One major thing that differentiated science-based medicine (SBM) from alternative medicine and quackery is that in SBM there is a generally accepted standard of care. This was even the case back in the days before the proliferation of evidence-based guidelines, in which professional societies and expert panels try their best to synthesize what is often an unwieldy mass of sometimes conflicting studies into guidelines on best care practices for different conditions. True, back then there was wider latitude because each physician was largely left to fend for himself in applying the medical literature to individual patients’ conditions, but even so there was still a standard of care that physicians practiced within. These days, with many more guidelines, there is less reason for variation in practice. We who take care of breast cancer patients, for example, have access to the NCCN guidelines and ASCO guidelines, among others, and although there are some differences around the edges the major guidelines tend to have broad areas of agreement on how to treat breast cancer that evolve based on science. For instance, routinely doing a radical mastectomy is no longer part of the standard of care, nor is routinely removing all the lymph nodes under the arm in a patient without known positive lymph nodes. The former hasn’t been the standard of care for at least 40 years, and the latter, although the standard of care when I trained, hasn’t been the standard of care for at least a decade now.
My point here is not to dwell on what the standard of care is for treating breast cancer or how it’s evolved through the decades, but simply to emphasize that there is a standard of care based on science and evidence. If a physician goes outside the standard of care without a very good reason for doing so, it can even be malpractice. With that in mind, consider the case of Dr. Daniel Kalb, a physician at Cool Springs Family Medicine (CSFM) in Franklin, TN. He made the news recently by loudly announcing that he will no longer administer vaccines at all. In essence, he proudly announced that he intended to begin committing malpractice:
On May 31, Dr. Kalb wrote an eight-point list (that has since been removed from the CSFM website but can be found here) about why CSFM will not offer vaccines to patients, noting his 15 years of experience with upset mothers who’ve shared their “vaccine injury stories.”
“Don’t tell me that they are making it up or they are just reaching for an explanation, or that it was a coincidence or that they are just too stressed, or that they are uninformed,” he wrote. “All of those arguments are stupid.”
After writing that “we can do better,” and questioning the HPV vaccine Gardasil (“Are you kidding me? It is not safe”), he takes a moment to defend the father of the anti-vaccination movement, Dr. Andrew Wakefield. Wakefield’s infamous paper on the link between the MMR vaccine and autism was retracted by The Lancet in 2010.
No, all of Dr. Kalb’s arguments are stupid. One wonders why, as a Brave Maverick Doctor, he deleted his eight point manifesto explaining why he would no longer offer vaccines to his patients in the wake of the publicity that came his way after he made his announcement. Is he perhaps…embarrassed? Or perhaps he fears to have too much attention directed at the fact that he just publicly announced that he was going to practice far, far outside the standard of care. Maybe he was concerned that some who were alarmed by his antivaccine stand stated that they were contacting the Tennessee Department of Health. Of course, because the Internet never forgets, we can look at what Kalb wrote for ourselves.
First and foremost, Kalb believes the discredited claim that vaccines cause autism:
We will no longer be administering Vaccines at Cool Springs Family Medicine (CSFM).
1. Because they can cause Autism – yes, I’ve had 15 years’ experience in taking care of ASD kids, that’s a lot of vaccine injury stories from moms. Don’t tell me that they are making it up or they are just reaching for an explanation, or that it was a coincidence or that they are just too stressed, or that they are uninformed. All of those arguments are stupid.
No, I repeat, all of Dr. Kalb’s arguments are stupid and scientifically ignorant. For instance, later in his list he writes:
7. Dr. Andew Wakefield’s research was properly defended and vindicated 4 years ago. The Lancet paper stands: There is a link between the MMR vaccine and Autism.
No doubt he’s referring to the claim, common in antivaccine circles, that because one of Andrew Wakefield’s co-investigators, John Walker-Smith, regained his license it must mean that Wakefield himself was exonerated and his research therefore rendered valid. Wrong, wrong, wrong. As Brian Deer explains, the Walker-Smith appeal succeeded largely because of some unique features of British law regulating physicians. Basically, the General Medical Council (GMC) panel’s practice, dating back decades, of giving one-line of findings for each charge without setting out its reasoning. Also, Walker-Smith had been cleared of dishonesty and was already 75 years old. He had also had the case hanging over him for six years, and there was little public interest to be served in pursuing him. In other words, the fact that Walker-Smith succeeded on appeal in regaining his medical license has no bearing on the case against Wakefield, nor does his success “exonerate” Wakefield or his 1998 Lancet study, which is still retracted and will remain retracted.
But Kalb, being antivaccine, believes Wakefield. He also invokes the dreaded “toxins” gambit:
2. Polysorbate 80, Aluminum, formaldehyde, animal DNA with viruses, and many other ingredients in vaccines, are not good to inject into babies. Think of cancer, and autoimmune disease.
None of which are toxic in the doses administered in vaccines, nor do they cause cancer or autoimmune disease. You might recognize the dreaded “formaldehyde” gambit” (a variant of the “toxins gambit”), which is such an easily debunked antivaccine claim that most antivaccinationists don’t use it that often any more. Suffice to say that the amount of formaldehyde in vaccines is tiny and, through normal metabolism, an infant’s body makes more formaldehyde than he receives from vaccines. Similarly, polysorbate 80 is unfairly demonized based on rat studies using huge doses of the chemical, far more than is in any vaccine. Aluminum in vaccines, of course, has never been linked to the dire consequences that antivaccinationists claim.
