In my five years in the blogosphere, two years blogging for SBM, and over a decade in Internet discussion forums about medicine and “alternative” medicine, I’ve learned a few things. One thing that I’ve learned is that one of the biggest differences between those whose world view is based on science and who therefore promote science-based medicine and those promoting pseudoscience, quackery, and anti-science is that science inculcates in its adherents a culture of free, open, and vigorous debate. Indeed, to outsiders, this debate can seem (and sometimes is) vicious. In other words, if you’re going to be a scientist, you need to have a thick skin because you will have to defend your hypotheses and conclusions, sometimes against some very hostile other scientists. That same attitude of a Darwinian struggle between scientific ideas, with only those best supported by evidence and with the most explanatory power surviving, is a world view that those not steeped in science have a hard time understanding.

Among those who don’t understand science, few have a harder time with the rough-and-tumble debate over evidence and science that routinely goes on among scientists than those advocating pseudoscience. Indeed, in marked contrast to scientists, they tend to cultivate cultures of the echo chamber. Examples abound and include discussion forums devoted to “alternative” medicine like CureZone, where never is heard a discouraging word — because anyone expressing too much skepticism about the prevailing view on such forums invariably finds himself first shunned by other members of the discussion forums and then, if he persists, booted from the forum by the moderators. In marked contrast, on skeptical forums, most of the time almost anything goes. True, the occasional supporter of woo who finds his way onto a skeptical forum will face a lot of criticism, some of it brutal. However, rarely will such a person be banned, unless he commits offenses unrelated to his questioning of scientific dogma, such as insulting or abusive behavior towards other forum participants or trolling. Such people may annoy the heck out of us skeptics sometimes, but on the other hand, they do actually from time to time challenge us to defend our science and prevent us from becoming too complacent. Indeed, that’s what I like about skeptics and being a scientist. Nothing or no one is sacred.

In marked contrast, supporters of pseudoscience are very much characterized by their aversion to scientific debate. The reason is obvious. They don’t have the goods. (If they did, what they’re advocating wouldn’t be pseudoscience.) They can’t win on science, reason, and evidence. The result is that they often end up forming communities that exist more to support their pseudoscience than to discover what does and does not actually work. Indeed, Prometheus describes this phenomenon well as he’s seen it in “autism biomed” discussion forums.

The same sort of group dynamics occurs in forums like CureZone and many others. Those who try to apply science and skepticism to the prevailing dogma of the group usually end up banned or give up in disgust. Indeed, at the anti-vaccine crank blog Age of Autism, comments are ruthlessly censored, and anyone who disagrees too strongly with the prevailing “wisdom” that vaccines cause autism will soon find himself or herself permanently banned. One consequence of this can be that the adherents of such views become progressively less able to defend their views in an evidence- and science-based argument, because they simply aren’t used to having them challenged based on evidence and science. Indeed some no longer even know how to react to criticism other than by lashing out. We’ve seen this before on this very blog, where anti-vaccine activist J.B. Handley lashed out at Steve Novella, while from time to time various anti-vaccine activists, J.B. Handley included, and promoters of pseudoscience and quackery periodically launch prolonged ad hominem attacks on me1,2,3,4,5,6,7,8,9,10.

Another consequence is that promoters of unscientific and anti-scientific “medical” modalities have a tendency to be lawsuit-happy. We at SBM have written about this time and time again, both here and on individual bloggers’ blogs. The most recent and famous victim of this tendency is Simon Singh, who is being sued by the British Chiropractic Association for pointing out that there is no evidence behind their claims to be able to treat allergies and colic and quite correctly characterized such claims as “bogus.” Thanks to Britain’s notoriously plaintiff-friendly libel laws, Singh is fighting an uphill battle, too, and may very well lose. Fortunately, his case has become a cause célèbre, and Sense About Science has rallied public opinion in his favor and, more importantly, of reforming the U.K.’s antiquated anti-free speech libel laws — please sign the petition. However, Singh’s case is simply the most famous current example of how promoters of pseudoscience try to suppress criticism with legal threats or action. There have been several others before, including Andy Lewis of Quackometer, whose ISP caved in to legal threats from the highly dubious Dr. Joseph Chikelue Obi (who bills himself as the “world’s top expert in nutritional immunomudulation“). This came on hot on the heels of legal thuggery directed against him by the Society of Homeopaths. In both of these cases, the attempted legal action backfired spectacularly, as dozens, perhaps hundreds, of bloggers republished the posts verbatim that the Society of Homeopaths and “Dr.” Obi had successfully suppressed. Another example includes Kathleen Seidel, who was subject to a frivolous and punitive subpoena by lawyer Clifford Shoemaker, who is well known for bringing lawsuits based on the pseudoscience that vaccines cause autism. Fortunately, Shoemaker overreached and was forced to retreat in shame.

