Battling antivaccinationists at FreedomFest

Like so many other skeptics, I just returned from TAM, which, despite all the conflict and drama surrounding it this year, actually turned out to be a highly enjoyable experience for myself and most people I talked to. As I’ve been doing the last few years, I joined up with Steve Novella and other proponents of science-based medicine to do a workshop about how difficult it is to find decent health information on the Internet, and how the “University of Google” all too frequently puts quackery on the same level as reliable sources of medical information because all that matters for most search engines when it comes to ranking search results is the number and kinds of sites that link to a given site.

One of the best things that happened at TAM was also one of the most unexpected. it could also have been the worst thing that happened there, but fortunately it turned into a major skeptical win. Yes, I know that’s a bit of a spoiler, but the fun of this story is journey, so to speak, not the outcome. Wednesday evening, I happened to run into Evan Bernstein, who informed me of something that Steve Novella was going to do the next day, right after our workshop. Basically, I learned that Steve was going to debate an antivaccinationist. Evan didn’t know any details other than that Michael Shermer had arranged it and that Steve had been tapped at the last minute. He didn’t even know who the antivaccinationist was going to be or what the event was. Naturally, I was intrigued.

So, the next morning I asked Steve about it. I turns out that the event was FreedomFest, a right-wing/Libertarian confab that happened to be going on at the same time as TAM up the road a piece on the Strip at Bally’s. Steve didn’t know who the antivaccinationist was going to be either, which made me marvel at him. I don’t know that I’d have the confidence agree to walk into the lion’s den with less than a day’s notice not even knowing who my opponent is. Steve invited me along. Clearly, this was was an opportunity that I couldn’t resist. So we met up with Michael Shermer, and it was from him that I learned that Steve’s opponent would be Dr. Julian Whitaker.

My eyes lit up.

To my surprise, neither Steve nor Michael knew who Dr. Whitaker was. Being more than happy to give them some background on Dr. Whitaker, I told them. Regular readers here might remember that I’ve mentioned Dr. Whitaker before. First off, he’s a big fan of Dr. Stanislaw Burzynski, serving as the primary pro-Burzynski medical “expert” in that propagandistic paean to the brave maverick doctor, Burzynski: The Movie:

Dr. Whitaker is also big among the “alternative medicine” crowd for his claims to be able to cure diabetes “naturally,” without food or drugs (of course!). In doing so, he claims that metformin doesn’t work, antibiotics don’t work (because, apparently, they don’t succeed in saving every diabetic foot) and that, in general, conventional medicine doesn’t work. If you really want to know all you need to know about him in a nutshell, Dr. Whitaker is apparently one of Suzanne Somers’ doctors and was featured prominently in her cancer quackery book Knockout.

But how did this whole event come about? According to Shermer, apparently the doctor who was originally going to be Dr. Whitaker’s opponent, a local pulmonologist, became ill at the last minute and couldn’t appear. I rather suspect in retrospect that Dr. Whitaker probably now wishes that his original opponent hadn’t been forced to bow out. (You’ll see why soon enough.) The next question I wondered about was: Why was this pseudodebate going to be held at FreedomFest? That’s easy. If you look at the FreedomFest program and scroll down to Dr. Whitaker, you’ll note that he is the founder of the Freedom of Health Foundation, which is, as you probably guessed, an organization designed to promote “health freedom” (or, as I like to call it, freedom for quacks from pesky government interference directed at protecting the public).

So, the stage was set. Michael Shermer invited us to hop into his car, and we headed up to the strip to join the battle.

The debate

We arrived at Bally’s about 45 minutes before the debate was scheduled, wending our way through the casino and hotel to easily find the convention area where FreedomFest was being held. Even though we hadn’t registered and didn’t have a badge, the organizer Mark Skousen was more than happy to let us wander around the exhibit area until it was time for the debate. It was an…interesting experience. Not unexpectedly, there were various publishers and authors pushing books that either claimed that President Obama is destroying America, blamed him for the economic meltdown, made apocalyptic predictions about our health care system in the wake of the passage of “Obamacare” (properly known as the Patient Protection and Affordable Care Act), and in general attacking anything “socialist,” which apparently includes the entire Democratic Party and a lot of Republicans as well, all aided and abetted, of course, by the “liberal” media. Peppered in among the right wing literature, there were also various conservative and libertarian activist groups trying to get people to join up and stop Obama from destroying America. (I notice that Obama destroying America seemed to be a major theme running through a lot of the exhibits I saw at FreedomFest.) There were also a lot of investment companies that I had never heard of before, such as Sovereign Investment services (one wonders if it meant this “sovereign“), as well as that old popular standard, companies hawking gold coins or gold bullion as a hedge against the day the economy completely collapses.

