“Germany, we have a problem…” Or: Should anything be done about two bad apples of pseudoscience on the tree of ScienceBlogs.de?

Well, it looks as though I’ve stepped into it yet one more time.

Believe it or not, I hadn’t intended to stir up trouble among the ScienceBlogs collective, both English- and German-speaking. Really. Oh, I’ll admit that there are occasionally times when I actually do mean to stir up trouble. One recent example is when it was rumored that Robert F. Kennedy, Jr. might be chosen to be Secretary of the Interior or, even worse, Director of the EPA. Much to my surprise, I actually did manage to stir up a goodly amount of blogospheric reaction, too. Although I believed it to be a good cause, this case was still a bit of an aberration, though. Usually, when I do mean to stir up a reaction against an problem that I perceive, I tend to fail miserably. The truly ironic corollary to this principle is that posts in which I didn’t really mean to cause trouble (or at least not that much) and that didn’t take much time or effort to write tend to be the ones that end up attracting hundreds of fevered comments. So it was on Sunday, when in response to a reader’s question I took about 15 minutes to whip off a quick post about some disturbing examples of what seemed to be antivaccinationist nonsense and entitled it Is there an antivaccinationist on ScienceBlogs.de? Help me figure it out, my German-speaking readers!

The title was not ironic. It was a statement of my concern and confusion. I don’t speak German; so all I could do was use Babelfish, Google Translate, and other online tools to get a rough idea of what the blogger, Bert Ehgartner, whose blog is called Lob der Krankheit, which various German readers have translated as “Praise of Illness” or “Praise of Disease,” was saying. However, what my reader had told me about one post, “Aluminium muss raus aus Impfstoffen!”, which means “aluminum must be removed (or eliminated) from vaccines” was concerning enough, which is why I investigated in the first place. The post consisted of an interview with a physician named Dr. Klaus Hartmann, who appears to make part of his living as a plaintiff’s witness testifying in vaccine injury cases in Germany. Even in a Babelfish translation, I could tell that this was a post that was not science-based. In it Ehgartner repeated several bits of misinformation that I had heard before from antivaccinationists about the HPV vaccine, ones similar to the ones I had taken on here and here. Moreover, Ehgartner seems to have a thing against aluminum in vaccines, blaming it for all sorts of neurodevelopmental problems, scientific evidence be damned. I realized instantly that this is very much of a piece with our American antivaccinationists, who, having finally realized that evidence is increasingly piling up against mercury in vaccines as a cause of autism, have made aluminum into the new mercury, so to speak. Does this make Ehgartner an antivaccinationist? Not in and of itself, but it sure did look suspicious. Certainly there was enough in that post alone to send up red flags. That’s why I literally asked my German-speaking readers for help in evaluating Ehargarten’s blog. I needed it.

Then I came across a post, which was clearly an anti-big pharma rant that seemed to be saying that the flu vaccine is useless and in essence a ploy by big pharma to make lots of money. In it Ehgartner also likened flu experts to “vacuum cleaner salesmen.” More red flags. And then there was a post entitled Neues Diagnose-Verfahren bestätigt Hirnschäden bei ADHS. Fortunately (or, perhaps unfortunately for me), one of my German readers translated this post. All I can say is: Wow. It’s bad. Painfully bad. Let’s take a look. Note that I took some minor liberties with the translation provided me to correct awkward grammatical constructions and phraseology, but not in a way that changes the meaning of the translation significantly.

Also, I will point out that the article that Ehgartner is discussing is this one. It’s actually a rather interesting study in which a special MRI technique, known as large deformation diffeomorphic metric mapping (LDDMM), was used to compare brain morphology in boys with ADHD to that in neurotypical normally developing boys. The results: “Boys with ADHD showed significantly smaller basal ganglia volumes compared with typically developing boys, and LDDMM revealed the groups remarkably differed in basal ganglia shapes. Volume compression was seen bilaterally in the caudate head and body and anterior putamen as well as in the left anterior globus pallidus and right ventral putamen. Volume expansion was most pronounced in the posterior putamen. No volume or shape differences were revealed in girls with ADHD.” Personally, I find it rather interesting that there were anatomically detectable differences in the brains of boys with ADHD compared to controls but not in girls. Unfortunately, Ehgartner represents the results thusly:

Whether the changes were present from birth or they were caused by inflammatory processes or exposure to toxins at a young age, for instance, is not clear and constitutes the main mystery of ADHD. Possible causes for this disorder have been fiercely debated for decades. Sometimes, the question arises whether it even constitutes a disorder, or whether society is merely unable to cope with “especially active and naughty children” and therefore “sedates them with pharmaceuticals.” These statements usually come from people who have never closely interacted with affected individuals.

