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Dunking on a 7′ hoop, or: Refuting Dr. Vinay Prasad’s attack on medical skepticism

This week, eminent young rising star oncologist Dr. Vinay Prasad once again expressed his disdain for skeptics. To borrow Dr. Prasad’s own metaphor, Orac shows how the esteemed oncologist’s renewed attack on medical skeptics is like dunking on a 7′ hoop. Unfortunately, it needs to be done, and Orac does it, refuting a truly ignorant and misguided attack.

Skeptics, like Rodney Dangerfield, “don’t get no respect, no respect at all,” at least not from academics. This lack of respect for what we do (and for science communication in general) has historically ranged from indifference to outright disdain and contempt and is nothing new. For example, Carl Sagan’s fame and science communication negatively impacted his career. Arguably, nowhere has this been more true than in the branch of skepticism dealing with medical claims and quackery; in other words, the very branch with which I’m most associated. Basically, there remains a prevalent attitude out there among all too many physicians, particularly academics, that countering quacks and antivaxxers is just so damned easy that it’s not worth our precious time and mental effort as physicians.  To some extent, that attitude is changing, a process that, from my perspective, began with the growing prominence of the antivaccine movement several years ago, whose growing influence resulted in measles outbreaks, and accelerated with the arrival of the COVID-19 pandemic in the US earlier this year and the tsunami of medical misinformation, quackery, and conspiracy theories that followed. Even so, the more things change, the more they stay the same, at least in some ways, which brings us to the case of someone whom I like to refer to as the very eminent rising star in oncology (VERSO), Dr. Vinay Prasad.

Late last year, Dr. Prasad made a bit of a splash (and suffered a bit of well-earned blowback) on social media. As I discussed shortly before the pandemic hit, a couple of months before that he had started Tweeting disdainfully and contemptuously about how criticizing Goop’s selling of jade eggs and other pseudoscience was like “dunking on a 7′ hoop” and how skeptics should put the hoop back up to 10′ by—of course!—joining him in taking on clinical trial shenanigans by big pharma. During our exchange, he even went so far as to suggest that I give up my usual topics for six months and spend those six months doing what he does (because—don’t you know?—what he does is so much more difficult and worthwhile). Interestingly, as I wrote that particular post, I had noticed that Dr. Prasad had deleted the most obnoxious of his Tweets, in which he had made fun of skeptics who deconstruct quackery and pseudoscience and communicate science-based medicine to the public, implying that such activity is so painful easy (you know, “dunking on a 7′ hoop”) as to be unworthy of our efforts and that what he does, analyze clinical trials and question commonly used medical interventions, is so much more difficult.

Of course, it never occurred to the eminent Dr. Prasad there’s considerable overlap in skillsets, given that skeptics frequently have to go deep into the weeds of the design and methodology of clinical trials of, say, acupuncture or homeopathy to demonstrate why these studies do not show what advocates claim. When this was pointed out to him, even more obnoxiously (and disingenuously), he portrayed that rebuttal as tacit confirmation that we skeptics secretly really do think that what he does is of so much more value than what we do and that that’s why we were arguing that we in fact do do the same sorts of analyses of clinical trials that he does. I’m not going to rehash that particular incident any more than I already have, except than to refer you to the last section of this post, other than as a prelude to say that this week Dr. Prasad was up to his old antics again.

What you care about = Waste of time. What I care about = So very, very important.

A year went by, and during that time Dr. Prasad did occasionally say the same sorts of things on Twitter, as I discovered from third parties (by then we had blocked each other). I only occasionally took notice, given that the COVID-19 pandemic and its accompanying torrent of bad science, pseudoscience, misinformation, and disinformation had more or less consumed my blogging efforts, with little time left for any other topic. Then, a couple of days ago, I saw that he had published an article on MedPage Today entitled, Applying Skepticism to Medical Skepticism, with the subtitle, “Debunking should focus on areas most in need — which might not be homeopathy.” Yes, basically Dr. Prasad, for whatever reason, decided to double down on his analogy. Worse, his article demonstrates that, not only has he learned nothing, but he still doesn’t even understand what he is criticizing as a waste of time. Basically, he’s learned nothing.

After expressing surprise that he got blowback on Twitter for having posted a Tweet with an image of a man literally dunking on what looks like to me a 4′ (not 7′ hoop) and writing, “Dunking on alternative medicine is like dunking on a 7-foot hoop; let’s raise it back up to 10 feet,” Dr. Prasad launches into condescension:

To my surprise, my tweet struck a nerve. My impression is that it was irritating to folks who, for the most part, spend time debating and debunking alternative and complementary claims or self-identify as doing so. Their objections to my tweet were twofold — first, some felt that they also spent time criticizing conventional medicine, and second, alternative medicine topics — like cupping and acupuncture — are important ways people waste their own time and money and are worthy of debunking. I hope that my thinking through this topic has the potential to inspire the next generation of skeptics to pursue the topics we need more activism on.

There’s no better way to win over people who normally would be natural allies than to dismissively inform them that you view what they do as so much less important, so much less difficult, and so much less worthwhile than what you do, right? Why on earth would they ever get their hackles up over that? And the very eminent Dr. Prasad was surprised that the reaction to his statement was so negative? No doubt he’ll be equally surprised at the negative reaction his MedPage Today article will likely engender. (Or maybe not. I suspect this time he is intentionally trolling skeptics, for whatever reason.)

Whatever the case, though, as before, Dr. Prasad is not only attacking a straw man version of medical skepticism, but he’s also misrepresenting some of our objections to his characterization of what we do. In this, he reminds me a lot of Scientific American journalist John Horgan, who in 2016 was invited to give a talk to the Northeast Conference on Science and Skepticism (NECSS), an opportunity he decided to use to take the skeptics in attendance to task for spending time analyzing and debunking what he called “soft topics” (e.g., Bigfoot and homeopathy) instead of his preferred “hard topics” (e.g., cancer screening and, yes, war). At the time, my response was very similar to what my reaction to Dr. Prasad’s latest was, because Dr. Prasad’s entire argument is basically the same, just limited to medicine. Just as John Horgan argued, in essence, “Why are you wasting time on Bigfoot and homeopathy when you should be devoting your efforts to conventional medical issues like cancer screening or to world peace?” Dr. Prasad is arguing, “Why are you wasting your time on homeopathy when you should be doing what I do?” Along the way, he makes some hilariously off-base claims. Or they would be hilarious if he weren’t so influential.

I once referred to Horgan’s shtick as “’Soft targets’ = What you care about. ‘Hard targets’ = what I care about.” Dr. Prasad’s shtick is a variant on the same theme, in essence, “What you care about = A waste of time and way too easy to be worth wasting brainpower on. What I care about = So very, very important and so very satisfyingly intellectually challenging.” (Oh, so very, very, very important. And difficult. While what you do is pathetically easy and unimportant. Why don’t you realize that, you ignorant boobs?)

I also like Dan Loxton’s response to this sort of dismissive, contemptuous argument:

I’ve spent much of my career confronting the common argument that skeptics should not perform the service skeptics do best, but instead tackle other subjects we may not be qualified to address. It’s a head scratcher, honestly. “You have specialized expertise in X, but I think X is trivial. Why don’t you specialize in Y, because I think Y is important?” Nobody ever says this to Shakespeare scholars or doctors or plumbers. (“Dear ‘fire fighters,’ fight fires less and solve more murders”?) Seemingly everyone says it to skeptics.

As I put it at the time, if someone came up to me and said, “Why don’t you stop writing about alternative medicine, antivaccine pseudoscience, and homeopathy and look at Bigfoot instead?” I’d laugh dismissively. Admittedly, it also grates when someone like Dr. Prasad says something like, “Why don’t you stop writing about alternative medicine, antivaccine pseudoscience,, and homeopathy and focus on cancer screening instead, medical devices, and useless surgical procedures instead?” Why? Because I’ve been writing about mammography and cancer screening, including over diagnosis and the shortcomings of screening for well over a decade! I even have a publication in the New England Journal of Medicine expressing skepticism over whether mammography and prostate-specific antigen screening has had as large an impact on deaths from breast cancer and prostate cancer as claimed. It’s even with H. Gilbert Welch, someone whom Dr. Prasad expresses great admiration for. Heck, I’ve repeatedly likened vertebroplasty to acupuncture—starting eleven years ago! Basically, skeptics can walk and chew gum at the same time—unlike Dr. Prasad apparently.