My favorite line from Kalb’s little manifesto, one that shows he’s just making it up the way Deepak Chopra makes it up when he invokes the word “quantum” is this:
3. Epigenetics is a new science that explains exactly why, not every child is going to react the same way to vaccines, and sacrificing the few, for the many is not acceptable. Actually, if you understand the science, which many mothers with vaccine inured children do, you can see that it is actually many are at risk and are asked to be sacrificed for the few.
6. Vaccine development began in earnest in the 1930’s. Genetics, Epigenetics, the role of environmental toxins on the immune system, is much more recent than that. Guess what? We know a lot more now. Isn’t it time to incorporate that knowledge into the development of safe vaccines?
You know, if you substituted the word “quantum” or, more appropriately, “magic” for the word “epigenetics,” and you’ll get the same level of meaning and understanding. It sounds as though Kalb has been listening to too much John Rappaport, who is fond of invoking epigenetics in a very quacky way in pieces like Mandatory vaccination: California is ordering genetic alteration. I can only say to Kalb: Epigenetics. You keep using that word. I do not think it means what you think it means. I’m guessing that Kalb is invoking epigenetics as an explanation for how vaccines “cause autism” or for how different children can be more “sensitive” to the evil autism-inducing magic of vaccines but doesn’t know what he is talking about. No, wait. Strike that. There’s no guessing about it. He definitely doesn’t know what he’s talking about.
As for the bit about genetics and the role of environmental toxins on the immune system, Kalb is both correct and incorrect. He’s correct that we know a lot more about these things than we did in the 1930s. He’s wrong that this knowledge has supported the idea that vaccines cause autism or harm the immune system or made that idea any more plausible. As they say, if you can’t dazzle ‘em with brilliance, baffle ‘em with BS. Let’s just say Kalb laying down some stinky stuff.
After some typical misinformation about Gardasil, which, because it protects against a sexually-transmitted virus, antivaccinationists hate more than any other vaccine, with the possible exception of the birth dose of the hepatitis B vaccine, which, not coincidentally, also protects against a virus often transmitted through sex, Kalb lays down a real howler:
8. The argument that we will be thrust into the dark ages if we suspend the vaccine program is nonsense. There are many arguments against this, but, to make it simple, we are in the dark ages. We have a plague of autoimmune diseases including Autism. There is a plaque of Acquired Immune Dysfunction (ring a bell?).
Listen, I know I have been a little tongue and cheek about this, but really, I could wax on for a long time on any one of the 8 points that I brought up, and I’m sure I could list a lot more. I am not going to do that in cyperspace, I am not going to engage in internet battles, but, just as I have always done, as is my responsibility as a Family Physician, I will be an advocate for each of my patients as best as I know how. Also, I will always continue to respect the informed choices my patients make.
“Acquired Immune Dysfunction”? Oh, dear. Could Kalb be any more obvious? Be that as it may, he seems oblivious to the fact that the reason the incidences of vaccine-preventable diseases remains as low as it does is because we vaccinate against these diseases. Dr. Kalb’s reasoning abilities don’t seem too sharp, either, given that he buys into the “CDC whistleblower” conspiracy theory (just type “CDC whistleblower” or “William Thompson” in the search box of this blog if you want to know more about this particular flight of antivaccine fancy). And what persuaded Dr. Kalb of all these things?
To be honest, I have to wonder from the last paragraph if Kalb’s post was a joke gone horribly awry, given that he sounds as though he’s backing off on his announcement, using plausible deniability in the form of saying, I will always continue to respect the informed choices my patients can make.” Presumably that means that he would respect the choice of parents who choose to vaccinate according to the CDC schedule. of course, such parents would be very unlikely to want Dr. Kalb as their child’s doctor. So I suspect that Kalb meant what he said but was shocked by the backlash.
Of course, it’s not surprising that Dr. Kalb is antivaccine. He is a practitioner of “integrative” medicine, which means that he integrates quackery with his medicine. It’s all there, too. His clinic offers colon cleanses, hyperbaric oxygen, and “detox” programs. He advertises a lot of supplements from a variety of questionable companies. It’s not surprising that Kalb has now declared himself full-on antivaccine. Being antivaccine goes hand-in-hand with integrative medicine.
From my perspective, Dr. Kalb should be stripped of his medical license, as should all antivaccine pediatricians. A very basic standard of care for children is vaccination against common childhood diseases, and Dr. Kalb is violating that standard. In fact, from my perspective he has just announced that he will from here on out be committing malpractice. I might be able to concede a little bit of wiggle room for physicians who delay vaccines in order to hand hold antivaccine parents and ultimately get their children vaccinated, although that is less than optimal and is poor care. However, a physician who takes care of children who bluntly states that he will no longer administer vaccines at all has rejected the standard of care. He is a danger to his patients and a danger to his community. That ought to be more than enough reason to strip him of his license to practice. No doubt antivaccinationists will accuse me of being “intolerant,” but, from my perspective, if you’re a physician you have a duty not to practice in a way that will harm your patients, and if Dr. Kalb has rejected vaccines he is most definitely practicing in a way that will harm his patients, even leaving aside the pseudoscientific treatments he offers.
Let him go to naturopathy school and become an ND. He’ll be way more at home as an ND than he is as an MD. Fantasy with respect to vaccines is par for the course for NDs. It should be a disqualification for an MD.