Completing a trio of antivaccine-sympathetic California pediatricians

I appear to have fallen into one of my ruts again. Or maybe it’s not a rut. I just feel as though I’ve been doing too many posts on the antivaccine movement, to the point where I wonder if I’m starting to fall into a rut. In actuality, it doesn’t really matter. If I feel as though I’m getting tired of a topic, then that’s enough. It’s just that the antivaccine movement, even as bottomless a font of stupidity, misinformation, pseudoscience, and quackery as it is, sometimes goes on a tear. When it does that, I have a hard time restraining myself from trying to blog about all of it, as impossible a task as that is. For example, we had antivaccine hero Dr. Bob Sears ranting about his patients’ parents who were justifiably concerned about the ongoing measles outbreak in southern California given that their children are unprotected because they are unvaccinated—not just once but twice. Then we had our old pal, pediatrician to the antivaccine stars’ children Dr. Jay “I’m not antivaccine but I trash them constantly with unscientific nonsense” Gordon “reassuring” the same kind of parents: Antivaccine parents who are getting a bit worried because their children are unvaccinated and the measles outbreak shows no signs of abating yet.

Now we have another antivaccine pediatrician being interviewed in Mother Jones in an article with the truly annoying title My Interview With a Pediatrician Who Thinks Vaccines Are “Messing With Nature”: Is She Right? The interview in question is with a pediatrician named Dr. Stacia Kenet Lansman, founder of a practice known as Pediatric Alternatives. The very name of the practice tells me everything I need to know about it. Well, actually, not entirely. This passage from the Mother Jones article describing it does:

In 1998, she founded Pediatric Alternatives, with the goal of combining Western medicine with nontraditional methods like homeopathy, herbalism, and dietary treatments. This approach, she hoped, would “start children and families out with healthy habits and routines so that they are more likely to stay healthy.” The practice flourished. Today, she and four other physicians at Pediatric Alternatives treat somewhere between 1,500 and 2,000 patients from around the Bay Area.

And here’s the interview:

So, basically, Dr. runs a crunchy “integrative medicine” practice in the Bay Area. Is it any surprise that she’s antivaccine? Not at all! Not only does “integrative medicine” integrate quackery with science-based medicine, but it frequently “integrates” unscientific antivaccine views with science-based medicine. And, boy, does her practice‘s website show it! Check it out:

Integrative medicine is the convergence of ancient healing wisdom with the medical practices of western medicine. At Pediatric Alternatives, through our combined training in western medicine, homeopathy, herbal medicine, naturopathic medicine and nutrition, we are able to treat more illnesses naturally without the use of antibiotics or other prescription medications.

Amusingly, one of the bits of “ancient healing wisdom” offered by Pediatric Alternatives is homeopathy, which isn’t actually ancient (having been invented by Samuel Hahnemann only a little more than 200 years ago) and is actually Western, having been invented in Germany. Regular readers know that homeopathy has two main “laws,” the law of similars, which states that to relieve a symptom you use a substance that causes that symptom in healthy people. It’s a totally unscientific law whose basis is far more rooted in concepts of sympathetic magic than it is in science—or even reality. Then there’s the law of infinitesimals, which states that serially diluting a substance (with vigorous shaking, known as “succussion,” between each step being absolutely essential to “potentize” the mixture) actually makes it more powerful. Unfortunately for homeopaths, they tend to dilute substance far beyond Avogadro’s number. A typical homeopathic dilution is 30C, where C = a 100-fold dilution. So 30C = 30 one hundred-fold dilutions, or an overall dilution factor of 1060. Given that Avogadro’s number is only on the order of 6 x 1023, you can see the problem. Homeopathic remedies are water in which the magical ingredients have been diluted to nonexistence.

Pediatric Alternatives also offers naturopathy, which I’ve described on numerous occasions as a cornucopia of quackery. And so it is. After all, you can’t have naturopathy without homeopathy, because homeopathy is considered what one might call a “core competency” of naturopathy and is a key component of the curriculae of schools of naturopathy. It’s even a major component of the naturopathy licensing examination.