I’ll stop with this line of rebuttal (at least for the moment) because no doubt the ever-so-eminent Dr. Prasad will once again disingenuously interpret it as an admission that secretly I really do think that what he does is more important than what skeptics do. I will mention, though, that Dr. Prasad, as before, makes a number of rookie mistakes. One thing that’s particularly annoying is how he seems to think that his criticisms, which are really very unoriginal, haven’t been a topic of discussion and debate among those of us who’ve been at this a while. Basically, Dr. Prasad, like John Horgan before him, seems to think that he’s the first one to have made brilliant observations about medical skepticism that none of us have ever thought of before! In this, he reminds me of a couple of physicists I’ve discussed before who seem to think they’ve identified major shortcomings in our understanding of cancer that cancer biologists, surgeons, and physicians haven’t considered and already rejected or computer scientists who think that artificial intelligence will “solve” cancer in a decade.

Let’s dig in point by point.

A self-refuting argument

Dr. Prasad makes a simple point before he launches into his list of criteria that he believes medical skeptics should use as a framework to prioritize their efforts:

Let me start by acknowledging a truth of the cosmos: time is a fixed commodity. If one spends most of one’s time critiquing acupuncture or homeopathy — those are hours not spent critiquing robotic surgery, prostate-specific antigen screening, or a new prescription drug. Of course, any single person may have written on a variety of topics, but every hour spent on one activity is time taken from another. If you wrote 5,000 words on homeopathy, there is some other topic you did not write 5,000 words on. And, the truth is, there is waste — i.e., things that don’t work — in all domains: alternative and complementary medicine, but also conventional medicine. In other words, skepticism has an opportunity cost.

I was a bit amused reading this passage, because that “5,000 words” dig is almost certainly aimed at me, given my reputation for verbosity.

The contention that there is only limited time and that time spent doing one thing is time taken away from doing something else is what I like to refer to as a “Well, duh!” observation, a statement whose truth is so obvious that the most appropriate response is, “Well, duh!” But Dr. Prasad is clever. Note the false equivalence. He notes that there is waste in “all domains: alternative and complementary medicine but also conventional medicine,” as though the two were even on the same planet or in the same order of magnitude when it comes to waste. Let’s just put it this way. Complementary and alternative medicine (CAM) is nearly all waste because very little of it actually works! (And what does work tends to include science-based modalities, like nutrition and lifestyle, co-opted by CAM advocates.) Very little of it is supported by scientific evidence, and a whole lot of it is actually disproven rather than unproven. (There’s homeopathy again!) Yet Dr. Prasad seems to want you to think that conventional medicine, which, one must admit, does have a significant number of practices that are not as well-supported by evidence as they should be, is just as bad. It’s not. Not by a long shot! However, this false equivalence serves Dr. Prasad’s deceptive purpose in that it implies that time spent debunking quackery is “wasting time” that could be oh-so-much better applied to what Dr. Prasad considers important.

This is basically a self-refuting argument, and I can’t think of a better way of saying it than this:

And:

Yes, Dr. Prasad’s “opportunity cost” argument is a self-refuting argument. (After, all, even if it took Dr. Prasad, say, only a half hour to write his MedPage Today article, that’s a half hour that could have gone into critiquing the menace of big pharma. Why is he wasting his time criticizing skeptics for debunking homeopathy when he could be criticizing big pharma?) This is particularly true in that the vast majority of those of us who refute quack claims and debunk alternative medicine do it as a hobby. Unlike the case for Dr. Prasad, our activities promoting science-based medicine are not our careers. Dr. Prasad spends his work time doing what he does and garners copious funding for it, resulting in professional advancement and rewards. Nothing could be further from the truth when it comes to medical skepticism aimed at alternative medicine; indeed, few have managed to forge anything resembling a successful academic career applying skepticism to alternative medicine (although I do see more opportunities emerging in studying science denial, like the antivaccine movement). Dr. Prasad doesn’t seem to realize that his suggestion is yet another false equivalence and that, in reality, what he is suggesting is that we skeptics should spend all our free time that we normally devote to what he refers to dunking on a low hoop to doing what he does.

Cost and harm

The first four items in Dr. Prasad’s “framework” of how to think about prioritizing skeptical activities all boil down to three things: Cost, harm, and whether it affects other people; so I will treat them as a single block. First, Dr. Prasad makes this observation:

1. Cost. All things being equal, we should focus our energies on interventions that cost more (per unit), and have greater budgetary impact (total cost for all units). Some medical devices and pills cost in the tens and thousands of dollars per use or month, and conventional healthcare is a nontrivial portion of the U.S. gross domestic product. Conventional medicine is like alternative medicine in terms of budget impact, but add one or two more zeros.

Using the same argument, perhaps we should disparage doctors who focus their time on rare diseases because, well, you know, they affect so few people and cost so little money compared to the big diseases like heart disease, cancer, diabetes, and asthma. Actually, that is rather how our current system works. Given that there is only a limited amount of resources and time, of course people tend to devote their time and resources to the more common, big problems, but we generally don’t disparage people who decide to devote their time to less common problems that cost less money, do we?

Also, Dr. Prasad’s is a very US-centric view. In the US, alternative medicine is big business, but not as big as big pharma and big medical device, but the same is not necessarily true elsewhere in the world, as I will discuss in a moment in the context of Dr. Prasad’s other arguments.

Let’s move on to #2:

2. Harm and invasiveness. All things being equal, we should focus our time on interventions that have greater harms — death, perforation, cardiac arrest — than those that offer minor harms — cutaneous bruising. We should focus more on things that are invasive — placed inside or within — that those that are merely superficial.

It’s here that I’m going to throw Dr. Prasad’s opportunity cost argument right back at him. Sure, many, if not most, alternative medicine treatments are harmless. However, it is also true that there are quite a few alternative medicine treatments that are potentially very harmful, such as subjecting autistic children to bleach by mouth and enema to treat their autism, black salve to treat cancer, chiropractic (vertebral dissections, anyone), and even acupuncture. In other words, the “harms” of alternative medicine are not just “cutaneous bruising” (as from cupping). Those examples aside, much of the harm of alternative medicine is the opportunity cost; in other words, patients who pursue ineffective treatments for their disease end up letting their disease progress to the point where it causes more harm (or even kills them) or at least becomes a lot more difficult and expensive to treat. It’s funny how selective Dr. Prasad is in applying his “opportunity cost” argument. Or maybe it isn’t, as he appears to be mainly trolling with extremely disingenuous arguments.

I’ll treat #3 and #4 together:

  1. Does it affect other people? This is an important factor. Topics that affect others — the spread of contagious infections — are fundamentally different than topics that affect only ourselves — e.g., cupping for pain. We should give extra attention, all things equal, to practices that have implications for others — like infectious diseases.
  2. Who pays? I think it matters who pays for a therapy. Individuals are free to use their own money as they see fit. An individual might spend money on a lavish car or golf clubs, or even furniture, wallpaper, or décor. Wearing a copper bracelet for arthritis or wearing a silver one for beauty are both things we do because they make us feel better. Ultimately it is impossible to tell someone how they ought to spend their own money. At the same time, practices covered by health insurance are all of our concern. Through tax subsidies, government funded healthcare, these are things we all pay for; thus, we have a special responsibility to think critically about them.

Of course, the main reason skeptics spend so much effort on refuting antivaccine pseudoscience is that, by scaring parents out of vaccinating their children, antivaxxers endanger other children. In the age of COVID-19, antivaccine disinformation could result in the unnecessary deaths of untold thousands who will refuse to be vaccinated against SARS-CoV-2. I’m glad to see that Dr. Prasad agrees with us that combatting such disinformation is important!

As for the question of who pays for woo, Dr. Prasad demonstrates shocking ignorance. He seems to labor under the delusion that alternative medicine is solely the province of Goop-loving, jade egg-buying, homeopathy-loving people with, as British comedians David Mitchell and Robert Webb once put it, more money than sense and that none of “our” money goes to purchase this quackery.