More seriously, it has been suggested that ADHD should be classified as part of the autism spectrum. Here, roughly the same sex ratio is observed (about three times as many affected boys), the same significance of a heritable component and roughly the same age of manifestation. The main problem with autism is a lack of appropriate “networks” in the brain, so that certain important areas are not in contact with each other, but individual areas can be especially highly developed à la “Rain Man”. Therefore, ADHD would be a special form of autism. Which disorder manifests itself would therefore depend on the type and extent of brain damage.

Nothing in the study suggested inflammation as a cause of the anatomic differences detected in the study. In addition, the above claim that ADHD should be classified as a “special form of autism is a serious overreading of some studies that implicated the same chromosomal region in both ASD and ADHD, combined with the common fallacy of confusing correlation with causation. Note also how Ehgartner refers to the changes in the brain that this study found in boys with ADHD as “brain damage.” I don’t know if that’s a mistranslation or not, but it sure doesn’t sound good. Still, the above isn’t the worst part of the post, which descends rapidly into highly dubious, science-free assertions:

According to this hypothesis, an environmental component must exist. The heritable component merely influences the susceptibility to this unknown factor.  The fact that congenital disorders generally have a stable prevelance over centuries, whereas ADHD and autism cases have been increasing over the past decades supports this. According to the CDC, 1 in 100 children are affected by autism nowadays. Around four percent of German children suffer from ADHD. On average, there is one “Fidgety Philip” in every classroom. But what is this environmental influence?

Some suspect the culprit is the ongoing onslaught of stimuli children are subjected to by television, computer games and mobile phones. Others blame the lack of structure at school or overly high standards at school. Older hypotheses identify bad parenting, neglect and trauma at an early age as the cause. However, it would be unusual for any of these to cause brain damage. A year ago, a study in The Lancet addressed the influence of food additives on hyperactivity. Certain colouring agents and the preservative sodium benzoate were identified as problematic.

Note how Ehgartner completely ignores widened diagnostic criteria, increased awareness, and diagnostic substition as explanations for the apparent increase in autism diagnoses, as well as for ADHD diagnoses and simply assumes that it must be an environmental cause. That’s not so unreasonable on the surface, but it overlooks so many factors relevant to this discussion that it is as simplistic as it gets. There’s a reason. His rationale seems to be: ADHD and autism rates are rising; it must be “toxins”! Sound familiar? If you’re a regular reader of this blog, it should. Note how Ehgartner also makes the same sort of noises that the proponents of a link between vaccines and autism make about an autism (and ADHD) “epidemic.” In fact, there is good evidence that there is no autism epidemic, but rather that the increase in autism diagnoses, a congenital neurodevelopmental disorder that should seemingly have a stable prevalence. Indeed, it is more likely than not that the true prevalence of autism is stable corrected for diagnostic substitution and these other factors.

Next Ehgartner moves on to a series of dubious hypotheses for the causes of ADHD, such as computer games, mobile phones, or bad parenting. This is actually clever, because it sets the stage for his preferred idea for what the cause of this “brain damage” is by allowing him to seem to have considered and dismissed a number of other possibilities. Never mind that it’s not correct to refer to the changes in a congenital brain disorder as “brain damage” and applying that label to children with ADHD is in fact offensive. Never mind that most of the other possible hypotheses dismissed are scientifically highly implausible at best and utterly discredited at worst. That’s an inherent part of the structure of these arguments. In any case, you always know what’s coming next after a set up like this. (At least I do.) Given a buildup like that, there’s only one thing that could be following next. Yes, Ehgartner thinks the apparent increase in autism and ADHD must be due to those evil vaccines:

Personally, I think it would be important to investigate the possible influence administering vaccines to babies without prejudice; more specifically, the aluminium salts currently found in two thirds of vaccines given to children as adjuvants. A recent Canadian study has already shown that these substances have considerable potential for toxicity.

