Dr. Jay Gordon: Pediatrician Warrior

Note: The following is a collaborative post between James (a.k.a. Dad of Cameron of Autism Street) and Orac. Feel free to tell which parts were written by whom.:-)

Jenny McCarthy’s latest book, Mother Warriors: A Nation of Parents Healing Autism Against All Odds, contains a foreword penned by “pediatrician to the stars’ children”, Dr. Jay Gordon. Dr. Gordon (or, as he often refers to himself, Dr. Jay), is the pediatrician for Jenny McCarthy’s son Evan, whose autism McCarthy blames on vaccines and whom she has also claimed to have “cured” of autism with so-called “biomedical interventions. Dr. Gordon has frequently shown up on this blog, mainly to complain piteously whenever he is criticized for being “anti-vaccine” because he not only parrots anti-vaccine pseudoscience but gives speeches to antivaccine rallies, along with Jenny McCarthy, Robert F. Kennedy, Jr., Boyd Haley, and other luminaries of the antivaccine movement. We’ve never quite understood why Dr. Gordon gets so upset at being labeled “anti-vaccine” when his words are apologetics for the anti-vaccine movement, and his actions give it aid and comfort. If past internet exchanges with Dr. Gordon are any indication, one could expect that this foreword would be replete with pseudoscience and “brave maverick doctor” posturing. Readers are not likely to be disappointed in this regard. In fact, Dr. Gordon has surpassed himself in giving in completely to the dark side of the anti-vaccine movement. Aside from completely unsupported claims of fact like, “Vaccines can cause autism,” and “hyperbaric oxygen works,” to assertions of “tremendous increase in autism,” Dr. Gordon has laid out quite a spread of logical fallacies and pseudoscience.

“Help, help! I’m being ridiculed!”

Dr. Gordon doesn’t waste any time when it comes to deploying logical fallacies, in fact he begins right from paragraph one:

The AAP and the Centers for Disease Control and Prevention (CDC) are filled with doctors who not only don’t believe the ideas in this book but actively ridicule them and spend a lot of money trying to disprove the causes and treatments so well presented when Jenny Mccarthy and others in the cure-autism community speak and write.

Unfortunately, ridicule neither validates nor invalidates a claim. The AAP and the CDC may have doctors who ridicule the ideas in Jenny’s book, but that they ridicule such claims does not make those doctors incorrect. In fact, what Dr. Gordon appears to be doing is combining a whine about being ridiculed with the Galileo gambit, in which those “brave maverick doctors” are implicitly likened to Galileo, who was persecuted for his science because it conflicted with the reigning paradigms of the time. It’s an invalid comparison, as Michael Shermer writes in his book Why People Believe Weird Things:

For every Galileo shown the instruments of torture for advocating scientific truth, there are a thousand (or ten thousand) unknowns whose ‘truths’ never pass scientific muster with other scientists. The scientific community cannot be expected to test every fanstastic claim that comes along, especially when so many are logically inconsistent.

Or, more succinctly:

They laughed at Copernicus. They laughed at the Wright brothers. Yes, well, they also laughed at the Marx Brothers. Being laughed at does not mean you are right.

There are many variations of this saying attributed to many skeptics, not just Michael Shermer, one of which goes “They laughed at Bozo the Clown, too.”

Of course, being laughed at does not mean that Dr. Gordon and the merry band of antivaccinationists to whom he provides counsel and gives talks at antivaccine rallies such as the “Green Our Vaccines” rally four months ago, whose ideas he defends while oh-so-selfrighteously proclaiming at every instance when he is criticized that he is “not antivaccine,” and with whom he pals around, are correct either. Sometimes, as in this case, ridicule is completely appropriate.

Indeed, as regular readers know, this very blog is written by a doctor who actively ridicules many of Jenny McCarthy’s claims with great gusto–because they are richly deserving of ridicule. It doesn’t make Orac or those other doctors correct, but it doesn’t make them incorrect, either. What makes them correct from a scientific standpoint is that current science supports them and does not Jenny McCarthy–or Dr. Gordon, for that matter. In fact, what’s rather disappointing is that the CDC and AAP have only recently roused themselves from their torpor to recognized the threat to public health represented by the sort of dangerous nonsense that Jenny is pushing to push back. It may be too little, too late.

In addition, Dr. Gordon is one to talk about ridicule. After all, what is he doing in his foreword but ridiculing the AAP, CDC, and any who have the temerity to point out that science does not support Jenny McCarthy’s ridiculous (and we chose that word intentionally) claims.