He’s quite wrong, and, once again, also demonstrates a very US-centric view of the world—and an ignorant view at that. For example, let’s go back to Dr. Prasad’s favorite hobby horse whose debunking he loves to keep contemptuously referring to as “dunking on a 7′ hoop.” Did Dr. Prasad ever hear of the United States Pharmacopeia-National Formulary (USP-NF) or the Homeopathic Pharmacopeia of the United States (HPUS)? Yes, the FDA determines what homeopathic remedies are permissible, something mandated by law since 1938! Does Dr. Prasad even know that some states (e.g., Arizona) license homeopathic physicians? Does he know that many states license naturopaths and that all naturopaths are trained in homeopathy? (As I put it, you can’t have naturopathy without homeopathy.) Homeopathy is part and parcel of naturopathy, with the naturopathic licensing examination (NPLEX) featuring clinical vignettes and questions involving homeopathy, and, while some naturopaths don’t practice homeopathy, most do. Also, did I mention that naturopathy is infiltrating academic medical centers and that the Veterans Administration is increasingly paying to have naturopaths and all manner of other alternative medicine practitioners treat veterans in its medical centers? Indeed, the VA even hired a true believer to bring quackery to veterans.

That’s just the US. In France, the government reimbursed its citizens for homeopathy for many years until it was finally decided to phase this funding out as a result of—you guessed it!—skeptical activism. These skeptics also paid a price, with attacks and one of them even seeing his license suspended for signing an anti-homeopathy statement. Meanwhile, traditional Chinese medicine (TCM) is big business in China, with China working actively to export it to the world and to codify it through its influence over the World Health Organization into the ICD-11, all while criminalizing criticism of TCM. China has even reportedly forced people to undergo TCM treatment for COVID-19. Meanwhile, in Germany and other parts of Europe, quack cancer clinics preying on desperate patients are big business spreading to other parts of the world.

I could go on and on and on about cost (NCCIH, anyone?), but you get the idea. Dr. Prasad is not only clueless about what medical skeptics do, but he’s utterly oblivious to the cost and potential harms of what he views as “harmless” alternative medicine, at least “harmless” in comparison to the harms he considers important.

Vinay Prasad on “unmet need” and power of persuasion?

I’m going to treat #5 and 7 as a unit, because it strikes me as appropriate. First, Dr. Prasad is so very, very, very concerned about our ability to persuade. This is a not unreasonable concern, but, again, he treats his utterly unoriginal observation as though it were some startling new revelation that we clueless skeptics had never considered before. Noting that whether or not a new drug or device is the best treatment for a given disease is a question that tends to have “swing voters,” or a “massive number of healthcare providers who simply have not taken a stand” and are therefore presumably open to persuasion, he goes on to write:

Issues that are deeply challenging are those that wed politics, identity, and tribalism. Topics like herbal medicine, chiropractic, and (sadly) even masks during COVID-19 may have become so deeply polarized and tied to identity that argument can no longer persuade. In these cases, if the cause is sufficiently important — such as MMR vaccination — I think we should move towards randomized trials of different persuasion strategies to find what actually works. If, however, a topic fails by several aforementioned metrics, I think we might just have to let it go.

Wait, what? Here, Dr. Prasad seems to be suggesting that because issues such as the use of masks to slow the spread of COVID-19 and vaccination against measles, for example, have become so polarizing and wedded to political or ideological “tribal” identity, we desperately need randomized clinical trials of of different persuasion strategies to tell us which ones work. In and of itself, that’s not a horrible idea, but it’s almost as though Dr. Prasad is either utterly ignorant of the entire discipline of communications known as science communication. (If only we had people who have studied these questions and tried to figure out the answer to the question of which science communication strategies work the best!) I find Dr. Prasad’s attitude particularly odd in the middle of a pandemic, in which countering misinformation that keeps people from cooperating with public health interventions or, now, being vaccinated against COVID-19, could literally save thousands upon thousands of lives. Do you see the inconsistency at the heart of his arguments?

It’s also as though Dr. Prasad thinks that skeptics don’t think of these things routinely pretty much every day and that we spend our time trying to persuade the hard-core, those who are nearly unpersuadable. We actually agree that these people are so unlikely to change their minds and then only at the cost of incredible effort that our efforts are better spent elsewhere. Indeed, one reason why I now emphasize the central role of conspiracy theories in medical denialism, antivaccine views, and quackery is not just because conspiracy theories are central to these problems (they are), but because recognizing this centrality allows the crafting of “pre-bunking” messages that empower those susceptible to messages by the hard core science deniers by recognizing the characteristics of conspiracy theories and bad arguments before they encounter them.

Dr. Prasad’s arguments get worse, though:

7. Unmet need. You as a skeptic should take stock of which fields have unmet needs. My research team is doing some ongoing work to identify places in medicine where no one is a critical third party. These places desperately need you. Just like investigative journalism, sometimes the best stories emerge from domains where no one is looking (e.g., local politics). I worry that some topics have oversized interests — acupuncture — while others are neglected entirely — base of skull surgery.

Acupuncture is an oversized interest? What planet is Dr. Prasad on? Does he realize how few in number and influence critics of acupuncture are in comparison to the number of academics who have uncritically embraced this unscientific practice based on a prescientific understanding of how the body works? Does he even know that, for example, Harvard has offered a yearly course in acupuncture for well over a decade now and actively defends it against criticism? Does he realize how many academic cancer centers offer acupuncture or that acupuncture has now infiltrated the American Society of Clinical Oncology (ASCO) conference, the cancer conference that, I’m sure, he attends every year? (ASCO has even endorsed a set of quack guidelines for treating cancer.) Contrary to Dr. Prasad’s Twitter-warped perception of the issue, skeptics taking on alternative and “integrative” medicine are far more akin to how Dr. Prasad sees himself with respect to big pharma and big device: Outgunned, outmanned, and outspent by the opposition. Skeptics are addressing a largely unmet need!

His is, again, that most offensive of dismissive arguments, namely, “Why aren’t you interested in what I’m interested in, because what I’m interested in is so much more important than what you’re interested in?”

While I’m on this, Dr. Prasad apparently thinks that the reason we do what we do is because we love them clicks:

Above all else, the goal of skepticism is to encourage better healthcare choices. In the world of Facebook and Twitter it is easy to be misled. Absolute and blanket condemnation may be popular amongst people already inclined to oppose complementary and alternative medicine, but perhaps unlikely to persuade anyone who sees value in the practices. The modern information ecosystem encourages preaching to our choirs, rather than broadening our base. We must be careful to avoid this temptation.

Again, Dr. Prasad seems to think that we’ve never even considered the problems of “preaching to the choir,” while ignoring the observation that preaching to the choir is not always a bad thing; for instance, it can be a very good thing indeed when it motivates skeptics and gives them the tools to join the fray. He also seems to think that we are incapable of nuance, but maybe that’s just projection. Come to think of it, maybe Dr. Prasad’s accusation of being controversial for the clicks is projection too. (I suspect that there is no “maybe” about it.)

One area where Vinay Prasad and I agree

In the name of looking for common ground, I’m going to conclude with one point that Dr. Prasad makes that I actually agree with, but my agreement with him on this point actually makes what he does with his observation even more puzzling to me:

6. Your unique skill set. In deciding what you should spend your time on, it is important to think about what you are uniquely qualified and able to comment on. If you are a practicing orthopedic surgeon or allergist-immunologist, you are part of a tiny guild of people who have the knowledge to even identify the excesses in your field. Sure, you can talk about vitamin C, but so can many others. Why not focus on what few can do?

No skeptic I know of would disagree with the contention that people should do what their unique skillsets make them uniquely qualified to do. The problem is, as Steve Novella has pointed out, that Dr. Prasad seems not to view skepticism, science-based (as opposed to evidence-based) medicine, and science communication as a skillsets. Similarly, his perspective seems to be warped by the very social media tendencies he decries. He seems to think that, because he’s riled up a lot of skeptics on Twitter resulting in their taking him to task, there must be a lot of us compared to doctors like him.

