Peter Gøtzsche and the antivaxers

I almost didn’t write about today’s topic because, like many Twitter kerfuffles, it’s something that happened one day and was seemingly resolved two days later—and that two days ago is now a week past. On the other hand, this saga gives me the opportunity to discuss, at least as much as I can based on what I know, a bit about the saga of Prof. Peter Gøtzsche, former director of the Nordic Cochrane Collaborative and someone who’s known for being quite outspoken. He’s also someone who’s flirted with some rather dubious ideas, up to and including antivaccine ideas about the human papilloma virus (HPV) vaccine. It is also a story that allows me to discuss an antivaccine group that I’ve been meaning to discuss for a long time, namely Physicians for Informed Consent (PIC), having encountered one of its members six months ago. Also, even though this event seemed to have been resolved a week ago, as you will see, it’s not really, as I will explain at the end in an update describing what’s happened over he last week.

Here’s how it began the Friday before last:

Here is how the PIC website appeared last weekend, with the full lineup:

As you might expect, a Twitter storm erupted over this. Note the list of other speakers, a veritable rogues’ gallery of antivaccine “luminaries”, including Robert F. Kennedy, Jr, Mary Holland, and Toni Bark (more on each of them later). Note that the organizer of the workshop is Physicians for Informed Consent, an antivaccine group of physicians that specializes in discouraging vaccination under the guise of promoting “informed consent”. It is, of course, in actuality misinformed consent that PIC promotes, as I will discuss. Unfortunately, however, PIC is influential because it is made up of physicians and medical professionals, much as the Association of American Physicians and Surgeons (AAPS) is influential even though it is in reality an Ayn Rand-worshiping political group masquerading as a medical professional society. Because I happened to be out sick that Friday (don’t ask), I myself had time to contribute a rather long thread about why it would be a horrible idea for Prof. Gøtzsche to speak at this conference:

Ultimately, on Sunday morning, Prof. Gøtzsche Tweeted that he was not going to be speaking at the conference:

Notice the rather strange phrasing of the last sentence.Also notice how Prof. Gøtzsche didn’t say that was withdrawing from the conference as a speaker and make an excuse, such as that he didn’t know the nature of the workshop when he agreed to appear. He just said, “I am not speaking at this event.” I found that rather odd as well. What does that mean? He did, after all, appear to have been the conference headliner, based on his prominent position at the top of the bill.

So what happened? How could Prof. Gøtzsche, who by any stretch of the imagination has been a very eminent voice for evidence-based medicine even counting his recent travails, have agreed to speak for an antivaccine group? And, no, I don’t think PIC lied about him being on its lineup for its conference, as I have seen a few of Prof. Gøtzsche’s defenders claim. That would have been stupid and self-destructive in the extreme, as having someone like Prof. Gøtzsche say that PIC lied about his having agreed to speak would have been a public relations disaster even worse than the PR disaster of him pulling out of the conference.

Let’s look at the conference first. Then we’ll look at Prof. Gøtzsche’s recent history. Finally, I’ll describe why I consider PIC an antivaccine group, although the conference lineup itself is probably reason enough to conclude that PIC is antivaccine.

PIC Workshop and Luncheon 2019

The PIC Workshop and Luncheon is scheduled for March 17, 2019 in Costa Mesa, California, and Peter C. Gøtzsche is the headliner. The title of his talk was to be How Mandatory Vaccination Violates Medical Ethics, which is not an auspicious-sounding title. In fact, it’s a title that antivaxers would love because they frequently make the unfounded claim that “forced” or “mandatory” vaccination is the moral equivalent of what the Nazi doctors on trial at Nuremberg did. Indeed, some explicitly claim that school vaccine mandates are against the Nuremberg code. It’s a frequent antivaccine talking point. For example, the grand dame of the antivaccine movement herself, Barbara Loe Fisher, the founder of one of the oldest American antivaccine groups, the National Vaccine Information Center, once did a video entitled “From Nuremberg to California: Why Informed Consent Matters in the 21st Century“, a video that I deconstructed elsewhere in my usual inimitable fashion. Let’s just say that her video featured Nazi analogies. Lots of Nazi analogies, and that antivaxers like to liken vaccine mandates to the Holocaust.

In any event, Prof. Gøtzsche should have known that this is a favorite antivaccine talking point and chosen a less provocative, less antivaccine-sounding title. (If he didn’t, then he was painfully ignorant of antivaccine tactics.) Now, there is nothing wrong with discussing the ethics of vaccine mandates. However, appearing with antivaccine “luminaries” at an antivaccine conference organized by an antivaccine group is not a good look, particularly when the title of your talk echoes a favorite antivaccine talking point.