Special Pleading

In the next paragraph, aside from claiming to have read a lot of books about parents of children with autism and expressing his own desire to write a book about causes and treatments, Dr. Gordon brings up genetics and environment, and then pleads on behalf of the parents.

The concepts are best articulated by Francis Collin’s quote “Genetics loads the gun and environment pulls the trigger,” and the notion that nobody knows your child better than you do.

As a generalization, the logic of “parents know best” is fallacious. A trained pediatric infectious disease specialist probably understands the components and function of a child’s immune system better than a typical accountant. If a child contracts a serious infectious disease, and the available parent is an accountant, who should give treatment advice?

Another aspect of this “parent knows best” fallacy is that the emotional bond between parent and child makes parents very much not objective observers. Indeed, because of their attentiveness to children, they are very likely to confuse correlation with causation. Dr. Offit gave an excellent example of this in his book Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. In it, he describes a child who has a seizure in his pediatrician’s office while the nurse was drawing up some routine vaccines to be given at that office visit. He points out that if the child had had that seizure a few minutes later, a few hours later, or perhaps as much as a few days later, very likely to the parent it would have appeared that the vaccine had caused it. But correlation does not equal causation, and when looked at at the population level in studies quite large enough to detect very small correlations, no correlation between either mercury-containing vaccines and autism or vaccines in general and autism has been found. The reason there appears to be a correlation is because the symptoms of autism often first manifest themselves at an age when children are receiving the bulk of their childhood vaccines.

Not that any of that makes any difference to Dr. Gordon. Next, he makes a couple of assertions of what he considers to be fact.

Begging The Question

Vaccines can cause autism.

Dr. Gordon offers not one whit of scientific evidence to support this claim. He simply makes it as though it were self-evident. It’s not, and there is no good scientific evidence that vaccines can cause autism. When challenged to provide support for this sort of assertion, Dr. Gordon is invariably flummoxed, usually retreating back to his “clinical experience” and logical fallacies, more of which are discussed below. His stating that “vaccines can cause autism” in this way suggests that no specific scientific support or mechanism for autism causation will be offered. Readers will need to chalk this up to the following format of fallacious logic, “X is true. The evidence for this claim is that X is true.”

False Dilemma

Diet and supplements and other alternatives to doing nothing can lead to recovery from autism. Period.

The implication would seem to be that alternative medicine and “doing nothing” are the only choices. They are not, but pseudoscientists pushing the vaccine-autism link and “biomedical” treatments for autism desperately want parents to believe that these are the only two choices. Although “recovery” certainly isn’t clearly defined by Dr. Gordon, parents can focus on education and social skills without getting into the expense of unnecessary supplements, restrictive diets, or other alternative medicine at all. Although some may not, many parents who focus on education and social skills for will see “improvement” as a result.

There is a false premise under this fallacy as well, and that is that autism is a condition of developmental stasis and that any development observed must be due to whatever intervention the parent is making. It is not; autism is a condition of developmental delay. Autistic children can and do develop, sometimes dramatically. Occasionally even dramatically enough to lose their diagnosis of autistic spectrum disorder. Morever, there is a great deal of expectation effect in parents’ reporting of the results of their interventions, along with a lot of confirmation bias. Consequently, it is impossible to say with any scientific validity that any “biomedical” intervention “works” in “improving” autistic symptoms without controlled randomized trials. Anecdotal experience and “personal clinical experience” (favored by Dr. Gordon) do not constitute sound scientific evidence, no matter how much Dr. Gordon would like to persuade you that they do. After all, physicians believed for hundreds of years that bloodletting was an effective treatment for a wide variety of conditions based on “personal clinical experience” and anecdotes.

An excellent discussion of the appropriate role of anecdotes and how much credence should be given to them can be found here.

The “Evil Doctors” Straw Man

Gordon writes (presumptuously speaking for all doctors):

We doctors need to stop deceiving our patients into thinking that immunizations are “free.” Every medical intervention costs the body something, and we have a legal and moral obligation to tell parents.

Above all else, physicians also have a legal and moral obligation to be accurate in boiling down the best scientific evidence for a medical intervention, and claiming that vaccines might cause autism based on no good scientific evidence that they can or do is simply not accurate.

