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Let’s say you attended a talk at a major medical conference that discussed how conflicts of interest bias medicine and science. How receptive to this message might you be? The speaker, a physician-scientist, has impeccable educational credentials, including a faculty appointment at a major university. This talk discusses how the medical information disseminated through the media tends to be overly optimistic, with a publication bias against negative results – industry-funded studies notoriously so. Many physicians and scientists have attended such talks, and it appears to me the medical community is growing more interested in this line of discussion. I have personally written about conflicts of interest in medicine and remain concerned about their influence.

Now, how might your perception of such a talk change if it were presented at an anti-vaccine conference, set alongside a talk given by disgraced physician Andrew Wakefield, the man who ignited the autism-vaccine controversy two decades ago? The implications of this line of questioning would quickly change.

I remain disquieted by this type of scenario, which is common in conspiratorial health networks. I recently wrote for Science-Based Medicine about the need to evaluate the entire context surrounding scientific remarks on controversial topics – borrowing the legal term “extrinsic evidence” – as many alternative health advocates utilize dog-whistle messaging to couch their true views in more acceptable terms. In my last piece, I discussed how an engineer named Alasdair Philips, who believes cell phones and WiFi are causing cancer and “frying our brains”, managed to publish a medical paper and have it credulously disseminated through the mainstream media. Mr. Philips is a member of an alternative health community that believes in “electromagnetic hypersensitivity” (EHS), in which a poorly-defined and subjective symptomatology is attributed to vague electromagnetic or microwave radiation exposure.

Going beyond medical authority

In researching this topic, I became acquainted with a number of physicians who support the existence of this condition and the role of electromagnetic radiation in causing it. A recent article published in the British newspaper The Guardian essentially claimed a massive cover-up of the dangers of cell phones was taking place, and as evidence referred to a petition they claimed was signed by “236 scientists worldwide who have published more than 2,000 peer-reviewed studies.” In examining the signatories of this petition, I found many of the participants weren’t scientists, and few were major scientific contributors. Some of the physicians who signed this petition, however, were well-credentialed and maintained clinical practices and scientific research. I also found some of these petition signers held other, even more fringe views: anti-vaccine sentiments, claims to have cured autism, or proposing electromagnetic radiation as the cause of AIDS. Conspiracies, like the Sand People of Star Wars, seem to ride single file to hide their numbers.

One physician who signed this petition was Dr. Beatrice Golomb, a professor of medicine at the University of California, San Diego. She holds an MD and a PhD, has participated in government committees, and publishes scientific work regularly. In short, Dr. Golomb’s resume is unimpeachable, and, frankly, more impressive than mine. Dr. Golomb is the physician discussed above who has spoken alongside Andrew Wakefield at an anti-vaccine conference.

I am dwelling on Dr. Golomb because I recently read an article in The New York Times about a mysterious illness afflicting American diplomats in Cuba (and later China), only to find Dr. Golomb quoted as an expert. The article discusses how in 2016 some people in the American embassy in Havana started developing a puzzling constellation of symptoms, first hearing unusual sounds and later developing dizziness, headaches, and other maladies. The illness has been subject to intense political and medical investigation. One hypothesis, which has been variably embraced by different stakeholders, is that the victims may have been subject to a deliberate political attack, potentially with a weapon utilizing microwave radiation.

Dr. Golomb appears convinced that the diplomats’ symptoms are caused by electromagnetic/microwave radiation. She is even publishing a peer-reviewed journal article on the topic, which The New York Times linked to in preprint form. Her “expert” view carries substantial weight in The New York Times article, her photo prominently displayed.

Before we discuss Dr. Golomb’s published views about this particular incident, let’s examine some of the “extrinsic evidence”, illustrating important lessons about conspiratorial health networks. Besides participating in an anti-vaccine conference, Dr. Golomb once sat for an interview with noted conspiracy theorist Dr. Joseph Mercola. Dr. Golomb also participated in an interview on an online radio show that focused on electromagnetic hypersensitivity but also endorsed other conspiracy theories, its description even mentioning the notorious “Agenda 21” theory.

