You know how you know when you’ve been effective deconstructing quackery or antivaccine pseudoscience? It’s when quacks and pseudoscientists strike back. It’s when they attack you. As much as Mike Adams’ near daily tirades against me last year caused problems and poisoned my Google reputation (which was, obviously, the goal), I could reassure myself with the knowledge that his attacks meant that I had gotten to him. When Steve Novella was sued by a quack, as much as I didn’t want to be sued by anyone, I knew that the fact that someone would sue him was testament to his effectiveness. Basically, counterattacks, character assassination, and, occasionally, legal threats are the price skeptics pay when they are effective.
Jen Gunter has been very effective. Testament to her effectiveness is an article published on the goop website yesterday entitled Uncensored: A Word from Our Doctors. goop (note the lower case “g,” which is just too “edgy” for words), you might recall, is Gwyneth Paltrow’s “lifestyle” website, brand, and store that exists to serve up dubious health, beauty, and lifestyle advice (and, above all, sell very expensive beauty and “wellness” products) to affluent, woo-susceptible (and nearly all white) women. Basically, she dispenses alternative health advice to a certain set, or, as it’s been called, “pure, unadulterated, blood-diamond free, organic-certified, biodynamic, moon-dusted bullshit.” Given that goop has been around since 2008, I only stand amazed that it wasn’t until only three weeks ago that I first wrote about the rich vein of pseudoscience there in the wake of its having hit national news by claiming that what are basically stickers known as “Body Vibes” (which the goop store conveniently sells) can readjust your energy somehow and that they were made from a NASA-developed material. This latter claim was so patently false that NASA actually bothered to deny it. I suspect goop has been really feeling the heat since then, because as a result it had become the punchline for late night comedians like Stephen Colbert, who did a couple of memorable sketches making fun of goop, such as this hilarious one:
Ouch. That one’s gonna leave a mark.
Gwyneth Paltrow and goop: Going low and punching down
Stephen Colbert, however, was too big a target for Paltrow and goop, because he could easily strike back to devastating effect on his popular late night show. So they punched down instead. Jen Gunter was also a convenient target because she has been arguably its most persistent and long time critic. goop, of course, was a huge and very tempting target, as it seemed there was no bullshit too ridiculous or quackery too quacky for Paltrow to embrace and profit from. Indeed, I was reminded of this, ironically enough, mere hours before goop launched its attack on Dr. Gunter, I came across a paean to The One Quackery To Rule Them All, homeopathy, in which utterly risible claim that in most countries “outside the United States, homeopathics are the first line of defense against ailment, from the common cold to bruising to muscle pain,” which is just plain not true. It also lays down credulous nonsense that totally buys into homeopathic quackery, nonsense like this:
In homeopathy, the original substance is diluted many times and succussed (shaken) through a complex preparation process. Most practitioners use premade homeopathic remedies that are either sold in their office or in pharmacies, or health food stores, though they can also be made by hand. In homeopathy, the end product contains “energy,” but no molecules of the original substance due to the dilution process. The fact that homeopathics function on an energetic basis is a major reason that so many naysayers claim quackery, despite countless clinical studies proving otherwise. The mechanism of action that gives homeopathics their power is complex, and experts are now studying quantum physics and the science of non-locality to more completely understand how homeopathics work.
This is, of course, more unadulterated pseudoscience, the same sort of handwaving nonsense that homeopaths have been using to justify their quackery ever since they discovered how to appropriate quantum physics.
So it was with a chuckle that I read the self-righteous attack on Jen Gunter. It consists of an introduction, then brief articles by two doctors associated with goop, Dr. Steven Gundry and Dr. Aviva Romm. Through it all, the self-righteousness and tone trolling are epic right from the beginning:
As goop has grown, so has the attention we receive. We consistently find ourselves to be of interest to many—and for that, we are grateful—but we also find that there are third parties who critique goop to leverage that interest and bring attention to themselves. Encouraging discussion of new ideas is certainly one of our goals, but indiscriminate attacks that question the motivation and integrity of the doctors who contribute to the site is not. This is the first in a series of posts revisiting these topics and offering our contributing M.D.’s a chance to articulate theirs, in a respectful and substantive manner.
