I’ve just returned from TAM, along with Steve Novella and Harriet Hall. While there, we joined up with Rachael Dunlop to do what has become a yearly feature of TAM, the Science-Based Medicine workshop, as well as a panel discussion on one of our favorite subjects, “integrative” medicine. Between it all, I did the usual TAM thing, meeting up with old friends, taking in some talks, and, of course, spending the evenings imbibing more alcohol than I probably should have so that I could look and feel my best for our morning sessions, particularly given my difficulty adapting to the time change. One thing I did was completely unexpected, something I learned about the night before our workshop when I happened to run into Evan Bernstein. He informed me of something that our fearless leader Steve Novella was going to do the next day right after our workshop. In a nutshell, Evan told me that Steve was going to debate an antivaccinationist. Evan didn’t know any details other than that Michael Shermer had arranged it and that Steve had been tapped at the last minute. Evan didn’t even know who the antivaccinationist was going to be or what the event was. Naturally, I was intrigued.
So, the next morning I asked Steve about it. I turns out that the event was FreedomFest, a right-wing/Libertarian confab that happened to be going on at the same time as TAM up the road a piece on the Strip at Bally’s. Steve didn’t know who the antivaccinationist was going to be either, which made me marvel at him. I don’t know that I’d have the confidence agree to walk into the lion’s den with less than a day’s notice not even knowing who my opponent is. Steve was more than happy to invite me along. Clearly, this was was an opportunity that I couldn’t resist. So we met up with Michael Shermer, and it was from him that I learned that Steve’s opponent was to be Dr. Julian Whitaker.
My eyes lit up.
To my surprise, neither Steve nor Michael knew who Dr. Whitaker was. Being more than happy to give them some background on Dr. Whitaker, I told them. Regular readers here might remember that I’ve mentioned Dr. Whitaker before. First off, he’s a big fan of Dr. Stanislaw Burzynski, serving as the primary pro-Burzynski medical “expert” in that propagandistic paean to the brave maverick doctor, Burzynski: The Movie:
Dr. Whitaker is also big among the “alternative medicine” crowd for his claims to be able to cure diabetes “naturally,” without food or drugs (of course!). In doing so, he claims that metformin doesn’t work, antibiotics don’t work (because, apparently, they don’t succeed in saving every diabetic foot) and that, in general, conventional medicine doesn’t work. At his Wellness Center, he treats patients with diabetes and heart disease with acupuncture, nutritional supplements, diet, hyperbaric oxygen, chelation therapy, and a wide variety of other questionable therapies. (Hyperbaric oxygen could work for diabetic feet, but chelation therapy is useless and dangerous and acupuncture is nothing more than placebo medicine).
If you really want to know all you need to know about him in a nutshell, I’ll simply state that Dr. Whitaker is apparently one of Suzanne Somers’ doctors and was featured prominently in her cancer quackery book Knockout.
But how did this whole event come about? According to Shermer, apparently the doctor who was originally going to be Dr. Whitaker’s opponent, a local pulmonologist, became ill at the last minute and couldn’t appear. I rather suspect in retrospect that Dr. Whitaker probably now wishes that his original opponent hadn’t been forced to bow out. (You’ll see why soon enough.) The next question I wondered about was: Why was this pseudodebate going to be held at FreedomFest? That’s easy. If you look at the FreedomFest program and scroll down to Dr. Whitaker, you’ll note that he is the founder of the Freedom of Health Foundation, which is, as you probably guessed, an organization designed to promote “health freedom” (or, as I like to call it, freedom for quacks from pesky government interference directed at protecting the public). Not surprisingly, he is very much opposed to California Bill AB2109, which would mandate informed consent for parents who want to claim religious or philosophical exemptions to school vaccine mandates. Kimball Atwood has written about these sorts of organizations before and mentioned Dr. Whitaker in particular.
So, the stage was set. Michael Shermer invited us to hop into his car, and we headed up to the strip to join the battle.
