Over the weekend, I was perusing my Google Alerts, along with various blogs and news websites, looking for my weekly topic, when I noticed a disturbance in the pseudoscience Force. It’s a phenomenon I’ve noticed many times before, but, as far as I can tell, I haven’t actually blogged about it here, at least not specifically, although I have mentioned it, particularly in posts about Stanislaw Burzynski. I have, however, blogged about it over at my not-so-super-secret other blog, which means that some of the thoughts (if you can call them that) that I plan to lay down in this post will likely seem familiar to some of you, but I think this is an important enough topic that I should cover it here, too. As arrogant as I might sometimes seem, even I’m not so deluded as to think that the fraction of SBM readers who are regulars at my not-so-super-secret other blog is anything greater than a clear minority, and even for those of you for whom there’s overlap I’ll try to make things different enough to be interesting.

On Friday, Sharon Hill published a post over at Doubtful News entitled Chiropractors get their spine out of place over critique. It’s about how chiropractors have reacted to a post by Steve Salzberg over at Forbes entitled New Medicare Data Reveal Startling $496 Million Wasted On Chiropractors. Salzberg’s blog post was basically about just that, namely the amount of money billed Medicare by chiropractors, information that’s possible to obtain since the government released Medicare billing data for individual practitioners. Salzberg pointed out that half a billion dollars is a lot of money, more than twice as much as what is wasted every year on the National Center for Complementary and Alternative Medicine (NCCAM) and the National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine (OCCAM). The result was rapid. Chiropractors swarmed, complaining to Forbes.com, and making the usual threats to sue, much as they actually did sue Simon Singh and, fortunately, saw their lawsuit blow up in their faces.

This, of course, can be looked upon as a purely mercenary protection of turf and livelihood not unlike how Daniel Kopans attacks any study that finds mammography to be less effective than thought (or even ineffective) in decreasing deaths from breast cancer. There is, however, a form of backlash against criticism of pseudoscience that is different and, when I first encountered it, more disturbing to deal with. It’s a level of pure, visceral hatred that is difficult to understand; that is, until you try to put yourself into your “enemy’s” shoes. Consider this post an exercise in doing just that, an exercise that will no doubt shock at least one of our readers.

How lots of “them” really view “us”

Those of us who dedicate considerable time and effort to combatting quackery generally do it because we think we’re doing good. Certainly, I wouldn’t spend so much time blogging the way I do, both here and at my not-so-super-secret other blog, if I didn’t think so. It’s true that I also enjoy it, but if I were doing this just for enjoyment I’m sure I could manage to find other topics that I could write about. In actuality, way back in deepest darkest beginnings of my blogging career, I did write about a lot of other things. My skeptical topics were more general in nature (rather like the way Steve Novella’s topics still are at NeuroLogica Blog), encompassing not just medicine but evolution versus “intelligent design” creationism, religion, Holocaust denial, history, and even the occasional foray into politics. Over time such diversions became rarer, to the point where I hardly ever write about topics other than medicine anymore, even at the not-so-super-secret other blog. I think that the reason for that is simple: It’s what I’m most passionate about, and I think it’s where I can do the most good. Like most bloggers supporting skepticism and, in particular, science-based medicine, I think of myself as doing my part to educate, hopefully in an entertaining fashion, and I’ve been rewarded with one of the more popular medical blogs out there and a small degree of notoriety. Indeed, I sometimes think of myself as a microcelebrity (or even nanocelebrity), because I have a little bit of fame, but it doesn’t really extend outside of the blogosphere. That’s fine with me, as it’s enough that occasionally a reporter will contact me for a quote about a story I’ve blogged about.

It’s often instructive, however, lest I become too smug or comfortable, to take note of how the “other side” thinks of those of us who try to promote SBM and, in doing so, educate the world about quackery. The way we think of ourselves does not resemble in any way what the quacks and antivaccinationists think of us. At some level this is not surprising. After all, any of us who’ve been at this for a while and managed to accumulate enough of an audience to be noticed by the “other side” will be subject to charges that we are “pharma shills,” hopelessly in the pay of big pharma. To the “other side,” obviously that must be why we do what we do, because we can’t possibly be doing this because we’re passionate about our beliefs. It’s such a common (and specious) attack that more than seven years ago I coined a term for it (at least I think I coined the term—I can’t find its use before my first post on it), the “pharma shill gambit,” a post I later appropriated for this very blog.

