We were directed by a reader to the website of Kelly Brogan, MD, because they were concerned about the mental illness denial they found there. What I found there was a bottomless pit of medical pseudoscience. It’s a great example of how, in today’s environment, it is easy for a professional to turn themselves into a brand, to essentially function as a guru, and market all sorts of nice-sounding nonsense. A thorough debunking off all the pseudoscience I found there would be a herculean task, so here are two examples.
There are many common themes regular readers here will recognize running through Brogan’s claims. The appeal to nature fallacy, of course, is dominant, as is vague reference to modern “toxins“. Brogan also frequently portrays the current consensus of medical opinion and standard of care as a simplistic straw man. She also appears fond of quoting experts and the literature entirely out of context.
Her anti-vaccine essay starts with an appeal to the paleo diet, and all the pseudoscience that implies. She writes:
Our radical departure from sugarless, low-starch, high-nutrient, and mostly raw foods, to cooked grains (and their secondary reiteration in grain-fed animal products) marked a transition that had profound implications, affecting not only human physiology, but the very structure of human consciousness itself.
Our ancestors have been cooking with fire for 1-1.8 million years. In fact, this innovation allowed them to extract more nutrients from a wider variety of foods, and is credited with an expanse of our brain and the ability to spread out throughout the world. Further, prior to modern agriculture our ancestors were living on the brink of starvation. Developed modern countries enjoy a greater variety of foods year round, with better nutrition, than at any other time in human history. This is evidence by greater average height of modern people in developed nations, and better overall health.
There are legitimate arguments to be made about our abundance diet and sedentary lifestyles. In a way we are victims of our own success, but these are also problems of longevity – only problems because average life expectancy has nearly doubled. But the problem of modern infections has nothing to do with our diet.
She applies similar dubious logic to the immune system:
Is it possible that vaccinology has applied a reductionist – one disease, one drug/vaccine – model to an evolutionarily adapted system with built-in complexities we have barely begun to appreciate? Is it possible that we have misapprehended immunity, or are still fundamentally learning about its most basic principles? If we are to accept that billions of years have gone into priming our physiology for interface with pathogens, as enemies, but also as commensals, then we must acknowledge that there is more to immunity than antibody response.
In this one paragraph we get a microcosm of her common pseudoscientific strategies. The first is to set up a straw man about modern science. She starts by dissing reductionism – proper scientific reductionism is a perfectly useful strategy for understanding the world by digging down to basic mechanisms. She is confusing proper reductionism with hyperreductionism, by essentially equating the two. She equates it with an overly simplistic and narrow view of how things work, which is not the case.
Of course the immune system is complex. She later implies that scientists focus solely on antibody mediated immunity and ignore cell-based immunity – uh, no. She appears to be either completely ignorant of modern immunology, or indifferent to the truth.
She then sets herself up as a guru, by asking questions and in so doing implying that mainstream scientists have not asked the same questions.
She moves on to the “paleo” strategy with an evolutionary justification – we evolved to be perfect, and modern science is just messing it up. This is nonsense. She touts the “billions” of years our immune systems have evolved to confront pathogens, but ignores the fact that those pathogens have also been evolving for the same amount of time to evade immune systems. Further, once we started living in larger and larger cities, we created conditions for pathogens to rapidly evolve and spread.
Evolution is powerful, but it is not a perfect role model. It is messy, cares not for our quality of life, and tends to settle on solutions that are “good enough” for survival. Sure, we have survived as a species, but not without epidemics, outbreaks, and constant infections plaguing us. This is not due to our diet, or modern “toxins”. The microbes are simply winning the evolution war, and our best defense is hygiene and modern medicine, including vaccines.
She follows up with some standard anti-vaccine tropes, such as claiming that “natural” immunity is better than vaccines:
The push to generate synthetic immunity via vaccination attempts to co-opt this phenomena – community-based interactions and immune information-tracking have been hijacked by the application of vaccines such that lasting immunity and re-stimulation of that immune response by passive exposure and maternal transfer has been sabotaged.
There is no evidence for her claims. There is evidence that herd immunity is extremely effective. The notion of “synthetic” immunity is also highly misleading. Vaccines work by stimulating the immune system with either attenuated organism, dead organisms, or parts of organisms that are recognized by the immune system. The mechanism is exactly the same as is triggered by an infection, except without the infection part. There is nothing synthetic about it.
There is much more, but I will end with this stunning example of ignorance from someone with MD after their name:
After the live Salk vaccine paralyzed hundreds of adults and children, strategic redefinition of polio in 1955 eliminated labeling as “poliomyelitis”, all of the cases of acute flaccid paralysis caused by myriad viruses and also toxic exposures such as DDT. In fact, what would have formerly been called polio, transverse myelitis and Guillain-Barre are increasingly common today.
Essentially she is arguing that polio was not nearly eradicated, but just redefined through diagnostic substitution. Transverse myelitis and Guillain-Barre (GBS) would not have been called polio. She needs to retake her neurology course. Polio is an infection of the anterior horn cells – one particular part of the spinal cord. Transverse myelitis, as the name implies, is inflammation across the entire spinal cord in one region (hence “transverse”). Also, transverse myelitis is often auto-immune, while polio is a virus.
Claiming GBS will be confused for polio is even worse. GBS is also auto-immune (often a post-infectious auto-immune syndrome), which affects the peripheral nerves. It doesn’t even affect the spinal cord (usually, although sometimes it can spread there – but still looks nothing like polio).
These are clinically distinct syndromes, with very different diagnostic testing results. The notion that polio was simply redefined as GBS and transverse myelitis is utter nonsense, but she can probably count on most of her customers not having the neurological background to know this.
Brogan applies a similar approach to depression, and all mental illness. She argues that psychiatric symptoms are mostly due to our diet and modern lifestyle, and that mainstream doctors and scientists have it all wrong (because she is the guru with magical insight). And of course she will sell you supplements and detoxifiers to cure all the real causes that she is smart enough to see.
Here is her depression straw man:
However, even the evolutionary mismatch theory of depression relies on the dangerous assumption that all depression is the same: that depression is one disease, with one origin and a universal set of symptoms.
And who, exactly, makes this assumption? I am not aware of any professional who would argue or has argued that all depression is “one disease”. First, it is considered a disorder, not a disease. Further, it is recognized that depression is both a normal human emotion, but also can become a disorder with many possible causes and manifestations.
Ironically, it is Brogan who is limiting the possible causes of depression, by arguing that it is mostly due to our modern lifestyle. Her “many causes” of depression are mostly different types of reactive depression – reacting to life events and stressors. She also has a category for drug-induced depression.
Missing is depression caused by a genetic predisposition or an actual brain disorder. This, of course, doesn’t fit her narrative that medical problems are generally due to not living in caves and eating raw vegetables.
So essentially she includes in her picture of depression many things that are already included in standard practice, but she pretends like it is some amazing insight. She also adds some pseudoscientific, speculative, or simply unproven causes that fit her narrative. And she ignores major categories of depression with solid science behind them.
Her approach to vaccine, depression, and other ailments (perhaps I will tackle her migraine pseudoscience separately) is typical of the “so-called alternative medicine” (SCAM) approach. Modern medical science has slowly and carefully built an evolving standard of care through research, discussion, reviews, and practice. She casually dismisses this hard-won standard, and substitutes her own narrative.
The strong consensus of scientific opinion has it all wrong, she argues. She, as the guru, has unique insight to see what is really going on – and here is some flimsy, speculative, and misinterpreted science to support my position. Buy my books, buy my supplements – but don’t read those references too carefully, just trust me.