Naturopaths and vaccines

I realize I’ve been remiss. After all, three or four weeks ago, I pointed out that the week of October 7 to 14, this very week, was going to be Quackery Week. Well, it wasn’t actually I who first declared this week quackery week. It was actually our very own U.s. Senate, which, as I pointed out, passed S.Res.221, which declared:

A resolution designating the week of October 7 through October 13, 2013, as “Naturopathic Medicine Week” to recognize the value of naturopathic medicine in providing safe, effective, and affordable health care.

Given that the vast majority of naturopathy is quackery, particularly given that naturopathy schools require the teaching of The One Quackery To Rule Them All (homeopathy) and the naturopathic board examination tests candidates on that very same quackery, it only made sense that Naturopathic Medicine Week 2013 is, in fact, Quackery Week. Thanks, Senator Milkulski!

So here we are, nearly three days into Quackery Week, and I haven’t written anything about naturopathic quackery. Then, last night I saw a comment on my not-so-super-secret blog lacking in both pseudonyms and (as much) Insolence as you are used to seeing right here. In it, a naturopathy apologist responds to a comment pointing out the tendency of naturopaths to be antivaccine by insisting that “LICENSED ND’s” don’t advocate “for or against” vaccines but rather “give the patient information to objectively decide for themselves by weighing the risks of both.” Hoo-boy. When I read that, it was like throwing the proverbial red meat in front of a starving pit bull. Even more interesting, this particular person cited a link to a post on the blog of a Montana naturopath named Erika Krumbeck, who opines All naturopaths are against vaccinations, right?

Well, that’s a bit of a straw man argument. Not a promising start. No one that I know of says that “all” naturopaths are against vaccinations. We do, however, say, based on copious evidence, that most naturopaths tend to be antivaccine to one degree or another. Krumbeck begins:

Continuing on the hot-button issues in the field of Complementary and Alternative Medicine (CAM) is that of vaccinations. Once again I’m going out on a bit of a limb with this one, because I’m presenting my personal views and not necessarily those of the profession as a whole. I can, however, share my experience of what I’ve seen most naturopaths advocate…

So all naturopaths are against vaccinations, right? Certainly there are vehement opponents of vaccination amongst naturopathic physicians. Conversely, our community of physicians also has a group who are vocal supporters of rigidly following the CDC schedule. Most naturopathic physicians, especially those who specialize in naturopathic pediatrics, take a third stance, which I call the knowledge-based approach.

Krumbeck seems very eager to reassure her readers that she really and truly isn’t antivaccine and that she even goes so far as to vaccinate her children. Good for her! Unfortunately, if she’s like most other naturopaths I’ve encountered, her “knowledge-based approach” is in reality an example of what I like to refer to as “misinformed consent.” You can see it right here in her paragraphs above through her use of false balance. Sure, she tells us, there are naturopaths who are rabidly antivaccine. It’s nice that she’s admitted that. But, she assures us, there are naturopaths who are “vocal supporters of rigidly following the CDC schedule. Now, personally, I’d love to meet these naturopaths who try to out-Offit Paul Offit, but I’ve never encountered a naturopath who advocates “rigidly following the CDC schedule.” Ever. And I’ve looked. If they exist, they appear not to blog or maintain websites. Whenever I see what naturopaths have to say about vaccines, it’s either a whole lot of easily shot down antivaccine tropes, or it’s a mush, wishy-washy false equivalence between the antivaccine and pro-science-based medicine viewpoint much like Krumbeck’s blog post.

Even in her blog post, you can see that she’s trying desperately to follow the fallacy of the golden mean, also known as the argument to moderation the “middle ground” fallacy. You can tell from her post that this is what she is doing by how she characterizes antivaccine naturopaths as “vehement opponents of vaccination” and these mystical magical (and probably nonexistent) pro-vaccine naturopaths as “vocal supporters of rigidly following the CDC schedule.” Having thus set up the two sides as unreasonable and rigid, she then portrays herself and “most” naturopaths as taking a “third stance.” She even goes so far as to characterize this stance as being “knowledge-based.” Of course, given what passes for “knowledge” about vaccines among naturopaths, what Krumbeck is most likely really recommending to her patients is a “misinformation-based” set of recommendations, resulting in what I like to call “misinformed consent.