And I haven’t even mentioned über-quack Matthias Rath trying to silence Ben Goldacre through litigation

The most recent flavor of anti-science groups using the law to silence critics seems to be anti-vaccine activists. And, I’m sad to report that this time around it is Barbara Loe Fisher of the organization with the most Orwellian name, the National Vaccine Information Center (NVIC), who is suing Dr. Paul Offit; Amy Wallace, who quoted him in her excellent article published in WIRED Magazine in October (for which J.B. Handley launched misogynistic attacks on her); and Condé Naste, WIRED’s publisher. Here is the legal complaint (scrubbed of home addresses of the private parties involved).

This is not the first time an anti-vaccine activist has sued Dr. Offit. Just last year, Handley sued Dr. Paul Offit for a passage in his 2008 book Autism’s False Prophets, which included highly unflattering portraits (and, in my opinion, justifiably so) of anti-vaccinationists like Mr. Handley, including a discussion of a threatening post by Handley posted to an anti-vaccine mailing list, in which he said to the “neurodiverse folks monitoring this list”:

We will bring the full resources of myself and Generation Rescue to stop this. We will sue you for libel and we will go after your homes and assets. My lawyers live to investigate and sue people like you.

This, of course, sums up the attitude of all too many anti-science activists. They can’t win on the science; so they try to suppress criticism through legal action. Sadly, it’s their most potent weapon, certainly far more potent than any scientific argument they can come up with, given that even in the relatively defendant-friendly U.S. libel suits can be so intimidating that they will effectively silence criticism.

I don’t know enough of the details of the suit to determine whether Handley’s case had any merit or not, and I’m not a lawyer anyway. I tend to doubt that it did. Regardless of the merit of his suit (or, more probably, the lack thereof), I am pretty sure I have deduced Handley’s intent, as his e-mail and postings on AoA certainly leave no doubt as to his attitude. I also know that it’s very interesting that, as Squillo points out, Handley’s lawsuit was not filed on the basis of libel, but rather on “false light invasion of privacy” rather than for libel (a form of defamation), probably because false light is less well-defined than libel and easier to prevail on, perhaps as a result of Dr. Offit’s lawyer’s response. Whatever the case, Dr. Offit and his lawyers decided to settle rather than fight, with the settlement being an apology, an agreement to correct the passage in dispute, and a $5,000 donation to one of Jenny McCarthy’s favored autism charities, all of which to me sounds very much like a token settlement. I may be totally wrong about this, but my guess is that Dr. Offit just didn’t want to go through the pain of a full trial, which is, of course, the point of such legal actions; being sued is painful for anyone, and many decide it’s easier to cave than to fight, even when they have a strong case. My second guess is that Handley may have had just enough of a case plus a set of pockets deep enough to make a lot of trouble but probably not a good enough case to have had a high likelihood of prevailing if it had gone to trial. Otherwise, given his visceral hatred of Dr. Offit, I highly doubt that Handley would have agreed to such a tiny token settlement. (Another possibility to be considered is that Handley didn’t really want Generation Rescue and himself to be subject to discovery regarding the incidents at the heart of the disputed passage had the legal case moved forward.) On the other hand, Offit’s settling is a huge propaganda victory for Handley, which he has been trumpeting on his blog.

Unfortunately, Handley’s apparent success appears to have emboldened other anti-vaccine activists, and this, I suspect, is why Barbara Loe Fisher likely decided that she might be able to cause Dr. Offit some trouble. So cause him trouble she did by suing over this passage from Amy Wallace’s article:

Paul Offit has a slightly nasal voice and a forceful delivery that conspire to make him sound remarkably like Hawkeye Pierce, the cantankerous doctor played by Alan Alda on the TV series M*A*S*H. As a young man, Offit was a big fan of the show (though he felt then, and does now, that Hawkeye was “much cooler than me”). Offit is quick-witted, funny, and — despite a generally mild-mannered mien — sometimes so assertive as to seem brash. “Scientists, bound only by reason, are society’s true anarchists,” he has written — and he clearly sees himself as one. “Kaflooey theories” make him crazy, especially if they catch on. Fisher, who has long been the media’s go-to interview for what some in the autism arena call “parents rights,” makes him particularly nuts, as in “You just want to scream.” The reason? “She lies,” he says flatly.