Most doctors would not agree to a statement claiming that “we doctors are deceiving our patients into thinking that immunizations are free.” Doctors do consider the contraindications before administering any injection – that alone conveys knowledge that all medical procedures are not “free.” Immunization requires a risk/benefit analysis. Don’t forget that every infectious disease cost the body something. Doctors also have a moral obligation to more than any one set of parents. They have legal and moral obligations to every patient that enters their offices on any given day. As an example, if a doctor can prevent the spread of an infectious disease (like the measles) to an innocent infant (too young to be vaccinated), by not allowing unvaccinated children in the office, he or she arguably has a moral obligation to do so. This of course has absolutely nothing to do with autism, and neither does much of the rest of the foreword for that matter, but let’s move on.

The “Pharma Shill” Gambit

Quoth Dr. Gordon:

The official position of the American Academy of Pediatrics may be the same as my personal position, but they are far too involved with the pharmaceutical industry to actually do anything but pay lip service to an open discussion. The CDC and the AAP are filled with doctors whose research, speaking engagements, and travel are often funded by the manufacturers of vaccines. Many of these same doctors are paid consultants, and some later go to work full-time for the pharmaceutical industry.

This is a gambit beloved of cranks that has been described before on this blog: The Pharma Shill Gambit. Indeed, Dr. Gordon has on occasion tried out this particular gambit on Orac himself in e-mails demanding to know if he receives renumeration from pharmaceutical companies. Dr. Jay was most disappointed to learn that Orac does not. (So was Orac to have to tell him that, for that matter–just kidding.) Dr. Gordon’s also rather quick to pull out the pharma shill gambit as well to preemptively slime those who might refute antivaccination and pro-quackery nonsense, after which he retreats to the “oh, sorry, we spoke too soon and really didn’t mean it” ploy.

Ties to, and support from, the pharmaceutical industry may exist, and they should be watched and carefully considered. However, research funding simply being connected to vaccine manufacturers, does not invalidate real science. Poor data, statistics, experimental methodology, and lack of reproducibility invalidate science. Sure there’s probably room for added transparency in any such arrangement where industry is involved with, or even produces some of the science, but the bottom line is that the alternative to acknowledging the actual science, is for one to believe in a vast conspiracy, hell-bent on hurting children and counting truckloads of money. This isn’t likely for most rational people.

Tu Quoque

Dr. Gordon is incensed:

They have called Jenny McCarthy and me “dangerous” for alerting parents to the possible risks of vaccinations. They forget that it was one of their own, Dr. Neal Halsey, who wrote the definitive article for the Journal of the American Medical Association in 1999. Entitled “Limiting Infant Exposure to Thimerosal in Vaccines and Other Sources of Mercury,” this was the catalyst for removing most mercury from most vaccines.

While Halsey’s concern at the time was surely genuine, with respect to autism it’s now known to have been unfounded. Indeed, as documented in Autism’s False Prophets, Dr. Halsey through the force of his personality and his alarmist statements managed to push through a recommendation to remove thimerosal from vaccines, even though the vast majority of the doctors and scientists on the panel didn’t believe that the evidence warranted such a quick move without further study and consideration. Claiming possible risks of vaccines in general with respect to autism (especially if unsubstantiated) is not justified, simply because Dr. Halsey did the same thing in the past with respect to thimerosal. Two wrongs don’t make a right. Indeed, Dr. Halsey, through his alarmist predictions and his pushing through a policy recommendation based on an excessive interpretation of the precautionary principle and that was also not well-supported by science, arguably did more to set the stage for the rise of the mercury militia antivaccination movement–and Jenny McCarthy and Dr. Gordon, as well. After all, the government was in essence saying, “Don’t worry about thimerosal; it’s not dangerous” while removing it from vaccines made it appear that the government believed otherwise. When asked about this apparent disconnect, the response was along the lines of, “Thimerosal isn’t dangerous, but removing it makes vaccines even safer.” No wonder parents were confused. No wonder demagogues like J. B. Handley and Jenny McCarthy, in concert with their apologists like Dr. Gordon, seized on that single action.

We actually think, in retrospect, that a better approach would have been the one advocated by Peter Sandman, namely to admit that the decision was a response to anti-vaccinationist pressure (“If you’re so sure thimerosal is safe, why are you removing it?” “Because our critics won that fight!”) and to point out that, whether it’s a genuine risk or not, a vaccine that significant numbers of people fear to take (or to let their children take) isn’t an effective vaccine.

Red Herring

Dr. Gordon is apparently smart enough to realize that beating the dead “autism = mercury poisoning” horse will not help his flailing arguments against vaccines, and he quickly changes the subject:

Yes, most vaccines have much less mercury, but wait until the evidence against aluminum in vaccines becomes common knowledge. The body of research regarding aluminum’s harm to human cells already contains hundreds of articles.