And who are these antivaccine luminaries? They include:

  • Robert F. Kennedy, Jr. What is there to say about RFK, Jr. that I haven’t already said many times? I first encountered his antivaccine stylings in 2005, when he wrote “Deadly Immunity”, a joint publication of Salon.com and Rolling Stone, to the eternal shame of both publications. It was basically the recounting of an antivaccine conspiracy theory. Later, I encountered him arguing that if you criticize women who are antivaccine you must hate mothers. More recently, RFK Jr. has teamed up with antivaccine reporter Sharyl Attkisson to promote what I like to call a “new-old conspiracy theory” of the “the CDC knew how bad vaccines are” variety. It’s nonsense, of course, as all of Sharyl Attkisson’s conspiracy theories are, and is rooted in the claims of a useful idiot named Dr. Robert Zimmermann. The title of his talk is “Mandatory Vaccines & Public Health”. Notice how the speakers at his conference fetishize the word “mandatory”.
  • Toni Bark, MD. Dr. Bark is a “holistic” doctor who became a naturopath and also, as many naturopaths do, practices homeopathy. Hilariously, she was a speaker, along with Andrew Wakefield, on the Conspira-Sea Cruise, a cruise for conspiracy theory lovers. She was also a panelist for an antivaccine panel discussion called One Conversation, where she laid down some serious antivaccine misinformation. She’s a member of an embarrassing (to me) group of antivaccine physicians, although given that she’s become a naturopath I have a hard time considering her a physician any more. Unfortunately, Bark’s quackiness has not prevented her from being allowed to testify in vaccine cases, including, alas, one that happened in my neck of the woods a year ago. I was, however, amused at how Bark didn’t exactly cover herself in glory at that trial. No wonder she has her own entry in the Encyclopedia of American Loons. Still, she represents herself as an “expert witness” in “vaccine injury”.
  • Mary Holland. Mary Holland is a lawyer and faculty at, of all places, NYU, and she too has her own entry in the aforementioned Encyclopedia of American Loons. Basically, she tries to use the courts and authoring books to promote the scientifically discredited idea that vaccines cause autism. She also uses her status to find ways to brief congressional aides about the Vaccine Court and let misinformation flow. She’s also not above flouting clinical trial ethics by doing crappy human subjects research without IRB approval.
  • Rick Jaffe. Rick Jaffe is best known as the lawyer of cancer quack Stanislaw Burzynski, although the two had a falling out over unpaid legal fees. Basically, he’s one of those “health freedom” lawyers who specializes in defending quacks who get in trouble with the FDA or the law. These days, he spends his time railing against efforts to eliminate CME credit for courses in “integrative medicine” quackery and defending the owners of quack stem cell clinics, although in fairness, their quackery seems occasionally to be too much for even him to defend.

So what will the workshop include? Here’s PIC’s own description of it:

The PIC Workshop & Luncheon will include world-renowned speakers and collaborative discussions on medical ethics, public health, mandatory vaccination, medical exemptions, infectious diseases and law. Attendees will experience both an educational and think-tank environment, network with medical experts and top lawyers, and connect with their colleagues. In addition, attendees will participate in workgroup sessions where they will learn best practices in recommending a medical exemption to vaccination that will enable them to protect at-risk children from vaccine injuries.

Topics will include:

  • Mandatory vaccination and medical ethics
  • Practical tools and best practices for protecting at-risk children from vaccine injuries and elevating patient health outcomes
  • Educational materials to help assess the risks of an infectious disease versus the risks of the corresponding vaccine
  • Current and historical infectious disease data from the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics
  • Existing scientific research on complications that can result from vaccine adverse events and medical circumstances that increase the risk of vaccine side effects
  • The enactment of the National Childhood Vaccine Injury Act (NCVIA) of 1986
  • The Vaccine Adverse Event Reporting System (VAERS) and the limitations of passive surveillance systems (e.g., as few as 1% of serious side effects from medical products are reported to passive surveillance systems)
  • The National Vaccine Injury Compensation Program (VICP), vaccine adverse events listed on the VICP Table of Injuries, and the compensation of $4 billion for severe vaccine injury cases

I see…much antivaccine material in this. There are a lot of antivaccine tropes in this list, and the NCVIA is a favorite bogeyman of the antivaccine movement. For instance, that bit about the “current and historical infectious disease data from the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics” strongly suggests to me the “vaccines didn’t save us,” a favorite gambit parroted by antivaxers ranging from Julian Whitaker to J.B. Handley to Dr. David Brownstein to Dr. Gary G. Kohls.

