As I approached what I should write about for the first post of 2022 for Science-Based Medicine, I debated between addressing a topic or piece of misinformation that I had neglected due to having taken a week off or writing about something more “meta”. (No, not the metaverse or Facebook’s crappy new name!) As the week wore on, and my wife and I were confronted directly by the lack of testing for COVID-19 for ourselves (don’t ask), followed by spending New Years Eve in the emergency room with a family member (don’t ask), I found that my psychic energy—if you’ll excuse me using that term—just wasn’t up to a detailed takedown of anything. So meta it is!

This brings me to something I saw before the holidays on Twitter about retiring NIH director Francis Collins that irritated me so much that I had thought of changing my plans to take last Monday off. Fortunately, I didn’t, which allowed me to contemplate it more and my anger to recede. That doesn’t change my level of frustration, but I figured I’d lead 2022 with it.

Here’s what I mean:

At the time, Dr. Collins had been on a farewell tour since having announced that he would be stepping down as NIH Director. Annoyingly, at nearly every stop he repeated his regret at how he (and NIH) had long failed to appreciate how potent health and antivaccine misinformation and conspiracy theories were and how badly they would impede public health efforts to slow the spread of COVID-19 before vaccines were available and to vaccinate the populace. This led to a number of articles like:

Let’s examine the problem with Dr. Collins’ take.

The problem with Dr. Collins (and the rest of the public health apparatus prepandemic)

Let’s begin with what appear to be the most shared quotes from Dr. Collins regarding medical misinformation, aside from his using his status as a religious man to urge evangelicals to reject vaccine- and COVID-19-related misinformation:

You’ve watched science and politics collide for years. Do you believe politicization of science has grown worse?

It is much worse. And it’s a reflection of the fact that polarization is much worse — and tribalism is much worse. We’re in a really bad place. If science happens to produce a result that a political perspective doesn’t like, then science has to be attacked. That’s exactly what we see now happening, to the detriment of getting the facts out there.

What role does the NIH have in pushing back against misinformation about science?

This has turned out to be a much more severe situation than I would have imagined a year ago. I wish we had more insights from behavioural social science research into how this has come to pass, and why it could have gotten so completely widespread. I want to call this out as one of my most major concerns as I stepped down from the NIH, of looking at the situation in our nation. Somewhere along the way, our political hyperpolarization began having a lot of really dangerous consequences, where in many instances we seem to have lost a sense of how to tell the difference between a fact and an opinion — or some Facebook post that’s, frankly, a lie. That’s truly dangerous. That’s another epidemic that is not going to go away even if we triumph over COVID-19. We need to figure out what happened here, and how to bring ourselves back to a place where our nation has a more stable future.

In another interview:

You have called it “bizarre” that politics influences precautions like mask-wearing. Can you talk more about divisiveness and disinformation around science?

We have two epidemics. One is caused by the virus that causes COVID-19. The other is an epidemic of misinformation and distrust about science.

People’s conclusions about almost everything seem to be driven by what their ‘tribe’ says is right. Objective facts often get overruled by the latest political statement or the conspiracy that just popped up on Facebook.

Estimates are that more than 100,000 Americans have died in 2021 unnecessarily because of misinformation campaigns that discouraged people from taking advantage of lifesaving vaccines.

We need all those who have the ability to sift through evidence to work tirelessly to get accurate information out to the public. It can’t just be coming from the government or scientists, because sadly we’re now considered a little bit suspect. It also needs to come from community leaders.

And politicians who have been some of the worst offenders in spreading misinformation need to recognize that history is going to judge them harshly.

This is a common view among those completely out of touch with what’s been happening “on the ground”, so to speak: Who could possibly have predicted what’s happened in the last two years? The retort of a lot of us who’ve been at this a while is: Who couldn’t have? I will admit that even I didn’t foresee things getting quite as bad as they have, but I was at least in the ballpark, writing about the first coronavirus conspiracy theory I encountered, way back in January 2020, before COVID-19 even had a final name, much less had become a pandemic. In the meantime, we were pointing out how COVID-19 was a golden opportunity for quackery and conspiracy theories.

I couldn’t help but get a little peeved and Tweet:

And friend of SBM Dr. Mark Hoofnagle noted:

There were a lot of similar responses from groups that promoted vaccination and countered antivaccine misinformation long before the pandemic.

Elite physicians and scientists like Dr. Collins also tend to assume that it’s so bad now solely because of political polarization. While political polarization is quite bad right now, those of us who have dealt with medical misinformation of this sort for decades know that it is not, strictly speaking, political polarization that is responsible for the tsunami of COVID-19 misinformation, although certainly it contributes. While I’m glad that someone of Collins’ stature is finally recognizing that misinformation and disinformation about health, in particular vaccines and COVID-19, are having a horrific effect and leading to unnecessary death and suffering, I can’t help but be frustrated over the long delay.

