EDITOR’S NOTICE: NOTE THE DISCLAIMER. Also note that there is a followup to this post entitled The price of opposing medical pseudoscience that is highly recommended after you read this post.

The “pharma shill gambit”: The quack’s favorite flavor of ad hominem argument

One of the very favorite and most commonly used tactics to attack criticism in the armamentarium of pseudoscientists, cranks, and quacks (not to mention politicians) is the ad hominem fallacy. In this fallacy, rather than addressing the actual evidence and science that demonstrate their favorite brand of woo to be nothing more than fairy dust, the idea is to preemptively attack and discredit the person. The ad hominem is not just insults or concluding that someone is ignorant because, well, they say ignorant things and make stupid arguments (in which case calling someone stupid or ignorant might just be drawing a valid, albeit impolitic, conclusion from observations of that person’s behavior), but rather arguing or insinuating that you shouldn’t accept someone’s arguments not because their arguments are weak but because they have this personal characteristic or that or belong to this group or that. Truly, the ad hominem is right up there with demanding public “debates” with skeptics as a favored defense strategy of cranks of all stripes.

Among the very favorite flavors of ad hominem attack used by quacks, cranks, and pseudoscientists is the fallacy of poisoning the well. This particular fallacy alludes to the medieval European myth that the Black Plague was caused by Jews poisoning town wells. Not surprisingly, this myth was used as a justification for pogroms and the persecution of the Jews. The idea is to poison how others view your opponent by preemptively attacking them. Well do I know this fallacy, having been at the receiving end of it many times! Basically, it involves invoking something bad or biased about a person’s situation or personality and then using a phrase something like, “Of course he (or she) would say that” to dismiss a person’s arguments, the implication being that the person receives such benefits from holding the position being attacked or has such a personality that he couldn’t argue otherwise regardless of the evidence. In my admittedly anecdotal experience, far and away the most common use of the ad hominem from quacks and pseudoscientists is what I once described as “the pharma shill gambit.” The idea behind this gambit when it comes to attacking those of us who promote science-based medicine is to tar one’s opponent as being a “shill” for big pharma or claiming that we have a conflict of interest so blatant that “of course we would say that.” In most cases, the bogey man is big pharma, in whose pockets we SBM bloggers are supposed to be safely (and profitably) ensconced, blogging away in our underwear for big bucks and, following the orders of our supposed paymasters, attacking anything that has even a whiff of being “alternative” or that “questions” the safety and/or efficacy of vaccines.

While I realize that there is such a thing as an “astroturf” campaign, in the vast majority of cases, the pharma shill gambit is nothing more than the variant of the ad hominem fallacy known as poisoning the well. I also realize that conflicts of interest (COIs) matter, particularly undisclosed COIs. Indeed, I wrote a rather lengthy post (I know, I know, do I write any other length of post?) about 8 months ago laying out my views regarding COIs in science-based medicine. The short version is that we all have COIs of some sort or another, be they financial, belief-based, or emotional, and more disclosure is usually better, to let the reader decide for himself. As far as COIs related to big pharma or finances, I think Mark Crislip put it quite well in his most recent Quackcast when he said that if a study is funded by big pharma, he decreases the strength of the evidence in his mind by a set amount. However, evidence is evidence, and, although it is reasonable to increase one’s level of skepticism if there is a major COI involving the authors, be it big pharma or otherwise, it is not reasonable to use that COI as the sole reason for rejecting its findings out of hand. That’s just an intellectually lazy excuse to dismiss the study, nothing more. Indeed, one prominent difference between a scientist and a pseudoscientist or quack is that in general scientists understand this and struggle to assign the correct degree of skepticism due to a COI when analyzing scientific studies, while quacks and pseudoscientists do not. It’s far easier for them just to put their fingers in their ears and scream “Conflict of interest! Conflict of interest!” and then use that to dismiss completely their opponent’s argument. It’s simple, neat, and it doesn’t require all that nasty thinking and weighing of evidence..