Don’t get me wrong. There were a lot of respectable exhibitors there, too, such as Reason Magazine and others, but there was a lot of dodgy stuff there as well. Naturally the Heartland Institute, the Cato Institute, and Heritage Foundation were there to promote anthropogenic global warming denialism, among their other causes. It wasn’t just politics and economics, either. There was also a bit of the old woo, as well. Prominent among the woo was a company selling hair loss remedies. (Given the setting, the jokes practically write themselves.) Then Michael Shermer showed us a booth selling pendants that supposedly provide “hidden meanings.” We spoke with the proprietor a while. She was very friendly and cordial to us, but it rapidly became clear that this hiddenmeanings jewelry fused an unholy combination of The Secret, numerology, and Bible Code-like readings of—you guessed it—hidden meanings in the symbols and text that can be found in the symbol in the jewelry. Let’s just put it this way. One of the slogans of the company is “It can mean Anything to Anybody at Anytime!”

I’m sure that’s probably true.

As the time drew near, we ceased our odyssey through libertarian commerce and headed over to the Silver Room, where the debate was to be held. I immediately saw that something else was wrong. As we entered the room, we immediately encountered a woman passing out a newsletter, Dr. Whitaker’s Health & Healing: Your Definitive Guide to Wellness Medicine. It was the September 2011 issue, and, emblazoned across the page was a large headline Vaccinations: The Destruction of Our Country. This does not bode well, I thought, as I thumbed through the newsletter, which packed pretty much every major antivaccine trope into a single article to produce antivaccine pseudoscience so dense that it collapsed into a black hole, beyond whose event horizon no science, reason, or critical thinking could escape. I could feel the pull on my neurons, which cried out not to be sucked down into the black hole. Fortunately, Orac is made of sterner stuff than that. I did, however, take a picture of the newsletter for your edification because I didn’t want to give Dr. Whitaker my e-mail address to get his online newsletter:

As you might imagine, I immediately recognized Dr. Whitaker. He’s not hard to miss, being a rather large, gregarious, and somewhat imposing man, who immediately came up to greet Michael Shermer, who introduced him to Steve and myself.

Then I saw the moderator.

My first thought was that she looked very, very familiar, but I just couldn’t remember who she was. Then, hanging in the background given that I wasn’t the featured speaker and was basically tagging along for support, I saw her introduce herself and Dr. Whitaker to Steve and Michael as Leslie Manookian. It was then that I knew that this was going to be a typical pseudodebate about pseudoscience. Before Steve went up on stage, I warned him that I thought Dr. Whitaker was probably pretty slick and might well be able to do the Gish gallop with aplomb. I also warned him that the moderator was a die-hard antivaccine propagandist, having made—you guessed it!—a propaganda movie that I reviewed last year, The Greater Good. I later learned that there were going to be two screenings of the movie at FreedomFest, one at 8 PM that night and one the next afternoon. Lovely, I thought. The health freedom wing of the Libertarian movement is flaunting its embrace of antivaccinationism at one of its big conferences. Marvelous.

And so the debate began. Manookian started out by saying she never questioned vaccines until “she met a guy.” Apparently, this guy believed that his child had been rendered autistic by vaccinations, having regressed within a fairly recent time frame after a round of vaccines. She then “did research” and became increasingly appalled by what she found, which, from what I could tell, were mostly anecdotes and the usual pseudoscientific arguments used by antivaccinationists. As a result, Manookian became an antivaccinationist—sorry, a vaccine “skeptic”—so much so that she went on to make an antivaccine propaganda movie, to which I subjected myself in order to review.

