This blog is entitled Science-Based Medicine for a reason, and that’s because we here at SBM believe that the best method to result in the most efficacious treatments for the most people is through the application of science to the evaluation of the biology, pathophysiology, and treatment of disease and disorders.
I may (or may not) be departing a bit from the views of my co-bloggers with this belief, but for purposes of this blog I consider “medicine” to go far beyond what we as physicians do when we undertake to treat patients. In fact, in my view, the purview of science-based medicine should not be so limited but should include any area where decisions, actions, or policy have a direct impact on health. Thus, my definition of science-based medicine encompasses environmental policy, because of the profound effect on human health environmental pollution and toxins can have. Unfortunately for those of us who don’t like its messiness, such a view drives me even more directly into politics than previous issues I’ve taken on. Like Dr. Novella, I rarely write about politics, but when it directly impacts science-based medicine. Mostly, such discussions here on SBM have involved the regulation of the medical profession by government, as Dr. Atwood discussed recently (1, 2, 3) in the context of the difficulties medical boards have in preventing quackery to my discussion of how a quack like Dr. Rashid Buttar could continue to practice in North Carolina, despite his despicable preying upon desperate cancer patients and the parents of children with autism, not to mention the frequent criticisms of the National Center for Complementary and Alternative Medicine. Dr. Sampson, on the other hand, was more than willing to examine a much more explicitly political issue, namely the number of Iraq War dead (1, 2), and that provoked a bit of disagreement with our commenters, not to mention me.
Recently, hot on the heels of the election of Barack Obama in the Presidential election last week, an issue relevant to several aspects of where science-based medicine intersects public policy popped up. Steve Novella has already commented on it on his own blog, as have numerous other medical bloggers, science bloggers, and political bloggers but I feel justified in commenting on it here, for the reasons that I’ve just mentioned. The controversy is that antivaccine activist and true believer in the scientifically discredited notion that mercury in the thimerosal preservative in vaccines causes autism, Robert F. Kennedy, Jr., is being seriously considered by Barack Obama either to head the Environmental Protection Agency or even to be Secretary of the Interior. Like our fearless leader Steve, I believe that such a selection would be an unmitigated disaster for science policy in government.
I understand that politics is a dirty business. I also understand that to win frequently idealism has to be checked at the door. I understand that Obama came of age, politically, in the rough-and-tumble Chicago machine. Having lived in Chicago for three years back in the 1990s, I understand exactly what that means. I even understand that some measure of political payback is often necessary, or that Obama might think he needs to do something to mollify certain wings of his Party. As Politico put it:
The selection of Kennedy would be a shrewd early move for the new presidential team. Obama advisers said the nomination would please both Sen. Hillary Clinton (D-N.Y.) and Sen. Edward M. Kennedy (D-Mass.).
It also would raise the profile of the EPA, which would help endear Obama to liberals who may be disappointed on other issues important to the Democratic left because of budget restrictions.
Even so, I have a hard time imagining a quicker way for Obama to put the lie to his dedication to science-based policy than to appoint such a vocal and energetic booster of the pseudoscience that mercury in vaccines cause autism into such an influential post. It would be a horrific self-inflicted wound.
RFK, Jr. and antivaccine activism
RFK, Jr. first came to my attention when he published a screed simultaneously on Salon.com and Rolling Stone, entitled Deadly Immunity, which argued that mercury in the thimerosal preservative that used to be in vaccines. It was a screed that was so dishonest and full of misinformation and distortions that at the time bloggers labeled it the “biggest, steamingest, drippiest turd I’ve ever seen it [Salon.com] publish“; “RFK, Jr.’s completely dishonest thimerosal article“; as well as “lies, damned lies, and quote-mining.” Even liberal blogger Majikthise concluded that the actual transcript of the Simpsonwood Conference, described in such conspiratorial detail as a conference in which the CDC decided to cover up “smoking gun” data showing that thimerosal in vaccines causes autism didn’t come close to vindicating Kennedy’s grandiose claims and that “nothing said at Simpsonwood suggests an attempt to whitewash or cover up anything.” That didn’t stop RFK, Jr. from spewing one conspiracy theory after another about how the CDC and big pharma supposedly “covered up” a link between mercury in vaccines and autism, all the while misrepresenting the science.
For example, here he is on TV around the time of Deadly Immunity:
Note one particularly outrageous example of confusing correlation with causation as RFK, Jr. points out that thimerosal first started to be used in vaccines in the 1930s and “almost immediately” the syndrome of autism was noticed. Of course, autism was first described as a syndrome in 1943 by Leo Kanner; before that there was no condition generally recognized as autism; so this observation is completely spurious, especially since there is copious evidence that behavioral syndromes that were almost certainly autism have been with us for a very long time. They were simply called something different.