Poor babies. Here’s some advice to doctors associated with goop: If you embrace quackery and help goop sell it, then you deserve to have your motivation and integrity questioned. (Yeah, I said it.) This is also tone trolling turned up to 11, in which criticism is portrayed as “indiscriminate attacks.” It’s a common practice among quacks and those who sell quackery to portray righteous anger, snark, and colorful language sometimes used by skeptics when deconstructing nonsensical claims of the sort made on goop on a near-daily basis as being unreasonable. Indeed, Paltrow hereself even Tweeted:
— Gwyneth Paltrow (@GwynethPaltrow) July 13, 2017
That’s mighty funny for a woman who not too long ago responded to critics thusly:
“I’m interested in criticism based on fact, not on projections,” says Paltrow, in other words, “If you want to fuck with me, bring your A game.” (She’s so enamored of the phrase, a friend had it put on matchbooks and cocktail napkins for her as a gift.)
“Go high.” You keep using that term. I do not think that it means what you think it means.
Dr. Stephen Gundry: Mansplaining and tone trolling
After that, I couldn’t help but laugh out loud as I read Dr. Gundry’s oh-so-disappointed tone trolling:
I have read Dr. Jennifer Gunter’s recent diatribe online about some of goop’s advice, and since one of my recommendations was mentioned, and my credentials and motives were brought into question, I believe I have the right and duty to respond.
First, Dr. Gunter, I have been in academic medicine for forty years and up until your posting, have never seen a medical discussion start or end with the “F-bomb,” yet yours did. A very wise Professor of Surgery at the University of Michigan once instructed me to never write anything that my mother or child wouldn’t be proud to read. I hope, for the sake of your mother and child, that a re-reading of your article fails his test, and following his sage advice, that you will remove it.
Poor baby. Basically, his argument boils down to: “Dr. Gunter used the F-bomb. She’s mean and nasty; so she must be wrong.” In any case, I went to the University of Michigan Medical School too, dude. People—some faculty—cussed from time to time. Also, never have I seen such a passive-aggressive, self-righteous combination of tone trolling and mansplaining in a single article. One wonders why he doesn’t apply the same standard to his boss or business partner or whatever she is, Gwyneth Paltrow. His is merely a somewhat more subtle form of ad hominem attack. One also has to wonder why goop decided to attack Dr. Gunter specifically and not, say, Prof. Tim Caulfield, who actually wrote a book entitled Is Gwyneth Paltrow Wrong About Everything?: How the Famous Sell Us Elixirs of Health, Beauty & Happiness. Could it be because the editors of goop thought it would be easier to paint a woman as unreasonable and—dare I say it?—hysterical? Perish the thought!
I’ll get back to Dr. Gundry in a moment.
Defending against charges of quackery by referencing…examples of quackery
Here’s another passage I couldn’t help but laugh at:
Some of the coverage that goop receives suggests that women are lemmings, ready to jump off a cliff whenever one of our doctors discusses checking for EBV, or Candida, or low levels of vitamin D—or, heaven forbid, take a walk barefoot. As women, we chafe at the idea that we are not intelligent enough to read something and take what serves us, and leave what does not. We simply want information; we want autonomy over our health. That’s why we do unfiltered Q&As, so you can hear directly from doctors; we see no reason to interpret or influence what they’re saying, to tell you what to think.
The “walk barefoot” reference amused me the most. It’s a reference to an interview with Clint Ober. Those of you familiar with various forms of the most ridiculous quackery out there will recall that Ober, who’s been featured Dr. Oz’s show, is probably the most famous advocate of “earthing,” the idea that by being directly connected to the earth through bare skin you’ll be “energetically connecting with Mother Earth” through its “infinite supply of electrons” and reaping all sorts of health benefits. A corollary of this view is that wearing shoes is bad because it blocks that “connection.” I’ve written about how bogus earthing is before. Basically, goop is being incredibly disingenuous here. It’s making it sound as though skeptics were criticizing it for nothing worse than advocating walking barefoot, ignoring that the criticisms were not over just walking barefoot and were in fact about all the earthing pseudoscience.