We arrived at Bally’s about 45 minutes before the debate was scheduled, wending our way through the casino and hotel to easily find the convention area where FreedomFest was being held. Even though we hadn’t registered and didn’t have a badge, the organizer Mark Skousen was more than happy to let us wander around the exhibit area until it was time for the debate. It was an interesting experience, but not really appropriate for SBM. (Maybe I’ll discuss it elsewhere at my not-so-super-secret other blog. For one thing, we saw Steve Forbes walk right past us.) In any case, we arrived at the Silver Room, where the debate was to be held, and I immediately saw that something else was wrong. As we entered the room, we immediately encountered a woman passing out pens and small note pads. That wasn’t the problem. The problem was that she was also passing out a newsletter, Dr. Whitaker’s Health & Healing: Your Definitive Guide to Wellness Medicine. It was the September 2011 issue, and, emblazoned across the page was a large headline Vaccinations: The Destruction of Our Country. This does not bode well, I thought, as I thumbed through the newsletter, which packed pretty much every major antivaccine trope into a single article.
As you might imagine, I immediately recognized Dr. Whitaker. He’s not hard to miss, being a rather large, gregarious, and somewhat imposing man, who immediately came up to greet Shermer.
Then I saw the moderator.
My first thought was that she looked very, very familiar, but I just couldn’t remember who she was. Then, hanging in the background given that I wasn’t the featured speaker and was basically tagging along for support, I saw her introduce herself and Dr. Whitaker to Steve and Michael as Leslie Manookian. It was then that I knew that this was going to be a typical pseudodebate over pseudoscience. Before Steve went up on stage, I warned him that I thought Dr. Whitaker was probably pretty slick and might well be able to do the Gish gallop with aplomb. I also warned him that the moderator was a die-hard antivaccine propagandist, having made—you guessed it!—a propaganda movie that I reviewed last year, The Greater Good. I later learned that there were going to be two screenings of the movie at FreedomFest, one at 8 PM that night and one the next afternoon. Lovely, I thought. The health freedom wing of the Libertarian movement is flaunting its embrace of antivaccinationism at one of its big conferences. Marvelous.
And so the debate began. Manookian started out by saying she never questioned vaccines until “she met a guy.” Apparently, this guy believed that his child had been rendered autistic by vaccinations, having regressed within a fairly recent time frame after a round of vaccines. She then “did research” and became increasingly appalled by what she found, which, from what I could tell, were mostly anecdotes and the usual pseudoscientific arguments used by antivaccinationists. As a result, Manookian became an antivaccinationist—sorry, a vaccine “skeptic”—so much so that she went on to make an antivaccine propaganda movie, to which I subjected myself in order to review.
She then went on to start the debate out by asking Drs. Whitaker and Novella why there is a “debate” about vaccines. At this point, my teeth immediately began to grind, to the point where I feared for my molar enamel. This is a typical framing of what I (and many others) like to call a “manufactroversy.” Basically, the word manufactroversy is short for “manufactured controversy” and is basically a pseudocontroversy that is created to oppose conclusions overwhelmingly supported by the evidence and/or science. Examples abound, of course: Anthropogenic global warming, vaccines, much of alternative medicine, “9/11 Truthers,” and “birthers.” The bottom line, is that there is no scientific controversy over whether vaccines cause autism. The question has been asked multiple times and answered multiple times: No. Of course, being a scientist, I have to qualify that just a little bit by saying that “no” means that we can’t detect an effect above the noise level of the epidemiological studies that have been done. In other words, even if there is an effect, it is so small that it can’t be detected by current epidemiological methods, which can detect pretty darned small effects. For all intents and purposes, as far as science can tell, vaccines do not cause autism. Neither does the mercury in the thimerosal preservative that until 2001 was used in many childhood vaccines. They just don’t; scientists have moved on, regardless of what antivaccinationists claim.
Dr. Whitaker started out with what was essentially the same old tropes, including confusing correlation with causation, harping about how autism prevalence has appeared to skyrocket since the 1980s and 1990s. He made the claim that almost no child was developmentally disabled 30 years ago but now one in 88 children are diagnosed as having an autism spectrum disorder. During this segment, he also went on about how chronic diseases are skyrocketing along with autism and that it must be the evil vaccines. OK, I added the “evil” part, but it was quite clear that Dr. Whitaker thinks that they are evil. He made that very clear. So did Manookian, for that matter.