Since that “splash” in 2005, RFK, Jr. has stayed unrelentingly on message that mercury in the thimerosal in vaccines is a major cause of autism. He’s also continued to repeat his accusations that the CDC and big pharma are conspiring to keep the evidence that thimerosal-containing vaccines cause autism and all sorts of other horrific complications a secret, that the press is “too lazy” to research the link, and that scientists sympathetic to his point of view are being prevented from doing the research that would prove the connection or somehow otherwise “muzzled.” He has not retreated even one inch, even though numerous lines of evidence, including several very large epidemiological studies, have failed to find a link between mercury and autism or vaccines and autism. For example, he misrepresented a letter to the CDC by Smith-Kline-Beecham as being evidence of some dark conspiracy by the CDC to “discourage” the removal of mercury from vaccines when it was obviously nothing more than the CDC turning back an obvious attempt by SKB to profit from the then incipient thimerosal scare by securing an exclusive contract with the government to supply thimerosal-free vaccines. Meanwhile, RFK, Jr. has been launching histrionic attacks against anyone who dares to call him for his antivaccine winguttery, accusing them of “hating mothers,” all the while cherry-picking studies, conspiracy-mongering, and ignoring the great mass of evidence that does not support his viewpoint. As Mark Hoofnagle put it:
The conspiracy has landed! And it’s a doozy. The CDC, the IOM, the American Association of Pediatrics, and the Pharmaceutical companies are all in cohoots! And don’t forget those bureaucrats (said through clenched teeth), you know how they’re always on the side of evil. And the Pediatricians! If kids didn’t get sick, they’d be out of a job! Clearly they want autism to be pervasive.
Because to RFK, Jr., it’s always a conspiracy. Most recently, he gave a speech at the infamous “Green Our Vaccines” antivaccination rally, led by ex-Playmate, game show hostess, and gross-out comedienne turned “mother warrior” against vaccines, Jenny McCarthy:
See Kennedy praising reporter Dan Olmsted (who is known for his breathless and credulous reporting of any study or news that seems to support his view that vaccines cause autism), while claiming that he got “dragged into this issue” because “the truth became undeniable to me.” Never mind that three years after his infamous article, the evidence that there is no correlation between mercury in vaccines and autism has in fact only grown stronger, with each successive study failing to find a correlation between mercury-containing vaccines and autism building upon the next. Indeed, the very observation that autism incidence has not declined by now, seven years after the removal thimerosal from nearly every childhood vaccine is about as powerful an epidemiological experiment to test the hypothesis that mercury in vaccines causes autism as there could be. The hypothesis has clearly failed this test, as well as many others. On this issue, RFK, Jr. is, quite frankly, a crank, as he proclaims that he agrees with mothers who think that vaccines are are “destroying the health” of their children and making the “sickest generation of American children in the history of our country.” His speech, as expected, is thick with conspiracy theories and in the third part he attacks Dr. Paul Offit, whom he famously called a “biostitute.”
Why did RFK, Jr. become a true believer in the thimerosal myth?
A question that keeps coming up is an obvious one. RFK, Jr. is not a physician or scientist. He’s a lawyer and activist for environmentalist causes. So how on earth did he become arguably the second most famous antivaccine activist after Jenny McCarthy? Why?
If I may be so bold (or rash) to speculate, I believe that the reason is most likely that RFK, Jr. clearly likes to see himself as an advocate for the downtrodden, people victimized by corporations polluting their land and air, people without the means to fight back. Certainly there are such people, and arguably RFK, Jr. has championed their cause, sometimes against long odds. In the mercury militia, he found what he thought to be another such group. Indeed, if you watch the videos of his speech to the “Green Our Vaccines” rally, you’ll see that he makes a point of mentioning that several mothers who believed that mercury in vaccines cause autism had approached him with their ideas and that they had lamented to him how they couldn’t get any traction from the CDC and that no one believed them. My speculation (albeit, I think, a reasonable one) is that because RFK, Jr. correctly knew that too much environmental mercury is a bad thing that could result in health problems and because he is also clearly not too savvy about the science, he was easily seduced by the idea that mercury in vaccines was just like mercury in the environment and could cause autism and other neurological disorders. (Never mind that environmental mercury doesn’t cause autism, either.) Instead of dispassionately looking at the science to see if there was anything behind it, he looked at it from the point of view of an advocate. Not surprisingly, he was able to find evidence he wanted to support the conclusion he was predisposed to believe through his self-image and prior history of advocacy. Add to that RFK, Jr.’s well-documented tendency to see dark conspiracies everywhere between corporations and the government over the environment, throw in the false “conspiracy” over the Simpsonwood Conference, and–voilà!–he was an instant convert to the cult of the mercury militia. After all, few groups of cranks see as many dark conspiracies as the mercury militia and antivaccinationists in general.