The fallacy of moderation is a fallacy because it assumes that two opposing viewpoints are equally, or roughly equally, valid and that therefore the “truth” is likely to lie somewhere between the two extreme positions. An excellent quote on this particular fallacy comes from Cenk Uygur, of The Young Turks, who said, “If CNN did sports reporting, every game would be a tie.” He was referring to the tendency towards false balance and the closely related fallacy of the golden mean. Or, you can look at it this way. The underlying assumption in this fallacy is that extreme positions are generally never reasonable or correct, which leads to the assumption that the “correct” view must lie somewhere between the extreme positions. While this sort of reasoning can work reasonably well in politics, in science it is only reasonable if two positions have roughly the same amount of scientific evidence and experimentation to support them. In the case of the antivaccine movement versus supporters of science-based medicine defending vaccines, this is most assuredly not the case. The evidence supporting the “adverse reactions” claimed by antivaccinationists to be due to vaccines (autism, neurodevelopmental disorders, asthma, diabetes, sudden infant death syndrome, and more) are actually not caused by vaccines. The evidence showing no link between these conditions and diseases and vaccines is overwhelming, while the evidence supporting the antivaccine position is either nonexistent or pseudoscience.

The fallacy of the golden mean leads Krumbeck to write this howler:

The knowledge-based approach is based on educating the parents to make an informed decision on which vaccines to administer, and allows parents to choose the timeline. Naturopathic doctors clearly list the risks of each vaccine, based on actual scientific evidence, not heresay or celebrity endorsement. Physicians also clearly state the risks of each disease, and the potential consequences of not vaccinating. Parents are informed of which age group benefits from each vaccine (meningitis and pertussis are typically more deadly in early infancy), so they are aware of appropriate timing. Parents are given the CDC guidelines and explained the rationale behind the CDC schedule’s timing. Physicians will often point toward alternative vaccine schedules if the parents are so inclined (like Dr. Sears’ vaccine schedule).

The drawbacks to this approach are somewhat obvious – Yes, this explanation takes time! This is another reason why office visits to a naturopathic pediatrician are double or triple the length to a conventional pediatrician. It also requires intelligent and responsible parents to weigh many options and make difficult decisions, especially if they decide on an alternative vaccine schedule.

I do particularly like that bit about “intelligent and responsible parents.” The not-so-subtle implication on Krumbeck’s part is that her patients are clearly “intelligent and responsible,” which is why she can use this approach with them. Meanwhile, later in her blog post, Krumbeck proudly refers to “informing” parents before they “blindly follow a physicians recommendation to use a certain vaccine schedule.” Good physicians inform their patients and don’t dwell on issues with vaccines that aren’t issues. Unfortunately, Krumbeck appears not to be one of those practitioners. For example, she has a webinar (for only $29) that she calls Vaccines Demystified. I wasn’t willing to spend $29 to see what’s in it, although there is an introduction on her YouTube channel:

In the two minutes or so, there’s nothing particularly objectionable, but it’s hard not to get the impression that the answers to the questions she asks are not particularly science-based, even as she brags about having read over three hundred journal articles and abstracts. I can see one area right in the introduction in which I sense some downplaying of the risks of not vaccinating. She keeps emphasizing telling the “actual risks” of your child getting the disease. One wonders if she points out that these risks are so low for some diseases precisely because of herd immunity due to vaccines. She also takes pains to mention that this is “not a pro-vaccine or antivaccine lecture.” That tells me right there that the appeal to moderation will play prominently in her video.

The same sort of appeal to moderation is at play in this post, Aluminum in vaccines, which features this section from her “Vaccines Demystified” video:

It’s basically a whole lot of tropes about aluminum in vaccines wrapped in what I like to call the fallacy of false ignorance. This is not the same thing as the more commonly used appeal to ignorance. By “false ignorance,” I mean making a claim that science doesn’t know something or that there is no evidence, when in fact science does know and there is evidence. This technique is at play all over the post, such as in this passage:

So is there any safety research?

No. (Dr. Erika laughs ironically. Sigh.)