In the interview, Dr. Golomb supports the existence of electromagnetic hypersensitivity and multiple chemical sensitivity. As doctors, we should be taking our patients’ concerns seriously, and many people are truly suffering from symptoms, which they attribute to electromagnetic radiation or other environmental exposures, though these purported causes appear unlikely. But there is a difference between keeping an open mind about unexplained health problems and conspiratorial thinking, as evidenced by a proliferation of multiple, contradictory conspiracies within the same communities. Dr. Golomb seems comfortable in this world. Take the following exchange:

Interviewer: “Now we’re being bombarded with manmade stressors such as the chemtrails, and vaccinations, and fluoridation of water and genetically modified foods. And how does that come into play then with EMS [electromagnetic sensitivity]?”

Golomb: “Well, you make a very interesting point. And in essence, I think what a lot of what us feel about gulf war illness is that there may be a few particularly powerful oxidative stress exposures that they had but that the confluence of multiple oxidative stressor exposures at levels above what the body’s prepared to defend against in my view is probably the force that is propelling gulf war illness. And I would even suggest an analogy between autism spectrum disorder and gulf war illness.”

This moment is worth dissecting. The interviewer rattles off a list of outright conspiracies that no doctor should endorse: chemtrails (which don’t exist), vaccines and fluoridation (which are not making us sick or controlling our minds), and genetically modified foods (which have no proven health risks), in addition to the controversial electromagnetic hypersensitivity. Any doctor who hears such talk about chemtrails, vaccination, and fluoridation should be alarmed, and she appears unfazed.

The same questions could be raised about her presence in anti-vaccine circles. She sits on the scientific advisory board for the anti-vaccine organization CMSRI. In the same interview, she repeats many of the anti-vaccine dog whistles that are used to gain support from mainstream audiences, for example the need for “vaccine choice” or that we are receiving “too many” vaccines.

Interviewer: “What areas of medicine are we finding that choice will no longer be an option?”

Golomb: “One setting are vaccinations in childhood. And I’m not anti-vaccine, but it is the case that we have an industry that was abruptly made a cash cow for drug companies when it was made the case that the government indemnified companies against harm associated with vaccines. And the timing of that aligns fairly closely with the timing of efforts to characterize anyone who raises any safety concerns in any setting as anti-science, anti-this, anti-that. And also the efforts to ramp up insistence that vaccination opt-out not be acceptable. And the problem with that is that even if the full vaccine approach as it now used which now includes many many more childhood vaccines than we were exposed to when we were children, even if it is completely appropriate and safe in its current setting, there are two things: one, there are always a subgroup of people that will be harmed by anything, and it is desirable to understand who those people are in order that they can be protected.”

Anti-vaccine advocates almost universally deny being “anti-vaccine”, but her relationship to the anti-vaccine movement seems hard to ignore. Dr. Golomb even finds a place in her new paper on the diplomats’ mysterious illness to tangentially suggest a link between autism, oxidative stress, mitochondrial dysfunction, and electromagnetic radiation. This is a common belief within the anti-vaccine and “autism biomed” communities.

Networks of doubt

Dr. Golomb’s credentials support her being interviewed as an expert by The New York Times. Dr. Golomb is experienced, articulate, and holds views about conflicts of interest that many in medicine would agree with. Yet clearly there are also aspects of her work that speak against her credibility on controversial medical topics, such as the health effects of electromagnetic radiation. I don’t mean to single her out, and I have no personal knowledge of her work other than what has been presented publicly. I simply think this case exemplifies a larger problem in the health media.

After all, how is a newspaper, beset by deadlines and budgets, supposed to choose its experts? What we should not do is revert to “malignant relativism,” and dismiss the importance of authority entirely. Yet as the media becomes more interested in iconoclastic or controversial medical views, they must not assume a respectable-appearing physician who holds an unconventional view is ahead of his or her time and not simply a quack. Not only people who shout on street corners are susceptible to conspiratorial communities. These social networks are powerful and insidious, and defy an easy explanation as to why people succumb to them.

Organized conspiratorial networks allow an idea to appear more mainstream than it truly is. UCSD, for example, supports Dr. Golomb’s recent work, even publishing a press release. To evaluate the work, the press release sought out an expert who “was not involved” in the study. They chose Dr. David Carpenter, another physician with excellent credentials. Yet Dr. Carpenter’s praise is not as objective as it may seem. Dr. Carpenter also believes in the health effects of non-ionizing electromagnetic radiation, editing a journal that frequently publishes views sympathetic to this. He once claimed “up to 15 percent of all cases of childhood cancer might be attributable to exposure to magnetic fields”. He has signed the cell phone petition along with Dr. Golomb, and is an author on the “BioInitiative Report,” a study on EMF that has been criticized as biased and unscientific. Dr. Carpenter has even promoted his views on Info Wars, today’s most notorious conspiracy theorist organ – one recently banned by the major social media platforms.