Yes, quacks, cranks, and pseudoscientists really, really like their “poisoning the well”-style ad hominem attacks. So much do they rely on such attacks that, when they can’t find a real COI to use, abuse, and exaggerate, they’ll make one up, hence the pharma shill gambit. Certainly they’ve tried it on me many times. Over the last six years I’ve lost track of how many times anti-vaccine zealots, homeopaths, Suzanne Somers and Jenny McCarthy fans, HIV/AIDS denialists, and supporters of “alternative medicine” have asked me accusingly, “Who do you work for?” or outright accused me, “I bet you work for Merck” or [insert most hated pharmaceutical company here — I used Merck because of the whole Vioxx issue]. Then they don’t believe me when I point out to them that, sadly, the amount of funding I receive from any medical or pharmaceutical company is…..[drum roll, please]….zero!

That’s right. Zero. Nada. Zip. Sadly, being a high-ranking mouthpiece of big pharma doesn’t pay what people think it pays. Clearly, I need a new agent. Or just an agent. And a ruthless editor, come to think of it. Be that as it may, over the weekend I became aware that apparently I’m once again in the sights of the anti-vaccine propaganda blog Age of Autism and that the apparent weapon to be used to attack me is the pharma shill gambit.

Dr. Gorski gets an e-mail

Of all the brands of pseudoscience-supporters who’ve attacked me over the years, none have been as persistent or nasty as the merry band of anti-vaccine activists at Generation Rescue (GR) and its wholly owned subsidiary propaganda blog Age of Autism (AoA). Usually, it’s J.B. Handley who’s been on the attack, beginning two years ago with the usual sort of title J.B. comes up with David Gorski, MD: The Worldwide Wanker of Woo, Dr. David Gorski and His Merry Band of Idiots Don’t Like Full Page Ads, and Dr. David Gorski Jumps the Shark over Desiree Jennings Case. He also apparently hates Steve Novella, too, and there are other anti-vaccine activists out there just as vitriolic, including one named Craig Willoughby, who started a blog, one main purpose of which appears to be to savage yours truly’s good blog buddy, if you know what I mean.

All of this is my usual logorrheic style of introducing my notification that AoA is about to launch yet another such attack. I know this because on Saturday morning I woke up to find this in my e-mail:

Dr. Gorski,

This is Jake Crosby. I am doing a piece about your acknowledgment that disclosure of conflicts of interest is important, yet your lab at Wayne State University stands to benefit from Sanofi-Aventis money for the breast cancer research you are conducting on a drug the company manufactures and markets, Riluzole, which is also being studied for the treatment of autism. Why isn’t any of this disclosed on your blogs? I await your reply.


Jake Crosby
Age of Autism
Contributing Editor with Autism

Oh, dear. It would appear that Jake has found a “gotcha.” At least, he clearly thinks he does. He is sadly mistaken, which is why I sent back an e-mail saying that I couldn’t respond on Saturday with anything other than a brief message pointing out that I receive no money from Sanofi-Aventis or any other pharmaceutical company, nor am I likely to any time in the foreseeable future. Then on Sunday I wrote this post.

In any case, clearly, Jake didn’t bother to read my disclaimer:

Dr. Gorski has been funded over the last decade by institutional funds, the Department of Defense, the National Cancer Institute, the ASCO Foundation, and the Breast Cancer Research Foundation. He currently receives no funding from pharmaceutical companies, although he did once receive a modest payment for an invention from such a company back in the mid-1990s. Indeed, so bereft of pharmaceutical funding is Dr. Gorski that before his talks, when he is required to make his disclosures of conflicts of interest, he often jokes that no pharmaceutical company is interested enough in his research to want to give him any money. Maybe one day that will change, but for now, like most biomedical scientists in academia, he must beg the NIH and other granting agencies for the money to keep his lab going.