However, how we are seen by our opponents is much worse than mere specious allegations of undisclosed conflicts of interest, in which (apparently) nefarious drug companies are paying us to sit at our computers in our underwear turning out attack after attack on antivaccinationists and practitioners of “natural healing.” I was reminded of this last year perusing the various blogs and attacks written about those of us who have been so critical of Stanislaw Burzynski. As you recall, I’ve been very critical of Burzynski on a number of occasions for his peddling of ineffective “antineoplastons,” his promotion of what I have referred to as “personalized gene-targeted cancer therapy for dummies,” his playing fast and loose with human subjects protections in the numerous clinical trials he runs, and his arrogance of ignorance. Basically, I’ve made no secret of the fact that I view Burzynski as someone who is incompetent as an oncologist and highly unethical as a researcher who charges patients huge sums of money to be in his clinical trials that never seem to end up being published.

So, about a year ago, when I noted that a patient’s family that reported that apparently the FDA was in the process of auditing the Burzynski Clinic (an audit whose results we now know), that Burzynski hadn’t been able to use antineoplastons in children for a few months then, and that apparently he had also been banned from administering antineoplastons to adults as well. I kept the identity of the patient confidential, as did other bloggers writing about the family’s post. Not long after, however, I learned that the family had learned about how their post has leaked out. More importantly, I learned how they viewed those of us trying to report on Burzynski’s activities:

It has come to my attention that there are some uninvited guests following our posts about [REDACTED]. Even with all our progress and good news, anti-Burzynski weirdos find ways to take information I privately post and exploit it as negative criticism. I will be upping the security on our site and removing certain users from allowing access to our account. If I block you by mistake, please take a moment and send me a message. Friends, family, friends of friends.. you should know how to contact me. I will gladly add you back. If I have never met you, and you have good reason to follow our page, even if you are just curious about Burzynski and have come across our story, I will add you back if I can verify your intent is not malicious.

Yes, there are anti-Burzynski groups. Makes no sense to me why these people waste time and want to take away our freedoms. Fortunately, they only have each other and no one really cares about all the effort they put into creating articles and web pages and blabber. I never even heard of such people! I wonder if these cavemen even have iPhones yet, I’m surprised they can work the computer. I debated making [REDACTED]’s page public, but I am not into exploiting my child, as these groups are into exploiting children and adults, mainly those who are no longer with us who happen to be patients of the clinic. What I have found in following some facebook pages of kids with terminal illnesses, it seems there are always those people that think they know everything and post really evil, heartless comments. Apparently, I’m not immune to this.

Please do not waste a second of your time trying to avenge are [sic] little hero and Dr. Burzynski. It really would do them great satisfaction to know that they rubbed someone the wrong way. Evil people feed off of aggravating others. Bad people have no place in our healing journey.

Yes, that’s right, and it might be jarring to some skeptics. In marked contrast to how I view most believers in pseudoscience and quackery, such as antivaccinationism or patients pursuing dubious cancer therapies, which is that they are wrong, that they’ve made a horrible mistake but I can to some extent understand it on the basis of human nature, believers such as Burzynski patients and their families view us skeptics as downright evil. To some extent, one can understand this. (Here’s where I try to put myself into their shoes.) These parents believe that Burzynski has either saved their child or loved one or is the only hope for their terminally ill relative to survive. They know they’ve made a decision that their doctors almost certainly tried to talk them out of. Rather than let in a modicum of doubt about that decision, it is easier to view those of us who are trying to combat the misinformation that is used to support the Burzynski Clinic and his activities as heartless monsters, enemies who are actively trying to prevent their children from being cured of cancer. And, yes, that is really how they view us.