Anti-EMF advocates may not be industry shills like those who deny climate change or the dangers of smoking, but they follow a similar playbook, utilizing a small network of credentialed experts throughout the media to create legitimacy. With both anti-EMF advocates and climate change denial, for example, petitions circulate where participation by experts is misleadingly inflated, a concept discussed in the 2014 documentary Merchants of Doubt.

Reporting on uncertainty

Proximity to Andrew Wakefield and Joseph Mercola aside, what if Dr. Golomb is right about electromagnetic radiation causing the symptoms of the Cuban diplomats? Her peer-reviewed paper appears to offer some endorsement. Yet the uncertainty surrounding this topic is far greater than activists and the media are willing to admit.

The thrust of Dr. Golomb’s argument in the preprint is that the symptoms suffered by the diplomats “conform closely” to symptoms related to electromagnetic hypersensitivity. The most obvious concern with this hypothesis is that it presupposes electromagnetic hypersensitivity exists as a real disease, which is not endorsed by experts as a condition truly related to electromagnetic radiation. The paper provides no shortage of citations trying to prove its existence – over 600! This is probably the longest reference list I’ve personally seen in a medical article. But the translation of basic science and patient anecdote into proven clinical meaning is not as simple as aggregating citations.

The other concern is that the symptoms reported by the diplomats and from those who believe they suffer from electromagnetic hypersensitivity are not particularly specific. Dr. Golomb’s paper compares rates of headache, cognitive problems, sleep problems, irritability, anxiety, dizziness, etc. Many medical conditions can present with these symptoms, yet that does not imply their underlying cause is the same. In fact, the underlying prevalence of non-specific constitutional symptoms in the general population is high. The CDC reports, for example, that 10-15% of adults often feel exhausted and 17-21% of adults often have pain.

The New York Times article increased the popular credibility of the “microwave attack” hypothesis, but only later have replies by more credible experts made clear the extent of the uncertainty regarding the cause of the diplomats’ condition and so-called electromagnetic hypersensitivity. While most studies don’t support a connection between non-ionizing radiation and health effects, a recent study by the National Toxicology Program has not been entirely negative. Studies about environmental exposure to non-ionizing radiation may also not be entirely applicable to a hypothetical weapon designed to cause harm.

In both cases, some experts have proposed psychogenic illness or mass hysteria as causes. The physicians who studied the diplomats dispute this hypothesis, claiming objective findings are not compatible with this. Even when these conditions appear to fit a particular circumstance, we must always be wary of medicine’s sordid habit of blaming symptoms on mental illness, only to later be proven wrong.

In the end, the symptoms people are experiencing are real, and we do not yet have conclusive, positive evidence of their cause. Physicians and the media, then, are encouraged to speculate. How are we supposed to address such uncertainty in medicine? Physicians and the media alike both appear uncomfortable with simply stating “we don’t know.” Instead, this vacuum is often filled with unfounded hypothesizing. This situation naturally benefits those who are overconfident in their hypotheses and are willing to make the most powerful claims. Experts with minority views and patients with compelling personal stories drive the narrative.

Scientists, physicians, and journalists all profess to go where the facts lead them, but often the facts aren’t enough. In their place, we should not rely on empty authority or compelling hypotheses, because errors in these situations will not be random. Uncertainty will be filled with organized and politicized networks of advocates, happy to share fringe views in dog-whistle form.

How to find appropriate experts

In light of this and similar cases, here are a few suggestions for how journalists can vet experts on controversial health topics:

  1. Ask experts about their views on other topics frequently subject to conspiracies to gauge participation in these communities.
  2. Perform basic internet searching to see what they are saying in other media outlets.
  3. Identify and disclose any financial conflicts of interest.
  4. Ask about motivations for their research. Is this person an activist or someone who personally feels they suffer from health problems due to this condition? This doesn’t mean automatically dismissing this person, but it should prompt further questioning.
  5. Don’t try to portray “both sides” by interviewing extremists on either end.
  6. Be wary about including an expert’s “hypothesis” if it is not part of the mainstream scientific debate about the topic, with other independent sources available for review.
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Posted by Benjamin Mazer

Benjamin Mazer, MD is a resident in pathology at Yale-New Haven Hospital. His views are his own, and don’t represent those of his employer. You can reach out to him at @BenMazer on Twitter.