Unfortunately, RFK, Jr. is apparently unable to distinguish between people who are indeed victims of the depradations of corporations and government and suffer health problems as a result (who do need a champion) and those who only think they are abused by corporations and the government but in fact are not (who need, more than anything else, a serious reality check more than a champion). His seeing himself as a champion of the abused predisposed him to believe the pseudoscience of the mercury militia, and he hasn’t looked back since he first made his splash in 2005. That RFK, Jr. does indeed view himself this way was demonstrated very well in a post he wrote for The Huffington Post last year, in which he defended Katie Wright and the quackery that is chelation therapy for autism:
The poisonous public attacks on Katie Wright this week–for revealing that her autistic son Christian (grandson of NBC Chair Bob Wright), has recovered significant function after chelation treatments to remove mercury — surprised many observers unfamiliar with the acrimonious debate over the mercury-based vaccine preservative Thimerosal. But the patronizing attacks on the mothers of autistic children who have organized to oppose this brain-killing poison is one of the most persistent tactics employed by those defending Thimerosal against the barrage of scientific evidence linking it to the epidemic of pediatric neurological disorders, including autism. Mothers of autistics are routinely dismissed as irrational, hysterical, or as a newspaper editor told me last week, “desperate to find the reason for their children’s illnesses,” and therefore, overwrought and disconnected.
Many of them [mercury militia mothers] approached the link skeptically and only through dispassionate and diligent investigation became convinced that Thimerosal-laced vaccines destroyed their children’s brains. As a group they have sat through hundreds of meetings and scientific conferences, and studied research papers and medical tests. They have networked with each other at meetings and on the Web. Along the way they have stoically endured the abuse routinely heaped upon them by the vaccine industry and public health authorities and casual dismissal by reporters and editors too lazy to do their jobs.
The CDC and IOM base their defense of Thimerosal on these flimsy studies, their own formidable reputations, and their faith that journalists won’t take the time to critically read the science. The bureaucrats are simultaneously using their influence, energies and clout to derail, defund and suppress any scientific study that may verify the link between Thimerosal and brain disorders…The federal agencies have refused to release the massive public health information accumulated in their Vaccine Safety Database (VSD) apparently to keep independent scientists from reviewing evidence that could prove the link. They are also muzzling or blackballing scientists who want to conduct such studies.
Get out the tinfoil hats, everyone! That’s right: Not only do those who argue for science hate mothers, but we’re either part of a vast conspiracy, too “lazy” to do our research, or “muzzled” by the CDC and big pharma. This is the world RFK, Jr. inhabits. Whatever good he may have done with his environmental advocacy, he is in grave danger of tipping the overall balance of good to evil that he’s done to the evil side by his persistent advocacy of antivaccine pseudoscience in the face of increasingly overwhelming evidence that there is no detectable correlation between either thimerosal-containing vaccines and autism or vaccines in general and autism.
Why RFK, Jr.’s antivaccine views matter
A common argument against concerns such as the ones I laid out above about RFK, Jr.’s advocacy of vaccine pseudoscience is that the EPA and Department of the Interior do not set vaccine policy. In other words, it is argued that, sure, RFK, Jr. is a total crank when it comes to vaccines, but he’s on the side of right and goodness when it comes to the environment. That argument seems reasonable enough, as far as it goes, but it looks at the question from far too narrow a viewpoint. The more appropriate viewpoint is what the appointement of RFK, Jr. to a major government agency responsible for turning environmental law and policy into regulations that impact the health of every citizen in the U.S would say about the commitment of the U.S. government not just to science-baesd medicine but science-based policy in general. What it would say would not be good; indeed, it would put the lie to President-Elect Obama’s previous promises to be a “pro-science” President. RFK, Jr. has demonstrated himself on this issue not only to be prone to dubious science, but to have become a true believer in one of the most outrageous and dangerous forms of pseudoscience out there: antivaccinationism, or vaccine rejectionism. If you’re trying to build an administration ostensibly devoted to using the best science as the basis for public policy, and the EPA is one agency where that is incredibly important, you do not want someone who is so prone to pseudoscience and promoting misinformation running that agency. Moreover, RFK, Jr’s tendency to play fast and loose with science goes beyond mercury in vaccines and into the very area where he claims expertise, the environment, where he blames Katrina on global warming, for instance (not even Al Gore does that). Apparently, any “science” is good to him, as long as it appears to support his agenda. Add to that his “not in my backyard” hypocrisy in opposing a proposal to build wind power turbines off of Martha’s Vineyard, and it’s hard for me to comprehend how Obama could consider him for a post even for a moment.
