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Last week, I discussed what at the time I called the strange saga of Peter Gøtzsche and Physicians for Informed Consent. When my post was published, the outcome of the story wasn’t entirely resolved, although I had speculated on just what it was that had led Prof. Gøtzsche, formerly of Cochrane Nordic and a prominent (and, more recently, controversial) advocate for evidence-based medicine (EBM), to agree to speak at the Physicians for Informed Consent (PIC) Workshop and Luncheon 2019 on March 17, 2019 in Costa Mesa, California. If you read my post last week, hopefully you’ll recall that, after a two day Twitterstorm criticizing Prof. Gøtzsche for agreeing to speak alongside antivaccine “luminaries” like Robert F. Kennedy, Jr., Toni Bark, and Mary Holland at an antivaccine group’s workshop (and, make no mistake PIC is very much antivaccine), he finally announced this:

At the time, I speculated that perhaps PIC had invited Gøtzsche to give a talk on the ethics of vaccine mandates with an appeal that played to his well-known and oft-expressed extreme suspicion of big pharma, which he’s likened on more than one occasion to the mafia. I further speculated that perhaps Gøtzsche didn’t know the true nature of PIC, which was astounding to me, After all, all you have to do is to look at PIC’s Twitter feed, Facebook page, and its list of Directors and Advisors to tell right away that it is an antivaccine group. That implies that Prof. Gøtzsche didn’t bother with anything resembling due diligence before accepting PIC’s invitation to speak. In any event, after the Twitterstorm rubbed his face in the antivaccine nature of PIC and how he would be sharing a stage with Robert F. Kennedy, Jr. and a veritable rogues’ gallery of antivaccine cranks, Prof. Gøtzsche wisely decided to back out.

Of course, at the time, I had no way of knowing if my speculation was correct or not. Indeed, one particularly annoying woman on Twitter repeatedly took me to task as totally irresponsible for having dared to speculate about what had happened, to which I responded that this is not my first rodeo, so to speak. I’ve seen this sort of thing many times before, in which an antivaccine group tries to entice a real scientist to speak at one of its events under false or misleading pretenses, and therefore knew that this was the most likely explanation for how Prof. Gøtzsche was lured into speaking at the PIC workshop. Because of his well-known anti-pharma opinions, he appears to have been an easy mark for such persuasion.

It turns out that I was (mostly) correct. We now have an explanation. So why not just tack the now known explanation onto the end of my original post as an update? Simple. The explanation provides a pretext to discuss a rather interesting issue: Is it ever worthwhile for a science advocate to speak to a pseudoscience organization? First, though, let’s examine what we now know.

Peter Gøtzsche and PIC: What really happened?

It turns out that finding out what really happened and why Prof. Gøtzsche agreed to speak at PIC’s quackfest is not easy. Indeed, if you’re looking for an explanation of what happened, you’re going to have a hard time finding it…at least in English. Fortunately, I have loyal readers all over the world, and some of them pointed me to an article in Danish that included an interview with Prof. Gøtzsche about the incident, for example:

The article, it turns out, is not only in Danish but also behind a paywall. Fortunately, again, Danish readers helped me out by providing me the text in Danish. Not speaking Danish, I used Google Translate and cleaned up the result grammatically a bit to make the translation less awkward. (As an aside, there are some truly odd-sounding English phrases in these translations—or odder than the usual Google Translate English results. I suspect that they’re Danish idioms that Google Translate translated more or less literally, producing odd phrases like “ending up in the gab.”)

Whatever the case, let’s dig in:

Professor Peter Gøtzsche canceled his presentation at a workshop for a vaccine-skeptical organization after his participation became the subject of massive criticism. Grotesque, says the protagonist himself.

Antivaxers. They’re antivaxers. They are not “skeptics” or “vaccine-skeptical”. It drives me crazy when journalists refer to antivaxers as “vaccine skeptics”. Also, personally, I find it grotesque that someone with an international reputation like Prof. Gøtzsche would agree to lend his reputation to a group of antivaccine cranks, but that’s just me. (Actually, I’m sure it’s not.) In any event, here’s what happened, and it turns out that I more or less nailed it in my speculation:

»Hvordan obligatoriske vacciner krænker medicinsk etik.«

Something like that is the Danish translation of the title of the speech Professor Peter Gøtzsche was to hold at Physicians for Informed Consents (PIC) workshop in California until March. This is stated in the organization’s website.