That goop would defend itself by referencing quackery just as ridiculous as earthing and homeopathy bespeaks a lack of self-awareness beyond black hole-level dense. Ditto for referencing an article on chronic candida infection, a common quack diagnosis in which candida is blamed for all manner of vague symptoms. It is a fake illness. EBV does not cause every disease under the sun. Basically, goop is defending its doctors by crying, “We’re not quacks!” while at the same time referring to excellent examples suggesting that they very well might be or that, at the very least, they like the sound of ducks.
The introduction also unwittingly highlights the problem with quackademic medicine. It’s a shield for pseudoscience in medicine:
And speaking of doctors, we are drawn to physicians who are interested in both Western and Eastern modalities and incorporate the best from both, as they generally believe that while traditional medicine can be really good at saving lives, functional medicine is more adept at tackling issues that are chronic. These are the doctors we regularly feature on goop: doctors who publish in peer-reviewed journals; doctors who trained at the best institutions; doctors who are repeatedly at the forefront of medicine; doctors who persistently and aggressively maintain an open mind. The thing about science and medicine is that it evolves all the time. Studies and beliefs that we held sacred even in the last decade have since been proven to be unequivocally false, and sometimes even harmful. Meanwhile, other advances in science and medicine continue to change and save lives. It is not a perfect system; it is a human system.
See what I mean? goop can claim that its doctors are from the “best institutions,” “publish in the finest journal,” and are at the “forefront of medicine.” Couple that with the “science was wrong before” trope, and you can sow just enough doubt to make goop’s quackery seem as though it might actually be cutting edge. It’s not. Functional medicine, in fact, embodies the very worst traits of “alternative” and conventional medicine. It combines the use of quackery as quacky as homeopathy with the tendency towards overtesting and overtreating that are conventional medicine’s greatest weaknesses.
Then there’s the “medicine evolves” trope. Yes, medicine does evolve. Although its overall course is to be based in better science, there are many ups and downs along the way. Its progress can be frustratingly slow at times, and it can go down blind alleys at times. It is, however, self-correcting. It does not, however, self-correct by embracing vitalistic quackery like homeopathy or suggesting that putting a jade egg up a woman’s vagina will somehow have magical health benefits. Just because medicine evolves does not mean that totally implausible treatments like homeopathy or jade eggs are scientifically plausible—or ever will be.
Dr. Gundry: Science-based supplement hawker?
This brings me back to Dr. Gunter. The blog post by her that I remember the most was her discussion in January of why “Jade Eggs” sold by goop are pure pseudoscience and mystical mumbo-jumbo. Indeed, it’s rare that I see a product for which the claims are such obvious idiocy, and Dr. Jen showed that in her usual inimitable fashion. Another famous article by Gunter was her deconstruction of Paltrow’s recommendation that women steam their vaginas. Then, of course, Paltrow is into detox, detox, detox.
Of course, Dr. Gundry will have none of it. He has a peculiar level of tunnel vision. He paints himself as a science-based doctor at the very highest level of his profession. Arguably, he was, at least until 15 years ago, when, as he brags, he resigned a “Professor and Chairman of Cardiothoracic Surgery at a major medical school to devote myself to reversing disease with food and nutraceutical supplementation, instead of bypasses, stents, or medications, just like Hippocrates asked you and me to do when we took our oath: ‘Let food be thy medicine.’ And he works so, so hard at it. So hard. So very hard that he has to brag:
And finally, he taught that a physician’s job was to search out and remove the obstacles that are keeping the patient from healing themselves. For the last fifteen years, I’ve been doing just that seven days a week (yes, you read that right, Saturday and Sunday as well, just ask my overworked staff).