So there is a little bit of research in preterm infants about exposure to aluminum via parenteral feeding. We know that infants fed with parenteral nutrition (contaminated with aluminum) retained aluminum up to 75%. More than 10 days of exposure meant that they had neurological problems. They are also going to have bone problems as adolescents (that is very well researched at this point).

Later, she writes:

It’s quite possible that the aluminum content in vaccines is completely safe. However, it is also possible, given the lack of research, that aluminum as an adjuvant is not the best choice. What is clear is that there is concern in the scientific community, as well as calls for research on safety and the development of other adjuvants.

It doesn’t help that Krumbeck cites execrably awful—or is that awfully execrable?—papers by Lucija Tomljenovic and Christopher Shaw, whose antivaccine proclivities are now well known and have been documented on this very blog multiple times (for example, here, here, here, and here). Christopher Shaw even featured prominently in an antivaccine propaganda film, and examples of the sorts of pseudoscience and nonsense these two investigators routinely lay down are included in the links I just cited. Krumbeck even mentions the nonexistent ASIA syndrome.

To be fair, Krumbeck appears not to believe (or at least not very strongly) that vaccines cause autism, and that is a good thing, a veritable rarity among naturopaths, in my experience. Indeed, she wrote a post entitled It’s time to move beyond the autism/vaccine debate, in which she states:

As a physician specializing in pediatrics it is frustrating to continue to hear the conversation centered around vaccines causing autism. I believe we are doing the autistic community a disservice by continuing to wage a war of words regarding autism and vaccines. Though no study has looked at the totality of vaccines, at least the MMR vaccine/Autism link has been emphatically disproven in literature.

At least she recognizes that the MMR/autism link has been “emphatically disproven.” There’s also lots of other research that fails to show evidence of a link between vaccines and the mercury-containing preservative thimerosal or any relationship to the vaccine schedule. For a naturopath, though, admitting that the MMR doesn’t cause autism is major progress. Be that as it may, there is one bit of hilarity here, and that’s that Anne Dachel—yes, that Anne Dachel—overseer of the flying monkey brigade of the antivaccine crank blog Age of Autism didn’t like seeing a naturopath deny a link between vaccines and autism. She was also shocked to see a naturopath deny a link between vaccines and autism, so much so that she dive bombed the comment section of Krumbeck’s article, dropping her usual turds of antivaccine misinformation the same way we’ve seen her do so many times before. It’s also very useful in that it leads Krumbeck to drop the facade of not being antivaccine to some extent, if only for a moment. She cites Natasha Campbell-McBride, who believes in an incredibly ignorant and pseudoscientific version of the common “gut-autism hypothesis” so beloved of antivaccinationists and believes that vaccines are the “straw that breaks the camel’s back” with respect to autism.

Krumbeck then defends herself:

As a physician I am much more concerned about the aluminum-containing vaccines like DTaP, PCV and HiB which I think place a greater strain on the body’s ability to detoxify. It is incredibly unfortunate that no study has ever been performed comparing the full CDC schedule of vaccines vs. unvaccinated children. It is also very concerning that the latest Cochrane review for the MMR vaccine states that safety data is lacking (though they did state that there is no evidence to support an MMR-autism link, since that is one thing that HAS been studied).

So no, I am NOT a “pro-vaccine” physician, though I am also in no way an “anti-vaccine” physician. There is much that needs to be worked out in science. Physicians like myself need to educate our patients to weigh the pros and cons of vaccinating vs not vaccinating. These vaccines were developed for a reason – to save parents the anguish of potentially devastating diseases. Some are more severe and more common than others, and some are much more likely in certain situations.

As I said, Krumbeck demonstrates the fallacy of moderation in spades. She also spews common antivaccine tropes about aluminum, a demand for a “vaccinated versus unvaccinated” study, the apparent belief that the experts who develop recommendations for the vaccine schedule for the CDC don’t actually consider the prevalence of diseases when formulating recommendations.

Yes, in trying to argue that naturopaths aren’t all “antivaccine,” Not-A-Dr. Krumbeck demonstrates that at least one naturopath sure does spread a lot of antivaccine-leaning misinformation .