It’s true, too. Being a pharma shill apparently just doesn’t pay, although being an Associate Professor of Surgery at Wayne State University at least pays well enough to live on. Depressingly, it’s nowhere near as comfy as sitting back in my underwear, sipping coffee and typing screeds against quacks, cranks, and pseudoscientists. I actually have to work for a living! The indignity! You’d think the pharma overlords who rule the world with David Icke’s reptilians, the Illuminati, the Masons, and the Bilderberg Group could at least slip me a few hundred thousand every now and then to keep my lab churning out reductionist, non-wholistic “Western” science (or at least spring for a really good dinner at The Rattlesnake Club or Michael Symon’s Roast from time to time — now that would be worth selling my scientific soul for). But no. Not even a ride in their famed Black Helicopter (just ask David Ayoub), leaving me feeling as dissed and ignored as Mark Crislip. I continue to submit grant application after grant application to the NIH and various other funding agencies in a very hostile funding environment, hoping against hope to keep my lab going but suffering rejection after rejection. Where’s that filthy lucre? I’m tired and beat, with a severely bruised scientific ego right now, having just recently gotten discouraging news on my latest grant application.

Sanofi-Aventis and your fellow Pharma Lords, take me away!

But I digress. Clearly, a preemptive strike is indicated — nay, demanded against Jake’s impending attack. After all, the best defense is a good offense. However, something still gave me pause. I wondered whether I should bother to respond or, if I respond, it would be perceived as being too “mean” to beat up on Jake, particularly in the wake of a post I did a couple of weeks ago about Julie Obradovic. After all, Jake is young and inexperienced, a college student who’s “on the spectrum,” and it might initially appear unseemly to be too hard on him. Heck, although I’m sure he doesn’t believe it, I actually even kind of like Jake. He seems like basically an otherwise decent kid who’s clearly fallen in with the wrong crowd, namely J.B. Handley’s band of merry anti-vaccinationists at Generation Rescue and Age of Autism. Sadly, they’re corrupting him. Whenever I see Jake do stuff like this, I feel a fatherly impulse to try to set him straight, given that I am actually old enough to be his father. I want to sit him down and calmly ask him in the most fatherly manner I can muster what the hell he’s thinking doing stuff like this and hanging out at AoA promoting pseudoscience. My desire to try to correct a young man’s descent into pseudoscience aside, though, Jake is now an adult, and as an adult he needs to face the consequences of his words and deeds.

Jake Crosby: A rather confused young man with a penchant for conspiracy-laden ad hominem attacks

Sadly, from my perspective, Jake’s words and deeds do require some consequences. Since he’s joined AoA, Jake has made the conscious decision to adopt “poisoning the well”-style ad hominem attacks against anyone whom he perceives as opposing the scientifically discredited notion that vaccines cause autism as his personal modus operandi, apparently having learned at the feet of masters of the ad hominem, such as J.B. Handley, David Kirby, and Dan Olmsted. For example, last year Jake wrote an amazingly conspiracy-filled attack on Adam Bly, founder and CEO of Seed Magazine and creator, of course, ScienceBlogs, which is another home to Peter Lipson and one other SBM blogger, he who must not be named, if you know what I mean (and I think that most of you do).

The attack came in two parts. The first part was “Science” Blogs: Seed Media’s Aggressive Weed, Part I: Fertilizer From Pharma. In it, Jake insinuated that, because Seed and ScienceBlogs accept ads from pharmaceutical companies, both are clearly propaganda outlets for the pharmaceutical industry. Most hilariously, though, Jake claimed that, because Adam Bly had “served at the age of sixteen as the youngest guest researcher at the National Research Council — a Canadian government body that overseas scientific progress, studying ‘cell adhesion and cancer,'” and because of corporate sponsorship of the NRC by Sanofi-Aventis (damn, them, they have their tendrils everywhere!), apparently Adam Bly had been indoctrinated into the Dark Order of Pharma at the tender age of 16 and turned through some sort of dark Satanic ritual into a willing pawn doing the bidding of his pharma masters ever since. (Trust me, I exaggerate only slightly for dramatic effect. Or don’t trust me and read Jake’s original post for yourself.) Then in part II, Jake argues that, because there are members of Seed’s board of directors who have also either worked for or consulted for pharmaceutical companies, Seed and ScienceBlogs must exist only to promote big pharma propaganda, while conflating Steve Novella (who does not blog for ScienceBlogs) and the Discover blog network with ScienceBlogs as though they had anything to do with each other whatsoever.