But even though Gøtzsche would like to make the argument that vaccines should not be mandatory, he has nevertheless chosen to cancel his participation in the conference, where several stated vaccine opponents appear on the list of speakers.

Again, we’re talking Robert F. Kennedy, Jr., Mary Holland, Toni Bark, and a bevy of lawyers whose specialty is “vaccine injury”-related litigation and advising antivax doctors on how to write medical exemptions to California’s school vaccine mandate without getting into trouble with the state medical board. It doesn’t get much more antivaccine than that. Did Prof. Gøtzsche not ask who would be speaking at the conference as well? That’s always my first question when invited to speak at any conference with which I’m not familiar—and for very good reason. Unfortunately, Prof. Gøtzsche is not alone in this sort of failure.

So what did Gøtzsche hope to accomplish by appearing at the PIC Workshop? Well, it’s not exactly clear:

“It sounded interesting to take over, because I have the same basic point of view that they [PIC] have in terms of not having to be compulsory or something you are forced to do. Then we are almost over in psychiatry – this is the only place you force people to do something against their will. I believe that coercion in psychiatry clearly does more harm than good,” says the professor, who at the same time emphasizes that he was not aware that there would be speakers with such extreme views on the vaccine issue, as is the case when he agreed to appear.

Again, why did Prof. Gøtzsche apparently not bother to ask who would be speaking at the conference? Would he have recognized RFK, Jr. as an antivaxer if he had? After all, RFK Jr. risibly calls himself “fiercely pro-vaccine.” He most definitely is nothing of the sort.

Be that as it may, I can see why PIC likes Prof. Gøtzsche so much. Although he doesn’t realize it and would no doubt vehemently deny it, he definitely talks the antivax talk, at least with respect to “informed consent”, as well as any antivaxer I’ve encountered. My guess is that it’s because he’s too clueless to realize that what antivaxers consider “informed consent” is not what he, doctors, and ethicists consider informed consent, rather than because he is antivaccine. Rather, what antivaxers promote is, in actuality, “misinformed consent“, in which the risks of vaccination are vastly exaggerated (or even made up, like the claim that vaccines cause autism) and the benefits deemphasized or denied. It’s a favorite tactic and trope of the antivaccine movement.

As for vaccines being “forced”, that claim, too, is straight from the antivaccine playbook, although I applaud Prof. Gøtzsche for his restraint in not bringing up fascism—this time. Actually, Prof. Gøtzsche’s characterization of vaccination as “forced” reveals, at the very least, his profound lack of understanding of vaccine mandates in the US. No one is “forcing” children to be vaccinated. There are no vaccine stormtroopers kicking in the doors of vaccine-hesitant parents in the middle of the night and forcibly vaccinating their children. Instead, states have a very simple requirement. To go to school or daycare, a child must have had a certain minimal state-defined and mandated set of vaccinations, usually based on the CDC recommendations, unless there is a medical contraindication to receiving them. Each state sets its own requirements, as well. Moreover, in all but three states (West Virginia, Mississippi, and, since SB 277, California) it’s laughably easy to get a nonmedical exemption based on religious or personal beliefs to school vaccine mandates.

It turns out that Prof. Gøtzsche is also very unhappy with yours truly:

David Gorski calls the PIC an anti-vaccine organization – something the PIC itself rejects on its website – and thus believed that Gøtzsche’s willingness to speak at the organization’s workshop had to be considered as a sign of vaccine resistance.

Gøtzche himself believes that calling him a vaccine opponent is absolutely grotesque.

“I have worked in three stages also as the first reserve doctor at the epidemic department at Rigshospitalet (Infectious Medicine Clinic), so I know a lot about vaccines,” says Peter Gøtzsche, who made the decision to cancel, because one of his partners in the work with establishing a new institute for scientific freedom in Copenhagen feared that the storm would steal the focus from their work with the institute.

Here’s a hint. Prof. Gøtzsche published an unjustified and badly reasoned attack on the Cochrane Collaboration’s meta-analysis of the safety and efficacy of the human papilloma virus (HPV), that has been referred to (correctly, in my opinion) as a “hatchet job” that basically included a favorite anti-HPV trope about the use of saline placebo controls instead of adjuvant-containing placebo and another common antivaccine trope about the use of “surrogates” for cervical cancer, called cervical intraepithelial neoplasms (CIN). Then, after having been in essence fired as director of Cochrane Nordic, his next move is to…speak at an antivaccine conference? I’m sorry, but that’s not a good look. It bespeaks either receptiveness to at least some antivaccine views, in this case anti-HPV pseudoscience, or epic cluelessness. Take your pick.