Don’t believe me? Take a look at what Stanislaw Burzynski’s propagandist Eric Merola writes on his website about the “anti-Burzynski” bloggers:

Overall, you need to be able to think for yourself. Question everything, including me and this film. Feel free to verify all sources used for this film for yourself via the Sourced Transcript [link]. You will notice the “anti-Burzynski bloggers” refuse to do that or adhere to reputable sources. You might say, “they are preying on desperate cancer patients and families of cancer patients” by carelessly misleading their readers about Burzynski and his invention. This is a natural course of history when scientific innovation like this occurs, and is something that is to be expected. Never underestimate the irrationality of the human brain when it is confronted with something it doesn’t understand. These bloggers have an agenda, and are not open to rational discourse.

Our society is built on propaganda wars, and wars of information and disinformation. The fact that most people will basically believe anything they are told without bothering to find out if what they are told is true or not—makes them for easy prey, especially when they are dying of cancer. The writers of the “anti-Burzynski” bloggers know this—and take full advantage of this.

Of course, I did just that, going over Merola’s “sourced transcript” two and a half years ago in my original review of his movie. Be that as it may, notice the message being promoted. “Anti-Burzynski bloggers” are out there to keep you from being cured of cancer! They’re “preying on desperate cancer patients and families of cancer patients”! Why? Who knows? The best Merola can come up with is a variant of the Galileo Gambit, in which we skeptics apparently reflexively resist anything that’s different. It’s a common message among Burzynski supporters, having more recently shown up a Facebook post supporting McKenzie Lowe, whose parents were among those who successfully lobbied the FDA to allow a “compassionate use” exemption to let her receive antineoplastons, although the FDA did stipulate that it had to be a physician not associated with Burzynski administering the drug. In reality, if Burzynski had the goods, he could persuade us, which is why seeing Merola accuse us of “not being open to rational discourse” fried another one of my irony meters.

It’s not just Burzynski supporters, either. Antivaccine activists also believe that skeptics and supporters of SBM are out to get them. I don’t hide the fact that I sometimes amuse myself (and seek blogging material) by lurking in the comment sections after posts on antivaccine blogs. It doesn’t take much lurking in such corners of the blogosphere to discover that antivaccine activists really, really, really hate “science bloggers,” at least as much, if not more, than supporters of Burzynski. For example, take a look at some of the comments after this post on the antivaccine crank blog Age of Autism, epitomized by this one about “ScienceBloggers”:

They really go so out of their way (mounting hate campaigns like “ditchJenny” etc. etc. and this is why I honestly doubt their “Oh we’re not paid shills,” claims. Real, open minded science people wouldn’t be so militant and many scientists/doctors actually disagree with them anyways! Someone mentioned that most of them are either young, impressionable types or older has-beens who get off on bashing others with social media. The more that I think about it, they’re above all, bullies, not pro-science people. I have several friends with MS and it makes me sick as to how they malign anything to do with CCSVI (when MS drugs have killed SOOO many more people than angioplasty ever will) – I believe 3 people have died due to angioplasty- mostly due to having been given stents which they don’t even put in veins anymore. There’s a jerky journalist in our town who actually uses “Science” blogs as his source of information to write on health topics which is really scary (and lazy). It is beyond pathetic that grown up people waste time trying to prop up the status quo in healthcare when it is so obvious that there are serious questions that need to be asked and answered to do with vaccines and questions also to issues of MS cause and treatment.

Meanwhile, as if to give me more fodder just when I needed it, on this very blog in a comment after my post about the traditional Chinese herbal clinic at the Cleveland Clinic, Howard Wallach chastised me:

Thank God you rigid would-be totalitarians are losing the battle (in the US and Canada, anyway) to keep useful natural treatments and cures out of the hands of the general population! If you want to spend the hundreds of millions of dollars to perform studies that meet your satisfaction on hundreds of natural medicinals which have been used for millennia, go ahead and do it. You know darn well that few people are going to do so when there’s no huge financial gains to be made from non-patentable natural substances. I, personally, have had excellent, I would say tremendously successful results from Chinese and Tibetan medicine as well as Western neutriceuticals for a variety of conditions with nary a side effect. On the other hand I suffer permanent shoulder tendon damage from a fluoroquinolone and chronic gastritis from a prescription NSAID. I wish you every failure in your despicable cause.

