I did my general surgery residency at the University Hospitals of Cleveland (UHC), which was affiliated with Case Western Reserve University. At the time, there was an intense rivalry between UHC and its larger neighbor on Euclid Avenue, the Cleveland Clinic. This rivalry dates back many decades. In the early 1990s while working on my PhD, I also moonlighted as a flight physician on Metro LifeFlight. In that role I not infrequently delivered cardiac patients to the Cleveland Clinic, which has a well-respected and pioneering cardiovascular program. During my PhD studies, I also did a three month rotation with a cardiovascular researcher at the Cleveland Clinic. After these experiences, I couldn’t help but be impressed by the facility and respect UHC’s rival down the street.
Unfortunately, these days I’m not so much impressed by The Cleveland Clinic as appalled. The reason has been the Cleveland Clinic’s increasing embrace of quackery in the form of “integrative medicine.” It’s an embrace that’s gone farther than most ever thought it could, as evidence by a post published on a local Cleveland paper’s blog (Google cache version here) that reveals the director of the Cleveland Clinic Wellness Institute to have dangerous pseudoscientific antivaccine beliefs. It was a post that would have been quite at home on NaturalNews.com, Age of Autism, or any of a number of antivaccine websites. The post ignited a firestorm in the medical social media, as well it should. There was outrage, which was appropriate, but there was also surprise, which I didn’t share so much. After all, if you “integrate” medical quackery (e.g., naturopathy) that posits that a lot of disease is due to “toxins” that you must “detoxify” to cure, antivaccine quackery will not be far behind, given how much antivaccine ideologues blame “toxins” in vaccines for autism, ADHD, autoimmune disease, and all the other bad things they attribute to vaccines.
Before I get to the op-ed itself, let me briefly recap for viewers who are not familiar with the history of the Cleveland Clinic’s “pioneering” embrace of quackademic medicine. While I didn’t coin the term, I do use “quackademic medicine” a lot because it perfectly describes what is going on at academic medical centers like the Cleveland Clinic (and, alas, UHC as well these days). If there is a “leading light” of quackademic medicine, these days the Cleveland Clinic would definitely be in hot contention for that “honor.” Long ago, it founded the Cleveland Clinic Wellness Institute, which offers modalities ranging from acupuncture to energy medicine. Since then, the Cleveland Clinic has set up a traditional Chinese medicine herbal medicine clinic, staffed by a naturopath, and embraced functional medicine quackery by setting up a functional medicine clinic. Unfortunately, the functional medicine clinic has been wildly successful. There should have been some warning that there might be antivaccine pseudoscience in their Wellness Institute given that Dr. Mark Hyman, who founded the Clinic’s functional medicine clinic, is antivaccine. He even co-authored an antivaccine book with Robert F. Kennedy, Jr. entitled Thimerosal: Let the Science Speak: Mercury Toxicity in Vaccines and the Political, Regulatory, and Media Failures That Continue to Threaten Public Health, that blamed thimerosal for all sorts of ills two years ago.
Aside from its recruitment of Mark Hyman to such a high profile role, however, I had never had a concrete reason to doubt the Cleveland Clinic’s commitment to vaccination as a key public health intervention. Indeed, if there’s one area that proponents of integrative medicine are always quick to assure doctors and the public about, it’s vaccines. To my knowledge, all the major integrative medicine thought leaders (until now) have always told us in no uncertain terms that they are really, truly pro-vaccine. Even though the very same alternative medicine modalities, such as chiropractic, naturopathy, and various flavors of “natural medicine,” are quite frequently intensely antivaccine, proponents of integrative medicine are always quick to assure us that antivaccine beliefs will never, ever taint integrative medicine. Such claims have always had a hint of self-delusion, however.
Showing that delusion quite nicely is Cleveland Clinic physician Daniel Neides, MD, MBA, who wrote a blog post entitled “Make 2017 the year to avoid toxins (good luck) and master your domain” (again, Google cache version here; Google Cache’s involvement will be made clear momentarily.) His article made it impossible for The Cleveland Clinic to deny that it has a quack problem.