As for Prof. Gøtzche’s new Institute for Scientific Freedom, I must admit that when I heard that name I started thinking of “health freedom” organizations, and regular readers know what “health freedom” is usually code for. My somewhat cynical view of his new institute’s name aside, notice how what appears to have worried Prof. Gøtzsche more than…oh, you know…lending the air of scientific legitimacy that he carries through his prestige as a former leader of the Cochrane Collaboration…is that the kerfuffle over his speaking at an antivaccine conference would be an unpleasant distraction from his launch of his new institute, whose kickoff will be a conference on March 9, a mere week before the PIC conference.

This brings us to his stated reason for having agreed to speak at the PIC conference:

The cancellation annoys Peter Gøtzsche, because part of the purpose of his presence was to try to evade the sight of the vaccine skeptics. Something he had supported by PIC founder Shira Miller, who is extremely skeptical about Measles.

“Shira Miller is wrongly offended by her view of the measles vaccine, but she urged me to criticize what she wrote about measles. And I wanted to, because it’s a great vaccine, ”he says.

So Shira Miller encouraged Gøtzsche to rebut her anti-MMR pseudoscience, which is quite egregious? That seems a bit hard to believe; my guess is that she viewed getting Prof. Gøtzsche to speak at her conference and the status it would bestow on PIC would outweigh any minor annoyance that might occur if Gøtzsche were to criticize her rabidly antivaccine stylings. That brings us to the question: Is there ever a good reason for a pro-science advocate to address an antivaccine conference?

Into enemy territory

So, as we have learned, Prof. Gøtzsche’s rationale for speaking at the PIC conference seems to have been two-fold. First, he has the same “basic point of view” that vaccines shouldn’t be compulsory, which, contrary to what he thinks, is a view shared by the vast majority of pro-science advocates but is an argument favored by antivaxers to appeal to libertarian-leaning people. Second, he actually thought he could change minds at that meeting! No, seriously, he did:

Peter Gøtzsche finds it difficult to understand why the “street parliament”, which he calls the high-spirited forces on social media, finds his participation in an event such as PIC’s problematic, because if one cannot speak to the skeptics, one cannot push them into the right direction either, he believes.

“I am still considering how to spread some light in the anti-vaccine darkness without even ending up in the gab,” says Gøtzsche.

Again, this attitude seems on the surface so very high-minded—and maybe it is—but it’s also so very, very out of touch with reality. I remind you that the attendees of this meeting are not vaccine-averse parents who have been frightened by antivaccine misinformation. The speakers are all antivaccine activists, highly invested in the antivaccine ideology. Indeed, the lawyers who will be speaking specialize in vaccine “injury” litigation, while Toni Bark’s medical practice, such as it is, includes quack treatments for “vaccine injury” and RFK Jr. runs not just one but two antivaccine organizations, the World Mercury Project and Children’s Health Defense. Anyone interested in attending such a conference will likely be strongly antivaccine. These will not be people who are going to be persuaded by a single lecture, even by someone as eminent as Prof. Gøtzsche.

Worse, what would have come out of the conference would not have been changed minds among any of the participants. Rather, it would have been videos and pictures of antivaxers like RFK Jr. shaking hands with Prof. Gøtzsche and appearing with him on stage, thus appearing to give Prof. Gøtzsche’s imprimatur on the proceedings. That is, of course, exactly what antivaccine groups want when they try to entice someone like Prof. Gøtzsche to speak at their events. It’s what they want when they try to hold public debates with scientists, physicians, and science advocates. Such debates and events, in which antivaxers appear as seeming equals with someone like Prof. Gøtzsche elevate their crank viewpoint through proximity to real scientists and give the appearance to casual observers not familiar with antivaxers that there is an actual scientific debate. That’s almost certainly part of the reason why Shira Miller didn’t mind it if Prof. Gøtzsche were to criticize her anti-MMR pseudoscience and even encouraged him to do it. Of course she did! Having an eminent scientist go to the trouble of publicly refuting your antivaccine pseudoscience gives the false appearance that there is a real scientific debate!