Yes, as I said before, they really, really, really do hate us. They view us as The Enemy, evil people who are actively trying to keep them from healing their children of autism, every bit as much as the parents of Burzynski patients view us as actively wanting to kill their children by preventing them from being treated by the Savior Burzynski, or Mr. Wallach apparently views us as wanting to keep him from his health-preserving herbal remedies. It is an attitude and view that is actively promoted by Wakefield and his ilk, as well as their supporters, the way Eric Merola tries to whip up paranoia about what he calls “anti-Burzynski bloggers.” Indeed, it’s become a major meme in antivaccine circles to attack supporters of SBM who defend vaccine science and refute antivaccine pseudoscience as “bullies” and to characterize posts and articles that criticize antivaccine beliefs and activists as “hate speech.” In particular, antivaccine activists are unhappy that over the last couple of years the mainstream media appears to have started to figure out that, while “telling both sides of the story” is a good policy for politics and many other subjects, it’s not a good policy for stories about science and medicine in which one side is supported by massive evidence from multiple disciplines that all converges on a single conclusion, and the other side consists of pseudoscience and quackery. In other words, what Dara O’Briain describes in his immortal comedy bit appears to be becoming less common than it was, and antivaccinationists don’t like it.

We have to remember that, contrary to the way that we view most of the militant supporters of quackery, which is mistaken, wrong, misled by a combination of normal human cognitive characteristics such as confirmation bias and characteristics of disease such a placebo effects and regression to the mean, supporters of pseudoscience having to do with medicine not-infrequently view those of us who argue for SBM as not just wrong, but as vile, contemptible, less than human pharma shills who are out to prevent The Truth from being revealed to The People. To many of them, we are actively out to prevent lives from being saved or autistic children from being “recovered” by “autism biomed” based largely on the idea that vaccines cause autism That’s also why, like Burzynski patients, antivaccinationist go into full attack mode whenever there is criticism of their heroes, in particular Andrew Wakefield. One can’t help but remember a particularly telling quote about Wakefield from a story about the antivaccine movement three years ago. The quote came from J.B. Handley, founder of the antivaccine group now led by Jenny McCarthy, Generation Rescue, in a New York Times story: “To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one. He’s a symbol of how all of us feel.”

Handley’s choice of words was very telling, and the implication clear: To him, attacking Andrew Wakefield is akin to attacking Jesus Christ or Nelson Mandela. If you’re a Christian, how do you react to people who attack Jesus Christ? Not favorably, that’s for sure. What do you call such people? Infidels, heretics, apostates, atheists, that’s what. To people like J.B. Handley, these practitioners of antivaccine pseudoscience represent hope, and to attack them is to attack not just their beliefs but to attack hope itself. We have to remember that criticism of people like Wakefield or Burzynski only serves drive their worshipers closer. However, it is not their worshipers at whom I’m targeting my message, as I’ll discuss at the end.

Now “we” are “holocaust deniers” and “dirty rotten scoundrels”

“They” really do believe that “we” (i.e., skeptics and supporters of science-based medicine who criticize the various modalities they passionately believe in) are not just wrong, but downright evil. To some of them we are promoting a “vaccine-autism Holocaust.” If you don’t believe me that antivaccinationists not infrequently use this term, Google “vaccine autism Holocaust.” You’ll find posts lamenting this risibly hateful meme, but you’ll also find examples of antivaccinationists using just this meme. Indeed, one parent has even stated:

For me, the denial that there is an autism epidemic is the medical equivalent of denial of the holocaust. In the spirit of protecting the vaccine industry from any linkage to autism, the pro-vax side not only denies that vaccines may be linked to autism but denies that there even is an autism epidemic.