Dr. Daniel Neides: Antivaccine and “detox” quackery galore
Before I go on to discuss the misinformation, quackery, and pseudoscience in Dr. Neides’ article, I think it very important to point out why this is so disturbing. It boils down as much to to who he is not as to who he is. He is not Dr. Bob Sears. He is not Dr. Jay Gordon. He is not Andrew Wakefield. He is not Dr. Sherri Tenpenny. He is not Dr. Suzanne Humphries. All of these doctors are antivaccine, but none of them work for a major academic medical center. None of these doctors has any cachet outside of alternative medicine and antivaccine circles (but I repeat myself). None of them is the frikkin’ Acting Medical Director of the Tanya I. Edwards Center for Integrative Medicine and Vice Chair and Chief Operating Officer of the Cleveland Clinic Wellness Institute! (I wanted to use the real f-word, but we have a policy here at SBM not to use any cuss word stronger than a certain word for male bovine excrement. So I restrained myself. Barely.) As such, he is a high-ranking member of the “integrative medicine” club in academia. There is no way he should be writing or even believing garbage like this:
I am tired of all the nonsense we as American citizens are being fed while big business – and the government – continue to ignore the health and well-being of the fine people in this country. Why am I all fired up, you ask?
I, like everyone else, took the advice of the Centers for Disease Control (CDC) – the government – and received a flu shot. I chose to receive the preservative free vaccine, thinking I did not want any thimerasol (i.e. mercury) that the “regular” flu vaccine contains.
Makes sense, right? Why would any of us want to be injected with mercury if it can potentially cause harm? However, what I did not realize is that the preservative-free vaccine contains formaldehyde.
WHAT? How can you call it preservative-free, yet still put a preservative in it? And worse yet, formaldehyde is a known carcinogen. Yet, here we are, being lined up like cattle and injected with an unsafe product. Within 12 hours of receiving the vaccine, I was in bed feeling miserable and missed two days of work with a terrible cough and body aches.
My anger actually stems from a constant toxic burden that is contributing to the chronic disease epidemic. And yet the government continues to talk out of both sides of its mouth. We want our citizens to be healthy and take full advantage of the best healthcare system in the world (so we think), yet we don’t treat our bodies with the love and attention they deserve.
The stupid, it burns. I know, I know. Here on SBM, I’m supposed to be a bit more…civil…than my usual persona at my not-so-super secret other blog. Sorry. Not this time. I’m down with ZDoggMD’s rant on this one. What Dr. Neides is spewing is antivaccine bullshit of the highest—or should I say, lowest?—order. This is antivaccine nonsense that would not be in the least bit out of place on antivaccine crank blogs like Age of Autism, as I could easily demonstrate by taking Dr. Neides’ article and comparing it to any number of antivaccine propaganda pieces I’ve deconstructed over the years. Heck, Dr. Neides’ little rant here wouldn’t be out of place on NaturalNews.com. It really is just that bad. Even worse than that, it’s incredibly irresponsible for a physician like Dr. Neides to post an antivaccine rant like this right in the middle of flu season in which he blames “toxins” in the flu vaccine for his feeling crappy for a couple of days and having to miss work. There is no excuse, particularly when he uses the “toxins gambit.” In fact, what Dr. Neides is spewing is even more ignorant than the toxins gambit spewed by the average antivaccinationist. Yes, it’s just that bad. Here’s why.
Dr. Neides starts out equating thimerosal with mercury, which is not quite accurate. Yes, thimerosal was used as a preservative in childhood vaccines until its use ceased 15 years ago. Yes, thimerosal does contain mercury. However, it is not mercury, contrary to what is implied by Dr. Neides. As a family practice physician, he should also know that the hypothesis that mercury in vaccines causes autism is a failed hypothesis. Science just doesn’t support it. In the meantime, though, notice how Dr. Neides pivots from thimerosal as a preservative in vaccines to formaldehyde as a “preservative.” This can only be intentional, as it immediately brings to mind the use of formaldehyde as the main component of embalming fluid.