She then went on to start the debate out by asking Drs. Whitaker and Novella why there is a “debate” about vaccines. At this point, my teeth immediately began to grind, to the point where I feared for my molar enamel. This is a typical framing of what I (and many others) like to call a “manufactroversy.” Basically, the word manufactroversy is short for “manufactured controversy” and is basically a pseudocontroversy that is created to oppose conclusions overwhelmingly supported by the evidence and/or science. Examples abound, of course: Anthropogenic global warming, vaccines, much of alternative medicine, “9/11 Truthers,” and “birthers.” The bottom line, is that there is no scientific controversy over whether vaccines cause autism. The question has been asked multiple times and answered multiple times: No. Of course, being a scientist, I have to qualify that just a little bit by saying that “no” means that we can’t detect an effect above the noise level of the epidemiological studies that have been done. In other words, even if there is an effect, it is so small that it can’t be detected by current epidemiological methods, which can detect pretty darned small effects. For all intents and purposes, as far as science can tell, vaccines do not cause autism. Neither does the mercury in the thimerosal preservative that until 2001 was used in many childhood vaccines. They just don’t; scientists have moved on, regardless of what antivaccinationists claim.

Dr. Whitaker started out with what was essentially the same old tropes, including confusing correlation with causation, harping about how autism prevalence has skyrocketed since the 1980s and 1990s. He made the claim that almost no child was developmentally disabled 30 years ago but now one in 88 children are diagnosed as having an autism spectrum disorder. During this segment, he also went on about how chronic diseases are skyrocketing along with autism and that it must be the evil vaccines. OK, I added the “evil” part, but it was quite clear that Dr. Whitaker thinks that they are evil. He made that very clear. So did Manookian, for that matter.

This was just the warmup. Steve, as you might imagine, easily demolished these arguments, pointing out that correlation does not equal causation. He also discussed how there have been several very large studies that controlled for relevant variables have failed to find even (as I like to put it) even a whiff of a hint of a correlation between vaccination and either autism prevalence or onset. He discussed how we as humans are hard-wired to infer causation from observed correlation, which makes it very understandable that people mistakenly conclude that vaccines cause autism? Why? Because, as we’ve discussed time and time again here, autism is often diagnosed in the age range when children receive a lot of vaccines, which means that by random chance alone we will often see diagnoses made in close temporal proximity to a round of vaccinations. Moreover, it was easy for Steve to point out that diagnostic criteria were broadened in the early 1990s, that schools started screening for autism, and that schools also got funding from the government to help autistic students. Again, Dr. Whitaker’s arguments were softball pitches, easily hit out of the ballpark as Prince Fielder hit balls out of the ballpark three days earlier in the pre-Allstar Game Home Run Derby. In essence, Dr. Whitaker made the same sort of ignorant arguments that Dr. Jay Gordon regularly makes, as exemplified in the comments after this excellent post by Emily Willingham why the “autism epidemic” is almost certainly no epidemic at all.

There is one point that I would have added that Steve didn’t. It’s a general rule in medicine that the more you look for something, as in launching mass screening programs, the more you will find it. Always. Consider ductal carcinoma in situ (DCIS), which is a premalignant precursor of breast cancer, a certain percentage of which (not fully known) will progress to become breast cancer. Back in the early 1900s, DCIS was rare because by the time it grew large enough to be a palpable mass, it almost always had become invasive cancer. Now, thirty years after mass mammographic screening programs became prevalent, DCIS is a common diagnosis. Indeed, approximately 40% of breast cancer diagnoses are in fact DCIS, and a recent study found that DCIS incidence rose from 1.87 per 100,000 in the mid-1970s to 32.5 in 2004. That’s a more than 16-fold increase over 30 years, and it’s pretty much all due to the introduction of mammographic screening. This sort of thing should not be surprising to doctors, but apparently sometimes it is.