Since then, Jake has become a very skilled young Padawan who is being corrupted by the Sith and developing into a master of the pharma shill (or the closely related “minion of the CDC”) gambit. He’s applied it to promoters of science over anti-vaccine pseudoscience as varied as Chris Mooney (author of The Republican War on Science, Storm World, and Unscientific America, as well as the journalist who wrote an excellent article on the anti-vaccine movement about a year ago entitled Why does the vaccine/autism controversy live on?); Amy Wallace (who wrote the excellent WIRED article An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All, which resulted in misogynistic attacks on her by J.B. Handley); Trine Tsouderos (the Chicago Tribune journalist who has written multiple excellent articles on vaccine-autism pseudoscience and quackery over the last year or so); the producers of the FRONTLINE documentary on the anti-vaccine movement (SBM commentary here); and, of course, Paul Offit. Perhaps the most tortured use of the pharma shill gambit by Jake occurred when he tried to paint New York Times journalist Gardiner Harris as a hopeless shill for big pharma because — get this — Harris’ brother once worked for pharmaceutical companies (as recently as November 2004, yet!) and now works for a device manufacturer, meaning, as Jake put it, “Gardiner Harris’ brother still deals with pharmaceutical companies.” I kid you not. You just can’t make stuff like this up. (At least I can’t.)

So, with that background in mind, I asked my fellow SBM bloggers whether I should respond, ignore this, or hold back. The unanimous (at least among those who responded to my e-mail) consensus?

Go, get ‘im! So I will.

A retort and explanation from your humble blogger–with science!

Let me just say this to Jake: I do not receive any money from Sanofi-Aventis (or any other pharmaceutical company) to fund my research (or my blogging, for that matter). If you had bothered to read my disclaimer you’d know that. Sadly, I’m not likely to be getting any of that filthy lucre from Sanofi-Aventis any time soon. Again, read my disclaimer. My lab work is entirely funded by grants I’ve gotten through competitive applications and institutional start up funds I received when I accepted my current position. Indeed, Sanofi-Aventis doesn’t even supply me with the drug Rilutek (the trade name of Riluzole) to use for my clinical trial or experiments using mouse tumor models. That’s all funded by grants and startup funds too. Moreover, prior to Jake’s e-mail I had been completely unaware that Riluzole had even been considered for, much less tried as, a treatment for autism. I’m not a neurologist or pediatrician; so it’s unlikely that I would know about that, although I can say, knowing what I know about Riluzole, that it doesn’t strike me as a particularly promising approach.

At this point, no doubt my readers want to know just what on earth Jake is talking about as he tries to paint me as a willing sycophant, toady, and lackey of Sanofi-Aventis; so let me explain. I normally don’t discuss my own research very much on SBM, other than relatively vaguely, because to do so just seems entirely too self-serving to me. (Maybe my lack of self-promotion skills is one reason why the Dark Lords of Pharma want no part of me; or maybe it’s some of my posts, like the one likening vertebroplasty to acupuncture or this one lamenting a pharmaceutical company paying a publisher to publish a fake journal.) However, so that you and Jake understand why his approach is utter nonsense, I have to provide you with a brief primer of my work.