I never, ever thought I’d be saying this about a fellow ScienceBlogger, but…The Stupid, It Burns. In German.

There’s no good evidence to implicate aluminum in the development of ADHD, autism, or any other disorder other than Alzheimers, and the evidence linking aluminum to Alzheimer’s is weak and inconsistent indeed. The concentration on aluminum is nothing more than the old “bait and switch” in which antivaccinationists, now that mercury in vaccines has been exonerated as a cause of autism, have switched to various “toxins,” including formaldehyde and aluminum, forgetting that the dose makes the poison. It’s a ploy I like to call the “toxin gambit.” Does Ehgartner’s repetition of these antivaccine canards make him an antivaccinationist? Not necessarily, but it’s sure suspicious, especially coupled with his big pharma conspiracy-mongering elsewhere on his blog and his tendency to pull the “pharma shill gambit” on anyone who argues against him. The most charitable interpretation is that he is a credulous soul, prone to woo. The least charitable explanation tags him as an antivaccinationist. Neither are what I would consider models of bloggers I want to see on ScienceBlogs.

After writing my post, I thought it was bad enough that we might have an antivaccinationist on ScienceBlogs.de, but then readers in the comments started to point out something that I find even more disturbing about Ehgartner: He appears to be an HIV/AIDS denialist. For instance, he has signed the “Rethinking AIDS” (RA) manifesto/petition. RA, in case you’re not aware, is an HIV/AIDS denialist organization with prominent HIV/AIDS denialists Peter Duesberg and Christine Maggiore (remember her?) on its board. It advocates “rethinking” the hypothesis that HIV causes AIDS, and in fact “rethinker” is the denialists’ attempt to rebrand themselves as something reasonable, something other than denialists. I can’t speak for my fellow ScienceBloggers, but I am not happy about being associated with an HIV/AIDS denialist in the blog network for which I write. It matters not to me whether it’s the German division of ScienceBlogs; I make no distinction. To me, we’re all part of the same wonderfully dysfunctional family.

Another issue that came out in the discussions after my Sunday post is that there is at least one other German ScienceBlog that raises serious concerns about the blogger’s ability to distinguish medicine from quackery. Specifically, it’s a medical blog by Peter Artmann dubbed Medlog. Commenters pointed out that Artmann seems prone to some heavy duty, serious woo, the very sort that would if in English lead to a heapin’ helpin’ of not-so-Respecful Insolence. (Never let it be said that I allow a language barrier to keep me from delivering such a helping.) The problem is perhaps best encapsulated in Artmann’s post Ayurveda enthält Blei … ach nee. In it, he essentially argues that the heavy metal contamination with lead and mercury recently reported in all too many Ayurvedic herbal medicines is nothing to be concerned about because it’s all part of the medicine. I kid you not. A reader translated his post in my comments, and here is part of it (once again, I alter the translation for better grammar and style–I hope Thomas Xavier, the reader who was kind enough to do the translation, doesn’t take offense, and I also point out that the original still resides in my comments):

One of the most stupid bits of news from last week was a story about heavy metals in ayurvedic remedies. It was published by Zeit, Focus, and even the Ärzteblatt.

We could read about “contaminated” or “loaded” remedies, and that this happened “despite the manufacturer’s guarantee of purity.” But seriously. If there were no heavy metals in the remedies, it would not be Ayurvedic medicine. Metals are the active components of the Rasashastra-school of Ayurvedic medicine!

You read it right. Artmann is seriously arguing that the heavy metal contamination in Ayurvedic medicines that has been reported in multiple studies is a feature, not a bug! Truly, I can’t make stuff like this up, and I really wish that Artmann couldn’t either. This guy is a biologist?

Worse, he gets all “not-so-respectfully insolent,” which I could normally totally appreciate, the way a connoisseur enjoys a fine wine, except that he’s directing his sarcasm at those presumptuous scientists and journalists who reported the heavy metal contamination in the first place:

Can the editors be blamed? Well, the blame for this dumbing down should go to a renowned Journal. Of all things, the American journal for physicians JAMA published a study by Robert Saper, who – what breaking news- found out that Ayurvedic remedies contain heavy metals.

What a clever guy. Maybe, next time Saper will warn of pain during acupuncture and the usual suspects and then pass that news on. Attention: Acupuncture can cause pain, because you will be pricked (sounds a little bit like Feldbusch and belongs to the same league).