Not surprisingly, pseudoscience like homeopathy and naturopathy goes together very well with antivaccine views, and Dr. Kenet Lansman demonstrates that:

Given all this, it might surprise you to learn that one of Pediatric Alternatives’ policies is extremely unorthodox: It suggests that families delay certain childhood immunizations—in some cases for years past the age recommended by the Centers for Disease Control and Prevention—and forego others entirely. A little less than 20 percent of the families the practice treats choose not to vaccinate at all. The rest use a modified vaccine schedule.

I’m not sure why the author of the article, Kiera Butler, is surprised (or thinks that it is surprising) to learn that Pediatric Alternatives “selectively” vaccinates. Knowing what I know about “integrative” medicine, naturopathy, and homeopathy, I’d have been surprised if the pediatricians there actually followed the CDC vaccine schedule. Shocked actually. It’s totally to be expected that the do not, nor is it surprising that her philosophy about vaccines is very much like that of Dr. Jay Gordon:

Kenet Lansman tells me she would never deny any vaccine to parents who request it for their child. But she does share her personal beliefs with her patients: She fears that vaccines have contributed to the recent uptick in autoimmune disorders and other chronic conditions. “I think we’re just messing with nature, and we really don’t know what we’ve created,” she says. “We’ve reduced or largely eliminated many infectious diseases. But in their place, we have an epidemic of chronic illnesses in children. The incidence of asthma, allergies, and autism spectrum disorders has dramatically increased since the 1990s. And the reason for this we don’t know. But my concern is that vaccines have played a role.”

Like Dr. Jay, Dr. Kenet Lansman apparently won’t vaccinated unless the parents badger her to do so. Of course, parents who want to do the responsible thing and vaccinate their children according to the CDC schedule would be highly unlikely to go to a practice like Pediatric Alternatives; so I’m guessing that the problem of parents demanding appropriate vaccines for their children is a problem that Dr. Kenet Lansman rarely encounters. Come to think of it, I bet that Dr. Jay rarely encounters the problem as well. Parents who want to vaccinate their children are similarly unlikely to seek out a pediatrician like Dr. Jay.

So what vaccines does Pediatric Alternatives administer? At least the practice gives the DTaP shot—which protects against pertussis, diphtheria, and tetanus—during the child’s first year. It’s not clear to me from the interview whether Pediatric Alternatives administers all three doses in the first six months or whether they also give it at 15-18 months, 4-6 years, etc., as the CDC schedule recommends. From the phrasing, I suspect not. The practice also administers the vaccine against meningitis. Predictably, however, given the antipathy towards this vaccine among the antivaccine crowd, Dr. Kenet Lansman doesn’t vaccinated against hepatitis B at all, pulling out the tired old trope about how babies don’t “engage in sex or intravenous drug use.” She also doesn’t administer the varicella vaccine, nor does she appear to administer the polio vaccine. Worst of all, there’s this. She delays the MMR vaccine until age 3, and here’s the reason:

The main reason for the delay, Kenet Lansman says, is that she still believes there could be a link between vaccines and autism. She acknowledges that the scientific community has rejected this theory, yet she says she has seen children from her own practice who begin to show signs of autism shortly after being vaccinated. “My feeling is that if there is any risk that the vaccine is associated with autism, we should delay the vaccine during this vulnerable developmental window,” she says.

Yes, I see a definite resemblance to Dr. Jay here as well. She relies on “personal clinical experience” above scientific studies to tell her what she’s come to believe, that vaccines cause autism. A little confirmation bias, in which she remembers cases that correspond to her pre-existing belief, mixed with some confusing of correlation with causation, and there you have it: A pediatrician who falls for the failed hypothesis that vaccines cause autism. Her belief in pseudoscience comes at a potential cost: Leaving her patients vulnerable to vaccine-preventable diseases like measles longer than other children. She brags in the interview how none of her patients have developed vaccine-preventable diseases—much as Dr. Jay brags that he’s never seen a case of the measles. That is, of course, because both her and Dr. Jay’s patients are sponging off the herd immunity of those who actually do vaccinate. However, given her location in one of the epicenters of antivaccine views in the entire US and how she’s contributing to the number of unvaccinated children, it’s likely only a matter of time before she won’t be able to brag about that any more. On the other hand, I noticed in her interview that she used some rather weaselly words. She didn’t actually say that none of her patients have ever had vaccine-preventable diseases. Rather, she says, “We’ve never had one patient get a serious, life-threatening vaccine-preventable illness because we gave them a vaccine at a later date.”