Also, his antivaccine pseudocience and advocacy of autism quackery like chelation therapy aside, let’s not forget also that RFK, Jr. is utterly unqualified to run a major government agency, his environmentalist activities notwithstanding. The EPA is a sprawling bureaucracy charged with converting environmental law into concrete regulations and then enforcing those regulations. It takes a strong managerial skill set to run such an organization. Is there any evidence that RFK, Jr. has the managerial chops to run a bureaucracy as large and complex as the EPA? None that I can see. Certainly he doesn’t have the temperament for such a task. He’s always seeing dark conspiracies everywhere and is prone to fly off the handle and conflate policy disagreements with evil in the form of Adolf Hitler. After all, he’s been quoted thusly about reporters who don’t report what he thinks they should report, “They should all drink poison Kool Aid and restore integrity to their profession.” The man is so prone to see conspiracies everywhere that I sincerely wonder if any time a mail order company fails to deliver its product on time to him he starts thinking that the government and his enemies conspired to intercept it before it arrived at his house. However, looking at his prior advocacy, I can now see how his love of standing up for “the people” against the powerful could have led him astray when it comes to thimerosal in vaccines. The problem is that not all groups claiming to be downtrodden are, in fact, downtrodden, and not all groups claiming a government conspiracy against them are, in fact, victims of a conspiracy. As hard as it is to believe, there are times when the government and corporations are not conspiring and are actually closer to the side of good science than “the people.” The case of antivaccine activists is just one such example.
Finally, not only would letting RFK, Jr. anywhere near Interior or the EPA allow him to insinuate his pseudoscience into government policy, RFK, Jr. would be a profound embarrassment to the embryonic Obama Administration right from the start. His temperament, his tendency towards conspiracy-mongering and calling his opponents “Nazis” or “traitors,” and his credulity towards pseudoscience that allows him to cast himself as the Great Defender Of The Underdog would provide endless ammunition for Republicans to use against the Obama Administration. Worse, in most cases Obama’s opponents would be right: RFK, Jr. could be expected to politicize science and medicine every bit as much as the Bush Administration was accused of doing, just from a different political viewpoint. If the Bush Administration’s politicization of science was so bad, why should it be any more acceptable from Democrats?
Fortunately, one week after the first reports surfaced, I’m heartened that the reaction to the suggestion that RFK, Jr. was under serious consideration for a government post dealing with science-based policy has been quite negative, other than from the more radical edges of the Democratic Party and, of course, antivaccinationists such as those inhabiting the forums of Mothering.com, Age of Autism, and antivaccine blogs. Campaigns to contact the Obama transition team to protest the appointment of RFK, Jr. have been suggested, and the most recent speculation (as of Friday) about President-Elect Obama’s appointments contain nary a whisper of RFK, Jr for the EPA or Department of the Interior. Indeed, his name disappeared so quickly, that I now suspect that its mention in the first place was one of two things. First, it may have been a trial balloon. I doubt this first possibility, however, as reports that RFK, Jr. was being considered for Interior surfaced the day before the election, which is rather curious, not to mention that he was then mentioned the day after the election as a potential nominee to run the EPA. These observations make me now strongly suspect a second explanation: That the source of these reports was either RFK, Jr. himself through is supporters or his supporters acting on their own to create a buzz in support of his nomination to one of these two spots. This suspicion is stoked by an interview with RFK, Jr. reported on The Huffington Post in which he said, “If asked, I will serve.” As Howard Dean famously pointed out last week, anyone willing to talk about his chances to be appointed to the Obama Administration probably has no chance. I sincerely hope that this is the case with RFK, Jr.
It is my belief that policy that deals with public health and medicine should be based on the best available science. While it is true that politics is a matter of value judgments and that different people can look at the evidence and come to different conclusions based on the evidence and what they value, what we should all agree on, I hope, is that the evidence itself upon which such political value judgments are based should be of the highest quality and based on the strongest science. Morever, such policies should be reconsidered and possibly modified according to the latest science. RFK, Jr., through his stubborn clinging to the myth that mercury in vaccines causes autism and other neurological conditions, has demonstrated that not only is he anathema to science-based medicine but to science-based policy in general. I like to think that his staunch advocacy of a failed and pseudocientific notion about vaccines causing autism has finally come home to roost and bitten him in the proverbial posterior.
Now, let’s hope that President-Elect Obama appoints people dedicated to science-based medicine and science-based policy to the appropriate posts: FDA, the Department of Health and Human Services, EPA, National Science Foundation, Department of the Interior, and numerous others. After an Administration with a distressing tendency to politicize science based on conservative politics (stem cell research, anyone?), I would very much hate to see one doing the same thing based on liberal politics. Fortunately, I don’t think President-Elect Obama will fall into that trap, but that doesn’t mean I’m not keeping an eye on him for signs that he will.