Dr. Whitaker emulates Penn Jillette, but not in a good way

It was at this point that Dr. Whitaker lived up to the name of Penn Jillette’s Friday night party at TAM: He brought the stupid. Oh, man, did he bring the stupid! First, he stated unequivocally that he thought that vaccines were the primary cause of autism, scoffing at the idea that it was primarily genetic in nature or that vaccines were not causing it. As bad as that was, worse was to come, and it did when Dr. Whitaker showed this graph:

I reproduced this graph from his newsletter because I instantly saw that it was the same graph:

I want you to sit back for a minute and drink in the utter silliness of this graph, the utter lack of science, the utter nonsense. It’s been a long time since I’ve seen its like. I’m sure many of you can figure out what’s wrong with it on your own, but my duty as blogger demands that I explain, and I’ll give it exactly the time it deserves. Take a look. Notice how Dr. Whitaker extrapolates from a small dataset to produce curves that go right up to 100/100, or 100%. Steve’s jaw (and mine and, I daresay, Michael Shermer’s jaws) dropped in astonishment. That’s right. Dr. Whitaker produced a graph that predicted that by the year 2032 all boys will be diagnosed with an ASD and that by 2041 all girls will also have autism. I kid you not. Lest you think that this wasn’t Dr. Whitaker’s intention, that he didn’t know the implications of his extrapolation, I will quote from the relevant section of Dr. Whitaker’s newsletter discussing the graph:

Let’s do some simple math based on these solid statistics. Beginning in 1990, when the mass vaccination program took off, the incidence of autism and autism spectrum disorder in children exploded. The projections indicate that by the year 2031, virtually all male children will be diagnosed with autism or autism spectrum disorder, followed by all girls in 2041. Autistic kids will surely outnumber normal kids in the relatively near future. How will our society function if all kids age 10 and younger are so disables. This is the most frightening projection I can imagine, and it is simple math!

What is going on? The one obvious and absolute constant for these skyrocketing numbers of autistic and learning disabled children is vaccinations. Over the last 25 years, the number of vaccinations forced on our children has virtually exploded. Why? Are measles, mumps, chicken pox, and flu really that dangerous? In my opinion, irrevocable harm caused by vaccinations is infinitely worse than the diseases we vaccinated against.

Later, Dr. Whitaker writes:

There are only two things that can stop this madness. First, parents must have the right to decide what is injected into their children. Second, laibility must be borne by the pharmaceutical companies.

If these two things happen, we might recover from this nightmare. If they don’t, armed guards will be escorting our children to vaccination centers, and, within a few decades, our children—and our country—will be destroyed. Many of you will live to see this devastation. But most of your children and grandchildren will be so damaged by vaccinations that they will not notice it. They will be lost to autism. That, my friends, is simple math.

So, is Obama destroying America, or are vaccines destroying America? I get so confused.

Apparently Dr. Whitaker doesn’t recognize the difference between “simple” and “simple-minded.” I do rather admire the apocalyptic imagery for its sheer loony excess, combining antivaccine misinformation and anti-government conspiracy theories into a highly toxic brew. Fortunately, Dr. Whitaker did manage to restrain himself from using imagery quite as overblown during the debate, although it probably would have been more entertaining if he had not.

To cap it off the stupid, Dr. Whitaker scaled the Y-axis to go up to 120. This was so bad that I almost felt sorry for Dr. Whitaker. When Steve explained why these graphs were so silly, the audience “got it” instantly, and it was at that point that Dr. Whitaker began to lose the audience, which became fidgety when he spoke. Some of the audience even started muttering about how bad he was, and I’m not referring to Michael Shermer and myself. We were doing more than muttering about how pathetic Dr. Whitaker’s performance was. We were outright saying it to each other in those low voices people use when they have to say something but want to avoid disturbing others.

It was also at this point that I realized that I could actually do what Steve does. On balance, I knew how to answer all of Dr. Whitaker’s arguments as well as he did. In some cases, Steve did better than I probably could have. In other cases, I think I could have demolished Dr. Whitaker’s arguments even better than Steve did. What I lack is Steve’s preternatural ability to stay calm and not openly reveal his contempt for such a silly argument. Maybe I need to learn that. (Or not. I am, after all, Orac.) In the meantime, I was content to serve as Steve’s bulldog, which is why I went up to the table to see Dr. Whitaker after the talk and ask some pointed questions about how he generated the graph.