Hmmm. I bet she has had some patients get vaccine-preventable diseases. If I had been Butler, I would have called her out on that and asked her specifically if she had ever had any cases of measles among her patients? Pertussis? Varicella? My guess is that Dr. Kenet Lansman very carefully chose her words and that she, like many antivaccine pediatricians, dismiss the measles and other vaccine-preventable diseases as not being “serious.” Yes, that appears to be what she is doing.

Not surprisingly, Dr. Kenet Lansman is also big on confirmation bias in other areas. She claims that her office is “quiet during flu season,” which tells us little and that the children in her practice “actually seem healthier than most of their peers.” By what specific, objective measures? How would she know? This sounds suspiciously like the claim made by Mayer Eisenstein about his Homefirst practice in the Chicago area. Eisenstein, as you might recall, doesn’t vaccinate and claims that he’s never seen a single case of autism in his practice. Conveniently enough, he’s never actually published his numbers and can’t (or won’t) produce evidence to support his claims. Anyone want to bet whether Dr. Kenet Lansman can provide any sort of convincing data to support hers, either? I say she can’t, and I don’t blame you for not taking that bet.

Sadly, Butler’s interview, even though she says the right things about vaccines by quoting Paul Offit and other vaccine scientists who point out that there is no evidence that vaccines are correlated with autism or cause autism or that these “alternative” vaccine schedules do anything more than leave children unprotected against vaccine-preventable diseases, falls for “natural” trope:

At the end of my visit to Pediatric Alternatives, I found that I liked Dr. Kenet Lansman. I could tell that she was bright and caring and open-minded, and most impressively, she tried to think creatively about how to keep her patients healthy. She’s right that there is an epidemic of chronic autoimmune illnesses and autism among children, and a mounting body of research suggests that our aggressive pursuit of germs—both in our environment and in the human body—might have something to do with it: When we kill disease-causing germs, the theory goes, we kill beneficial bacteria, as well, making our bodies’ defense systems go haywire.

Well, I actually kind of like Dr. Jay, too, but that doesn’t stop me from ripping into his antivaccine-sympathetic views and his pseudoscience about vaccines. In any event, as I just wrote about the other day, there is no autism “epidemic.” It’s a zombie that just won’t die. Nor is there any evidence that the increase in prevalence of certain autoimmune diseases has anything to do with vaccines. As for the “hygeine” hypothesis, even if it’s correct it doesn’t justify antivaccine views or the use of naturopathy and homeopathy, the latter of which is the so obviously quackery that there’s good reason why it’s a favorite example used by skeptics to teach about quackery. Nor does it justify Dr. Kenet Lansman’s statement in her interview (on the video) that she believes that being exposed to such diseases “strengthens” the immune system and that we don’t need to be afraid of these illnesses. Yes, she’s just as irresponsible as Dr. Gordon and Dr. Sears.

As much as I attack the “tell both sides” meme in journalism when it’s applied ot pseudoscience, alternative medicine, or antivaccine views, at least Butler bothered to point out just how wrong Dr. Kenet Lansman is about vaccines. The problem is, she diluted that criticism by expressing sentiments that buy into the same unscientific world view shared by her subject. In the end, Dr. Kenet Lansman is a a pediatrician dripping with arrogance as she expresses “concern” that children are getting “too many” vaccines at a too young an age based, of course, on no evidence other than her “concern” and her confirmation bias. She then has the temerity to say that she “examined each vaccine individually” and, apparently thinking her judgment to be superior to that of the expert panels who come up with these recommendations.