The reason Jake mentioned Riluzole is because it’s one drug I study as a potential therapy for breast cancer. In fact, if I do say so myself, the project looking at Riluzole in breast cancer is an example of why science-based medicine is so cool compared to the fairy dust of “alternative” medicine or the pseudoscience that is the anti-vaccine movement. It all began a while back with a basic scientist at Rutgers named Suzie Chen, who wanted to make a transgenic mouse to study adipogenesis. So she used standard techniques to insert a gene she wanted to study, but after the transgenic mice were born the mice in one of the strains all developed skin lesions that looked like melanoma by the age of two to four months. Being a good and careful scientist, Dr. Chen realize that she had inadvertently created something really interesting, a mouse model of melanoma. So, teaming up with Dr. James Goydos, my surgical partner at The Cancer Institute of New Jersey (which is where I was at the time), Dr. Chen went back and looked at what had happened and figured out that the transgene had disrupted part of the regulatory region of a gene known as Grm1 (GRM1 in the human), which codes for a gene known as metabotropic glutamate receptor-1 (mGluR1), in such a manner that mGluR1 was being made at a level far higher than normal.

A word of explanation is in order here. Glutamate is a major neurotransmitter in mammals that functions by binding to either ionotropic or metabotropic receptors (genes: GRM1-GRM8; receptors: mGluR1-mGluR8). I’m not going to talk about ionotropic glutamate receptors. mGluRs belong to a family of G-protein-coupled seven transmembrane domain receptors (GPCRs), which mediate responses to a diverse array of signaling molecules, including hormones, neurotransmitters, chemokines, and autocrine and paracrine factors. In the mammalian CNS, mGluRs, which are categorized into either group I, II, or III receptors based on sequence, what compounds they bind, and how they signal in the cell, are essential for normal neuronal function, and have been implicated in diverse neurological pathology, particularly ALS. Their existence and importance in melanoma had previously been unsuspected.

Again, being a careful scientist, Suzie Chen went back and made a new transgenic mouse, this time using Grm1 engineered in such a way that it is only expressed in the melanocytes of the mouse strain created and observed very close to the same thing. Now here’s where things get really interesting. It turns out that there is already an FDA-approved drug that blocks glutamate release and signaling. This drug is Riluzole, and it’s used to treat amyotropic lateral sclerosis (ALS, a.k.a. Lou Gehrig’s disease). In fact (and Steve will correct me if I’m wrong) Riluzole is the only currently known drug that prolongs the life of ALS patients, albeit not by a lot. Truly, this was serendipity of the sort that most scientists never see in their lifetimes.

Why is Riluzole so important in this story, even though it doesn’t specifically inhibit the activity of mGluR1? Because it was already FDA-approved. Thus, testing it in cancer didn’t require a new drug approval, only an approval to test the off-label use of Riluzole against melanoma, which is what Drs. Goydos and Chen did, demonstrating that Riluzole inhibits the growth of melanoma in cell culture and in mouse tumor models, that it is an oncogene in melanoma, and that it showed promise against melanoma in a small pilot clinical trial. Dr. Goydos is currently running a clinical trial to test Riluzole in melanoma patients, one for patients with unresectable melanoma.

In the meantime, about three years ago I started collaborating with Dr. Goydos to see if mGluR1 is expressed in breast cancer. It turns out that it is and that it is active. Indeed, our first paper reporting these results has been submitted, and I’m busily putting together a paper to report our results in animal models, results that I reported at the recent ASCO meeting. I also have a small pilot clinical trial, funded by The ASCO Foundation and the Breast Cancer Research Foundation, that is going on right now. In the meantime, while my collaborators keep working on melanoma and some other tumor types, I’m working on figuring out how mGluR1 functions in breast cancer with the hope that the knowledge will lead to a treatment for breast cancer that can be taken as a pill and that has very low toxicity. Riluzole meets both criteria. If it passes clinical trials, it may well be a very useful drug for potentiating the effects of other cancer therapies, such as chemotherapy and radiation.

If this research works out, I’d like to think I did something good, building on the work of Drs. Chen and Goydos, to benefit breast cancer patients. In fact, I’m quite excited that we’re on the verge of publishing our first paper on our work and currently deep into the process of writing our second paper. Both, I hope, will appear before the end of 2010.

