotech’ company they fund, named Oxitec has come under scrutiny. However a critical 2010 Science article suggests the Foundation had not funded a 2009 project that saw release of the mosquito on the Caribbean island of Grand Cayman. In a very recent article on the Zika virus the authors give the same GM project the thumbs up.

They write under There must be a better way to control mosquitoes?

Not yet but they’re in the works. A British biotech called Oxitec—which was recently purchased by Intrexon, a U.S. synthetic biology company—has developed A. aegypti mosquitoes containing a gene construct that will kill their offspring before they reach adulthood. When massive numbers of male individuals of this strain are released in the wild, they will mate with local females, producing offspring that are not viable, which has been shown to make a dent in the population.

For now I can offer the below press releases.

To wind up we can turn back to Steve the homeopath to realise that like Nostradamus he’s had a bash at predicting the future.

He writes:

If there is any truth in this, conventional medicine will have to act quickly and effectively.

  • They will have to denounce this as a ‘conspiracy’ theory.
  • They will have to convince us that it is mosquitoes, and not Big Pharma, who have caused this microcephaly.
  • They will have to move quickly to defend mandatory vaccination, especially the vaccination of pregnant women.
  • They will have to convince us that the TDAP vaccine is different to the DPT vaccine that they have been giving our children for decades.

And perhaps most difficult of all, the pharmaceutical industry, and conventional medical doctors, will have to convince us that this time they are telling the truth about this matter!

In fact if there were a conspiracy under way the amount of work needed to pull it off would simply dwarf Steve’s list. More so all evidence suggests it is impossible to convince such minds of the truth – regardless of evidence.

Regrettably this is just another opportunistic and disturbing effort by predictable conspiracy theorists.

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The importance of critical thinking in discerning reputable sources

The volume of material published and shared by anti-fluoride, anti-vaccine, pro “alternative” health – all which fall under the deceptive catch phrase of “pro-choice” – is notably bereft of critical thinking.

No doubt there will always be some attracted to the notion of oppressive governments and dark conspiracies. Research indicates the psychological predisposition to conspiracy theory is highly resilient. Yet the persistence of the claim vaccines are the cause of a host of childhood ailments, that homeopathy is effective or that fluoride is a poison added to water supplies, may in part indicate poor cognitive manipulation of available information.

It is not uncommon to find preposterous claims circulating as a purported superior health choice. Such material is favoured by those who contend they are exercising “pro-choice” as a result of having “done my research”. It’s clear that no independent, accredited source has evaluated this “research”. It is more evident that the person has not sought reputable source material or thoroughly investigated critiques of the main aspects of their research. Let’s try claims by one so-called alternative. Homeopathy.

A good example would be claims made by homeopath Isaac Golden. Golden claims homeoprophylaxis (homeopathic immunisations) are a safe and effective alternative to vaccination. In a very short time one can find that homeopathy has not been shown to offer any measurable effect beyond placebo.

Consider the National Health and Medical Research Council statement on homeopathy [PDF].

The media release opens:

The National Health and Medical Research Council today released a statement concluding that there is no good quality evidence to support the claim that homeopathy is effective in treating health conditions. Its release follows a thorough review of the evidence, conducted as part of NHMRC’s responsibility to provide advice and support informed health care decisions by the Australian community.

The conclusion is based on the findings of a rigorous assessment of more than 1800 papers. Of these, 225 studies met the criteria to be included in NHMRC’s examination of the effectiveness of homeopathy. The review found no good quality, well-designed studies with enough participants to support the idea that homeopathy works better than a placebo, or causes health improvements equal to those of another treatment.

A little more time reading evidence based material will reveal the mechanism of homeopathy to be impossible. In short it simply cannot work without rewriting aspects of physics and chemistry. Homeopaths often actually admit this – while being dishonest about observed effects.

Homeopathy Plus

Golden himself makes much of having completed a PhD in homeoprophylaxis, leaving the uneducated listener or reader under the impression that this thoroughly discredited pseudoscience is in fact a safe option in health science. Or as opponents of vaccination insist: a Choice. Indeed Golden claims homeopathic vaccines are an option which is “comparably effective but which is non toxic, which provides no danger, no long term side effects”.

In June this year “Dr. Isaac Golden’s Academy” was offering a YesCourse.

IsaacGolden_YesCourse

Yet in his PhD abstract Golden admits;

The effectiveness of the program could not be established with statistical certainty given the limited sample size and the low probability of acquiring an infectious disease.

Indeed. Not to mention the reality of an ethics committee. Let’s be clear. No success was demonstrated with this paper. So Golden also writes:

However, a possible level of effectiveness of 90.3% was identified subject to specified limitations. Further research to confirm the effectiveness of the program is justified.

Possible efficacy, subject to specified limitations, that requires further research is a very, very clear way of documenting no effect. I apologise but there are no prizes for guessing Golden has not gone on to search for, much less publish, the possible efficacy. This won’t prevent him waxing lyrical on “my own PhD” as a source in defence of homeoprophylaxis.