That’s right. If you accept science and medicine, along with all the evidence that has failed to find a correlation between vaccines and autism, you’re the equivalent of David Irving, a Holocaust denier. Or worse. In the comments at the antivaccine propaganda blog Age of Autism I found a real gem about the 1977 swine flu vaccine campaign, right after this post:

None of us understood that the people behind the swine flu vaccine fiasco were criminals who were experimenting on the public just like the Nazis.

To antivaccinationists, not only are supporters of vaccine programs just like Holocaust deniers, but they’re the equivalent of Nazi doctors carrying out horrific experiments on concentration camp prisoners. It only makes sense, of course. Holocaust deniers are almost always Hitler admirers or Nazi sympathizers; so it’s only a small step to go from calling someone a Holocaust denier to calling him a Nazi.

Visions of pro-vaccine Nazis dancing in antivaccinationists’ heads aside, it didn’t take long for me to become aware of one more example of just how evil antivaccinationists think “we” are. It comes from Mama Mac at the Thinking Mom’s Revolution in the form of a post entitled Dirty. Rotten. Scoundrels. Mama Mac’s post consists of a list of people that she views as pure evil (or as “dirty rotten scoundrels).

Be that as it may, with one exception, the fourteen people listed as, apparently, “dirty rotten vaccine scoundrels” by Mama Mac are in actuality generally admirable people. We’ll dismiss one actual scoundrel first: Poul Thorsen. Antivaccinationists really, really like Poul Thorsen, not because he participated in (not ran) the Danish studies that failed to find a link between either the MMR vaccine or thimerosal in vaccines and autism. Thorsen, it turns out, has been accused of misappropriation and misuse of U.S. federal government grant money, and about a year ago the antivaccine movement went wild, trying to use the Thorsen case to distract from the inconvenient science that does not support their case. He was a convenient bogeyman, and they labored mightily to hold him up as “proof” that the Danish studies were hopelessly tainted by his fraud. Of course, even if Thorsen is guilty, that doesn’t invalidate the Danish studies, as he was a “middle of the pack” author. Moreover, there’s a lot more evidence out there than the Danish studies that support the safety of the vaccine program and the lack of correlation between vaccines and the dire outcomes antivaccinationists attribute to them. Even if the Danish studies were hopelessly tainted, it would not alter the scientific consensus, because the Danish studies are not the be-all and end-all of vaccine safety studies. They are just, to quote a cliché, another scientific brick in the wall supporting the safety of vaccines. In any case, if Thorsen is guilty, he really is a dirty, rotten scoundrel and should be locked up for a long time if convicted. He is not, however, a dirty rotten scoundrel who is the face of the vaccine program, as much as antivaccinationists stretch to try to convince you that he is.

The rest of Mama Mac’s list includes people who are, for the most part, people I admire: Paul Offit (of course!) is there, because to antivaccinationists like Mama Mac he is Sauron, Darth Vader, Voldemort, Hitler, Stalin, and Pol Pot all rolled up into one. Why? Because he invented a vaccine for rotavirus that has saved lives and prevented suffering, and for that he is considered pure evil. For his contribution and (more directly) for his unflagging promotion of vaccines and his willingness to call the nonsense promoted by antivaccinationists exactly what it is, nonsense, he’s been subjected to the vilest attacks and slander at the hands of the antivaccine movement. It’s not surprising that on a couple of occasions the pressure got to him a bit, and he lost his cool. I only wonder at how he could have kept his cool for so long, given what he’s put up with. Bill Gates is also there, of course. Since he retired from the active management of Microsoft and dedicated his great wealth to philanthropy he’s become another Dark Lord of Vaccination, mainly because a large focus of the Gates Foundation’s work has been to promote vaccination campaigns in Third World countries as a means of promoting health and ending the scourge of preventable disease and death there. He also has no patience for the nonsense of the antivaccine movement, which is a plus.