As my colleagues, who before the pandemic struggled to believe how (or dismissed the even the possibility that) people could believe the bizarre things about disease, medicine, and vaccines that we had been documenting for decades, were having their noses rubbed into the very bizarre things that people believe about disease, medicine, and vaccines, some of us had a hard time not rolling our eyes. I realize that saying “I told you so!” was probably not the most productive reaction in the world, but I hope you’ll forgive me that lapse and stay with me as I recount a little history and look at what might be done now and in the future.

“Shruggies” and even outright hostility

We at SBM, as well as a lot of other physicians, scientist, and others, have been warning about the malign effects of medical misinformation, pseudoscience, and conspiracy theories for decades, but few in authority listened or took the threat seriously. Why is this? And, more importantly, now that COVID-19 has awakened large number of physicians, public health officials, and scientists to the threat posed by medical and scientific misinformation of the sort that SBM has been combatting since 2008 and some SBM bloggers for even longer, how can we maintain that appreciation and momentum after the pandemic finally recedes into history?

Longtime readers might remember that during the first year of SBM’s existence one of our regular bloggers, Dr. Val Jones, coined a pithy term to describe the attitude held by most physicians towards antivaccine and medical misinformation: “Shruggies“, a term that she defined thusly:

Shruggie (noun): a person who doesn’t care about the science versus pseudoscience debate. When presented with descriptions of exaggerated or fraudulent health claims or practices, their response is to shrug. Shruggies are fairly inert, they will not argue the merits (or lack thereof) of complementary and alternative medicine (CAM) or pseudoscience in general. They simply aren’t all that interested in the discussion, and are somewhat puzzled by those who are.

She then went on to describe how she used to be a “shruggie” herself, but had come to appreciate the danger of medical misinformation, pseudoscience, and conspiracy theories, hence her willingness to join SBM as a blogger for a while before moving on (as most of our bloggers eventually do, sooner or later).

Unfortunately, there’s another attitude that’s also not at all uncommon among physicians, particularly academic physicians. It’s an attitude that goes beyond indifference into outright contempt for science communication aimed at correcting medical misinformation. The core of this attitude is based on the assumption that no one but crackpots would ever believe ridiculous things like homeopathy and antivaccine conspiracy theories and that it’s somehow “beneath” the oh-so-massive intellects of physicians, particularly academic physicians, to “waste” part of our supposedly-considerable brain power to debunk. To them, instead we should devote our incredible intellects and talents not to such dirty, plebeian concerns, such as alternative medicine and antivaccine misinformation, but rather to clinical trials, the depredations of big pharma, and topics like the question of overdiagnosis and mammography, a topic that I’ve covered a lot over the years.

Perhaps the best example of this attitude came from an oncologist named Dr. Vinay Prasad, who a couple of months before the pandemic mocked me and others who spend a lot of time deconstructing medical misinformation as being akin to LeBron James “dunking on a 7′ hoop”, the implication being that deconstructing medical misinformation (such as Goop’s jade eggs) is as easy to a physician as dunking on a short hoop would be to a basketball star.

Here’s a representative Tweet clearly directed at me (and hence deleted):

Prasad insult

The “fellowship-trained” part is the “tell” that he was probably referring to me.

Again, a lot of us had a hard time not rolling our eyes at the whole line of attack, even as this occurred roughly a month before the very first cases of deadly pneumonia due to a new coronavirus were observed in Wuhan, China:

I won’t say a lot more about this, other than to refer you to responses to Dr. Prasad by Steve Novella and myself, written a year ago, when inexplicably Dr. Prasad decided to double down on his Twitter attacks, which had not aged very well given that a deadly pandemic had appeared within months of his “7′ hoop” Tweets and was immediately followed a veritable tsunami of deadly misinformation, in the form of a MedPage Today article.

It isn’t just doctors, either, who discount the importance of “soft targets”. A few years ago, Scientific American columnist John Horgan made much the same arguments about skepticism in general, not just skepticism of dubious medical claims. I hasten to add right here that there are certainly legitimate criticisms of the skeptic movement and what topics that it tends to expend the most energy on, but Mr. Horgan wasn’t about that. He basically framed skepticism, much as Dr. Prasad did later, as attacking “soft targets” like homeopathy and Bigfoot and ignoring “hard targets” like cancer and world peace. (I’m not exaggerating.) As I put it at the time, his entire argument could be summed up as, “Soft targets” = What you care about. “Hard targets” = what I care about. (Very much like Dr. Prasad, actually.) Again, Steve Novella agreed, characterizing Mr. Horgan’s take as “superficial to the point of being wrong” and betraying “utter ignorance about what skeptics discuss and what our actual position is on the examples he gives”.