This was just the warmup. Steve, as you might imagine, easily demolished these arguments, pointing out that correlation does not equal causation. He also discussed how there have been several very large studies that controlled for relevant variables have failed to find even (as I like to put it) even a whiff of a hint of a correlation between vaccination and either autism prevalence or onset. He discussed how we as humans are hard-wired to infer causation from observed correlation, which makes it very understandable that people mistakenly conclude that vaccines cause autism? Why? Because, as we’ve discussed time and time again here, autism is often diagnosed in the age range when children receive a lot of vaccines, which means that by random chance alone we will often see diagnoses made in close temporal proximity to a round of vaccinations. Moreover, it was easy for Steve to point out that diagnostic criteria were broadened in the early 1990s, that schools started screening for autism, and that schools also got funding from the government to help autistic students. Again, Dr. Whitaker’s arguments were softball pitches, easily hit out of the ballpark as Prince Fielder hit balls out of the ballpark three days earlier in the pre-Allstar Game Home Run Derby. In essence, Dr. Whitaker made the same sort of ignorant arguments that Dr. Jay Gordon regularly makes, as exemplified in the comments after this excellent post by Emily Willingham why the “autism epidemic” is no epidemic at all.
There are only two areas where I would have added more than what Steve added. It doesn’t take much time to do so, but it can be very illuminating to the audience. First, I have some examples that I like to use to demonstrate why it’s silly to infer that vaccines cause autism just because autism prevalence has increased correlating with an increase in the number of vaccines. For example, what else happened in the early 1990s? Cell phones started to make an appearance, and by the early 2000s were ubiquitous. Maybe cell phones cause autism! (Wait, it’s probably already been claimed.) Or here’s another one. Before 1990, Internet usage outside of universities was pretty minimal. Even I, the wired, blogging, connected individual that I am now, did not have consistent online access until 1990 and didn’t use it a lot until two or three years later. Indeed, Netscape Navigator didn’t even show up until 1994. The point, of course, is that during the 1990s, Internet usage took off. So obviously the Internet causes autism!
The second thing I like to emphasize is that it’s a general rule in medicine that the more you look for something, as in launching mass screening programs, the more you will find it. Always. Consider ductal carcinoma in situ (DCIS), which is a premalignant precursor of breast cancer, a certain percentage of which (not fully known) will progress to become breast cancer. Back in the early 1900s, DCIS was rare because by the time it grew large enough to be a palpable mass, it almost always had become invasive cancer. Now, thirty years after mass mammographic screening programs became prevalent, DCIS is a common diagnosis. Indeed, approximately 40% of breast cancer diagnoses are in fact DCIS, and a recent study found that DCIS incidence rose from 1.87 per 100,000 in the mid-1970s to 32.5 in 2004. That’s a more than 16-fold increase over 30 years, and it’s pretty much all due to the introduction of mammographic screening. This sort of thing should not be surprising to doctors, but apparently sometimes it is.
Dr. Whitaker emulates Penn Jillette, but not in a good way
It was at this point that Dr. Whitaker lived up to the name of Penn Jillette’s Friday night party at TAM: He brought the stupid. Oh, man, did he bring the stupid! I’m sorry. I know that we’re not supposed to be quite so harsh here on SBM, but it’s been a long time since I’ve seen such a glaring example of mathematic, statistical, and scientific illiteracy. First, he stated unequivocally that he thought that vaccines were the primary cause of autism, scoffing at the idea that it was primarily genetic in nature or that vaccines were not causing it. As bad as that was, worse was to come, and it did when Dr. Whitaker showed this graph (sorry for the poor quality; the room was dark and all I had was my iPhone):
I reproduced this graph from his newsletter because I instantly saw that it was the same graph:
I want you to sit back for a minute and drink in the utter silliness of this graph, the utter lack of science, the utter nonsense. It’s been a long time since I’ve seen its like. I’m sure many of you can figure out what’s wrong with it on your own, but my duty as blogger demands that I explain, and I’ll give it exactly the time it deserves. Take a look. Notice how Dr. Whitaker extrapolates from a small dataset to produce curves that go right up to 100/100, or 100%. Steve’s jaw (and mine and, I daresay, Michael Shermer’s jaws) dropped in astonishment. That’s right. Dr. Whitaker produced a graph that predicted that by the year 2032 all boys will be diagnosed with an ASD and that by 2041 all girls will also have autism. I kid you not. Lest you think that this wasn’t Dr. Whitaker’s intention, that he didn’t know the implications of his extrapolation, I will quote from the relevant section of Dr. Whitaker’s newsletter discussing the graph:
Let’s do some simple math based on these solid statistics. Beginning in 1990, when the mass vaccination program took off, the incidence of autism and autism spectrum disorder in children exploded. The projections indicate that by the year 2031, virtually all male children will be diagnosed with autism or autism spectrum disorder, followed by all girls in 2041. Autistic kids will surely outnumber normal kids in the relatively near future. How will our society function if all kids age 10 and younger are so disables. This is the most frightening projection I can imagine, and it is simple math!