Of course, vaccines don’t contain formaldehyde as a preservative. Vaccines contain tiny amounts of formaldehyde because it is used to inactivate the viruses during the manufacture of vaccines. Moreover, the human body makes formaldehyde as a normal byproduct of metabolism. Surely, as a physician, Dr. Neides must know this from his biochemistry course in his first year of medical school. Perhaps he’s forgotten; so I’ll take this opportunity to school him. Formaldehyde is a common chemical that is found in many places and in many foods. As I noted before, it has a scary connotation because of its use to embalm bodies, but embalming bodies involves a high concentration of formaldehyde, a situation quite different from (and not analogous to) its presence in some vaccines. Formaldehyde is present in some—but by no means all—vaccines. For instance, it can’t be used in attenuated live virus vaccines because it would kill the virus. As far as vaccines that could have formaldehyde in them go, I like to refer the antivaccine cranks ranting about formaldehyde to the CHOP Vaccine Education Center entry on formaldehyde. Granted, true antivaccine cranks won’t pay attention because the Children’s Hospital of Philadelphia is where Paul Offit practices, and to antivaccine cranks Dr. Offit is Lord Voldemort, the Dark Lord Sauron, and Darth Vader all rolled up into one villain. However, presumably Dr. Neides is not part of the hard core antivaccine crankosphere. So maybe he would listen to Dr. Offit, who knows a hell of a lot more about vaccines than Dr. Neides does, when his website tells him that the amount of formaldehyde in vaccines is not a concern in an infant.
Basically, formaldehyde is everywhere in small amounts that are harmless. The dose makes the poison, and formaldehyde in vaccines does not reach levels that make it a poison. Add to this the fact that these calculations are for babies and that Dr. Neides is a fully grown adult male, and from a scientific standpoint Dr. Neides’ fear mongering about formaldehyde becomes even more ridiculously cringe-worthy. Then, when he refers to formaldehyde as a “known carcinogen,” Dr. Neides neglects to note that the carcinogenic properties of formaldehyde depend on high exposure, as in funeral industry workers.
Dr. Neides fears the “toxins”
If there’s one concept that underlies much of alternative medicine, in particular naturopathy, it’s the idea that “toxins” are at the root of all illness. If you accept that idea, then the obvious solution to the problem (and cure to the health problems and diseases caused by “toxins”) is to “detoxify.” Of course, the idea that “toxins” are causing all disease is a very ancient idea, dating back to ancient Egypt (at least). Sadly, Dr. Neides promises to commit his efforts in the new year to “educating” people about these dread “toxins”:
Our air, water, and food supplies are completely compromised and so it is time for us to take matters into our own hands. This year, I am committing to providing you with the educational resources to make you the best YOU. It may get confusing and frustrating at times, but stressing out over this won’t help. Take three deep belly breaths and let’s get started.
We live in a toxic soup. There are over 80,000 chemicals used in various industries country-wide. There are over 2,000 new chemicals being introduced annually. We breathe in these chemicals through exhaust, eat them in our processed foods (just look at the labels that have 20 or 30 ingredients and good luck pronouncing their names), textiles (clothing, bedding, furniture), and personal care products, including make-up, deodorant, shampoos, and soaps.
“Just look at the labels that have 20 or 30 ingredients and good luck pronouncing their names”? The Food Babe would be proud. Of course, we make fun of the Food Babe (Vani Hari) because of her extreme ignorance and her fear of chemicals that leads her to demonize chemicals whose names she can’t pronounce. I expect more of a physician, and yet here we see Dr. Neides making the same sort of ignorant appeal to ignorance in which chemicals whose names the average person can’t pronounce must be bad. I’ve referred to The Food Babe as the Jenny McCarthy of Food. It’s depressing in the extreme to see a physician in a leadership position in a major academic medical center making the same sorts of ignorant arguments as those favored by The Food Babe or the most idiotic of antivaccine websites. It’s even more depressing to see him actually recommend The Food Babe’s website, as Dr. Neides does later in the post by quoting a functional medicine quack, Jessica Hutchins’ endorsement of her.
Back to antivaccine fear mongering, courtesy of Dr. Neides
Not satisfied with his first volley of antivaccine fear mongering coupled with his invocation of “toxins” as the be-all and end-all of chronic disease, Dr. Neides proceeds to endorse the idea that vaccines cause autism, while leaving himself some plausible deniability, as he recounts a litany of antivaccine “greatest hits”:
Slight detour. Why do I mention autism now twice in this article. Because we have to wake up out of our trance and stop following bad advice. Does the vaccine burden – as has been debated for years – cause autism? I don’t know and will not debate that here. What I will stand up and scream is that newborns without intact immune systems and detoxification systems are being over-burdened with PRESERVATIVES AND ADJUVANTS IN THE VACCINES.