“Barbara Loe Fisher inflames people against me. And wrongly. I’m in this for the same reason she is. I care about kids. Does she think Merck is paying me to speak about vaccines? Is that the logic?” he asks, exasperated. (Merck is doing no such thing). But when it comes to mandating vaccinations, Offit says, Fisher is right about him: He is an adamant supporter.

Regular readers may have noticed that I almost never accuse anyone of lying. The reason is that I tend to believe that most anti-vaccine activists really and truly believe in their pseudoscience. Consequently, when they spread misinformation and outright nonsense, they are not technically lying, at least not most of the time, because they have no clue that what they are saying is false. Indeed, although I do not know the specifics upon which Dr. Offit based his claim that Loe Fisher “lies” (although having read some of the vitriolic attacks on Dr. Offit by members of the anti-vaccine movement I can certainly understand why he might come to that conclusion), I do know that she is profoundly wrong about the science of vaccines and, utterly impervious to any science contradicting her viewpoint, spreads misinformation, so much so that whether Loe Fisher believes what she says or knows it to be false almost becomes a moot point when so much egregious misinformation and pseudoscience is spread against the backdrop of mountains of evidence showing that they are not scientifically valid. The end effect is more or less the same in a practical sense, although whether it is in a legal sense I do not know.

Even so, in her complaint Loe Fisher takes takes Jenny McCarthy’s disingenuous claim that she is “not anti-vaccine, but pro-safe vaccine” to whole new heights of bizarre contortion. I’ve written about this technique before. Fisher is very clever and couches her views in rhetoric of freedom and “informed consent.” Yet, it is very clear from the NVIC website what its true agenda is. For instance, there is a “memorial” for “vaccine victims,” which states:

They are the men, women, and children who have died or been injured by vaccines in nations around the world for the past 200 years. This is a virtual Memorial dedicated to those whose lives have been forever changed by vaccines they were often required by law to use.

And concludes:

Our hope is that, by honoring those who are casualties of mass vaccination policies, there will be greater public awareness of the need to value and care as much about those who are harmed by the complications of vaccines as we care about those who are harmed by the complications of infectious diseases. This International Memorial for Vaccine Victims is offered to the world as testimony of the need to protect the biological integrity of life on this planet.

The NVIC also runs a website called Stand Up! Be Counted!, which states: “No Forced Vaccination. Not in America.” It also uses common anti-vaccine tropes, such as confusing correlation with causation for the “autism epidemic.” Meanwhile the NVIC page about the H1N1 vaccine cites dubious studies on mercury in vaccines, in particular the discredited Hewitson study that I blogged about here and here. Then there’s the Vaccine Law Firm Directory she maintains of lawyers ready to sue for vaccine injury. But perhaps most telling of all is the recent NVIC conference, in which luminaries of the anti-vaccine fringe presented their views and “data,” and in which the man who started the fear that the MMR vaccine causes autism based on the shoddiest of science and whom Barbara Loe Fisher herself has vociferously defended, namely Andrew Wakefield, was given NVIC’s Humanitarian Award. The conference also included total cranks such as Gary Null, who is anti-vaccine to the core, an HIV/AIDS denialist, coffee enema advocate, and supporter of cancer quackery, and David Ayoub, whose claim to fame is that he thinks that mass vaccination programs are a plot by the Illuminati, complete with black helicopters. Quite frankly, from my point of view, if Barbara Loe Fisher isn’t anti-vaccine, she sure has an amazingly odd way of showing it. It would be very interesting to ask her whether there is anything or any evidence that could ever persuade her that vaccination is far safer than the diseases vaccinated against. I tend to doubt it, although I have no doubt, given her silver tongue, that she’d dance around the question quite skillfully, move the goal posts, or propose impossible-to-meet (in the real world, at least) standard of evidence.