What is going on? The one obvious and absolute constant for these skyrocketing numbers of autistic and learning disabled children is vaccinations. Over the last 25 years, the number of vaccinations forced on our children has virtually exploded. Why? Are measles, mumps, chicken pox, and flu really that dangerous? In my opinion, irrevocable harm caused by vaccinations is infinitely worse than the diseases we vaccinated against.
Later, Dr. Whitaker writes:
There are only two things that can stop this madness. First, parents must have the right to decide what is injected into their children. Second, laibility must be borne by the pharmaceutical companies.
If these two things happen, we might recover from this nightmare. If they don’t, armed guards will be escorting our children to vaccination centers, and, within a few decades, our children—and our country—will be destroyed. Many of you will live to see this devastation. But most of your children and grandchildren will be so damaged by vaccinations that they will not notice it. They will be lost to autism. That, my friends, is simple math.
Apparently Dr. Whitaker doesn’t recognize the difference between “simple” and “simple-minded.” I do rather admire the apocalyptic imagery for its sheer paranoia. Fortunately, he restrained himself from using imagery quite as overblown during the debate.
To cap it off, Dr. Whitaker scaled the Y-axis to go up to 120. This was so bad that I almost felt sorry for Dr. Whitaker. When Dr. Novella explained why these graphs were so silly, the audience “got it” instantly, and it was at that point that Dr. Whitaker began to lose the audience.
It was also at this point that I realized that I could actually do what Steve does. On balance, I knew how to answer all of Dr. Whitaker’s arguments as well as he did. In some cases, Steve did better than I probably could have. In other cases, I think I could have demolished Dr. Whitaker’s arguments even better than Steve did. What I lack is Steve’s preternatural ability to stay calm and not openly reveal his contempt for such a silly argument. Maybe I need to learn that. In the meantime, I was content to serve as Steve’s bulldog, which is why I went up to the table to see Dr. Whitaker after the talk and ask some pointed questions about how he generated the graph. There was a real statistician there who also couldn’t believe how bad that graph was and was asking questions that I hadn’t thought of. Together, we completely flummoxed Dr. Whitaker.
We didn’t pull any punches, either, asking where he got the data, how he generated the data, what mathematical model he used to produce the graph, how he fitted the curve, how he could justify extrapolating so far from such a limited data set, how he decided what curve to fit, and how he can justify a curve that goes to 100% when there is virtually no condition that 100% of the population will suffer from except for (eventually) death. His answers were—shall we say?—not exactly convincing. He said the data were from the CDC (fair enough, although it would be interesting to know more specifically where he got his dataset) and that he just projected from the existing data. He had no clue, however, what mathematical model was used, what computer software was used, or what assumptions were made. He took my email address and promised to get send me the information. I have yet to receive it, despite sending Dr. Whitaker a friendly reminder on Twitter (@WhitakerMD; so feel free to “remind” him). To be fair, I will post about this again if he ever comes through. In the meantime, I really need to train myself to be more like Steve in these situations.
At least, I did get this amusing picture out of it.
I’m totally making this my Facebook profile picture for a while. I have other ideas of fun things to do with it. Another byproduct of my having met Dr. Whitaker is that I now know that he knew who I was and had read my review of The Greater Good. The best riposte he could come up with about it was to say, voice dripping with sarcasm, that he agreed that it was horrible that Leslie Manookian had changed her name. Of course, if you read my actual review of The Greater Good, you’ll realize that my point was that I thought she might have done that to make it harder to figure out that there is evidence on the web that she has practiced as a homeopath. Given his performance in the debate, I highly doubt he could refute one bit of science in it.