What I mean is this: There are lots of physicians who are critical of big pharma and big device, who analyze “conventional” clinical trials and find fault with them and their conclusions. There might not be a lot of physicians who’ve made an academic career of such criticism, as Dr. Prasad has (an achievement for which he deserves plaudits), but there are plenty of physicians who do this sort of thing. In contrast, in the grand scheme of things the number of physicians who engage in skeptical activism about alternative medicine is tiny indeed. Certainly, the increasing influence of the antivaccine movement and, now, the rise of COVID-19 science denialists have led to an increasing overlap between the groups of physicians and medical scientists who both analyze and critique the science behind conventional medicine and also combat medical misinformation and quackery, and I view that as a good thing. Indeed, I hope that overlap only grows and doesn’t recede once the pandemic finally abates. That being said, though, I’m going to turn Dr. Prasad’s argument right back at him: Medical skeptics are focusing on what the “few” can do better than the vast majority of doctors. We are doing what so few else are willing to do, and some of us are paying a price for it professionally and personally (aside from having to deal with the arrogant scorn of academics like Dr. Prasad).

I would add that physicians—and people in general—should also pursue what they are passionate about. If you’re passionate about critiquing clinical trials and thereby (hopefully) improving them, as Dr. Prasad is, then have at it! I won’t criticize you if what you’re doing has value to science and society. What is perpetually frustrating, though, is Dr. Prasad’s seeming inability to give skeptics the same consideration coupled with his highly annoying penchant for lecturing skeptics about how we should not concentrate on what we are passionate about even though our activities have value for science and society, simply because he doesn’t think it’s sufficiently “important’ or “challenging.” Indeed, Dr. Prasad’s concluding paragraph is profoundly offensive, as he returns to his “dunking on a 7′ hoop” analogy:

Social media algorithms encourage us to chase the popular, faddish and, dare I say, 7-foot topics — like homeopathy — and perhaps not the topics where we are desperately needed. Topics that cost a lot, impact budgets, are paid for by insurers, have serious harms, are invasive, affect others, where there are lots of undecided people, where there is unmet need, and where we, with our unique skillset can help. Those are the 10-foot issues. I think it’s time we raise the hoop.

Homeopathy is a “popular” and “faddish” topic? Again, what planet is Dr. Prasad living on? It’s a perpetual topic in skepticism because, no matter how ridiculous its precepts are, homeopathy just won’t die. Moreover, what skeptics do addresses almost exactly what Dr. Prasad claims it does not, “topics that cost a lot, impact budgets, are paid for by insurers, have serious harms, are invasive, affect others, where there are lots of undecided people, where there is unmet need, and where we, with our unique skillset can help.” Dr. Prasad seems to think that all we are battling as medical skeptics are jade eggs, magnetic bracelets, and chanting reiki masters. He is dismissing the pseudoscience and quackery that we battle with, in essence, a hearty “What’s the harm?” Meanwhile, although it is impossible to quantify exactly how many people are dying of COVID-19 due to conspiracy theories, pseudoscience, and science denial, there is no doubt that the toll is real and that the number affected is a very large one.

I conclude with a message for Dr. Prasad: No one expects him to join our efforts if he doesn’t consider what we do to be important or sufficiently “challenging” for his apparently stupendously awesome medical intellect. We could certainly use someone with his skillset, but such is life, and he’s generally doing good work in a subdiscipline of skepticism. I only wish that Dr. Prasad could bring himself to recognize or accept that we are also doing good and necessary work in skepticism, even if it’s not his cup of tea, so to speak. At the very least, he could do us the favor of not regularly shitting on what we do with his criticisms based in ignorance, arrogance, straw men, and false equivalence, because, given his ignorance of the pervasiveness and harm of medical misinformation and disinformation, coupled with his refusal to address what we actually do, refuting Dr. Prasad’s criticisms is, to borrow his own analogy, “dunking on a 7′ hoop.”

I have a suggestion. Dr. Prasad should either learn what we actually do by—well, duh!—actually talking to us instead of lecturing us or, being too lazy or uninterested to do that, at least do us the favor of staying out of our way. That would be one way he could raise the hoop back to 10′, because, as all skeptics recognize, attacking straw men is dunking on a 4′ hoop. Sadly, when not dealing with clinical trials and big pharma, Dr. Prasad sure does seem to love dunking on ridiculously low hoops.

Thus endeth my 5,000+ word treatise on Dr. Prasad’s bad arguments. You know, now that I’ve finished it, I have to admit: He might had a point. Dunking on a 7′ foot hoop like his criticisms of skepticism might have been a waste of my time. It’s a good thing for me that taking on pseudoscience in the age of a pandemic is more akin to my trying to dunk on a 12′ hoop as a person with mediocre (at best) skill playing basketball, and I now return to that task, which is never-ending.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

91 replies on “Dunking on a 7′ hoop, or: Refuting Dr. Vinay Prasad’s attack on medical skepticism”

Dr. Prada reminded me of the MAC Davis song:

Oh Lord it’s hard to be humble
When you’re perfect in every way
I can’t wait to look in the mirror
Cause I get better looking each day.
To know me is to love me
I must be a hell of a man

It seems to me the central problem is arrogance, not thinking that people have no doubt thought about what you’re doing and the problems and pitfalls with it. He could have read up on all these aspects of his work – some might think one should read up on the stuff relevant to ones work – but didn’t, instead choosing to pretend he alone can recognize blah blah blah. Can’t blame him for not wanting to do the work he should have, but it is hard and he obviously would prefer not to.

Sceptics, like Dr Prasad, write about what they think is important and what interests them.
Since late January, this blog has addressed Covid-19 most of the time, which has also captured the public’s interest overwhelmingly. If you think about it, many subjects at RI are indeed good background material for the current pandemic era: science denialism, anti-vaccination, how to convey SB information to the public, how social media interferes with public health, how individuals or groups transmit misinformation for profit and how governments’ and institutions’ realistic information can be disregarded because of other intervening factors.

I rarely comment but to this I will: #1, I hardily endorse your skepticism focus. #2, hard to put briefly, experts do have a tendency to want to speak to other experts about expert things, but the real need, as COVID as so clearly demonstrated is the appalling lack of any kind science/medicine literacy in this public. Yes, some interesting/important/difficult issue may deserve priority but the public will never know about it and they are bombarded daily with false information and thus who is going to counter this. It’s quite interesting to hear lawyers discuss how silly the Trump lawsuits are, even teaching the rest of us something about how the law really works, and, #3, you and your colleagues provide information for the rest of us to encounter medical/scientific stupidity F2F, while I didn’t succeed in convincing my sister of the stupidity of stem cell treatment for knees, at least I could present some arguments for her to consider. Your work gets amplified when the rest of us now have the facts. And, #4, please ignore anyone who does the my work is more important than yours, as something I’ve often encountered in my career and find intensely irritating and arrogant.

Oh, dmill96, I feel you on the “knee stem cells”. I took me months to try and talk my MIL out of it (eventually one of her friends said something that changed her mind), and I work in cell transplantation.
I know she didn’t want another knee replacement. I know that this thing sounded so easy. It’s really hard to argue against that.

Hopefully your sister won’t come to any harm from her injections.

If Dr. Prasad wishes to lead by example, he should furnish us with his daily schedule in detail, so that we can verify he only spends time on activities that further his expressed concerns. One hopes he doesn’t allow any hobbies or petty family matters to intrude on his vital work. Time potentially wasted on meals and excessive sleep should also be figured in.

I’d also appreciate seeing a photo of him standing next to a 7′ basketball hoop, to verify that he can even get up that high. 🙂

On a more serious note: an example of skeptics taking to heart the injunction to deal with More Important Matters is the change of direction at Skeptical Inquirer. There’s been a marked reduction in the debunking of supernatural claims and woo, in favor of earnest articles dealing with such subjects as climate change and race. While I agree with much of what the authors have to say on those matters, I enjoyed reading SI when it came to subjects like spontaneous human combustion and medical quackery. Instead, they’ve largely turned into a watered-down version of a mainstream publication like The Atlantic. They should have stuck to what they were good at.