Furthermore Golden’s work has been cited by Fran Sheffield of Homeopathy Plus in defence of her own business. The danger of Golden’s ambitious work and lax clarification can be summed up in Sheffield’s marketing. Referring to his inability to establish efficacy to any degree, she advertised:

Dr Isaac Golden confirmed that homeoprophylaxis provides the same degree, or better protection, than vaccines with none of their side effects or complications

In 2010, following a complaint from Dr. Ken Harvey, the TGA’s Complaints Resolution Panel ordered that a Retraction be published on site. Sheffield ignored the request. Regarding the TGA Therapeutic Goods Advertising Code, Sheffield was also noted to have acted in a misleading manner, abusing the trust and exploiting the lack of knowledge of consumers. A summary and key details can be found here at the Skeptics’ Book of Pooh-Pooh.

The notion that parents who choose alternatives are not actually researching or seeking reputable advice on their apparently “informed choice” is in this case further highlighted by ongoing offending by Fran Sheffield and Homeopathy Plus! In May 2012 the ACCC announced it had responded to complaints from the medical industry about bogus claims on the Homeopathy Plus! website. Namely that the pertussis vaccine was ineffective and that Homeopathy Plus! offered an effective homeopathic immunisation for pertussis.

On February 21st 2013 the ACCC instigated Federal Court proceedings against Homeopathy Plus! as the pseudoscience recalcitrant persisted in endangering the health of Australian children and infants. The claims made were in breach of the Competition and Consumer Act 2010, and were misleading and deceptive. The ACCC media release included;

The Australian Competition and Consumer Commission has instituted Federal Court proceedings over allegedly misleading claims on a homeopathy website regarding the effectiveness of the whooping cough (pertussis) vaccine.

The ACCC has taken proceeding against Homeopathy Plus! Australia Pty Ltd and against the owners of the Homeopathy Plus! website.

The claims on the Homeopathy Plus! website include statements that the whooping cough vaccine is “unreliable” and “largely ineffective” in preventing whooping cough and that homeopathic remedies are a safe and effective alternative for the prevention and treatment of whooping cough.

On December 23rd, 2014, the ACCC reported that the Federal Court had found both Homeopathy Plus! and Frances Sheffield had engaged in misleading conduct and made false or misleading representations regarding the effectiveness of the whooping cough vaccine and homeopathic remedies as an alternative in breach of the Australian Consumer Law. Sheffield and Homeopathy Plus! had engaged in misleading and deceptive conduct. Put simply, Fran Sheffield had continued to use her website to lie to unfortunate visitors who were not in the habit of critically investigating such claims.

Harking back to the echo of Isaac (My own PhD) Golden we read (emphasis mine);

The Court also found that Homeopathy Plus! and Ms Sheffield engaged in misleading and deceptive conduct and made false and misleading representations to the effect that there was an adequate foundation in medical science for the statement that homeopathic treatments are a safe and effective alternative to the whooping cough vaccine, when in fact no such foundation exists and the vaccine is the only treatment currently approved for use and accepted by medical practitioners for the prevention of whooping cough.

I should be clear. This is only one arm of a notable junk science making as a matter of course outrageous claims. To see that so many can be fooled into believing plain water can protect from disease in a manner no-one can explain, is to some, mind boggling. But to be even clearer the information to debunk such nonsense and thus protect yourself and family is there to be found.

It is plain that scam artists, conspiracy theorists and so on cannot be swayed by the findings of official investigations or years of scientific consensus. Thus it is better to ignore those who claim to hold an apparent truth or a wonderful therapy and subject their claims to robust and varied critique.

Critiques can be made for all of the pseudosciences purporting to offer a superior or natural alternative to evidence based medicine. The same applies to the unwarranted attacks on vaccines, fluoride, medical intervention and so on. A far better way to approach these topics is to do so with the confidence to review material from a bipartisan standpoint. Where claims of conspiracies or corporate corruption for profit are made be very skeptical.

Make a habit of visiting consumer advocacy groups, such as Choice. Spend some of that research time looking over the Therapeutic Goods Administration and the Australian Competition and Consumer Commission. We looked at both of these and the NHMRC, above. Let’s say the best your new friends at Essence Of Moonbeam are offering in response is a claimed conspiracy, the mocking of “sheeple” or bemoaning the trampling of rights (or that “informed choice”). I’d say you’re pretty safe in concluding genuine evidence has caught up with debunking their claims.

No-one can develop the skills or knowledge base from the Internet to argue that “my research” on one topic is sufficient to make decisions that are traditionally overseen by specialists or experts. The skill we can develop is that by which we can discern between a reputable source and a disreputable source. And this process should include discussions with genuine, experienced practitioners.

There is too much information on individual areas of health to allow us to investigate fully and believe we may come away educated and/or able to advise others. Where new trends are jostling for our attention and money there are recurring themes that help reveal them to be useless.

The skills we develop in discerning the reputable from bogus information sources are increasingly the skills that will benefit us in more ways than seeking optimal health.

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 better understand why we must travel back over 100 years. In 1909 D.D. Palmer’s son, Bartlett Joshua (or B.J.) Palmer wrote (Ref; 2003), (Ref; 2014):

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.

♠ This quote has been attributed to D.D. Palmer. However in 2013 the Journal of the Canadian Chiropractic Association, cited the author as B.J. Palmer.