I can’t help but mention before moving on to the next section how…interesting…it is that it didn’t take long after the pandemic hit before Dr. Prasad was issuing highly dubious hot takes on the COVID-19 pandemic and has become one of the foremost members of a group that we at SBM like to refer to as “COVID-19 contrarians”, doctors who tend to minimize the danger of COVID, exaggerate the risks of COVID-19 vaccines, and downplay (or sometimes even deny) the efficacy of public health interventions, such as masking and vaccines. As a result, he’s been featured on SBM several times, particularly by our newest member, Jonathan Howard. Examples include the time Dr. Prasad made bad arguments against an emergency use authorization (EUA) for COVID-19 vaccines in children, downplayed the risks of COVID-19 in children, praised an utterly incompetent study that “dumpster dived” into the VAERS database, and more. Indeed, Dr. Prasad even went so far as to characterize mask, social distancing, and vaccine mandates as the first steps on the road to fascism, basically going full Godwin, so to speak.

Dr. Prasad might represent one piece of anecdotal evidence, but his turn rather suggests that perhaps it would have served him better not to be so disparaging and full of contempt towards the efforts of us humble skeptics promoting science-based medicine and refuting misinformation. However, he is just a part of the problem.

Social media = fake news multiplied

Over the holiday break, I read a book by Jason Stanley, the Jacob Urowsky Professor of Philosophy at Yale University, entitled How Fascism Works: The Politics of Us and Them. I highly recommend the book, but hasten to point out that it is not my purpose to discuss actual fascism (much) in this post; that is, in contrast to Dr. Prasad’s misguided attempts to portray COVID-19 control measures as incipient fascism or, at the very least, a slippery slope towards the death of US democracy. Rather, one chapter very much caught my attention in light of the pandemic and the problem of disinformation and misinformation about COVID-19. In his book, Professor Stanley takes pains to point out that there is nothing new about “fake news”, referring to examples from history in which fake news was used to foment violence. For example, after World War I, mass hysteria was provoked by fake news stories about mass rape of German women by African troops serving with the French troops who were occupying the Rhineland. Noting the similarity between how fake news spread in history, Prof. Stanley notes about newer examples of fake news in the social media era:

The fact that all of this eerily mirrors the spread of the German propaganda campaign in the 1920s of the “Black Horror on the Rhine” should dissuade us from adopting the view, currently in vogue, that this sort of “fake news” is a consequence of the modern revolution in social media.

The point, of course, is that “fake news” is nothing new. Nor, of course, are rumors, stories of dubious provenance, and conspiracy theories. These have been with us ever since humans developed language and used for nefarious ends. What is new is that social media allows this sort of misinformation a rapid global reach that it could not achieve before, or, even if it did, would take months or years to do. Worse, social media companies labored too long under the delusion that “bad speech” (such as medical misinformation and conspiracy theories) could be driven out and countered by “good speech” based on data, science, and reason. Particularly disingenuous is that these companies knew that their algorithms are designed to amplify material that provokes “engagement” (shares, responses, etc.). What is most likely to encourage such “engagement”? Obviously, it’s material that angers, frightens, or otherwise provokes strong emotion, which is why misinformation- and conspiracy theory-laden content tends to spread very rapidly compared to any sort of science-based countering. What that means is that information that the ever-so-eminent Dr. Prasad would consider “ridiculous” or beneath his engaging with, can almost instantaneously spread to all corners of the earth with an Internet connection. While it is true that Facebook (excuse me, Meta), Twitter, and the rest are finally waking up to the danger, they appear unwilling to invest the resources necessary to take on the task of minimizing the spread of misinformation and conspiracy theories on their networks, often instead relying too much on algorithms that don’t work very well.

Bloggers, at least, have been warning about the problem of misinformation spreading for a long time. Back when I started my first blog on a snowy Saturday in December in 2004, part of my motivation (besides feeling that my efforts on Usenet were going nowhere and Usenet was a dying platform) was that I saw how fast medical misinformation was spreading on the Internet. Remember, too, that this was before Facebook had been made available to the general public, before Twitter, before the rise of YouTube, and before Instagram. Back then, blogs were the new “thing”, and I observed the rise and proliferation of a number of antivaccine blogs. Then, several years later, I noted the first fumbling efforts of antivaxxers to use Facebook and Twitter, efforts that, unfortunately albeit predictably, became much less fumbling and more adroit over time. Now, there is a veritable juggernaut of misinformation, a social media ecosystem in which quacks, antivaxxers, cranks, and grifters spread COVID-19 and antivax misinformation along with conspiracy theories and politically and ideologically motivated fake news in huge quantities.