“But isn’t it good, when you are notified of metals in ayurvedic remedies? I heard they even contain lead?”

But of course they do! The whole Rasashastra-school of Ayurvedic medicine is based on the use of metals. Lead is but one of the metals used. Traditionally, this medicin employs copper, silver, lead, iron, tin, zinc and even mercury.

“What, even mercury? Do they want to poison their patients?”

Well, its a different kind of medicine. The mercury (and all the other metals) are not administered as plain metals, but they are heated, crushed, heated again until only a white ash-like powder remains (this can take years). The resulting product is called bashma and swims on water (try this with pure mercury). Mercury is but one ingredient, other popular ones are lead and of course arsenic.

Yes, you read that right, too. Artmann is defending the presence of mercury, lead, and arsenic in Ayurvedic medicines as a feature, not a bug. But to him it’s just fine and dandy–hunky dory, even!–because faith in the healer makes it OK:

“Yes, but isn’t it good anyway, when you inform people that these alternative remedies contain dangerous ingredients? I mean, who has read the Rasashastra?”

No, it is very silly. If you use Ayurvedic medicine without practitioner, you have not understood the basic principle of alternative treatment. A HOLISTIC TREATMENT WITHOUT TRUST IN THE PRACTITIONER CANNOT HEAL ANYBODY.

This western attempt to combine several elements of traditional Chinese medicine and Ayurveda and what-do-I-know from Tibet, change nothing in your life, and then hope for the cure of a chronic disease lacks the most important part of all these doctrines: The faith in the healer.

I hope that regular readers of this blog will recognize the quackery inherent in this argument. Truly, I was flabbergasted when I read this and consider it far worse than Ehgartner’s parroting of antivaccine canards layered with seemingly reasonable plausible deniability that he is antivaccine. I could not believe that such woo is appearing under my beloved ScienceBlogs banner, under which I have proudly blogged for nearly three years now! I was especially disgusted with this comment in response to another commenter who pointed out that any remedy that absolutely requires faith in the healer to work is usually a placebo. A man after my own heart, this commenter then gave this snarky rejoinder, “Dancing completely naked three times around the fire is also sufficient and probably has fewer side effects.” (I like this guy.) Artmann replies (forgive the crude Google translation):

That so many experts in Ayurvedic medicine are gathered here together, I would have never have expected.

I am surprised by the arrogance of medical methods to the very different cultural roots and also have very different effects wants than the local medicine. And, of course, I wonder whether the commenters really believe that we are already at the end of what science has achieved.

[…]

At present, for skeptics who because of their vanity about sick people like to collect the placebo effect for all saddled with.

In principle, this is a gruesome and very poor idea and an obvious slap in the face to all mental suffering.

Ah, yes. The “arrogance” gambit. Personally, I wonder: Which is more arrogant? pointing out that there is potentially poisonous heavy metal contamination or the person who has the arrogance to assume that faith in an Ayurvedic healer can mitigate the toxicity of those metals?

So why am I making a such a big deal out of this? What’s the big deal, anyway? Can’t we all just get along?

In a word, no.

Now, no one around here claims that we ScienceBloggers are all above reproach and unfailingly brilliant, that we’re all saintly, or that we never, ever write stupid things. Certainly, I don’t, and certainly I’ve never claimed not to have fallen prey to my own personal foibles, resulting in the occasional dubious (or in retrospect completely embarrassing) post. And certainly, there have been quite a few times when I’ve strongly, even violently disagreed with something that a fellow ScienceBlogger has written and said so, even just last week. Nor would I pretend that I like every ScienceBlogger (regular readers will have an idea of who falls into the categories of ScienceBloggers I like or can’t stand), and I certainly don’t expect that every ScienceBlogger will like me (at least one doesn’t). You can’t have more than seventy people under one collective without personality clashes and substantive disagreements popping up, and we’ve had more than our share of drama, some of which I’ve contributed to. However, mere disagreements are not what I’m talking about here. Personal dislike has nothing to do with it, as I had never heard of the two bloggers in question before last weekend. No, this is a matter of protecting the ScienceBlogs name and brand. It’s all about quality.