Real conflicts of interest versus phantom conflicts of interest

The bottom line is that, for Jake’s insinuation to represent a true COI that needs to be reported up front when I write about vaccines and autism, at least three things would have to be true. First, I would have to be receiving money from Sanofi-Aventis. I am not. Second, I would have to have the reasonable expectation to receive money from Sanofi-Aventis. I do not. I’m not even angling for money from Sanofi-Aventis to run my lab. Third, I would have to know that Riluzole is being tested as a treatment for autistic children. I did not until Jake wrote to me. In fact, Jake isn’t even correct. I searched ClinicalTrials.gov, and all I could find was a study called Riluzole to Treat Child and Adolescent Obsessive-Compulsive Disorder With or Without Autism Spectrum Disorders. It’s clear that the primary purpose of this trial is to test Riluzole in children with obsessive-compulsive disorder and they just happen to be including children with ASD as well. I really don’t know why; it seems to me that including children with ASDs would only make the results of the study more difficult to interpret.

In any case, even if I had known that, it still wouldn’t have been a COI. I’m not a neurologist, and I don’t treat ASD or OCD. I’m never going to be doing research with Riluzole in children with ASD, OCD, or both. I’ll attempt to follow Jake’s tortured logic. Apparently, because Jake buys into the AoA-promoted myth that autism is in reality due to “vaccine injury,” to him anything that is used to treat autism is in fact equivalent to treating “vaccine injury.” Apparently it follows that, because I’m doing research involving Riluzole and there is a clinical trial using Riluzole to treat children with OCD, some of whom will also have an ASD, I must be defending vaccines and arguing against the idea that vaccines cause autism because I’m heavily invested in Riluzole as a treatment for “vaccine injury” as well as cancer. Either that, or Sanofi-Aventis must be paying me big bucks or because I stand to make money off of Riluzole if it’s found to be a good treatment for OCD and/or breast cancer.

I must admit, Jake’s “logic” confuses me. But, then, I don’t see conspiracies everywhere. (Well, most of the time, anyway.)

As I come to the end of one of my typically logorrheic magnum opi, I wonder two things. First, I wonder if anyone’s reading anymore or if everyone’s gone to sleep. Second, and more importantly, I wonder once again if I’ve been too hard on Jake. I don’t think so. If Jake did not have a documented history stretching well into last year of trying to slime everyone he can who has the temerity to argue against the scientifically discredited idea that vaccines cause autism or to criticize GR and AoA for promoting that myth with charges of either being in the pay (and therefore thrall) of big pharma, I probably would have written a shorter and friendlier version of this post and sent it to Jake as a private e-mail. Unfortunately, Jake does have a history of trying to slime anyone he thinks he can dig some “dirt” on with the charge of an undisclosed COI or of being in the thrall of big pharma and clearly has me in his sights as his next target. Sadly, Jake has learned from J.B. Handley and others at AoA.

Jake’s conspiracy-laden posts finding tenuous connections between his enemies that he trumpets as “undisclosed COIs” that to him apparently completely invalidate the science being argued, indicate to me that Jake fancies himself an investigative journalist and wants to play in the big leagues. Unfortunately, as I pointed out before, dismissing an opponent’s argument solely on the basis of a COI, perceived, real, or imaginary, is intellectually lazy. Clearly, Jake isn’t even ready to play Class A ball yet. He’s probably out of his depth in Little League. Even more unfortunately, as long as Jake stays affiliated with AoA, I don’t think he ever will be ready for the big leagues. It’s a shame, because Jake seems like a smart and ambitious kid who could have an impressive career at something and actually contribute to society rather than spreading conspiracy theories. What a waste. Maybe one of Jake’s professors will take an interest in him, take him under his or her wing, and mentor him away from the craziness.

I can always hope, can’t I?

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.