Of course, Gordon isn’t about to make any scientific connection to autism with the aluminum. He can’t, because there isn’t. Nor can he make any connection between aluminum and any measurable harm to infant health. Again, he can’t, because there isn’t. In reality, this is nothing more than a variation of the deceptive and downright brain-dead “toxin” gambit, one that Dr. Gordon has credulously parroted in the past before. Now that mercury has been largely exonerated as a potential cause of autism in several very large epidemiological studies, for the antivaccine movement aluminum has become the new mercury. So, being utterly unable to make a coherent case that aluminum adjuvants in vaccines cause harm, Dr. Gordon next resorts to even more fallacious logic.

Appeal To Fear

Quoth Dr. Gordon:

We can only guess what harm we might be causing to babies with the huge overdoses of aluminum.

This is what we like to call the “think of the children” gambit. The implication, of course, is that the harm has been and is being done (to children, yet)!) but it just hasn’t been detected yet. Given that aluminum has been used as an adjuvant in vaccines for nearly 80 years, and no harm has been detected counts for nothing to Dr. Jay, because above all it absolutely, positively has to be those nasty vaccines. Alternatively, one could look for evidence that aluminum in vaccines has anything to do with autism. It doesn’t, as far as science has yet been able to tell. However, once again with the utter failure of the thimerosal hypothesis of autism causation to hold up to scientific scrutiny over the last decade, antivaccinationists like Jenny McCarthy and their apologists who insist they aren’t antivaccine (like Dr. Gordon) have to start digging for other bogeymen in vaccines to blame for autism, because, once again, to them it absolutely, positively has to be the vaccines.

Following some praise for the former head of the NIH (Bernadine Healy), whom antivaccinationists have taken a liking to given her recent statements that seem to support their side but who has a rather checkered past when it comes to statements about science, and begging the question himself by asserting that “we need to study the link between vaccines and autism,” (when no such link has actually been established), Gordon moves on to the so-called “autism epidemic”.

The “Better Diagnosis” Straw Man

Dr. Gordon tells it like he thinks it is. Unfortunately, he’s so wrong he’s not even wrong:

Like many of you and like some of my colleagues, I’m extremely concerned about what has caused the tremendous increase in autism and related disorders over the past decade. The presumption that doctors are much better at diagnosis is absurd and unscientific. (I know that I’m not 400 or 800 percent smarter than I was years ago.)

The stupid, it burns. It sears.

If ever there were a straw man argument, this is it. This one, better known as the “better diagnosis” straw man, seeks to imply that any increases in autism prevalence cannot just be explained by “better diagnosis” (and therefore there must really be an autism epidemic). The problem for Dr. Gordon is that absolutely no one–we repeat, no one–is making such an argument. In reality, this particular straw man is an intellectual crutch, and an ineffective one at that, for those who don’t have the slightest idea how to address the real arguments of those who state (correctly so far), that there is no evidence of any autism epidemic. The real arguments are much more substantial than a simple, “doctors are better at diagnosis.” Read up on the changing definition of autism, broadening of diagnostic criteria, diagnostic substitution, increased awareness and recognition, and the influence of access to services, for more information.

A safe guess would be that Dr. Gordon is absolutely correct about one thing, and that the 400 or 800 percent smarter he acknowledges he’s not, would be approximately 400 or 800 percent off, had he claimed otherwise.

Science-Free Pleading

Dr. Gordon also likes to indulge in special pleading:

Last but far from least, we have to support and reinforce the intelligent and fiercely held hope these parents of children with autism have. Doctors have to acknowledge and help research the therapies that lead to recovery from autism, recovery brought on by therapies long ignored by the AAP and others. Dairy-free, gluten-free, sugar-free diets have succeeded far too many times for any doctor to claim that they’re not “evidence-based.”

That’s a pretty bold implication, asserting with such confidence that there are dietary therapies that lead to recovery from autism. It’s also not true that such claimed therapies have been ignored. They may not have had all the attention some true believers would like, but there is in fact research on the subject. Unfortunately, for Dr. Gordon’s assertion, the evidence that gluten-free diets improve autistic symptoms is much like the evidence for homeopathy. Smaller, unrandomized, uncontrolled trials suggest therapeutic effect, but the better designed the trial the more likely it is to show no effect distinguishable from placebo.