We didn’t pull any punches, either. We asked pointedly where he got the data, how he generated the data, what mathematical model he used to produce the graph, how he fitted the curve, how he could justify extrapolating so far from such a limited data set, how he decided what curve to fit, and how he can justify a curve that goes to 100% when there is virtually no condition that 100% of the population will suffer from except for (eventually) death. His answers were—shall we say?—not exactly convincing, and we kept trying to get a straight answer out of him. With only one exception, we failed. That exception was that Whitaker said that the data were from the CDC (fair enough, although it would be interesting to know the reference). How his group had created the graph, we never really found out. All he kept saying was that he just projected from the existing data. He had no clue, however, what mathematical model was used, what computer software was used, or what assumptions were made. He took my email address and promised to get send me the information. I have yet to receive it, despite sending Dr. Whitaker a friendly reminder on Twitter (@WhitakerMD; so feel free to “remind” him). To be fair, I will post about this again if he ever comes through. In the meantime, I really need to train myself to be more like Steve in these situations.

And all the rest

But enough of my shortcomings. How did the rest of the debate go? Well, it actually went pretty much like the first part of the debate. Steve basically mopped the floor with Dr. Whitaker. There was nothing left, not even a stain on the chair—metaphorically speaking, of course. It was actually rather painful to watch, in the way that it’s painful to watch one baseball team get pummeled by 12 runs, even when it’s a baseball team I really detest, like the New York Yankees. However, there was no “mercy rule” in debate. Basically, Dr. Whitaker trotted out a number of antivaccine “greatest hits,” and Steve pummeled him for it. For instance, Dr. Whitaker showed this graph:

Yes, this graph is yet another example of one of the oldest and most deceptive antivaccine tropes, one that I like to call the “vaccines didn’t save us” gambit. Basically, this intellectually dishonest—downright deceptive, actually—tactic involves pointing out that mortality was falling from a given infectious disease before a vaccine for it was introduced. In this case, it was measles and a few other diseases. The implication that antivaccinationists want people to draw is that hygiene, sanitation, and the like were the “real” causes of the decrease. The long version of the rebuttal this gambit is here. The short version is that disease incidence does not equal mortality and that measles incidence plummeted after the introduction of the vaccine. The reason mortality was falling before the vaccine was for other reasons. Medical care was getting better, and a smaller percentage of people who got the disease died from it. In fact, Dr. Whitaker explicitly stated the false premise behind this gambit, saying at one point that incidence equals mortality. Quite appropriately, Steve called him out on it, and did it in a way that the audience understood it.

Other issues that came up included some dubious antivaccine studies that we’ve covered at various times before, including some dubious antivaccine studies that we’ve covered at various times before. Dr. Whitaker also called for a “vaxed vs. unvaxed” study, but completely misunderstood the issues involved. He apparently thinks that such a study would could consist of just looking at vaccinated versus unvaccinated children without controls for various confounding factors. However, at times he seemed to be calling for a randomized “vaxed vs. untaxed” study, because at one point he complained about studies not having placebo controls. Steve pointed out that such a study would be unethical. Dr. Whitaker also complained about randomized studies of new vaccines because the placebo control wasn’t just saline but had all the other ingredients besides the antigens, including adjuvants, seemingly not realizing that, scientifically speaking, that is an even more appropriate control than saline.

Finally, the bulk of the last one third of the debate was more about politics than about science. Dr. Whitaker brought up a Supreme Court decision last year related to vaccines, specifically Bruesewitz v. Wyeth. He didn’t call it by that name, however; but it was obvious that that was what he was talking about. Not surprisingly, he also misrepresented the decision as stating that parents cannot sue vaccine manufacturers for vaccine injury. This is, of course, nonsense. The National Vaccine Injury Compensation Act of 1986, signed into law by President Ronald Reagan, established a no-fault compensation system, paid for by tax dollars, for children injured by vaccines. It created a new special court, the Vaccine Court, through which claims for compensation have to go through first.

This law was necessary because a flood of lawsuits was threatening the very foundation of the vaccine program, and Congress feared that there would be no vaccine manufacturers left in the United States because liability concerns would drive them out. Reasons for the law aside, not only do parents who think their children have been injured by a vaccine have recourse to the Vaccine Court, where, win or lose, their attorneys’ fees are paid by the government, parents who do not prevail in Vaccine Court can then sue in regular courts. The law simply says that they have to go through this special court first. The Vaccine Court also happens to have easier rules of evidence (i.e., not applying Daubert tests to expert witness testimony) and in essence bends over backward to try to compensate children injured by vaccines. Not only that, but the Vaccine Court reimburses claimants for reasonable attorney and court costs and, as a result, has become a bit of a gravy train for a certain group of lawyers who represent parents in front of the court. In any case, although there are a bunch of nuances about product liability and other issues, when you boil it down to its essence, all Bruesewitz v. Wyeth says is that the law as written currently prevents parents who do not prevail in Vaccine Court from suing in state court. They have to go to federal courts.What Dr. Whitaker harped on is what antivaccinationists always harp on about this decision is a line from the dissent by Justice Sotomayor about vaccines being “unavoidably unsafe.”

