No, there is no evidence that Hillary Clinton has Parkinson’s disease

Remember Vox Day?

Vox Day is the pseudonym used by a truly vile man named Theodore Beale. I first encountered him 11 years ago on the precursor to this blog, thanks to his antivaccine stylings and outright misogyny. Later, I learned the depths of his wingnuttery, such as his accepting pseudoscientific claims that vaccines cause sudden infant death syndrome, and several others. Hilariously, his anti-science rants are inevitably accompanied by smug posturing about how scientists are arrogant (pot, kettle, black) and how science is a corrupt system that is ideologically driven (talk about projection). Basically, he seizes on any criticism of how science is practiced as an excuse to attack science itself. That doesn’t even take into account his odious suggestion, ten years before Donald Trump made it, that we should forcibly eject 11 million immigrants here illegally, because, hey, it worked for Hitler. It was a “classic” that briefly made Vox too much of a wingnut for WorldNetDaily. Sadly, the Overton window appears to have shifted, such that Vox would no longer be too much of a wingnut for many publications.

It’s not surprising, then, that Vox is a Donald Trump supporter.

Also, given his history of accepting any crank science or medicine that fits into his preconceived world view, that Vox has also jumped onto the “Hillary is unfit to serve” bandwagon. Three weeks ago, I noted two very unhelpful and bordering on despicable misuses of medicine, both involving armchair diagnoses of political candidates. First, there was the tendency of those on the left to assign psychiatric diagnoses to Donald Trump. That was bad enough, but what Trump supporters were doing was arguably worse, namely insinuating all sorts of dark conspiracies to hide serious illness in Hillary Clinton. The “evidence” used upon which the various “diagnoses” assigned to Clinton has been risibly lean, but that didn’t stop wingnuts like Dr. Jane Orient and Dr. Gerard Gianoli, both of the crank doctors’ organization the Association of American Physicians and Surgeons (AAPS). Basically, based on pure speculation, they did some fine JAQing off and asked if Clinton had post-concussive syndrome from a concussion and a cerebral venous thrombosis suffered after falling when she was ill with the flu in 2012 and from which she appears to have made a full recovery. There have also been insinuations that she has Parkinson’s disease, based on…basically nothing.

I guess it should come as no surprise that Vox is totally down with that observation because…”experts.” It’s hilarious to me how Vox castigates legitimate experts who point out that his beliefs are nonsense, but says this about people who support his beliefs, like Dr. Ted Noel, an anesthesiologist who has concluded through a fair amount of contortions of logic, that Hillary Clinton “probably” has Parkinson’s disease:

That is the conclusion of a a board-certified Anesthesiologist with 36 years of experience, backed up by the observations of a) a victim of Parkinson’s Disease and b) a registered nurse who cares for patients with Parkinson’s Disease.

First off, being a “board-certified anesthesiologist” has little or nothing to do with expertise in neurology or Parkinson’s disease. Yet, note how Vox emphasizes that he has 36 years of experience, presumably at anesthesia. I’m sure he’s a perfectly capable anesthesiologist, but he’s no more qualified to diagnose Parkinson’s disease than any other non-neurologist, probably less, given his high degree of specialization. Yet, none of that stops him from posting a ridiculous video:

And an equally ridiculous article to go with it:

Noel is hilarious. He claims that he does “exactly what the CIA” does and looks at publicly available records to determine if there is a story that fits the observations. Here’s the problem. He gets the method backwards in that what he does is to start with the story he wants to tell and then cherry picks bits of information and video to weave together to tell that story, namely that Clinton has Parkinson’s disease. He begins with the standard conspiracy theories, going back to 2005 when Clinton fainted onstage. Particularly silly is one point where Noel recounts an episode where Clinton fell down and struck her head, noting that to strike your head falling requires a “complete loss of protective reflexes” and that dehydration from an illness isn’t enough to do it:

It explains every one of the items listed above. Further, since it is a diagnosis primarily made by observation, the video record is sufficient to create a high degree of certainty.

The 2009 fall where HRC broke her elbow suggests that she had working protective reflexes, and her arm took the brunt of the fall. But three years later, she had a catastrophic fall where her reflexes were unable to help her. It is notable that this fall took place at home, where she would have been unstressed and in a familiar setting. Failing reflexes are common in PD. Poor balance is also common in PD, and a fall without working protective reflexes is a prescription for head injury. Her subsequent concerns with transverse sinus thrombosis are plausibly related to the fall. Her need for fresnel lens glasses also fits with post-concussion syndrome.

Uh, no. It happens all the time. People fall and hit their heads. Noel is really stretching here. There were a total of three falls, and Noel stretches to claim that the first one was due to early Parkinson’s, the second one due to a Parkinson’s freeze. Noel keeps going on and on about how “I am not her treating physician” but that Parkinson’s is the most likely explanation for Clinton’s behavior and that she is a politician who “lies about everything.”