Everything old is new again

I conclude with a bit of fantasy here. As I said before, I’ve been sarcastically saying that “everything old is new again” for at least a year now. In general, I’m referring to antivaccine misinformation, and nearly every time I discuss specific COVID-19 antivax propaganda claims, I like to mention how none of these claims is new. Here are some examples of specific false or misleading claims:

I sometimes joke that the only reason that antivaxxers haven’t yet claimed that COVID-19 vaccines cause autism is because they weren’t approved for use in young children yet. I’m sure that will change, if it hasn’t already, with the EUA for a COVID vaccine for children ages 5-12, and, if that doesn’t do it, this old trope will appear when the vaccines are approved for children under five.

Then there was the claim that there is Hydra vulgaris in the vaccines. (Hydras are tiny freshwater animals that can grow to about an inch in size.) I guess that maybe there is one new antivax claim under the sun about COVID-19 vaccines. I suppose that this one could be filed as a variation on a favorite antivax technique of looking at vaccines under the microscope and gasping at scary-looking things whose identity antivaxxers don’t know, which has been done before.

And what about the Vaccine Adverse Events Reporting System (VAERS) database? My last post of 2021 discussed in detail the history of antivaxxers weaponizing VAERS, using its open nature and passive reporting design to paint a false portrait of vaccines as deadly—a new Holocaust, even!—causing autism, sterilizing our teenaged girls (Gardasil), and the like? Those of us familiar with the long history of antivaxxers weaponizing VAERS reports dating back to the 1990s were warning before the vaccines were released under an EUA over a year ago. Indeed, I was even writing about how VAERS was already being weaponized in December 2020, after I had received my first dose of the Pfizer vaccine.

Now here’s the fantasy.

Rod Serling

“Imagine, if you will…”

Imagine, if you will, that those of us “dunking on a 7′ hoop” hadn’t been mostly ignored or viewed as wasting our time. Imagine that, before the pandemic, there had been an appreciation among our profession that it is worthwhile, as Jonathan Howard put it, to debunk the seemingly ridiculous because it often serves as the basis for much less “benign” misinformation and pseudoscience. Imagine that the NIH hadn’t served, through the National Center for Complementary and Integrative Health (NCCIH), as a base for promoting pseudoscience in medicine since the 1990s, now run by a true believer in woo. Imagine that quackery such as anthroposophic medicine, homeopathy, and naturopathy hadn’t infiltrated leading academic centers as quackery infiltrated major medical journals. Imagine that this infiltration hadn’t led a medical center like the Cleveland Clinic to tolerate an antivaccine doctor like Dr. Daniel Niedes for so long. Imagine that Dr. Collins had actually done what he now regrets not having done (and that Dr. Anthony Fauci had done it too), and dedicated considerable NIH resources over decades leading up to the pandemic to understanding medical misinformation and conspiracy theories. Imagine that they understood the central conspiracy theory of the antivaccine movement, the conspiracy theory on which all antivax conspiracy theories are based and of which all antivax conspiracy theories are but a variation? Let’s go even farther and imagine that it was understood how all science denial is a form of conspiracy theory, so that it could have been foreseen how rapidly antivaxxers would team up with “anti-lockdown” and “antimask” protesters. Imagine that science communicators were appreciated, with science communication being widely understood to be a discipline in itself, contrary to the case over the last 25 years since Carl Sagan died. Imagine that state medical boards recognized that being a physician is a privilege, not a right, and that using one’s stature as a physician to spread dangerous health and antivaccine misinformation is an offense worthy of suffering the penalty of having one’s medical license removed, rather than having to have been dragged into that realization only a few months ago.

Would it all have made a difference if all the elements of my fantasy had been in place in January 2020? Maybe not, but I’m quite sure that we would nonetheless have been in much better shape to deal with the pandemic and wouldn’t have seen the fumbling efforts against, for instance, the Great Barrington Declaration “natural herd immunity” strategy, whose premises Collins himself said required a “devastating published takedown” but was unable or unwilling to do.

The question, of course, is: Now that physicians and scientists have finally awakened to the threat of health misinformation, how do we keep them engaged now? In the future, how do we our professions from retreating back into “shruggie” complacency or even “dunking on a 7′ hoop” hostility to combating this misinformation after the pandemic finally fades into history?

I don’t claim to know the answers now, but I have ideas that I hope to discuss in 2022, along with links between not just old antivaccine misinformation and COVID-19 misinformation, but how old alternative medicine beliefs undergird much of the misinformation we see. We at SBM will need help in advocating for science in medicine. Everything old might seem new again now, but it’s all just part of the longstanding problem of combatting irrational beliefs to which humans have always been prone.

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Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.