Dr. Prasad is probably pretty good at dissecting problems with clinical drug trials. I suspect he’d be lost trying to counter antivaxers’ claims regarding Covid-19 vaccines (he may not have noticed, but that’s a subject of major importance just now). I’d have problems trying to tease out statistical anomalies in papers on cancer medications, or developing advanced frameworks for clinical trials. Why would Prasad want what he’d undoubtedly view as much less expert people horning in on his focus of interest?

Why would Prasad want what he’d undoubtedly view as much less expert people horning in on his focus of interest?

Perhaps because he’d find it easy to shit on them from his elevated position? He clearly doesn’t want to waste his precious time actually doing the work to understand what the the science based medicine sceptics do, but if they transferred their efforts over to his field he’d have easy targets to dump all over.

I wish I’d kept the citation, but there was an article written in the late 1800s/early 1900s that actually made it into a medical journal about how the reason you no longer saw spontaneous human combustion was because of radiators. You see, alcoholics drink so much that their tissues become saturated, and when exposed to open flame, will ignite. But, no matter how long something sits on the radiator, it won’t burst into flame. It will simply get toasty.

As far as clinical drug trials vs. homeopathy, if you’re aiming at the general public and not specialty audiences, people can get homeopathic products at the grocery store, but have no access to trial drug, so they might find the homeopathy discussion more useful.

You see, alcoholics drink so much that their tissues become saturated, and when exposed to open flame, will ignite.

Colour me, well, skeptical.

Wikipedia gives the LD50 for alcohol in rodents as ~7.3g/kg, or about 0.7% by weight. It’d be easier to make beer catch fire.

When a chemistry-grounded mommy and daddy love each other very much, they sometimes produce chlorine trifluoride together, proceed to stand in it, and ‘poof’.

@prl/Terrie – Also at least parts of the temperance movement weren’t exactly noted for scientific rigour in their propaganda.

That’s interesting. I stopped subscribing years ago as I was tired of the supernatural and biblical stuff–I had dbunked all that all by myself (with a big thanks to Carl Sagan’s Demon Haunted World).

I did the same. The last article that I enjoyed was a take down of Bruno Bettelheim, the guy that decided autism was caused by “refrigerator mothers.” Then the other stuff was just repetitive. Eeks, I am sounding like Prasad. I did enjoy the comments in the back of the magazine.

But, I had three young children and things get cluttered. To reduce clutter, I canceled all but a couple of craft magazines (sewing for me, woodworking for hubby… though he decided to not renew). I did buy a disk with the first twenty years of SI content that I could read anytime at TAM 9.

Dr. Prasad is probably pretty good at dissecting problems with clinical drug trials. I suspect he’d be lost trying to counter antivaxers’ claims regarding Covid-19 vaccines (he may not have noticed, but that’s a subject of major importance just now).

Yes, he almost certainly would. The reason, of course, is that he’s used to drug company manipulation of clinical trial data, which is done for profit and uses predictable statistical tricks. These are different techniques than what are used by denialists like antivaxxers and COVID-19 deniers. Hell, I bet that Dr. Prasad would have a hard time dissecting a “positive” RCT of homeopathy and explaining why the “positive” result is not actually positive.

Dr. Gorski writes, “he’s used to drug company manipulation of clinical trial data, which is done for profit and uses predictable statistical tricks.”

What? Drug companies manipulate clinical trial data? They do it for profit? Wow! This is quite a revelation.

Thank you for finally admitting it.

Good day and good health to you.

What? Drug companies manipulate clinical trial data? They do it for profit? Wow! This is quite a revelation.

Thank you for finally admitting it.

Those of us with sufficient skill know this and recognise when it is being done and point it out. What we also know is that the science relied on by anti-vaxxers is truly awful.

Natalie White apparently missed the outcry from scientists when the companies in process of developing a SARS-CoV-2 vaccine were pumping their product via what is called “science by press release”.
They were met with skepticism and warnings about lack of data and transparency by scientists.
For example:
https://www.politico.com/news/2020/06/05/drugmakers-media-coronavirus-303895
I know “science by press release” was pretty much universally condemned here at RI in the comments.

Another part of the irony is that in 2020, there is no good excuse to being ignorant about the harms of misinformation and disinformation. If he does not realize why disinformation is a problem, including in medicine, he simply hasn’t been paying attention.

If he thinks it’s not important to debunk it and respond to it, he’s actively part of the problem that brought us where we are on the Covid-19 pandemic. By publishing his article, he is actively working against debunking, and setting us up for continuing problems.

That’s almost as

I don’t do this for the “slam dunk”. I do it because I have to protect my patients from infections and the anti-vaccine movement which has metastasized to an anti-public health movement thta is killing people in this pandemic. Wankers like Prasad make me glad I didn’t try fit in with academics like him.

I think Dr. Prasad might be the victim of too much academic success too fast. It’s gone to his head, and he thinks that what he does is so much more important than what others do that might be related. Yes, there’s definitely a huge helping of arrogance there, and he has some huge blind spots, such as his defending John Ioannidis (because they’re friends apparently) when Ioannidis went off spreading dubious science about COVID-19.

What’s really irritating and frustrating is that skeptics and Dr. Prasad should be natural allies. The battle against misinformation and disinformation, to us at least, doesn’t end with homeopathy, cupping, jade eggs, and, yes, antvaccine pseudoscience cancer quackery. The whole thing is a continuum, from the “ridiculous’ pseudoscience whose debunking Dr. Prasad dismisses as “dunking on a 7′ hoop” to conventional medical practices with poor science behind them to drug company shenanigans. As a favorite quote about Nazis goes in the movie “The Great Escape”:

…you talk about the High Command and the Luftwaffe, and then you talk about the Gestapo and the SS. To me, they’re the same! We’re fighting the bloody lot! There’s only one way to put it: they are the common enemies of everyone who believes in freedom.

I’d paraphrase that to say that we’re fighting the whole bloody lot, too, medical woo, bad science, and big pharma’s data manipulation! They’re the enemies of everyone who believes in science-based medicine!

That being said, division of labor is important. Skeptics, whether like me or like Dr. Prasad, should do concentrate on what they are passionate about and are good at and not shit on each other. Dr. Prasad needs to learn that lesson.

I can always tell when reasonable scientists ( Ioannidis, Gotzsche, Doshi etc) become entranced with “dubious” ideas/ material because they are raved about at PRN.fm. Usually, the scientist is lauded as an “Orthodox” medical professional who has now seen the light because their position is likened to the woo-fraught host’s nonsense even when it is only vaguely related

This occurs along with other frantic misinformation as Covid rages on and vaccines are introduced, alt med/ anti-vaxxers stir up doubts and fears –
–today AoA – Kim hurls hackneyed insults at a Bloomberg Opinion writer who dares to write that vaccines are less dangerous than the illness itself.
–Natural News publishes fear mongering about hiv being in Covid 19 vaccines.
–We experience the same from trolls here

Anyone who understands what mRNA is and how it is incorporated in the new vaccines to combat the virus should have no meaningful fears:
it illustrates that they don’t know what they’re talking about or they just lie easily.
Even the most simple news reports explain why the vaccine is not the virus and how it works: I’ve heard this hundreds of times on television and in print/ internet.
Some people can’t – or won’t- learn…

,

^^So much what you just said^^

Each of us doing what we do best and support each other in doing it and learn from each other.

I’ve been amazed for a while by the whisper network (or something) that has managed to put people off of the VZV vaccine down in the concentrations of Florida retirement communities that currently surround me.

(Not this one, but down the road.)

Crappy tertiary care is… crappy. My Dad is at least together enough to realize that vultures swarming around with hospice pamphlets have all the subtlety of used-car salesmen.

I used to listen to Dr. Prasad’s podcast before he went on his rant against skeptics, and as someone who isn’t a clinician I know I’m not his target audience. But how does he expect that people will understand how to evaluate clinical trials for issues like using substandard treatments as a control or survivor bias or cherry picking patient populations without also understanding that homeopathy is crap and naturopaths are just playing at being doctors? Maybe the hoop is low because many people, including some physicians, are still falling for these scams.