My guess is that Loe Fisher’s lawsuit has very little to do with her reputation. After all, among real scientists knowledgeable about vaccination (as opposed to anti-vaccine “scientists” like Andrew Wakefield) her reputation is that of a promoter of pseudoscience; in other words, her only scientific reputation is a bad one. Moreover, among Loe Fisher’s core constituency, I highly doubt that Dr. Offit’s saying “she lies” about her would have any effect whatsoever on its opinion of her veracity, other than, perhaps, to make her fans love and believe her all the more. After all, in the circles that she travels, Dr. Offit is viewed as practically akin to Satan himself and routinely castigated as “Dr. Proffit.” However, having her veracity called into doubt by a real vaccine scientist could potentially hurt Loe Fisher in her efforts to win mainstream acceptance, and that is probably the real concern driving the lawsuit.

Another reason that Fisher’s frequent, impassioned, indignant denials that she is anti-vaccine are hard to believe is that she is very one-sided in her application of her appeals to freedom. She states over and over again that she is for “informed consent” and the right of parents to express “philosophical exemptions.” No doubt a libertarian argument could be made on political and philosophical grounds to support such a position. But, as PalMD shows, when a private institution decides that it will require that students be fully vaccinated according to the recommended schedule before they can attend school, suddenly Fisher isn’t so supportive of the whole freedom thing anymore. For example, when a Jewish school in Pittsburgh decided that it would not accept philosphical exemptions, would require that its students, other than those with legtimate medical exemptions, be fully vaccinated, and would not accept a letter from anyone other than a child’s primary care physician in order to grant a medical exemption, Fisher was most displeased:

According to Loe Fisher, the federal vaccine injury compensation program, established by the National Childhood Vaccine Injury Act of 1986, has paid more than $2 billion to families of children who have been injured or died as a result of vaccination.

“Vaccination should not be separated out from the informed consent paradigm,” she said.

Since the establishment of the CDC and American Academy of Pediatrics recommendations regarding vaccination requirements, Loe Fisher continued, families seeking medical exemption from vaccination have found it rough going.

Because it’s hard for a family to find a physician to provide a medical exemption, Loe Fisher said, many must rely on the religious or philosophical exemption, available in almost all states, to avoid vaccination.

She is not in favor of a private school refusing to accept those exemptions which are provided for by state law.

“It is questionable for a school to narrow those exemptions and not allow a parent who believes a child is at risk to take an exemption,” Loe Fisher said.

In other words, Fisher is against the government’s mandating vaccination before a child can attend school, public or private, but if the administration of a private school voluntarily decides without any government laws or pressure that it is going to require vaccination of its students before admission and not accept philosphical exemptions, she thinks that the government should have the power to enforce philosophical vaccine exemptions on it. Her advocacy of freedom with respect to vaccination is rather one-sided, don’t you think? After all, I bet Loe Fisher supports the right of private schools, such as Waldorf Schools, that do not require vaccination, often have high percentages of unvaccinated children, and, of late, have become incubators for outbreaks of vaccine-preventable diseases, not to require that their students be vaccinated. Thus, Loe Fisher’s support for “vaccine choice” except when it is the choice of a private institution to mandate vaccines casts her assertion in her complaint that she “does not seek to prohibit or advise against vaccination but to ensure that vaccination is voluntary and that it proceeds following fully informed consent” in a rather dubious light and contributes to the overall impression that she is in reality not a “vaccine safety” activist, but an anti-vaccine activist.

He’s also a flaming hypocrite. In my opinion, of course.

After having read her website and seen her quoted in many interviews, my bottom line opinion is that Barbara Loe Fisher is anti-vaccine. True, she’s good at cloaking what I consider to be her anti-vaccine views in rhetoric of “freedom” and “informed consent,” but whenever push comes to shove, she’s against vaccines and clearly thinks that they do more harm than good. Nowhere have I ever seen her say that she supports a single vaccination as routine. Not one. Her entire organization supports the scientifically discredited notion that vaccines cause autism and holds conferences with anti-vaccine speakers. It prominently has a web page linked to from its main page whose purpose is to provide a memorial for “vaccine victims.” It’s hard not to conclude from this that she is anti-vaccine.

Moreover, Barbara Loe Fisher is one to talk about libel, after what she said about Dr. Offit the very article by Amy Wallace over which she is suing:

Against this backdrop, Fisher, a skilled debater who often faces down articulate, well-informed scientists on live TV, mentioned Offit frequently. She called him the leading “pro-forced-vaccination proponent” and cast him as a man who walks in lockstep with the pharmaceutical companies and demonizes caring parents.