There are also some other featured speakers/panelists at this antivaccine quackfest. For instance, there’s Greg Glaser, the general counsel for PIC; Jacques Simon, another lawyer; and Brad Hakala, still another lawyer. Let’s take a look at them in turn. For instance, here’s the PIC description of Greg Glaser, and here’s a direct quote from him featured on the PIC website:

Like most Americans, I just assumed vaccines were harmless. After my daughter’s first round of injections, the experience forced me to open my eyes and actually research the matter. I found a suspicious list of vaccine ingredients, and an absolute certainty of widespread, under-reported vaccine injury across our population. Seeing my nephew suffer after the MMR vaccine also prompted me to research holistic ways to detox from vaccine injury.

Yep, Greg Glaser is clearly antivaccine, and he believes that quack “detox” methods can heal “vaccine injury”. But what about Jacques Simon? One area of law he likes, apparently, is advising doctors on how to write medical exemptions in California without getting into trouble:

This legal panel of attorneys will examine SB277, the new California law that mandates all children receive a one-size-fits-all vaccine prescription in order to attend both public and private schools. These experts will discuss best practices for physicians writing medical exemptions, as well as the legal standards for alternative methods in diagnosis and treatment and their application in the vaccine field.

Not surprisingly, there will be similar panel at the 2019 PIC quackfest entitled “Best Practices for Physicians Recommending a Medical Exemption to Vaccination”. Clearly, the idea is to instruct physicians on how to write medical exemptions without being sanctioned by the California Board of Medicine, the way “Dr. Bob” Sears was. In other words, the idea is to continue the gravy train of selling bogus “medical exemptions” to the California school vaccine mandate without getting into legal trouble. And, make no mistake, it is a lucrative business for antivaccine doctors and quacks.

Meanwhile, Brad Hakala is known for filing dubious lawsuits against SB 277, the California law that eliminated nonmedical exemptions to school vaccine mandates.

Yes, this is an antivaccine confab. It’s more lawyers than quacks (Toni Bark being the only definite antivaccine quack), but calling it a quackfest is not an exaggeration.

Physicians for Informed Consent: Antivaccine to the core

In all the Twitter kerfuffle over Prof. Gøtzsche’s involvement with PIC, whoever runs the PIC Twitter feed was not at all pleased and felt obligated to deny most vociferously that PIC is antivaccine:

Of course, what PIC is really for is most definitely not informed consent, but rather what I like to refer to as “misinformed consent.” Also, get a load of the groups with which PIC has associated itself in a coalition:

  • Alliance for Natural Health
  • National Vaccine Information Center
  • Association of American Physicians and Surgeons (AAPS)
  • Oregonians for Medical Freedom
  • IPAK (This is Jeffrey Lyons-Weiler’s group, and he’s antivaccine.)
  • Vermont Coalition for Vaccine Choice
  • Informed Choice WA
  • Immunity Education Group
  • Michigan for Vaccine Choice
  • SANE Vax

And more. All of these are antivaccine groups. It’s not even a close call whether they are or not, and notice how many of them include the word “choice” in their titles. “Vaccine choice” is code for antivaccine.

As for PIC itself, it is a radical antivaccine group, as our good friend Skeptical Raptor has pointed out. For instance, look at its “leadership team” and some examples of who’s on it. Besides being loaded with “holistic” quacks, the PIC leadership team includes:

As I said before, if PIC is not antivaccine, as an organization it sure has a funny way of showing it. I mean, look at how it misrepresents the risks of the measles vaccine.

But what about Peter Gøtzsche?

So we’ve established that the conference that Peter Gøtzsche was apparently scheduled to headline is an antivaccine conference organized by an antivaccine group featuring some prominent antivaxers. So whatever possessed Gøtzsche to agree to appear at this antivax quackfest? PIC must have viewed it as a major coup to land someone with a reputation like his to speak, even better to get him to speak about how he thinks that vaccine mandates are unethical, a message that antivaxers will eat up. How on earth could one of the founders of the Cochrane Collaboration and the former director of Cochrane Nordic be so clueless as not to know that PIC is an antivaccine group and RFK Jr. is a leader of the antivaccine movement? Again, I repeat that I don’t believe the claims of some of Gøtzsche’s followers that he was never going to speak at PIC. A group like PIC wouldn’t advertise the appearance of someone like Peter Gøtzsche if it didn’t have at least an email from him committing to appear at its conference.