A Pubmed search (“Prasad V” with clinical trial filter) retrieved the very small number of clinical trials that he seems to have been involved in. There may be others, it’s hard to be sure that a medline search captures everything. One was a multicenter N=180 trial of cord blood to treat autism, and one was a secondary publication of results from the COBLT study of cord blood banking.

I was unable to find a single clinical trial for which he was principal investigator, designer, or lead author. As I said, maybe my lit search was incomplete.

But with experience like that, I’m glad he’s criticizing the clinical trials run by others.

I think each regular here rebutted one of the points I was noting as I read through this, so thanks because I need to go waste some time forwarding credible information to my children and grandchildren, all of whom I have managed to “brainwash” into being proper skeptics (which I am pretty sure is contributing to their survival of this pandemic).

Grandma Skeptic gets enquiries almost daily from one of her progeny (it’s a largish family) about some kind of woo and wastes even more time perusing RI and SBM for the appropriate time-wasting well-written and well-documented response. Good thing that, because she has wine to drink and runs to take to burn off that wine and cookie–because thanks to being born skeptical and drawn to wasting time reading about it, she knows that fad diets, herbs, or acupuncture won’t do it for her. (Yes, I know that it’s important to not eat the cookie to begin with–and the wine really is an actual serving–5-1/2 oz–I measure.)

If Prasad is so concerned about appropriate targets or subjects of interest for examination with a more sceptical perspective, why doesn’t do as I am sure several* here do and send a note to our esteemed erudite educator, Orac?
*Not to include certain usual suspects

Because he is the epitome of egg head. Ugly, and eggheadish. Ohh so many words to point out the glaring faults of others; every single word deserved; but that just proves to the others that, “I suck?” and they don’t like that. And… I forgot where I was going with this; so good night, Gorski, and thank you.

A long time ago, we had a French physician commenting here at RI, on about similar lines as Dr Prasad. To paraphrase, on about how homeopathy, by example, is obviously nonsense and doesn’t deserve any time debunking it, so we should spend our time more constructively on “real” medical issues.
That was before I learned that homeopathy was an accepted and recognized specialization choice in French medical school. There is an homeopath with a bona fide MD right at he corner of my street. Should I had known that at the time, I may have chimed in with some scathing remarks.

Personally, I think that all errors should be pointed out. I’ve seen attitudes that say you should ignore the harmless misapprehensions but I disagree totally. Firstly, people then go on to build on these falsehoods. Creating a life based on falsehood as it were. Start them off with a firm base and it’ll be to their benefit later. Secondly, if your mistakes are never corrected, you turn out like the antivaxxers who, without embarrassment, argue as if they are on the same level as someone with years of specific education and experience.

If nobody ever explains why you are wrong, you’ll think you’re right. Preferably start from birth! 😁

However, I frequently argue with people who know better than me. Mainly so I can get a better explanation as to why my assumptions are wrong.

you turn out like the antivaxxers

On a apropos note, we can also bring in the concept of crank magnetism.
We all have blinkers and could believe some weird stuff, but a lot of people tend to go down the rabbit hole and accumulate weird or misconstrued stuff.
Either building on previous misconceptions or slanted worldviews, or simply collecting them like so many knick-knacks.
In medical matters, naturopaths are a prime example.

Surprised to see no one’s yet mentioned
http://whatstheharm.net/
unless my scanning/searching of the thread has been too cursory.
This post got me looking at the site for the first time for some time: it looks well constructed, but it seems difficult to find recent examples (<10yrs), and many of the links are broken.
Would be a shame if it’s not maintained, but I can imagine it’s a whole load of heavy lifting for somebody.

Orac’s exceptional “skeptical” mind and medical writing skills are entertaining. Great post, Orac!

@ Dr. Vinay Prasad,

To be entertaining is to be influential, and Orac is entertaining.

@ Orac,

I admire your intestinal fortitude to jump into the mud and wrestle with the pigs, and RI skeptics.

One wonders how Dr. Prasad will react when one of his oncology patients tell him he’s all wrong about HPV causing cancer and that the HPV vaccine is useless and even worse – dangerous and deadly.
I’m sure he’ll just smile at them and not be bothered on whit with the evidence of the harm vaccine disinfo is causing.
I’m sure he’ll deny that there is any sense in attempting to refute the delusional anti-vaccine, anti-science disinformation promoted by vaccine grifters and foisted upon their naive and trusting acolytes.
.
A doctor/scientist who will not defend his science against bat shit insane crackpot propaganda that will kill their patients is hardly praiseworthy.
Prasad should be the one being lambasted for his inaction on the anti-vaccine and anti-science front.
His patients are going to die and he is too proud to combat the disinfo that is leading them to make deadly choices.
It’s like an auto mechanic who is told by his customers that a legion of crackpot sites/grifters have revealed that the engine doesn’t need oil – that’s all a pro-oil scam and he doesn’t try to correct the disinfo but merely replaces the engine… repeatedly.
.
…Some doctor he is.

Speaking of Dr. Prasad berating others for wasting their time on trivial matters:

According to an article on the website The Cancer Letter, Prasad has been a very busy beaver on Twitter, to the tune of 30,000 tweets (as of 2018). That sounds like an enormous drain of time and energy better spent on research looking into the truly important things Prasad emphasizes.

https://cancerletter.com/articles/20180622_1/

I found it interesting that Prasad is cited as resorting to name-calling when debating his ideas online, using adjectives like “stubborn” and “boneheaded” as well as telling opponents to “STFU”. Yet in another interview (on the MIT Technology Review website) he describes how he abhors others getting “personal” with him.

Sounds like he’s happy to dish it out, but very thin-skinned when he’s the target.

I have neither the education or experience of Orac, Dr. Prasad, or other commentors here, and am hesitant to offer my Little Tikes plastic 3 foot hoop perspective. However, from this perspective I see the overwhelming need for debunking woo and anti-science beliefs and rhetoric in communities, as well as in mommy groups and comment sections across social media. I see parents being told not to trust pediatricians and specialists, to avoid vaccines and medical interventions and use untested, unproven, and unregulated “therapies” such as homeopathy, essential oils, and herbs instead. I see children at best being subjected to lots of extra supplements and at worst suffering medical neglect. I see parents being told that they can “cure” autism with extremely restrictive diets or abuse such as MMS. I see women being convinced that it is safe to avoid prenatal care and to give birth without medical interventions. These are growing threats to individual and public health, and we need the voices of M.D.s, scientists, and other true experts to debunk those who are spreading this misinformation and disinformation.

I certainly don’t expect Dr. Prasad or others like him to waste their time reading comments on mommy blogs, but also doubt that he has any idea of the amount of harm being done every day by Big AntiPharma/ AntiScience and their true believers. The view from down here is often quite bleak; we need the voices and knowledge of expert skeptics to counter the damage being done by cranks, quacks, and snake oil salespersons.

Ever phished your ex, impersonated her on her favorite ‘mommy blog’, and thumbed out the most outlandish* crap to ever get ‘liked’? All the ‘friends’ stand in solidarity to find/make stuff up to validate it. Mommy blogs — It is the salt of Earth for a bored troll, I tells ya.

*factual doesn’t cut it because all the other ‘mommies’ have heard it all before

Well, then u are just missing out. Probably shot all your life-points doing mundane stuff involving real relationships and gloppy wetware.

@ Juilie B–concerned parents like you often tipped me off as to where pertussis outbreaks and unvaccinated clusters were in my practice area, which was very useful since the county health department citing non-existent HIPAA concerns would not give physician any geographically useful information. But those proud anti-vax “warriors” just can’t shut up about how great their kid getting a vaccine preventable disease is in their local mommy/parenting groups. If there’s someone in your area who can use what you are seeing (and that includes local reporters and TV stations, who often want to cover these stories), let them know. There’s no way any one person can filter through all the social media alt.med echo chambers, but there’s usually someone in your community who will help you fight these crazies.

Prasad and other specialists rarely deal with this stuff, if ever. I do all day long. So do others in the primary care fields. It’s getting worse by the day and, when I ask, I soon learn that most of it comes from the places you described…or just social media in general.