Maybe Dr. Offit should countersue for libel. It sounds as though he may have a case. After all, on the NVIC website, there is this little tidbit as well:

Offit’s attempt to exonerate DPT is part of a larger effort to convince the public – and drug company stockholders – that most vaccines, including his own, have no risks whatsoever.

I’d love to see Loe Fisher present evidence that Dr. Offit has ever said that most vaccines, including his own, have no risks whatsoever. But attacking Dr. Offit in such terms is not enough for Loe Fisher. As Kim Wombles points out, Loe Fisher sees her fight against vaccine mandates in apocalyptic terms, as she describes on the NVIC website:

The discrimination begins, always, with the majority in a society pointing the finger at a minority for somehow endangering the public health and welfare. Individuals in the minority group are singled out as different – ethnically, biologically, spiritually, morally – from the majority. The human impulse to fear, judge, marginalize or eliminate those different from the rest has left a blood soaked trail winding throughout the entire history of man from the Great Inquisition to the Holocaust; from the killing fields of Cambodia to Rwanda, Serbia and Tibet; while the persecution of those with leprosy, TB, AIDS, mental illness, and handicaps continues in every society.

Later in the same article, I found this quote by Loe Fisher likening Andrew Wakefield to a victim of the Inquisition:

I thought of the persecution of Andrew Wakefield, M.D., who is being punished by his British colleagues for daring to report an association between the MMR (measles-mumps-rubella) vaccine and neuroimmune dysfunction, including inflammatory bowel disease and autism. Like when the heads of heretics were impaled upon stakes on the Tower of London as a warning for all to see, the Wakefield inquisition is a spectacle designed to persuade all doctors contemplating questioning the safety of current mass vaccination policies to remain silent.

And this allusion to the Holocaust:

Holocaust survivor Elie Weisel has said “When you take an idea or a concept and turn it into an abstraction, that opens the way to take human beings and turn them, also, into abstractions.”

Individuals harmed by vaccines are not abstractions. They are human beings who deserve to be spared a lifetime of suffering rather than being thrown under the bus to prop up forced mass vaccination policies that fail to acknowledge biodiversity within the family of man.

When Barbara Loe Fisher likens the supporters of vaccination programs who correctly criticize her and those holding views similar to hers as “anti-vaccine” to Nazis or the Inquisition and their criticism to what the Nazis did to the Jews during the Holocaust or the Inquisition did to heretics, when she likens criticism of her stance on vaccines to the genocides in Cambodia and Rwanda, she shouldn’t be too surprised when a lot of people conclude that she is anti-vaccine, not pro-safe vaccine.

Just like those of the Society of Homeopaths, “Dr.” Obi, the British Chiropractors Association against Simon Singh, or Matthias Rath against Ben Goldacre, Loe Fisher’s lawsuit is also likely more about shutting up critics than it is about protecting her reputation. Clearly, Wallace’s article hurt the anti-vaccine movement. Moreover, if there’s one good thing about 2009, it’s that more and more mainstream media outlets stopped portraying the anti-vaccine movement as poor, persecuted parents and more and more portrayed it as a threat to public health based on pseudoscience, which it is. Yes, it’s true that individual stories from the movement can be very sad and compelling; many of these parents and their children have had a horribly rough time. However, we do not have to downplay their difficulties or insult them personally to point out that they are profoundly wrong based on science when they blame vaccines for their children’s autism and that their activities do represent a serious threat to public health. More and more reporters, like Trine Tsouderos and Amy Wallace, have come to realize that. Such reporters represent a threat. Moreover, demonizing these journalists online, as the anti-vaccine movement tried to do with Amy Wallace and Trine Tsouderos (the latter of whom was included in a Photoshopped collage with Steve Novella preparing to make a Thanksgiving feast of a baby), doesn’t work very well. That leaves lawsuits to intimidate those who would speak out and discourage other media outlets from writing similar stories.

I wonder. Sense About Science did a fantastic job of publicizing the Simon Singh libel case and using it to promote the need for reforming the U.K.’s libel laws. I wonder if it’s time for a similar movement right here in the U.S. to prevent promoters of pseudoscience from using the law to intimidate and harass defenders of science-based medicine. Although Dr. Offit probably has the financial means to defend himself, there are a lot of writers and bloggers who do not, should someone with deep pockets decide to try to silence them with a frivolous lawsuit. We definitely have a problem here, and I predict it’s going to get worse as pseudoscience movements like the anti-vaccine movement rightly become more and more marginalized.



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.