The problem, I think, is that something’s happened to Peter Gøtzsche over the last few years. Let’s just put it this way. I used to be an admirer. Indeed, over the last few years I’ve tried very hard to give him the benefit of the doubt, but have been having a harder and harder time doing so. However, his rhetoric has been becoming more and more radical, referring to big pharma as organized crime. He’s also been becoming more and more anti-psychiatry, to the point where his rhetoric sometimes sounds uncomfortably like Scientology.

Then there are vaccines. Basically, Gøtzsche and his colleagues at Cochrane Nordic wrote a poorly reasoned critique of a Cochrane meta-analysis of the HPV vaccine criticizing the original Cochrane article for being biased and ignoring evidence. It was widely agreed that Gøtzsche and colleagues (including Tom Jefferson, whom we’ve criticized before) had vastly overplayed its hand and massively overstated problems with the review. The end result of the kerfuffle was that Gøtzsche was removed from the board of directors of the Cochrane Collaboration, with some leaving with him. From my perspective, basically, Gøtzsche has become a bit of a crank on some issues, including psychiatry, the HPV vaccine, and, arguably, mammographic screening.

So why did Gøtzsche do it? There’s no doubt that it’s a good thing that he publicly announced that he won’t be speaking at the PIC antivax quackfest. That would have been a major victory for antivaxers, with Gøtzsche lending his prestige to PIC, exactly what the antivaccine cranks who run the organization wanted. Indeed, check out PIC’s press release announcing the conference, dated the day before the Twitterstorm erupted:

As part of a full day of scientific and legal sessions, the PIC Workshop & Luncheon will include a lecture by Professor Peter C. Gøtzsche entitled “How Mandatory Vaccination Violates Medical Ethics.” Professor Gøtzsche is a physician and specialist in internal medicine; the founder and former director of Nordic Cochrane Center, Copenhagen, Denmark; and cofounder of the Cochrane Collaboration. He has published more than 70 papers in “the big five” (BMJ, Lancet, JAMA, Annals of Internal Medicine, and New England Journal of Medicine), and his scientific works have been cited more than 40,000 times.

So, yes, whatever Gøtzsche has said, PIC sure thought he was going to speak.

Here’s what, at the time, I suspected to have happened. PIC invited Gøtzsche to give a talk on the ethics of vaccine mandates with an appeal that played to his ego and suspicion of big pharma. Likely Gøtzsche didn’t know the true nature of PIC, and now that he’s learned it he’s backed out, disingenuously representing antivaccine sentiments as being ideologically opposed to vaccination (something almost no antivaxer ever says). Sure, I could be wrong, but I don’t think I am. Barring Gøtzsche issuing a more complete explanation than his cryptic Tweet above, we’ll never know. Whatever happened, I hope Gøtzsche has learned a lesson.

It turns out that I was more right than wrong about this, but that I probably gave Gøtzsche too much of the benefit of the doubt.

What really happened?

If you’re looking for an explanation of what happened, you’re going to have a hard time finding it…at least in English. Fortunately, readers pointed me to an article in Danish that included an interview with Prof. Gøtzsche about the incident:

The article is in Danish and behind a paywall, but, again, readers helped me out by providing me the text. I did Google Translate and cleaned up the result grammatically a bit to make it less awkward:

Professor Peter Gøtzsche canceled his presentation at a workshop for vaccine-skeptical organization, after his participation became the subject of massive criticism. Grotesque, says the protagonist himself.

»Hvordan obligatoriske vacciner krænker medicinsk etik.«

Something like that is the Danish translation of the title of the speech Professor Peter Gøtzsche was to hold at Physicians for Informed Consents (PIC) workshop in California until March. This is stated in the organization’s website.

But even though Gøtzsche would like to make the argument that vaccines should not be mandatory, he has nevertheless chosen to cancel his participation at the conference, where several stated vaccine opponents appear on the list of speakers.

“It sounded interesting to take over, because I have the same basic point of view that they have in terms of not having to be compulsory or something you are forced to do. Then we are almost over in psychiatry – this is the only place you force people to do something against their will. I believe that coercion in psychiatry clearly does more harm than good, “says the professor, who at the same time emphasizes that he was not aware that there would be speakers with such extreme views on the vaccine issue, as is the case when he agreed to appear.

I can see why PIC likes Prof. Gøtzsche so much; although he doesn’t realize it, he definitely talks the antivax talk, at least with respect to “informed consent,” as well as any antivaxer. I realize that it’s because he’s too clueless to realize that what antivaxers consider “informed consent” is not what he, doctors, and ethicists consider informed consent, rather than because he is antivaccine, but, again, his appearance at PIC’s conference would have supported antivaccine misinformed consent.