Poor baby. Such dedication. And, he assures us, even though he has concierge patients, he also takes Medicare and Medicaid! He’s also a condescending dude as well:
I bring this up because I am writing this on a plane while returning from giving a paper to the 11th annual World Congress on Polyphenols Applications—on the effect of a lectin-limited diet, supplemented with polyphenols with fish oil, on intravascular markers of inflammation in 467 patients with known coronary disease. I won’t bore you, but when we removed high lectin-containing foods like grains, beans, and, yes, nightshades like your beloved tomatoes, their elevated markers of inflammation returned to normal. Great, but I’m not finished. Remember Koch’s postulates that must be fulfilled to prove the agent causes a disease (go ahead, look it up)? Well, once cured, you have to reintroduce the agent and see that the disease returns. Sure enough, in 57 patients, we reintroduced lectins, and back came the inflammation in all 57 patients’ next blood tests. Finally, you have to remove the agent again; which we did, and all 57 patients numbers normalized a second time, proving that indeed lectins were the cause of this process. Conclusion: Lectins cause human disease.
Actually, arguably lectins are the new gluten, something that can be toxic under some circumstances that are increasingly being co-opted as The One True Cause of All Chronic Diseases, and Dr. Gundry is the prophet of the new church of lectins. Unfortunately, the abstracts book for the 11th annual World Congress on Polyphenols Applications is behind a paywall; so I couldn’t look up the actual abstract, but the description is of a study that’s one of those clinical biomarker studies that are a dime a dozen, particularly in abstract form. Inflammatory markers are a favorite used in this type of study. As John Ioannidis has shown, such studies are frequently wrong. Moreover, they don’t reach the next step, which is to show actual concrete health benefits caused by changing the biomarkers measured. This is tricky enough to do in cancer, where overall survival and disease-free survival are pretty concrete outcomes to measure. It’s much less easy for claims such as those being made by Dr. Guntry. There’s an excellent discussion of Dr. Guntry’s obsession with lectins here if you want more information. I might have to look into the subject in more detail myself, but it’s pretty obvious that Dr. Gundry is reading too much into preliminary biomarker studies. Certainly, such studies are not enough to justify his selling supplements like this to target lectin:
The GundryMD line of products includes something he invented called vitamin G6. Another is a “lectin shield” that’s “designed to neutralize the effects of lectins.” These are available on his website for $79.99. There you can also get six jars of Vital Reds for $254.70. (Despite the name and claims to “boost energy and metabolism,” these reds claim not to be amphetamines.)
Here’s Lectin Shield. Basically, it’s a high-priced supplement that supposedly blocks dietary lectins, “supports intestinal health,” and helps “curb cravings and encourages digestive strength.” I’ll give Dr. Gundry credit. I’ve never heard anyone make a claim for a supplement of “supporting intestinal strength.” One wonders what a weak intestine looks like. His website even has this notice:
The information on this website has not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.
Wait. What? A quack Miranda warning? I thought that Dr. Gundry was purely science-based and that everything he recommends is based in science. How? He tells us so ad nauseam. He brags to Dr. Gunter that he’s a real doctor, ma-an, unlike Dr. Gunter and his critics. He does science! He has published hundreds of journal articles, abstracts, and book chapters! How dare you criticize him for fear mongering about lectins! He publishes in the Journal of International Society of Microbiota! Oh, wait:
Interesting that with all the emphasis on peer review, Journal of International Society of Microbiota is on its 3rd issue, not NCBI indexed.
— Duncan MacCannell (@dmaccannell) July 14, 2017
Not exactly impressive. I did a little PubMed search on Dr. Gundry. Unfortunately, there’s another S.R. Gundry, but it was easy to keep the other Dr. Gundry’s publications separate from more recent publications from our Dr. Gundry’s publications. (I highly doubt our Dr. Gundry is doing zebrafish research.) That means Dr. Gundry’s last PubMed indexed publication was 13 years ago, and he wasn’t even first author. True, he does have some abstracts since then, but no full publications in PubMed-indexed journals. Basically, he’s very much like Dr. Oz, a once highly respectable cardiothoracic surgeon who discovered woo and cashed in. Ironically, Dr. Gundry points to having been on Dr. Oz’s show as if being a guest on that cesspit of quackery boosts his scientific standing. The mind reels.