So for months Democrat governors have been questioning the “Trump” vaccine (and yes they used those very words).
Cuomo said that it was bad news that the vaccine might come out during the Trump administration and he and other governors were going “to fix or stop a vaccine distribution plan before it does damage”
And California governor was going to have 11 members of a team look at the FDA’s approval and the test results before allowing Californians to get the vaccine
And people wonder why 40-50% of the american population does not want to get the vaccine.

And a note to Orac please fix the picture of the glass breaking, it is very misleading as the rim height is 10 feet and has been since James Naismith set the height in 1891.
If an anti vaxer would make such a mistake the “Baconator” would be all over the post.

And people wonder why 40-50% of the american population does not want to get the vaccine.

What would you estimate the percentage of the commentariat to be that is rather tired of your clumsily determined attempts at frottage?

Because the politicization and enderpification of the agencies by firings and hirings of Trump toadie tools and a PR* campaign to include manipulation and witholding of data over science-based policy has eroded trust. For months,Trump himself has publicly tried to ‘rush’ things — He promised a vaccine before election day and then bemoned that did not happen because the company mearly wanted to slight him and cause his loss. Of course, some want their own science teams to go over the filings first.

If (probably already are) satisfied that it is safe then Trump will try to use your reguritation of those very concerns to withold doses from them dems.

Here is a prediction; Trump ain’t takin’ “His” vaccine. He, himself believes it to be unsafe when it probably isn’t; Despite him.

While my pushing the money drenched but heavily bureaucratic @US_FDA saved five years in the approval of NUMEROUS great new vaccines, it is still a big, old, slow turtle. Get the dam vaccines out NOW, Dr. Hahn @SteveFDA. Stop playing games and start saving lives!!!

— Donald J. Trump (@realDonaldTrump) December 11, 2020

https://www.mediaite.com/news/breaking-white-house-reportedly-pressured-fda-chief-was-told-to-approve-pfizer-vaccine-by-end-of-the-day-or-update-his-resume/

*right down to having those in his campaign hierarchy review and rewrite CDC guidance over, and over, and over again — always a watering down

Hahn’s “an untrue representation of the phone call” is muddied because, in an interview this morning, he declined to give any insight as to what might be a ‘true’ representation of the call. And we all ready know how Trump is and what Trump does and how his toadies give him cover over it {see: Sharpiegate}.

“What was so different, though, was the political involvement, not only from H.H.S. but then the White House, ultimately, that in so many ways hampered what our scientists were able to do,” she said.

Top C.D.C. officials devised workarounds. Instead of posting new guidance for schools and election officials in the spring, they published “updates” to previous guidance that skipped formal review from Washington. That prompted officials in Washington to insist on reviewing updates.

Brian Morgenstern, a White House spokesman, said that “all proposed guidelines and regulations with potentially sweeping effects on our economy, society and constitutional freedoms receive appropriate consultation from all stakeholders, including task force doctors, other experts and administration leaders.”
.
.
“Every time that the science clashed with the messaging, messaging won,” Mr. McGowan said.

Episodes of meddling sometimes turned absurd, they said. In the spring, the C.D.C. published an app that allowed Americans to screen themselves for symptoms of Covid-19. But the Trump administration decided to develop a similar tool with Apple. White House officials then demanded that the C.D.C. wipe its app off its website, Mr. McGowan said.
.
.
“It’s demoralizing to spend your entire career preparing for this moment, preparing for a pandemic like this. And then not be able to fully do your job,” Mr. McGowan said. “They need to be allowed to lead.”

https://www.nytimes.com./2020/12/16/us/politics/cdc-trump.html

So your ok with manipulation of misleading headlines or photos (or western blots or the title of your papers) to prove your point or make your point, interesting and yet ironic.

As to Nonards and Tiny Tim,
you wonder why people are hesitant to take this vaccine. It has been vilified since Trump announce the fast track, 10 months ago, mostly by democrats but the news media in general.
And to your point that Trump gets the vaccine, why would he have to get the shot, he has already had the virus and has immunity. I am sure if Trump did take the shot, you would all claim that he deprived someone else the vaccine.

To the Baconator, you posted 60% of the American people would take the covid shot. How is that any different than what I posted that, 40-50% of the american would decline the shot.
I bought a teen talking “Barbie” in 1992 for my daughter. The best phrase it has “Math class is tough” she still has it, worth a lot of “Rubles” today or since Biden was elected “Yuan”. You could learn lessons from that Barbie.

“why would he have to get the shot, he has already had the virus and has immunity.”

It’s a bold strategy, Cotton; Let’s see if it works out for him.

Also, at the risk of spoiling Orac’s fun over watching u vascillate over not getting it, that image was after a ten-foot hoop had just been torn down.

Go ‘Cats

“It has been vilified since Trump announce the fast track, 10 months ago, mostly by democrats but the news media in general.”

O,K. Mr. Snerdley; this next caller is brought to you by LifeLock and Norton SimplySafe worthless VPN…

I am sure if Trump did take the shot, you would all claim that he deprived someone else the vaccine.

He is in the at-risk age group. He is entitled to be first in line.
Now, if his Executive Order had resulted in the full production of the Pfizer vaccine – developed for a good part in Germany – becoming exclusively for US consumption, we Europeans may have made a hissyfit.

And to your point that Trump gets the vaccine, why would he have to get the shot, he has already had the virus and has immunity.

The last point remains to be confirmed.
No, I don’t mean i doubt that he got the virus. The whole circus made it clear they were worried.
I’m talking about getting lasting immunity. While documented reinfections cases have been very rare so far, coronoviruses are known to not give lasting immunity. Usually. This one may turn out to be different.
So maybe Trump is good for six more months, or more. Or maybe a booster shoot would do some good.
Ultimately, it’s none of my business. It’s between his doctor and him.

That being said, there is another reason as to why Trump should have considered getting the shot.
If Trump wanted to get some nice News coverage, getting publicly the vaccine would have been a very good operation.
He may even pretend-getting the vaccine, if he wanted – getting a saline instead of the vaccine.
That would have been a good occasion to act presidential and send a unifying message. “See, here is the vaccine I pushed the development for, and here I am taking it, for the American people”.
Missed opportunity here.

“acting presidential”* is not in the cards for this flimflam man.

*except for all the ‘pretend president’ this reality tv flop has managed to eek out.

That would have been a good occasion to act presidential and send a unifying message. “See, here is the vaccine I pushed the development for, and here I am taking it, for the American people”.

IIRC, Pfizer was not part of “Operation Warp Speed.”

@Scott Allen Problem is that Trump is such a awful manager. As a parting shot, he said that he would fire FDA commissioner if EUA for vaccine would not be accepted. Great way to build confidence, is it not ?

While I agree people can spend their money how they like, I’m not sure how much that counts when the purchase is made based on a false premise. Think about it like this: if someone gets scammed, we don’t think “oh they just spent money how they wanted to”, we realise they’ve been tricked and (ideally) punish the scammer. The same should be true of alt-med.

Unfortunately, Lower-case scott is conflating questions about fairness of vaccine distribution and a wish to have experts confirm the FDA’s recommendations with being antivaccine.

Gallup polling shows a continuing increase in the percentage of Americans who would accept a Covid-19 vaccine (60% say so, and that’s in response to a question about if they’d get vaccinated right now. A substantial number of fence-sitters are waiting for general usage to confirm effectiveness and safety of the leading vaccine candidate(s)).

The photo accompanying the article is “misleading” only to petty maroons.

Lower-case scott

I’m going to test out ‘randiscule’ to see whether Old French can successfully hold this allocoinage together.

A lot of fence sitters will naturally be in the later groups, because they’re not high risk, so I suspect that once we look back at “Who got the vaccine immediately upon becoming eligible” we’re going to see it’s most people.

Just a couple of points:

Preaching to the choir is also arming, educating and inspiring the choir, who will then reach more people, which is the important thing.

Homeopathy is very important as a gateway to ‘proper’ skepticism eg I consider myself to be reasonably intelligent, I have a wide interest in the world in general and try to keep myself reasonably well-informed, but until I read Ben Goldacre I had no idea about it – I had just assumed that homeopathy was some sort of herb based medicine, I can’t tell you the sense of shock and betrayal I felt on learning the truth – how can the government etc allow people to sell water as medicine without even warning us, it is an unspeakable outrage and betrayal of trust. The thing is that most people can understand why homeopathy is utterly worthless – but only if someone takes the trouble to explain it to them.