It’s hard not to conclude that “they” see “us” as narcissistic, lacking compassion, corrupt, and, yes, downright evil. Is it any wonder that they would come to the conclusion that virtually any tactic is justifiable in their crusade against medical science? It’s not hard to find similar quotes elsewhere about topics other than vaccines or Stanislaw Burzynski, either. Indeed, if you can stand the craziness and hostility, just wander on over to Patrick “Tim” Bolen’s website, and you’ll see even more hostile language directed at skeptics over not just vaccines, but cancer therapies, alternative medicine, supplements, and pretty much any other quackery you can think of. This hostility, this “us versus them” attitude is a feature, not a bug. Whipping it up is how quacks keep their supporters enthusiastic and how they continue to sell useless products. We’re not likely to penetrate such tribalism or to change the mind of people like Mama Mac, although on rare occasions we can.

What “our” real targets should be

When blogging about SBM versus quackery, my target is not people like J.B. Handley, Mama Mac, the bloggers at AoA or The Thinking Moms’ Revolution, or Eric Merola. These people are the very people who believe that I am an evil person hopelessly in the thrall of big pharma, which rewards me richly for crushing their hopes. (If that’s the case, I ask: Where is all that filthy lucre? Where is my Maserati? Where is my yacht? Where is my private jet? As an academic surgeon, I make a comfortable living and can afford a nice house and car, but that’s about it.) Speaking of filthy lucre, it’s also absolutely critical to distinguish between the reasons “they” attack “us.” If it’s a bunch of chiropractors protecting their turf, as far as I’m concerned, the gloves are off, and they’re fair game. Ditto if we’re talking about Stanislaw Burzynski or his propagandist Eric Merola. On the other hand, if it’s the desperate parents of a child with a terminal brain tumor or the terrified husband of a woman dying of a brain tumor, who are clinging to Burzynski as the only hope of saving her child, a much gentler approach is called for.

In any event, it’s far more important to get the fence-sitters and make sure good science-based information is out there for them. I also use a variety of techniques, ranging from the more—shall we say?—”insolent” to more dispassionate discussions of science, and everything in between. True, I do tend to lean more towards the more sarcastic end of the spectrum (which is why I admire Mark Crislip’s tone and posts so much), but, to be honest, I used to be a lot snarkier and nastier, no matter how much it might be hard for one of our readers to believe. (Go back and read some posts from around 2005-2008 at my not-so-secret other blog, if you don’t believe me.)

None of the backlash from believers in quackery should, however, deter us from deconstructing their icons. Andrew Wakefield, for example, has done great harm, and as a cancer doctor and researcher I simply can’t abide Burzynski’s activities—and rightly so, in my opinion. Certainly, I’ve never pulled any punches. On the other hand, we do have to remember who are targets are and what our goals are. I have no expectation that I will ever be able to convince someone like the parents whom I quoted at the beginning of this article, and there’s only about the same chance of active substance remaining in a 30C homeopathic remedy as there is of my persuading Eric Merola that his hagiographies of Stanislaw Burzynski are misguided, misinformation-packed propagandistic nonsense or that I don’t have a hidden tail and horns. Occasionally, I actually do get through to such people, but it’s so infrequent that I can’t count on it. My goal is instead to put science-based information out there, so that the fence sitters and undecided can encounter it. If the occasional true believer listens, then I’ve done far better than I would ever expect.

In the meantime, I don’t make the mistake of thinking that in return for my efforts I will ever receive anything but hatred and contempt from the “other” side. I’ve tried to put myself in the shoes of parents who have a dying child and believe that Stanislaw Burzynski can save him, parents who believe passionately that vaccines caused their child’s autism and that only “biomed” treatments can “recover” him, and even of people like Mr. Wallach, who passionately believe that whatever herbs he’s taking are responsible for his doing well right now. That’s why I know that I’ll almost certainly never change their minds, which just makes those all-too-uncommon occasions when I receive e-mails from former believers in quackery telling me that I started or contributed to the process of their rejecting pseudoscience and quackery that much more sweet. We at SBM do, however, have a hope of persuading the fence-sitters, and so do you—at least, as long as we remember always to ask ourselves Are we the baddies? and to remain able to answer honestly that we are not.

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.