An herbalist and midwife turned “integrative” doctor attacks
But what about Dr. Aviva Romm. She’s a bit less condescending to Dr. Gunter, but only a bit less. She starts out using standard “integrative medicine” tropes about how chronic disease is such a problem. Then she jumps into false equivalence:
Do all wellness trends pan out to be scientific and reliable? Of course not. Then again, neither do many of our trusted pharmaceuticals, tests, and procedures when given the test of time. And of the mainstream trends that turn out to be overtly dangerous—those fade fast. Do I think medical testing and treatments—including alternative ones—should ideally be safe, effective, and scientifically validated? Absolutely. Unfortunately, much like what happened with some of those I mentioned above, research was only done when the demand from consumers became loud enough to be heard or something became a big enough trend to merit attention.
In other words, don’t blame me for embracing all sorts of dubious treatments! I’m just catering to what patients want, as are all “integrative doctors” and “researchers” looking into reiki, acupuncture, and all the other nonsense “integrative medicine” is trying to “integrate” into medicine! Oh, and science was wrong before. (Surprise, surprise, both docs invoke that trope.) I wonder if she’d be willing to explain the scientific basis of goop’s promotion of Jade Eggs. Let’s just say that even the most questionable pharmaceutical drug has way, way more scientific evidence and clinical trials behind it that Jade Eggs. Or grounding. No, basically, goop is marketing quacky “wellness” to the worried well and credulous affluent women.
Then Dr. Aviva defends goop:
In a time when women are desperately hungry for safe alternatives to mainstream practices that too often fall short of helpful for chronic symptoms, and in the setting of a medical system that is continually falling short of providing lasting solutions to the chronic disease problems we’re facing: I prefer, rather than ridiculing vehicles that are actually highly effective at reaching large numbers of women who want to be well, to seek to understand what women are looking for, what the maintstream isn’t providing; and how we can work together to support those vehicles in elevating their content so that women are receiving the meaningful, and evidence-based answers, they want and deserve, whenever possible.
TRANSLATION: Don’t mock us, even though we peddle absolute bullshit. We’re highly effective at reaching large numbers of women who want to be well. Then we sell them bullshit. But don’t mock us for that.
Yes, women are looking for non-mainstream “alternatives” to maintain health. Unfortunately, that very trait makes them perfect marks for goop, which is highly effective at selling dubious nostrums to those very same women. Very little of it is actually evidence-based. Indeed, Dr. Romm offers all sorts of supplements to “detox” and “boost your immunity,” advertising herself as a midwife and herbalist. She’s also written a book on vaccines full of red flags for antivaccine beliefs, such as claiming to “offer a sensible, balanced discussion of the pros and cons of each routine childhood vaccination” and presenting “the full spectrum of options available to parents: full vaccination on a standardized or individualized schedule, selective vaccination, or no vaccinations at all.” She even offers advice for traveling with unvaccinated children and using herbs to provide “natural immunity.” None of this is science-based. Let’s just put it this way, Peggy O’Mara, publisher of that antivaccine magazine Mothering offered a blurb praising it, as did antivaccine pediatrician Dr. Lawrence Palevsky and a naturopath. Let’s just put it this way. She includes the antivaccine group National Vaccine Information Center among her list of “Vaccine Resources.” She also states that she purchases from various herbalist and homepathy companies. That book might be 16 years old, but she’s still peddling false equivalence and rotavirus vaccine fear mongering.
No, Dr. Romm can’t be said to be science-based, and I haven’t even gotten into her “adrenal thyroid revolution” yet. (That might have to be a topic for a future post.) She also promises “more to come” to push back:
So does goop, promising this is the “first of a series of posts” that will push back. Good. To this, respond:
And I echo Mark Hoofnagle’s response:
Bring it! pic.twitter.com/24Uuw5wkdY
— Mark Hoofnagle (@MarkHoofnagle) July 14, 2017
Yes, goop, Dr. Gundry, and Dr. Romm, can you smell what science-based medicine is cooking? Dr. Jen can. So can I. We’re all in the kitchen cooking with every other doc who supports science. I think that goop will become a much more frequent topic here (and elsewhere) now that we’ve been noticed. Don’t worry, Ms. Paltrow. We’ll bring our A-game.