I like to think that when Johnny Rotten said “Ever get the feeling you’ve been cheated” he was channeling the spirit of Hahnemann.

Is importnt Orac, Orac shud say. Othr doc, let Orac feel strong even if no cool.

Mos peopl shood no do Tritter btw.

@ Reality writes – “I know “science by press release” was pretty much universally condemned here at RI in the comments.” Yeah, really? That’s not what I am referring to. Pharmaceutical companies manipulate data, have faced criminal charges and paid fines for it. It’s part of the business plan/expenses. Don’t play dumb. You’re smarter than that. Is it time to post another corporate rap sheet?

This is more entertaining anyway. https://www.youtube.com/watch?v=CcmWpX6r2qI

Good day.

You would notice that antivax “science” get lots of comments here. Lots of autism and SIDS data comes from other sources than pharmaceutical companies.
You suggest that clinical trials are completely falsified. COVID vaccine is now in phase 4,
which is not controlled by Pfizer. if they falsified data, they would be exposed soon. Falsification would cost billions of dollars.

Natalie’s “Good day” signoff gives me an unwanted image of Paul Harvey in drag.

Need brain bleach. Does Costco sell it in 10-gallon jugs?

@Natalie White
Pharmaceutical companies manipulate data, have faced criminal charges and paid fines for it. It’s part of the business plan/expenses.Assuming best intentions, your logic is broken. You conflate corner cases with a market model. Do all pharmaceutical companies incorporate criminality into their business plan? (no). Why should the pharmaceutical companies be any different than any other companies? (doesn’t profit == evil??). Just because car mechanics have been known to provide less than excellent service doesn’t mean they are all arseclowns – or that I should start buying magic crystals instead of getting the car serviced by a mechanic. It’s not all or nothing, and you make the mistake of believing it is. A more balanced view doesn’t consist of two polar cases where only one can be true (and it wouldn’t automatically be because you cherry-picked a fault with the alternative “view”).

Just because there are problems with an airplane, doesn’t make it wise to invest in magic carpets instead.

@Huh writes, “Just because car mechanics have been known to provide less than excellent service doesn’t mean they are all arseclowns” Correct. I agree. If a mechanic is crap, their business won’t survive. Word gets around. People ask. People talk. A faulty mechanic can be charged with manslaughter. They don’t get the pHARMa liability loophole.

With the mechanic analogy, we have only two to choose from – Pfizer and Moderna. Pfizer’s rap sheet shows me all I need to know….unethical, dishonest. No problem as long as shareholders and execs keep getting paid.

Moderna has NEVER brought any product to market….and this is a new method/technology. Pass.

My immune system is robust. I’ll take my chances. I’ll keep wearing the muzzle in public because it’s mandated in Commifornia. Although the mask wearing doesn’t seem to be improving our numbers. Hmm? Go figure?

Thanks for your civil response.

Have you heard of Kary Mullis. He was a real scientist. Seemed like an honest, good guy. Too bad he died just months before this started. I wonder what he would say.

https://www.youtube.com/watch?v=qt-jmy-_MDQ

@Natalie White “I have robust immune system “. Famous lats words … Sadly, you would infect others. That is why it is not your business.
Moderna and Pfizer both have same vaccine, and Pfizer do have vaccines in the market. MRNA vaccines have not hit market before, because you know, nothing should be done first time. Trump picked it, because it is fastest way to produce vaccine.
You still believe that clinical trials were completely falsified ? It is part of surface protein, so problems should predictable.

Liability protections protect pharmaceutical companies from tort liability, in some circumstances.

They are not a barrier and have nothing to do with criminal prosecution. They are not protection against criminal actions, if there’s ground for one.

You don’t have to protect yourself against any disease. But rejecting protection based on misunderstanding law, conspiracy theories and anti-vaccine misinformation is a mistake, and others should understand that that’s where you are coming from.

1) Don’t care.
2) You know that there are huge parts of the world where you have to show a vaccine card to enter a country, right? Even if it’s just a layover? This is hardly new. Why are you so shocked and surprised by things that a very commonplace outside the US?

@ JustaTech – You make a lot of assumptions. I’m not shocked. I was answering Renates question.

“You know that there are huge parts of the world where you have to show a vaccine card to enter a country, right? Even if it’s just a layover?”

Where? To my knowledge, yellow fever will hold you up if there is no proof of vax. The Phillipines is now requiring polio, I think. The other vax are recommendations but not required. Where are these HUGE parts of the world? Citation please.

There is talk of making coronavirus vax a requirement and that is what I was referring to. What’s next proof of the lame flu vax?

Good day.

@Natalie White
The USA is not the entire world (4%?) – but it only took 30 seconds to find your claim of ‘PHARMa liability loophole” belongs in antivax soviet mindfuck hole it came from (https://en.wikipedia.org/wiki/List_of_largest_pharmaceutical_settlements). Yes pharmaceutical companies can be criminal – companies are made of people, people can be criminal (duh). Have you considered the role shareholders play in institutional criminality? It may explain why individual car mechanics don’t organise their criminality on the scale of companies that provide automotive mechanical services (or any other business). But if you want to play “whatabout” – perhaps you should follow Prasad’s sage advice and go enlighten banking critic forums with your magical thinking and misunderstanding of lais·sez faire economics (where an unregulated market shuns mechanics AFTER they’re killed lots of peoople). Hint: it’s government regulation that prosecutes and license car mechanics – and pharmaceutical companies. It’s why homeopathy, phrenology, and Goop should be exposed as scams – they hide behind the same “liability loophole” as “big phARmA” (profit, and freedumb of choice to play doctor on others).
Your self-evaluated “robust immune system” won’t protect your from COVID19, or HIV. As for masks – they definitely work AS PART of a layered defense strategy. i.e. they’re useless if you wear them on your chin and don’t wash your hands – you will still transmit the virus. Which is why I’m glad you won’t be allowed to fly – unless Trump or Gulliani start an airline. If you do fly here (Australia) I pity the passengers and flight crew that have to share the air with you, and the other travelers you’ll be quarantined with on arrival. All our muzzling in public has kept our economy going, minimized public harm, and protected civil rights (can’t have them without living people).
Seriously – do you not understand the relationship between public health and individual freedoms? Please don’t take it personally – I find your views repugnant but…. you’ve been lied to. Most of your views are built from false news. Much of it deliberately false. I hope you find the truth and keep yourself and your family and friends safe. I highly recommend Steakumms Twitter feed over Fox News and Fffffacebook.

“Please don’t take it personally – I find your views repugnant but…. you’ve been lied to. Most of your views are built from false news. Much of it deliberately false. I hope you find the truth and keep yourself and your family and friends safe.”

Aw..C’mon man! What a bunch of malarkey! Don’t fret with your fake concern. I’m doing great! I hope you are paid well for your time. Looks like your “beatdown” took a while to excrete. Just tryin’ to keep up with my reputation.

Good day mate.

https://www.youtube.com/watch?v=Zd85uKfZVxg

I always recommend reading Ben Goldacre. In this case, Nat, I suggest Bad Pharma. You know, the entire book based on the fight to get complete data from Pharma companies and exposing the marketing procedures used to get doctors to use their products, amongst other things. Written by a science and evidence based skeptic and doctor. Not by an antivaxxer. Problems with Pharmaceutical companies are well known. You guys are really late to the party.

It is worth repeating, Pharma data is NOT the only data. Pharma are NOT the only institutions carrying out studies and trials. America is NOT the only country in the world. No one relies solely on Pharma press releases to determine safety.

Thank you for taking on Prasad so deliciously. He is such an insufferable douche. I’m an ID doc and first encountered this guy on an OFID podcast and it dawned on me pretty fast that he was “off”. My main thought was “Why is the great Paul Sax interviewing this tool?”. Since then I’ve been happy to find so many kindred spirits on Twitter and the blogs I have followed faithfully for years, like yours. Everyone in medicine is far too familiar with this sort of massively overconfident dweeb Mama’s special boy type which infests our profession Ugh. He so richly deserves the skewering and you do it so well.

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