The adjuvants, like aluminum – used to stimulate the immune system to create antibodies – can be incredibly harmful to the developing nervous system. Some of the vaccines have helped reduce the incidence of childhood communicable diseases, like meningitis and pneumonia. That is great news. But not at the expense of neurologic diseases like autism and ADHD increasing at alarming rates.
When I was in medical school in the late 1980s, the rate of autism was 1 in 1,000 children. For those born in the 1950’s and 60’s, do you recall a single student in your grade with an Individualized Education Program (IEP) for ADHD or someone with a diagnosis of autism? I do not.
As of 2010, the rate of autism in the U.S. escalated to 1 in 68 children. The deniers will simply state that we do a better job of diagnosing this “disorder”. Really? Something (s) are over-burdening our ability to detoxify, and that is when the problems begin.
So let me be clear – vaccines can be helpful when used properly. But the vaccination timing and understanding one’s epigenetics (how your genes interact with the environment) are all critical to our risk of developing chronic disease. Please talk to your doctor about the optimal timing of vaccinations for your children, and therefore reduce your risk of raising a child with a neurologic complication.
I reproduced this lengthy passage to let you see it in all its antivaccine glory. Notice how he disingenuously claims not to be taking a position on whether vaccines cause autism. Why do I say “disingenuously”? Because his claim is nothing more than a variation of the “I’m not ‘antivaccine,’ I’m pro-vaccine safety” denial that many antivaccine activists use to deflect the charge that they are antivaccine. It’s been a favorite of Jenny McCarthy, for instance. I frequently refer to antivaccine dog whistles, which are terms that, to those unversed in antivaccine propaganda, sound benign but signal to antivaccine believers that the person using them is with them. Let’s just put it this way. Dr. Neides goes way, way beyond antivaccine dog whistles and into antivaccine bullhorn territory.
Let me count the antivaccine tropes in the passage above. Aluminum is dangerous to the immune and neurologic symptoms of newborns? Check. And wrong, wrong, wrong. The implied claim that vaccines cause autism? Check. And also wrong. There’s lots more evidence than this debunking the myth of the vaccine-autism link, but as an example, a small pebble pulled from a mountain of evidence not supporting a vaccine-autism link, I will mention a recent meta-analysis examining cohort studies involving nearly 1.3 million children conclusively failed to find a link between vaccines and autism. I’ll also mention a massive systematic review that found that severe adverse events due to vaccines are very, very rare. The claim that there is an “autism epidemic” and that it must be due to vaccines? Check. (And holy confusing correlation with causation, Batman!) Yes, this is another claim that is incorrect. Although the prevalence of autism disorders has increased to 1 in 68, existing evidence suggests that the increase is mainly due to broadening of the diagnostic criteria back in the 1990s and, yes, picking up more subclinical cases through increased screening. Whenever you look more closely for a condition or disease—any condition or disease—you will find more of it, often a lot more of it that had not been clinically apparent, as I explained in my discussion of autism prevalence. That’s not even counting diagnostic substitution and how, when you control for methods of capturing diagnoses, “true” autism prevalence has not changed detectably in at least 20 years.
Before I move on again, I can’t help but note how Dr. Neides invokes the magical mystical “epigenetics,” a concept that’s been embraced by quacks the way that proponents of “energy healing” embrace the term “quantum.” It’s the hottest fad in “integrative medicine” to “explain” how we can allegedly control our gene expression through the peerless power of our will. He even attacked the hepatitis B vaccine birth dose as unnecessary and dangerous, even though it is safe and there are good reasons to administer it at birth.
Basically, Dr. Neides’ post is nothing more than a list of antivaccine lies and detox quackery, all wrapped in a mantle of “I’m not ‘antivaccine,’ I’m pro-vaccine safety” and an attempt at plausible deniability (“I don’t know” and “I won’t debate here” whether vaccines cause autism), with a lukewarm concession that “some” vaccines do good and have reduced the incidence of deadly diseases coupled with a false equivalency (but only “at the expense of neurologic diseases like autism and ADHD increasing at alarming rates”). He is clearly antivaccine by my criteria at least.