And all the rest
But enough of my shortcomings. How did the rest of the debate go? Well, it actually went pretty much like the first part of the debate. Steve basically mopped the floor with Dr. Whitaker. There was nothing left, not even a stain on the chair—metaphorically speaking, of course. It was actually rather painful to watch, in the way that it’s painful to watch one baseball team get pummeled by 12 runs, even when it’s a baseball team I really detest, like the New York Yankees. However, there was no “mercy rule” in debate. Basically, Dr. Whitaker trotted out a number of antivaccine “greatest hits,” and Steve pummeled him for it. For instance, Dr. Whitaker showed this graph:
Yes, this graph is yet another example of one of the oldest and most deceptive antivaccine tropes, one that I like to call the “vaccines didn’t save us” gambit. Basically, this intellectually dishonest—downright deceptive, actually—tactic involves pointing out that mortality was falling from a given infectious disease before a vaccine for it was introduced. In this case, it was measles and a few other diseases. The implication that antivaccinationists want people to draw is that hygiene, sanitation, and the like were the “real” causes of the decrease. The long version of the rebuttal this gambit is here. The short version is that disease incidence does not equal mortality and that measles incidence plummeted after the introduction of the vaccine. The reason mortality was falling before the vaccine was for other reasons. Medical care was getting better, and a smaller percentage of people who got the disease died from it. In fact, Dr. Whitaker explicitly stated the false premise behind this gambit, saying at one point that incidence equals mortality. Quite appropriately, Steve called him out on it, and did it in a way that the audience understood it.
Other issues that came up included some dubious antivaccine studies that we’ve covered at various times before. Dr. Whitaker also called for a “vaxed vs. unvaxed” study, but completely misunderstood the issues involved. He apparently thinks that such a study would could consist of just looking at vaccinated versus unvaccinated children without controls for various confounding factors. However, at times he seemed to be calling for a randomized “vaxed vs. unvaxed” study, because at one point he complained about studies not having placebo controls. Steve pointed out that such a study would be unethical. Dr. Whitaker also complained about randomized studies of new vaccines because the placebo control wasn’t just saline but had all the other ingredients besides the antigens, including adjuvants, seemingly not realizing that, scientifically speaking, that is an even more appropriate control than saline.
Finally, the bulk of the last one third of the debate was more about politics than about science. Dr. Whitaker brought up a Supreme Court decision last year related to vaccines, specifically Bruesewitz v. Wyeth. He didn’t call it by that name, however; but it was obvious that that was what he was talking about. Not surprisingly, he also misrepresented the decision as stating that parents cannot sue vaccine manufacturers for vaccine injury. This is, of course, nonsense. The National Vaccine Injury Compensation Act of 1986, signed into law by President Ronald Reagan, established a no-fault compensation system, paid for by tax dollars, for children injured by vaccines. It created a new special court, the Vaccine Court, through which claims for compensation have to go through first.
This law was necessary because a flood of lawsuits was threatening the very foundation of the vaccine program, and Congress feared that there would be no vaccine manufacturers left in the United States because liability concerns would drive them out. Reasons for the law aside, not only do parents who think their children have been injured by a vaccine have recourse to the Vaccine Court, where, win or lose, their attorneys’ fees are paid by the government, parents who do not prevail in Vaccine Court can then sue in regular courts. The law simply says that they have to go through this special court first. The Vaccine Court also happens to have easier rules of evidence (i.e., not applying Daubert tests to expert witness testimony) and in essence bends over backward to try to compensate children injured by vaccines. Not only that, but the Vaccine Court reimburses claimants for reasonable attorney and court costs and, as a result, has become a bit of a gravy train for a certain group of lawyers who represent parents in front of the court. In any case, although there are a bunch of nuances about product liability and other issues, when you boil it down to its essence, all Bruesewitz v. Wyeth says is that the law as written currently prevents parents who do not prevail in Vaccine Court from suing in state court. They have to go to federal courts.What Dr. Whitaker harped on is what antivaccinationists always harp on about this decision is a line from the dissent by Justice Sotomayor about vaccines being “unavoidably unsafe.”
