Mea culpa! Orac praised the new CDC director for her pro-vaccine views, but missed the quackery in her past.

I have to start this post with a mea culpa, perhaps even a mea maxima culpa. I’ve been going on and on, in essence gloating about how the antivaccine movement was once again betrayed by Donald Trump. After the betrayal that was the appointment of the ultimate pro-vaccine pharma shill as FDA Commissioner, the second betrayal was the appointment of Dr. Brenda Fitzgerald as the new director of the Centers for Disease Control and Prevention. And, yes, on the surface, Dr. Fitzgerald doesn’t appear to be that bad a pick for CDC director. She has a history of being very pro-vaccine during her previous gig as Commissioner of Public Health in Georgia. She even supported early reading and language programs to support brain development, advocacy that everyone’s favorite quack defender Patrick “Tim” Bolen hilariously twisted into hinting that there must be something more to her and a fantasy of her showing up on her first day to demand that all the division heads cooperate with “investigations” into various nefarious deeds alleged in the fever dreams of antivaccine conspiracy theorists.

Before I get on with my self-abasement and mea culpa, I can’t help but give you a taste of his post Trump’s Pick For CDC Head – More Than Meets The Eye… In it Bolen cites a video of a TED Talk given by Dr. Fitzgerald on the simple practice of talking to babies and toddlers to nourish their brains and set them up for better performance in school and life:

The central thesis of Dr. Fitzgerald’s TED Talk is something that is utterly uncontroversial, namely emphasizing the importance of language development through talking to babies and toddlers and engaging with them. No pediatrician would argue with this, and, indeed, pediatricians and the American Academy of Pediatrics support early reading initiatives. Yet somehow Bolen spins Dr. Fitzgerald’s advocacy for promoting language development in infants and toddlers as meaning that she’s somehow sympathetic to antivaccine ideas! He starts out listing a standard list of antivaccine tropes about the CDC supposedly “covering up” evidence that vaccines cause autism. Then he goes into full-on fantasy mode:

Just suppose that on her very first day at the CDC, Brenda calls in ALL of the CDC Division heads and says “This fellow sitting here next to me is the Inspector General of the DHHS. He works DIRECTLY for my boss Tom Price MD and he is going to help me unravel some issues here at the CDC. You are hereby ORDERED to cooperate with him, and his employees, involving our ongoing investigation of malfeasance, misfeasance, and it’s cover-up. “

And then – “This other fellow here is Bobby Kennedy Jr. As you know President Trump has asked Bobby to form a Vaccine Safety Commission, which he has done. YOU are ORDERED to cooperate COMPLETELY with him and his Commission members. I want COMPLETE access, IMMEDIATELY, to the VSD information. Any questions?”

Finally – “As you know, the American Public has asked for a five-year moratorium on vaccines, etc… It is up to us, here at the CDC, to satisfy their concerns as fast as possible. Anyone who wants to resign, and move out of the country, will NOT be allowed to do so UNTIL you have been THOROUGHLY questioned by the Inspector General… There are those out there that say that vaccines are damaging a huge segment of our American population – Let’s see if they are right.”

I think this woman would get along VERY WELL with our Anti-Vaccine movement. So…

Yes, Donald Trump met with antivaccine crank Robert F. Kennedy, Jr. Unfortunately for him, nothing ever came of it. It’s been six months now since the two met and RFK Jr., ever the self-aggrandizing one, claimed that Trump offered him the chair of a commission to study vaccine safety, or autism, or something. Basically, this is nothing more than the delusional, self-reassuring fantasies of a man who supported Donald Trump for President and now, like so many Trump supporters, has to come to terms with the facxt that he’s been conned.

Amusingly, Bolen’s post was so delusional, so out of touch with reality, that even antivaxers called him out for wishful delusional thinking. On the other hand, maybe he saw something I didn’t, although that something clearly doesn’t have anything to do with vaccines. There is absolutely nothing I could find that implicated Dr. Fitzgerald with anything resembling antivaccine views, but that doesn’t mean her past is clean.

Here’s what I mean. When I originally alluded to my having missed a red flag, here’s what I meant. See if you can spot it in this passage from Dr. Fitzgerald’s official bio on the Georgia Department of Public Health website:

Brenda Fitzgerald, M.D., serves as the Commissioner of the Georgia Department of Public Health (DPH) and State Health Officer. Dr. Fitzgerald, a board-certified Obstetrician-Gynecologist and a Fellow in Anti-Aging Medicine, has practiced medicine for three decades.

Can you identify the red flag? Sure, I knew you could. I’m referring, of course, to Dr. Fitzgerald’s having been a Fellow in Anti-Aging Medicine. This is an enormous red flag that I should have noticed last week while writing a post about her for my not-so-secret other blog. Fortunately for me, Rita Rubin at Forbes noticed, and I noticed her article, allowing me to revise this post before it embarrassed me after going live:

Dr. Brenda Fitzgerald, appointed Friday as director of the U.S. Centers for Disease Control and Prevention, is a board-certified obstetrician/gynecologist who saw patients for 30 years in private practice.