His next bit of speculation is that a month after Clinton’s concussion she was experiencing occasional confusion, which he at least concedes is not uncommon after a concussion, but then he goes full on conspiracy wingnut. For instance, he shows video of Clinton nodding her head, pointing to that as evidence of Parkinson’s disease. Never mind that it’s something she’s done for a very long time, going back to the 1990s. To Noel, this isn’t just an odd tic; it’s a Parkinson’s tremor. Now, I’ve seen Parkinson’s tremors. Not surprisingly, Noel pulls up the video of Hillary with an exaggerated startle response, which Noel attributes to levodopa-induced dyskinesia. No, it’s not. I find it quite telling that nowhere in the video does Noel show video of actual Parkinson’s disease tremors or levodopa-induced dyskinesia to compare with Hillary Clinton’s movements. If he did, it would become obvious that Clinton’s behaviors are neither of these things.

Then there’s this:

PD is a chronic disease with a downhill prognosis. HRC’s instability and frequent cough suggest that her PD is advanced. This is not a good outlook for someone running for the Presidency. The office of the President is one of the highest stress jobs in the world. Stress sets off PD episodes, which render the sufferer incapable of proper response.

At this point, a bit of speculation seems appropriate. HRC talks about her yoga sessions. But no one we know of has ever documented one. It is possible that this is cover for sessions designed to teach her coping mechanisms for PD or for rest breaks. Exhaustion makes PD worse.

HRC’s coughing suggests that her swallowing disorder is advanced, placing her closer to an aspiration pneumonia that would disable or kill her. That’s bad enough, but PD has one more, even more dangerous step in its progression.

As PD continues, cognitive problems can develop. In time, they become full-blown dementia. The United States cannot survive if its President is mentally impaired.

Yes, the cough thing. Since I last wrote about this, conspiracy theorists have started to point out that Hillary Clinton coughs a lot. That’s prompted me to point out that I, too, cough a lot, because I have seasonal allergies and frequently get bronchitis in the wintertime and have for as long as I can remember. People who have seen me give talks certain times of the year probably noted that I usually had at least a low grade cough. Now think of it this way. Clinton has been on the campaign trail for over a year and a half, giving as many as several talks a day and, when not giving speeches, is forced to speak with campaign staff, donors, and others. So what if she has a cough? I bet if you looked hard enough you could find video of Donald Trump coughing or, going to past elections, Barack Obama or Mitt Romney coughing. Constant public speaking can do that.

No one seems to be asking if Newt Gingrich has Parkinson’s, even though he coughed as he wondered if Clinton’s coughing meant she was seriously ill.

Parkinson’s disease is indeed a serious, progressive, degenerative neurologic disease. Perhaps the best indication that Clinton almost certainly does not have Parkinson’s disease is how carefully Noel and the peddlers of this particular conspiracy theory had to cherry pick video of Clinton to find brief snippets that they could point to as Parkinson’s-associated tremors, “brain freeze,” and levodopa-induced dyskinesia. As Steve Novella, a board-certified neurologist, pointed out when I was on The Skeptics’ Guide to the Universe three weeks ago, the exaggerated startle response pointed to by Noel is not a Parkinsonian freeze, nor was it dystonia or a seizure. As Novella points out, Parkinson’s is an “across the room” diagnosis that is easy for a trained neurologist to recognize, particularly if it is advanced, which, remember, is what Noel is claiming.

Ever wonder why none of these videos shows actual patients with Parkinson’s disease with dyskinesia or resting tremors for comparison? (And, no, a static photo of Michael J. Fox looking “bug-eyed” doesn’t count.) Ever wonder why, out of literally thousands of hours of video of Hillary Clinton taken over the last two years and then before, when she was Secretary of State, that these few snippets of video that can be tortured to sort of look like Parkinson’s disease symptoms are the best that Dr. Noel (and before him, Martin Shkreli and Dr. Jane Orient) could come up with? Did you ever wonder why not a single board-certified neurologist has stepped forward and say, “Yeah, that looks like Parkinson’s”? The reason is simple. It doesn’t. Those startled looks are not dyskinesia, and that head bob is probably a nervous tic, not resting tremor. Seriously. Advanced Parkinson’s disease is not something you can hide when you’re on video hundreds, if not thousands, of hours a year. It’s just not. the very fact that these few snippets of video are the best that the conspiracy mongers can come up with is excellent evidence that Hillary Clinton does not have Parkinson’s disease. If she had Parkinson’s disease, it would have been noticed long ago by someone other than a greedy pharmaceutical entrepreneur, the CEO of a crank physician organization, or an anesthesiologist with a political agenda who asks near the end of his video about who would run the country if Hillary Clinton were incapacitated and then shows a photo like this:

Bill Clinton

Yep, he insinuates. It’ll be Bill Clinton running the country again. Of course, the Constitution declares the line of succession, and if Hillary Clinton were elected and were to become incapacitated, her Vice President, Tim Kaine, would assume the duties of the Presidency, Dr. Noel’s insinuation that if he were to do so the Clintons would “lose their juice,” not withstanding or his “question” wondering whether Clinton had a “freeze” during the Benghazi attack and that’s why it was such a disaster. (I just knew he’d manage to work Benghazi in there somewhere.)

Insinuations about the health of political candidates and leaders is nothing new. However, these conspiracy theories about Hillary Clinton’s health from the fever swamps of Alex Jones territory take it to a level I do not recall ever having seen before. No wonder Vox Day eats them up. As brilliant as he thinks he is, he is the living embodiment of the Dunning-Kruger effect and the arrogance of ignorance.