Fortunately, Stinus Lindgreen (RV), a bioinformatics expert from the University of Copenhagen who sits in the regional council of the Capital and is active advocating for vaccines, gets it:

But although Stinus Lindgreen shares Peter Gøtzsche’s view that vaccines should not be mandatory, he is far from agreeing that the way to “fight” the growing vaccine resistance is to speak somewhere like PIC’s workshop.

“The people who attend are not in doubt. They are opponents, and their attitude, I do not think you can make much sense of,” he says.

On the other hand, there is a risk that you will be used as a form of advertisement for the organisation’s attitudes, he believes. Because even though Peter Gøtzsche was planning to criticize Shira Miller’s skepticism towards the measles vaccine when he took the stage, it would only be those attending who would get that part of Gøtzsche’s talk.

What would remain would still be a picture of Peter Gøtzsche next to Robert Kennedy Jr. under the title: “How compulsory vaccines violate medical ethics.”

Exactly right and exactly what I just said above. Lindgreen also answers the question, “How do you get to know their attitude if you can’t talk to them?” His answer is very much my answer as well:

“Of course you have to, but I think it makes more sense to talk to those who are in fact in doubt. Those who have read some of all that is out there about vaccines and are in doubt about how to relate. For they are interested in finding out what is up and down in the debate on vaccines. The very strong opponents I simply do not believe you can persuade,” he says.

Precisely. That brings me back to the question of whether it is ever appropriate for a science-advocate to “go into the lion’s den”, so to speak and speak to antivaxers, quacks, creationists, or whatever brand of pseudoscience you want to name. In this particular case, let’s take a look at Prof. Gøtzsche’s stated goal for speaking at this meeting, besides his desire to argue that “compulsory vaccination” is unethical and his affinity for PIC’s position. He says he wants to change minds, a goal that he is doomed not to reach from the start, given the very nature of a meeting like PIC’s and of the people who speak at and attend such meetings. To believe that you are going to change minds at a meeting like that requires extreme arrogance and/or extreme ignorance of human psychology, in particular how difficult it is to change people’s beliefs that have become entwined with their very sense of identity. Worse, not only will you fail to persuade anyone, but buy appearing, you’ll actually help promote the cause you claim to be opposing by bravely striding into the lions’ den.

But are there other purposes that might be served by presenting at a conference like the PIC Workshop? I’ve been thinking about this. Maybe it’s a failure of imagination on my part (with which my readers can help me out), or maybe it’s because it’s basically always a bad idea, and no good can come of it. I’ve always said that, when it comes to vaccines, it’s pointless to try to persuade hard-core antivaxers, as changing their mind is quite rare. Usually, if an antivaxer changes his or her mind, it’s because of something that happened in his or her life or from some insight that arises from within. The fence-sitters, the ones frightened by antivaccine information, these are the ones who can be reached. That’s why this sort of work involving meeting with parents and providing information that can assuage their fears.

And the beat goes on

Gøtzsche might be really angry because I referred to him as having gone “full antivax,” but I regret nothing in terms of criticizing him for, wittingly or unwittingly, letting himself be used as a tool of an antivaccine organization, especially since, as of last night, he was still featured on the PIC webpage touting the conference, and a PIC representative was responding to inquiries with this:

Translation:

Quite a bit. Shira Miller (PIC-Pins) has told me that they are doing what they can to get Gøtzsche to speak anyway. So maybe because they still hope? But yes, not fat if you buy the ticket because of Gøtzsche!

And:

So, will Gøtzsche be speaking at the PIC conference? He publicly announced that he would not be, and I have no reason to doubt his word. However, it is odd that PIC representatives are apparently jerking around potential attendees by leaving a photo of Prof. Gøtzsche on the conference webpage and telling them that they still hope that he will speak. If I were Prof. Gøtzsche, I’d be demanding that the PIC take my picture down and stop featuring me on its website.

In the end, Prof. Gøtzsche has no one to blame but himself for this debacle. He misunderstood the nature of an antivaccine group that invited him to speak in order to use him to promote their message and had an inordinate and unjustified confidence in his ability to persuade what are in essence ideologues and fanatics that they are wrong. He’s lost the plot to an alarming degree, and I don’t see him getting it back any time soon.

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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.

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