That was the CliffsNotes version of the ruling. You can find out more here and here.
The final question was a simple one: Should there be mandatory vaccination? Obviously Dr. Whitaker railed on about “health freedom” and how parents should have the right to control the health care of their children. I also rather suspect that this was the main reason most people attended, because the audience definitely got antsy when the discussion veered away from this topic after the question was mentioned. Steve wisely took the tack that this is a political question, not a scientific question. He then reiterated that the science is clear: School vaccine mandates lead to higher vaccination rates, which lead to lower rates of vaccine-preventable illnesses. It is thus up to us and the political process what we wish to do with these scientific findings. And that’s what I usually say, too. Science informs policy, but it is the political process that determines policy. School vaccine mandates work, and at the very least it should be as hard to get exemptions, be they religious or philosophical, to such mandates as it is to follow the vaccine schedule. But that’s just my view. Unfortunately, this was not the first time that FreedomFest has promoted antivaccinationism and “alternative” medicine. Later, I found last year’s list of FreedomFest speakers, and Dr. Whitaker was listed there, having presented a talk entitled Vaccines: Good or Bad? (gee, I wonder on which side he came down), and in 2010 he presented a talk entitled “Treatment for Heart Disease, Diabetes, and Cancer; the good, the bad, and the stupid.” There’s no doubt that Dr. Whitaker is good at presenting stupid arguments. The problem is that he doesn’t know which arguments are stupid and which are not. I don’t know which conclusion flowing from Dr. Whitaker’s performance is scarier: That he actually believes this stuff and can’t see how unscientific it is or that he knows how unscientific his arguments are but makes them anyway.
When all is said and done, I must admit that I was actually rather shocked at the outcome of this debate. I say that not because I don’t have total faith in Steve’s abilities and didn’t expect him to acquit himself well, but rather for the same reason that I’ve always thought it was a bad idea to debate pseudoscientists. I realize that not everyone agrees with me about this, and, because Steve and I are brothers in arms against quackery, it was a no-brainer to support him in any way I could. Be that as it may, I expected Dr. Whitaker to be much slicker and harder to handle than he in fact turned out to be, such that in the end the audience might have been left with the impression that there were two scientifically legitimate sides to this issue (exactly the reason why I don’t like “debates” with pseudoscientists). Quite frankly, though, Dr. Whitaker was painfully bad, and I felt really stupid for having so massively overestimated his capabilities at debate and rhetoric. On the other hand, it’s always better to overestimate your opponent than to underestimate him. In any case, Dr. Whitaker made easily rebutted arguments, couldn’t even Gish Gallop very well at all, was ignorant of the science, even bad studies that purport to show a link between vaccines and autism, and appeared completely flummoxed by obvious points that any halfway decent debater would expect his opponent to make. In short, he looked every bit as though he had expected a cakewalk and as though he is used to adoration, not challenge. Steve gave him a challenge, and more, and from the reaction of the audience I’m also pretty sure that Steve got through to at least a few fence sitters. Even in an audience predisposed towards “health freedom,” good arguments can win out over bad. Still, I wonder whether they would have won out if Dr. Whitaker hadn’t been such an atrocious debater.
I will finish by pointing out that it’s one thing for an antivaccine “party” like the Canary Party to link up with a local Tea Party organization, as Kent Heckenlively crowed about recently. It’s quite another thing when a national meeting in which many of the luminaries of conservatism, libertarianism, and the Tea Party movement go to pow-wow together allows such rank antivaccine nonsense a prominent place in its program, complete with a pseudo-“debate” and two screenings of a movie that is nothing more than rank antivaccine propaganda disguised as a “tell both sides”-style “balanced” documentary. I noted above that this is not the first time this has happened, but I also checked the 2008 and 2009 speaker lists. There was no Dr. Whitaker, nor were there any talks on vaccines. That makes me think that giving the “health freedom” and antivaccine movements a forum is a relatively recent feature of FreedomFest for which Mr. Skousen should be profoundly ashamed. One can only hope that he is sufficiently embarrassed by Dr. Whitaker’s and Ms. Manookian’s performance that he does not invite them back next year. That they were ever given a forum at all at FreedomFest will be a blight on the conference for years to come.