That was the CliffsNotes version of the ruling. You can find out more here and here.

The final question was a simple one: Should there be mandatory vaccination? Obviously Dr. Whitaker railed on about “health freedom” and how parents should have the right to control the health care of their children. I also rather suspect that this was the main reason most people attended, because the audience definitely got antsy when the discussion veered away from this topic after the question was mentioned. Steve wisely took the tack that this is a political question, not a scientific question. He then reiterated that the science is clear: School vaccine mandates lead to higher vaccination rates, which lead to lower rates of vaccine-preventable illnesses. It is thus up to us and the political process what we wish to do with these scientific findings. And that’s what I usually say, too. Science informs policy, but it is the political process that determines policy. School vaccine mandates work, and at the very least it should be as hard to get exemptions, be they religious or philosophical, to such mandates as it is to follow the vaccine schedule. But that’s just my view.

When all is said and done, I must admit that I was actually rather shocked at the outcome of this debate. I say that not because I don’t have total faith in Steve’s abilities and didn’t expect him to acquit himself well, but rather for the same reason that I’ve always thought it was a bad idea to debate pseudoscientists. I realize that not everyone agrees with me about this, and, because Steve and I work together, I thought it was my duty to support him in any way I could. Be that as it may, I expected Dr. Whitaker to be much slicker and harder to handle than he in fact turned out to be. Quite frankly, he was painfully bad, and I felt really stupid for having overestimated his abilities so massively. On the other hand, it’s always better to overestimate your opponent than to underestimate him. In any case, Dr. Whitaker made easily rebutted arguments, couldn’t even Gish Gallop very well at all, was ignorant of the science, even bad studies that purport to show a link between vaccines and autism, and appeared completely flummoxed by obvious points that any halfway decent debater would expect his opponent to make. In short, he looked every bit as though he had expected a cakewalk and as though he is used to adoration, not challenge.

Steve gave him that, and more. From the reaction of the audience, I’m also pretty sure that he got through to some fence sitters.

Unfortunately, it’s not a surprise that this sort of nonsense showed up at FreedomFest. Antivaccine quackery is not just for crunchy well-off liberals living in enclaves on the coasts. It’s quite popular among the “health freedom” movement, and the health freedom movement is very much sympathetic to the Tea Party movement, as I’ve pointed out recently mentioning a post by Kent Heckenlively at the antivaccine propaganda blog Age of Autism in which he bragged about connections between the Canary Party (which is rabidly antivaccine) and the Tea Party in California. One also notes that in the comments after that post, Jake Crosby extensively parroted Tea Party talking points.

I will finish by pointing out that it’s one thing for an antivaccine “party” like the Canary Party to link up with a local Tea Party organization. It’s quite another thing when a national meeting in which many of the luminaries of conservatism, libertarianism, and the Tea Party movement go to pow-wow together starts giving a platform to antivaccinationists. It is disturbing in the extreme that what has become a major conservative meeting every year would allow such rank antivaccine quackery a prominent place in its program, with a “debate” and two screenings of a movie that is nothing more than antivaccine propaganda disguised as a “tell both sides”-style “balanced” documentary. It’s not the first time this has happened, either. I found last year’s list of speakers, and Dr. Whitaker was there, giving a talk entitled Vaccines: Good or Bad?, and in 2010 he presented a talk entitled “Treatment for Heart Disease, Diabetes, and Cancer; the good, the bad, and the stupid.” This seems to be a relatively recent development, too. I checked the 2008 and 2009 speaker lists, and there was no Dr. Whitaker, nor were there any talks on vaccines. Given this recently added “feature” of FreedomFest, all I can say to Mr. Skousen is: For shame!