As for vaccines being “forced,” that, too, is straight from the antivaccine playbook and his characterization of vaccination as “forced” reveals, at the very least, a profound lack of understanding of vaccine mandates in the US. No one is “forcing” children to be vaccinated. There are no vaccine stormtroopers kicking in the doors of vaccine-hesitant parents in the middle of the night and forcibly vaccinating their children. Instead, we have a very simple requirement. To go to school or daycare, a child must have had a certain minimal set of vaccinations, based on the CDC recommendations with each state setting its own requirements, unless there is a medical contraindication to receiving them. Moreover, in all but three states (West Virginia, Mississippi, and, since SB 277, California) it’s laughably easy to get a nonmedical exemption based on religious or personal beliefs to school vaccine mandates.

Gøtzsche is also either deluded or arrogant—or both. He seems to think that by appearing at an event like PIC he can change antivaxers’ minds:

Peter Gøtzsche finds it difficult to understand why the “street parliament”, which he calls the high-spirited forces on social media, finds his participation in an event such as PIC’s problematic, because if one cannot speak to the skeptics, one cannot push them into the right direction either, he believes.

“I am still considering how to spread some light in the anti-vaccine darkness without even ending up in the gab,” says Gøtzsche.

Again, this attitude seems on the surface so very high-minded—and maybe it is—but it’s also so very, very out of touch with reality. These are not vaccine-averse parents attending this meeting. The speakers are all antivaccine activists, highly invested in the antivaccine ideology, and the vast majority, if not all, of the attendees will be hard core antivaxers. These are not people who are going to be persuaded by a single lecture, even by someone as eminent as Prof. Gøtzsche. Moreover, what would have come out of the conference would have been videos and pictures of antivaxers like RFK Jr. shaking hands with Prof. Gøtzsche and appearing with him on stage, thus appearing to give Prof. Gøtzsche’s imprimatur on the proceedings, which is exactly what antivaccine groups want when they try to entice someone like Prof. Gøtzsche to speak at their events. It’s what they want when they try to hold public debates with scientists, physicians, and science advocates, to elevate their crank viewpoint through proximity to real scientists and their giving the appearance that there is an actual scientific debate. Elsewhere in the article Prof. Gøtzsche says that he wanted to explain why PIC founder Shira Miller is so wrong about the measles vaccine and that Miller wanted him to. Of course she did! Having an eminent scientist go to the trouble of publicly refuting your antivaccine pseudoscience gives the false appearance that there is a real scientific debate! It would have been a win for Miller if Gøtzsche did this, because she’d instantly be elevated.

Fortunately, Stinus Lindgreen (RV), a bioinformatics expert from the University of Copenhagen who sits in the regional council of the Capital and is active advocating for vaccines, gets it:

But although Stinus Lindgreen shares Peter Gøtzsche’s view that vaccines should not be mandatory, he is far from agreeing that the way to “fight” the growing vaccine resistance is to speak somewhere like PIC’s workshop.

“The people who attend are not in doubt. They are opponents, and their attitude, I do not think you can make much sense of,” he says.

On the other hand, there is a risk that you will be used as a form of advertisement for the organisation’s attitudes, he believes. Because even though Peter Gøtzsche was planning to criticize Shira Miller’s skepticism towards the measles vaccine when he took the stage, it would only be those attending who would get that part of Gøtzsche’s talk.

What would remain would still be a picture of Peter Gøtzsche next to Robert Kennedy Jr. under the title: “How compulsory vaccines violate medical ethics.”

Exactly. Gøtzsche might be really pissed off because I referred to him as having gone “full antivax,” but I regret nothing else in terms of criticizing him for letting himself be used as a tool of an antivaccine organization, especially since, as of yesterday, he is still featured on the PIC webpage touting the conference, and a PIC representative was responding to inquiries with this:

Translation:

Quite a bit. Shira Miller (PIC-Pins) has told me that they are doing what they can to get Gøtzsche to speak anyway. So maybe because they still hope? But yes, not fat if you buy the ticket because of Gøtzsche!

And:

So, will Gøtzsche be speaking at the PIC conference? He publicly announced that he would not be, but PIC representatives are apparently jerking around potential attendees by leaving his picture on the conference webpage and telling them that they still hope that he will speak.

I assume that Gøtzsche meant what he said when he declared that he would no longer be speaking at the PIC conference, but, even so, I’m done giving him the benefit of the doubt. He no longer deserves it, as far as I’m concerned.