No one, least of all The Cleveland Clinic, should be surprised by such antivaccine views in “integrative medicine”
As you might imagine, Dr. Neides’ article unleashed a social media firestorm over the weekend, with STAT News noting the PR…difficulties…caused by Dr. Neides’ post. Also, Tara Haelle over at Forbes did a deconstruction. I’m a bit late to the game, but that’s not necessarily a bad thing. It allows me to comment on not just Dr. Neides’ post, but the reaction to it.
Dr. Neides’ post was temporarily taken down (hence the need for Google Cache, it’s now back up with a note that it was “inexplicably removed” for a couple hours), and he issued a very unconvincing apology, saying that that he “fully supports vaccination” and was only trying to open a conversation about their safety, not question their use. Later, through a Cleveland Clinic spokeswoman, he issued this statement:
I apologize and regret publishing a blog that has caused so much concern and confusion for the public and medical community,” the statement said. “I fully support vaccinations and my concern was meant to be positive around the safety of them.
Dr. Neides sure has a strange way of being “positive around the safety of” vaccines, wouldn’t you say? After all, he did liken vaccination to being “lined up like cattle and injected with an unsafe product.” Indeed, his imagery of cattle going to the slaughter is a common one used by antivaccine ideologues. Perhaps Dr. Neides considered his words “positive around the safety” of vaccines because he showed amazing self-restraint in not using the word “sheeple” to describe those being vaccinated. I bet that’s it.
In any event, this is far from the first time I’ve seen this sort of “notpology” from an antivaccine doctor caught publicly spewing antivaccine quackery. Indeed, Dr. Neides’ notpologies include common standard issue responses that are not to be believed, particularly in light of the highly inflammatory language in his blog post and in some of his responses in the comments.
The Cleveland Clinic, for its part, released a statement yesterday:
Cleveland Clinic is fully committed to evidence-based medicine. Harmful myths and untruths about vaccinations have been scientifically debunked in rigorous ways. We completely support vaccinations to protect people, especially children who are particularly vulnerable. Our physician published his statement without authorization from Cleveland Clinic. His views do not reflect the position of Cleveland Clinic and appropriate disciplinary action will be taken.
This is, of course, the bare minimum The Cleveland Clinic could have done, but I rather suspect its leadership is waiting until today to figure out what to do.
I feel for the science-based physicians and scientists who work for the Cleveland Clinic, and there are a lot of them. I know someone who gets medical care from the Cleveland Clinic, and what’s relayed to me is that the primary care doc seen scoffs at all the “wellness” woo. Indeed, Amrit Gill, the patient safety officer at The Cleveland Clinic, took to Twitter to defend her institution:
— Amrit Gill (@amritgillmd) January 8, 2017
A cutting response:
— David Gorski (@gorskon) January 8, 2017
My guess is that it’s a combination of ignorance of just how bad the quackery is and the shruggie disease. Same as it ever was.
It must be pointed out that the Cleveland Clinic brought this PR debacle on itself. It was well-nigh inevitable that antivaccine pseudoscience would eventually rear its ugly head in some form or another the moment the Clinic embraced quackery wholeheartedly for its Wellness Institute. Indeed, I welcome this PR meltdown, because I hope that it will finally shine a light on the utter quackery that has been promoted by the Cleveland Clinic over the last decade at least and how that quackery is inseparable from the antivaccine quackery promoted by Dr. Neides in his post. I also hope that this debacle shines attention on Dr. Hyman as well, who has largely gotten a pass.
Even though the Cleveland Clinic officially disavowed Dr. Neides’ position on vaccines, it continues to cling to pseudomedicine where antivaccine views are inherent, such as chiropractic, energy medicine, and others. Its staff list is chock full of chiropractors, acupuncturists, reiki masters, and “holistic doctors.” I also note that Dr. Mark Hyman, founder and director of the Cleveland Clinic’s functional medicine clinic, co-authored an antivaccine book with one of the most famous antivaccine cranks out there, Robert F. Kennedy, Jr. They even appeared on The Dr. Oz Show together to discuss the book! He’s also written blog posts in which he blamed vaccines for autism and recommended rank quackery to treat autism.
Let’s just put it this way using one example. The Cleveland Clinic hired the co-author of an antivaccine book to run its functional medicine clinic, and it’s surprised that antivaccine views have apparently found a comfy home in its Wellness Institute? I can’t help but be reminded of Captain Renault in Casablanca and how he was shocked—shocked—to find that gambling quackery is going on here!