Unlike any OB/GYN I know, Fitzgerald treated men as well as women. That’s because besides being board-certified in obstetrics and gynecology, she is a fellow in “anti-aging medicine.”

I was as disappointed to learn this as Dr. David Goldstein:

“I’m shocked,” Dr. David Goldstein, a professor of obstetrics and gynecology at the New York University School of Medicine and treasurer of the International Menopause Society, said after I told him that Fitzgerald’s biography identifies her as an anti-aging medicine fellow.

Goldstein described so-called anti-aging treatments as “snake oil” that “plays on people’s worst fears about their mortality.”

“If she (Fitzgerald) was one of these people who was marketing anti-aging medicine, that’s scary,” he said.

Here’s the webpage of her OB/GYN practice in 2010, a year before she was appointed Georgia’s Commissioner of Public Health. Poking around the website, I learned that she was first “certified” in “anti-aging” medicine in 2007, which is rather late in her practice career (she would have been 60 years old then) and also only four years before she was appointed Public Health Commissioner.

Particularly damning is this FAQ on Dr. Fitzgerald’s website. A couple of choice excerpts follow:

Q. What is the most common aging problem you see?
A. “Middle age spread”. As we age, the hormones that regulate body metabolism decline. The problem may be insulin resistance, nutrient deficiency, thyroid abnormality, or other hormone deficiency. Most people, by the time they are forty, are simply not eating 5000 calories a day in beer and junk food. They are frustrated because they are trying to eat good things or are eating what they have always eaten, or less, and are still gaining weight. We are now able to accurately evaluate the exact cause of weight gain, and recommend a plan to correct it.

Q. How do I know that I am taking the right supplements?
A. We can now measure the vitamins, antioxidants, necessary fats, and proteins in your cells with a simple blood test. If you like the supplements you are taking (Juice Plus, for example), we can tell you what you need to add. If you do not know what to take, we can give you the newest research for the best replacements.

So basically, Dr. Fitzgerald was into weight loss woo as well as anti-aging woo. (The two often go together.) She did a bunch of what were almost certainly unnecessary lab tests in order to figure out what supplements her patients “needed” and then ordered followup lab tests to see if she was giving her patients enough supplements. As is the case with nearly all such practices, most of it was cash on the barrelhead:

Q. Will insurance cover anti-aging care?
A. Traditional insurance plans often do not cover preventive medical care. We will try to help you determine if you are covered, but be aware that most coverage changes often and always with less coverage. We will continue to seek those labs that offer the highest quality, best cost tests. We will be happy to arrange monthly payments without additional charges for you. We will always give you our charges before services and we are always willing to look for other ways to get what you need, like labs at the health department.

I also note that Dr. Fitzgerald was into prescribing Suzanne Somers’ favorite form of woo, “bioidentical hormones.” Not good. Definitely not good.

I haven’t really discussed the American Academy of Anti-Aging Medicine (AAAAM or A4M) before. It’s the organization that offered the “fellowship” that Dr. Fitgerald completed. Put simply, A4M is what Kimball Atwood used to refer to as a pseudomedical pseudoprofessional organization (PPO). These organizations basically exist in order to provide a veneer of respectability to what is often gross quackery. In this case, A4M offers “fellowships” in a number of “specialties,” including Metabolic,
Nutritional and Functional Medicine, Integrative Cancer Therapy, Stem Cell Therapy, Integrative Medicine, and, of course, Anti-Aging Medicine. It also offers a number of “certifications” in various specialties, such as Advanced Metabolic Endocrinology, Weight Management, Brain Fitness, Lifestyle Coaching, Advanced Injectables, Addiction, and Sexual Health and Treatment. Then there are a bunch of online courses offered for quite the sum. The Stem Cell Fellowship, for instance, offers four modules at $2,500 per module. That’s a cool $10,000 to complete the training. The Anti-Aging Fellowship has three modules at $2,500 apiece. The Integrative Cancer Care Fellowship has eight modules at—you guessed it—$2,500 apiece, for a cool $20,000 to complete the course.

It’s not clear to me exactly which fellowship Dr. Fitzgerald finished, as the anti-aging fellowship is now referred to as the “Aesthetic Anti-Aging Fellowship” and now includes alot of surgical procedures, chemical peels, Botox, hair transfer, and “body sculpting,” but maybe the fellowship was different ten years ago. On the other hand, the module on “noninvasive body contouring” offers:

• Perform body mass index measurements, anthropomorphic measurements, and medical photography to document clinical presentation and results
• Prescribe organic whole foods, low glycemic diet along with appropriate detoxification, hormone balancing, and treatment of food allergy for optimal BMI

And:

• Develop a working knowledge of aesthetic devices and energies used in body contouring including Radiofrequency, Acoustic wave, Infrared energy, a novel chilling device, and lymphatic massage. Gain practical knowledge from aesthetic experts regarding the utility and effectiveness of these devices as well as their specific indications

“Detoxification”? “Hormone balancing”? Treatment of what are almost certainly nonexistent “food allergies”? Use of all sorts of devices that are almost certainly not evidence-based? Yes, there be quackery here, just as there be quackery over at the Stem Cell Fellowship:

Gain expert knowledge regarding the disease background, statistics, etiology, current standard of care, and issues/controversies surrounding current treatments for many neurological and neurodegenerative conditions, including:

• Parkinson’s disease
• Dementia
• Alzheimer’s disease
• Cerebral palsy
• Stroke
• Traumatic Brain Injury
• Autism
• Amyotrophic lateral sclerosis (ALS)
• Huntington’s disease
• Spinal cord injury
• Neuropathy

There is no convincing clinical evidence yet that stem cell therapy improves outcomes in stroke, ALS, Huntington’s disease, or dementia—or any of these conditions, really. Treating someone with autism with stem cells is, in my not-so-humble opinion, not only quackery but utter malpractice. Yet these are the sorts of things A4M teaches its “fellows.” And don’t get me started on “functional medicine,” training in which is also offered by A4M. It’s quackery, too. The list goes on and on. Yet Dr. Fitzgerald did one of the A4M “fellowships,” after which she offered what she was taught to women and men, supposedly to help them deal with aging better.

By yesterday afternoon, I felt as though I had gotten whiplash from my turnabout on Dr. Fitzgerald. When I first learned of her impending appointment, I started out very relieved and happy at how pro-vaccine she is and how she seemed to hit all the right notes on public health, particularly the importance of early childhood reading. I was also relieved that she didn’t appear to be too dogmatic on culture war issues embraced by conservative Republicans that could interfere with her ability to serve as a science-based CDC director. Then I learned about her anti-aging fellowship and her previous medical practice offering typical dubious anti-aging treatments such as “bioidentical hormones,” detoxification, and supplements galore. Now I’m not so sure.

One thing that interested me was the question of why. Remember, Dr. Fitzgerald had practiced OB/GYN for over 30 years before she did her fellowship in anti-aging medicine. She was clinical faculty at Emory University, and a president of the Georgia OB/GYN Society. Presumably, her practice was evidence- and science-based. By the time she finished her A4M fellowship, she was 60 years old. So why did she do it? On her website, it says:

Q. Why did you become interested in anti-aging medicine?
A. I got older! The life expectancy for women in 1900 was 48. The majority of women never reached the hormone depleted state of menopause just 100 years ago. Now most of us can expect to live half of our lives without natural optimal hormone production. My goal is to have all my patients, and me, be vigorous and vital for essentially their entire lives. I want to be struck by lightning on the golf course at 120…. and I want that for you.

Clearly, Dr. Fitzgerald didn’t understand life expectancies. The reason life expectancy was so low in 1900 was because of infectious diseases that killed children. If a child born in 1900 made it to age 20, average life expectancy was to between the ages of 60 or 65, meaning the majority of girls who made it past the high mortality period of childhood did reach menopause. It’s not a reassuring statement, and it almost makes me wonder if Bolen might have been on to something after all.

What partially reassures me is that, since Dr. Fitzgerald became Georgia Public Health Commissioner, she appears not to have engaged in anything resembling quackery. She appears to have supported science and was pro-vaccine. Her one big misstep was that on at least one occasion she failed to stand up to a big corporation (Coca-Cola) whose products are not good for health. That leaves a very important question: Where does the balance fall? The answer is: I don’t know, but I’m echoing some of the complaints I saw on the Forbes article:

I asked a couple of women’s health advocates what they thought about having an anti-aging medicine doctor lead the CDC.

“I’m so disappointed that the first female OB/GYN picked to head the CDC is someone who embraces the unproven and anti-scientific claims of the so-called anti-aging movement,” Cindy Pearson, executive director of the National Women’s Health Network, a nonprofit in Washington, D.C., told me.

“The public needs someone who supports public health recommendations that are based on science,” Pearson said, “not someone who tries to scare her patients by talking about ‘the hormone-depleted state of menopause’ and recommending unproven and potentially dangerous bio-identical hormones.”

It’s also been noted that Dr. Fitzgerald isn’t a great pick to head the CDC because she’s not a researcher. For instance, Diana Zuckerman, president of the National Center for Health Research, a nonprofit in Washington, D.C. noted:

“Her pitch as a physician suggests that, in addition to not being a researcher, she was providing treatments to patients that were not based on credible science,” Zuckerman told me after looking at the archived website for Fitzgerald’s former medical practice. “If a patient wants to try such treatments, and a doctor wants to prescribe them—preferably giving informed consent that the benefits are unproven—that’s up to them.

“But putting that doctor in charge of the CDC, a crucial public health agency, doesn’t make sense.”

Indeed.

Dr. Fitzgerald’s case suggests that you can be pro-vaccine and still be q quack. Worse, not being a researcher grounded in science, Dr. Fitzgerald is in danger of not being able to distinguish pseudoscience from science when antivaxers come calling (and they will come calling) to demand an “investigation” into the “CDC whistleblower” manufactroversy and other issues relevant to vaccines. I suppose under the Trump Administration, she’s the best we can hope for, and, more than that, all we can do is to hope that she consistently listens to the scientists at the CDC. I’m now not as optimistic as I once was.