Let’s set that aside for the moment though. Is there more to Dr. Gordon’s unscientific assertion that diets have succeeded far too many times for any doctor to claim that they’re not “evidence-based”? Perhaps he’ll present some scientific evidence in support of his claim. We’ll follow his next few sentences step by step.

Another Straw Man

Only the best straw men will do for Dr. Gordon:

Evidence doesn’t spring just from medical studies funded by drug companies and supervised by MDs and researchers on their payrolls.

Brilliant! Not only is this a classic straw man argument, but the pharma shill gambit is woven seamlessly into it! Alas for poor Dr. Gordon, no one, and we mean no one, is claiming that evidence can only spring from medical studies funded by drug companies and supervised by MDs and researchers on their payrolls. That doesn’t mean satisfactory evidence can come from just anywhere though. So, where does Dr. Gordon suggest we look for this evidence? Surprise, surprise! It’s not from scientists!

Argumentum ad populum

Dr. Gordon expresses his solidarity with The People:

Evidence can come from the hundreds of families and doctors who have watched children with autism get better and even fully recover from the symptoms that have kept them from mainstream education and social opportunities. This is hard evidence and to deny it is specious reasoning and bad science.

Oh, we see. You don’t have any science to support a claim? Just make something up to take the place of science. We have news for Dr. Gordon, anecdotes from hundreds of families and doctors, is not strong evidence. To accept it, let alone credulously repeat it, is not reasoning, it is to suspend logic (explanation below). We won’t say that Dr. Gordon’s apparent acceptance of anecdote is not “good science.” Rather, it is not science at all. In the critically thinking world, to which Dr. Gordon is apparently an outsider, acceptance of anecdote as “evidence” is called “believing.” The very reason that science developed is because it became more and more apparent that humans are prone to find patterns where none exist, especially when looking at small numbers and limited information. Such pattern finding ability probably had a survival advantage in the past, but it leaves humans with cognitive quirks that lead us frequently to attribute causation when none exists. The scientific method exists to correct for that and to prevent the beliefs of scientists from dictating the outcome of experiments–quite the opposite of antivaccinationist pseudoscience.

Dr. Gordon’s argument is nothing more than logic suspended. It’s argumentum ad populum: appeal to popularity. The observation that supposedly hundreds of families and doctors have watched children with autism get better and even fully recover from the symptoms is very close to meaningless. It wouldn’t matter if there were thousands of families and doctors with the claim. A large number of believers doesn’t equate to truth of the conclusion. There are hundreds, if not thousands, of people who have claimed to have seen Bigfoot. Does this mean that Bigfoot is real? There are hundreds, if not thousands, of people who claim to have been abducted by aliens and subjected to various experiments. According to Dr. Gordon’s apparent logic, he should answer, “evidence can come from the hundreds of outdoorsmen and others who have seen Bigfoot” that Bigfoot exists or “evidence can come from hundreds of people who have been abducted by aliens” that aliens are visiting Earth and abducting people. Many other examples come to mind: Belief in ghosts, psychics, astrology. Many, many people believe in these things and have believed in these things for millennia. Does that mean they are real or work?

In Conclusion

Peeled back to its core, Dr. Gordon’s entire foreword says very little about autism, or Jenny McCarthy’s understanding of the subject. It appears to be little more than an indictment of vaccines in general, and a fallacy-filled presentation of “science doesn’t have all the answers” and “vaccines did it.”

Based on excessive use of fallacious logic, our lesson from this foreword from Dr. Gordon can be summed up thusly, “complete bullshit probably follows.” We’re sure that wasn’t Dr. Gordon’s intention (the book clearly isn’t aimed at critical thinkers or scientist types anyway), but this pediatrician’s foreword is enough to encourage us to save our money.

And you should save yours, too.

And we really wish that Dr. Gordon had not debased himself so far. He seems like a nice enough guy, but he seems too enamored of the hero status he’s been given by the anti-vaccine contingent and his time in the limelight with the celebrity mother of his patient. Worse, given that McCarthy’s book seems to argue that biomedical interventions can cure autism, Dr. Gordon’s giving his stamp of approval makes us wonder whether he prescribes the woo described therein. In the end, because Dr. Gordon strikes us as a nice enough guy whose credulity and lack of scientific acumen has led him down the wrong path, we keep hoping against hope he’ll eventually see the light. However, his penning such a brain dead, fallacy-filled introduction to a brain dead, fallacy-filled book advocating dangerous quackery does not make us optimistic that this will ever happen. More’s the pity.