That part where one of Rick’s employees brings Captain Renault his gambling winnings is especially applicable to this situation.
As for Dr. Neides, I’m only disappointed that it took so long for others to take notice of his belief in rank quackery. All you have to do is to peruse his list of blog posts for Cleveland.com to see his proclivity for “detox” quackery in posts with titles like “To combat chemicals tainting our food and air, detoxify” (in which he fully bought into claims that glyphosate causes inflammatory bowel disease, obesity, depression, ADHD, autism, Alzheimer’s disease, Parkinson’s disease, ALS, multiple sclerosis, cancer, infertility and developmental malformations), “Everyday toxins poison our best intentions” (in which Dr. Neides lists a bunch of chemicals to avoid), and the like. He also appears to treat his patients for “chronic candida” infection, a favorite quack diagnosis. I also can’t help but note that in a 2014 post Dr. Neides recommended the flu vaccine, noting the 2009 H1N1 influenza pandemic. What happened since then? Who knows? Was one bad reaction (if it was even that) to a flu shot enough to change his mind so much?
His extracurricular activities aside, there’s another alarming thing I noted about Dr. Neides. He’s also Associate Director of Clinical Education for The Cleveland Clinic Lerner College of Medicine (CCLCM), where he oversees all clinical activities during years three through five of the medical school. That means he plays a big role in how medical students at The Cleveland Clinic are educated. That is profoundly scary.
I can’t help but finish this long post by referring you to the Cleveland Clinic’s reiki factsheet. (I’ve saved a copy in case it disappears.) I urge you to read it in its entirety. It’s chock full of references to “life force energy,” the practitioner’s and patient’s “energy field,” and the “universal source,” with no science whatsoever, representing complete acceptance of the mystical mumbo-jumbo behind reiki. After you read this, you will understand why I liken reiki to faith healing. Both reiki and faith healing rely on a belief that some sort of healing power can be channeled by the practitioner from a source to the patient. In the case of faith healing, that source is the Judeo-Christian god. In the case of reiki, it’s the “universal source.” They’re the same thing, faith healing. It’s just that they’re based on different religious traditions.
My purpose in referring you to this factsheet is simple. If an institution embraces mystical or religious quackery like reiki uncritically as valid medicine, it soon won’t be able to limit the magical thinking to just a few areas, particularly if the quackery is popular and makes money, as it appears to be and do at the Cleveland Clinic Wellness Institute.
As Alan Levinovitz put it on Twitter:
— Alan Levinovitz (@AlanLevinovitz) January 8, 2017
After that, he went off on an epic Twitterstorm explaining further what I’m talking about.
If you as an institution embrace multiple forms of magical thinking, you shouldn’t be surprised if your institution’s belief in magical thinking grows and metastasizes. Nothing will be off-limits, even antivaccine views. Now, The Cleveland Clinic has a TCM herbal clinic and a functional medicine center. Given how integral beliefs in “detoxification,” from which naturally flow antivaccine beliefs, are so much part of the quackery being “integrated” into medicine through integrative medicine, it should not be a surprise that there are at least two antivaccine quacks in leadership positions at the Cleveland Clinic, Drs. Mark Hyman and Daniel Neides. After all, if you “integrate” medicine that teaches that “toxins” cause disease and “detoxification” is the cure, antivaccine quackery can’t be far behind, and when you abandon science for magical thinking nothing is off limits to magic.
The Cleveland Clinic can discipline or fire Dr. Neides from his leadership positions for his irresponsible post (which looks to be the likely outcome now), but that won’t solve its problem. That’s because The Cleveland Clinic’s problem stems from the integration of quackery into its Wellness Institute. Unless the leadership of The Cleveland Clinic cleans house in a big way, eliminating the quackery, what will happen is that the remaining “integrative medicine” doctors who are antivaccine will simply know not to speak publicly about their antivaccine beliefs. Even though firing Dr. Neides would be a good first step in cleaning house, it would be nowhere near enough to fix the problem at The Cleveland Clinic.
Finally, I hope that this whole kerfuffle is just the wakeup call needed for all the good doctors at The Cleveland Clinic who practice science-based medicine to learn just how deep the quackery at their institution runs, a wakeup call that leads them to a shruggie awakening to realize that it’s not that great a step from seemingly “benign” woo to dangerous woo, like antivaccine woo.