Perhaps I’m ridiculously naïve, but I always thought that, whatever our fractious behavior and arguments over religion or politics or even scientific issues (which, let’s face it, are often full of sound and fury, signifying nothing), one thing ScienceBlogs stands for is communicating what good science is to the masses and why it’s so cool. I’ve also assumed that what it stands against is pseudoscience and misinformation. My complaint is not a matter of scientific disagreement or being annoyed by a couple of contrarians defending positions that are weak and not well-supported by the evidence. It is about clear and obvious misinformation about what science says about vaccines, autism, ADHD, and disease published under the banner of ScienceBlogs. In the case of Peter Artmann, it is about a ScienceBlogger who defends obvious quackery and makes utterly unscientific assertions while doing so. I don’t know about my fellow ScienceBloggers, be they English- or German-speaking, but I don’t like being associated with two such bloggers. I don’t like it at all. As much as I hate to say it, we clearly have a problem in our German division.

What I hate to say even more is that the leadership of our German division does not appear to “get it.” Indeed, Jessica Riccò, one of the editors of ScienceBlogs Germany, showed up in the comments to complain. I was disappointed to see that she apparently does not know that Rethinking AIDS is an HIV/AIDS denialist organization. Worse, she makes arguments from authority in pointing out that Ehgartner has apparently written for mainstream German publications. Unfortunately, by that criteria, David Kirby (who’s freelanced for the New York Times) or Dan Olmsted (who, remember, used to write for UPI) would qualify as excellent ScienceBloggers. Worse, she argues that because Ehgartner has never denied that HIV causes AIDS or urged parents not to vaccinate on ScienceBlogs.de itself, it’s OK to have him there, while labeling the criticism against him a “fatuous witch hunt.” By that definition, I suppose it would be fine to have Peter Duesberg blog for ScienceBlogs too, as long as he doesn’t write about his HIV/AIDS “skepticism,” or for Mark Geier and Boyd Haley to join the collective, as long as they don’t urge parents not to vaccinate. Heck, why not invite Dr. Michael Egnor to blog about neuroscience, as long as he doesn’t mention evolution? He is a neurosurgeon, after all. True, maybe such a situation wouldn’t be as bad as letting the antivaccine blog Age of Autism or the HIV/AIDS denialist blog HIV/AIDS Skepticism join the collective, but it would still damage the ScienceBlogs brand, and it sullies all the other excellent scientific, medical, and skeptical bloggers housed both on the U.S. and German versions of ScienceBlogs. Besides, why should we settle for “least bad” rather than actively promoting and fostering excellence? In any case, the argument that a ScienceBlogger can be a crank or support quackery as long as he does not advocate crankery and quackery on ScienceBlogs does not hold up in the face of Peter Artmann, who is clearly arguing for dangerous quackery by telling his readers that heavy metal in their Ayurvedic herbal remedies is not harmful, as long as an Ayurvedic healer directs their use. People could suffer heavy metal poisoning as a result of following such advice, and that advice appeared on ScienceBlogs.de.

In the end, I sincerely hope that The Powers That Be, both here in the U.S. and in Germany, view the identification of these two dubious bloggers as an opportunity to define what the scientific standards should be for ScienceBloggers. I realize that there has been a fair amount of whining and wringing of hands in the comments, in which the ever-reliable logical fallacy of the slippery slope argument has led a couple of commenters to ask “But where do you draw the line? Where will it all end?” This is accompanied with the suggestion that enforcing some standards against obvious pseudoscience will inevitably lead to the censoring of posts that stray from a ScienceBlogs-imposed political and scientific orthodoxy and muzzling any blogger with controversial views. Bullshit. I’m not referring to scientific controversies, no matter how contentious. I’m referring to obvious pseudoscience, like homeopathy–like claiming that the metals in Ayruvedic medicines won’t hurt you if a magic yogi administers them. The slippery slope argument is far more often than not a logical fallacy, and its invocation nearly always an argument for doing nothing. I see no evidence that it is anything different here. Enforcing minimal standards does not inevitably lead to mass censorship, and I would hope that a minimal standard we can agree on is “no consistent advocacy or promotion of obvious pseudoscience (homepathy, creationism, Holocaust denial, 9/11 Truther conspiracy theories, perpetual motion machines, etc.) on ScienceBlogs.”

Is that so much to ask? I don’t think so. What about you?