A self-proclaimed EBM expert rushes to kiss RFK Jr.’s conspiracy-spewing posterior

Remember a week and a half ago, when in my post about why RFK Jr. will be such a catastrophe for public health and biomedical research as Secretary of Health and Human Services, I said that I’d try to post more regularly? I’m half tempted to insert this scene from a forty-year-old Arnold Schwarzenegger movie:

Of course, I didn’t lie. Really, I didn’t. I meant it at the time. It’s just that, once again, life intervened. In any case, in the ten days since I last posted, a lot has happened, or, as John Oliver would say, it has been a busy week. Since RFK Jr.’s nomination was announced, we now know most of the rogues’ gallery of grifters, antivaxxers, MAGA opportunists, and a Fox News pundit, who will be running the various agencies that fall under HHS. For example, does anyone remember Dr. Dave Weldon? I almost didn’t, because I hadn’t thought about him in years. It turns out that Weldon is a real blast from the antivax past, a Representative from Florida who, along with Indiana Rep. Dan Burton, was one of the main go-to Congressmen for the antivax movement in the late 1990s and early 2000s. He was voted out of office 16 years ago, but he’s back, this time nominated to run the Centers for Disease Control and Prevention. Yes, if Weldon can win confirmation, there will be diehard “thimerosal in vaccines causes autism” antivax conspiracy theorist in charge of the CDC, reporting to a diehard “thimerosal in vaccines causes autism”—in reality just “vaccines cause autism” conspiracy theorist—boss, RFK, Jr.

I could go on but will just list the rogues’ gallery that is Donald Trump’s health nominees that we know of so far:

• HHS Secretary: Robert F. Kennedy, Jr.
• CDC Director: Dr. Dave Weldon, who has no qualifications other than being a physician and is antivax.
• FDA: Dr. Martin Makary, We’ve discussed him before.
• Surgeon-General: Dr. Janette Nesheiwat. (In fairness, she doesn’t appear to be antivax. She is, however, a Fox News pundit and sells a line of self-designed supplements on her website, because of course she does. “Surgeon-General recommended”?)
• NIH Director: Dr. Jay Bhattacharya (probably; it’s not official yet)

You get the idea.

Obviously, any self-respecting physician who views himself as all about the science and evidence with respect to healthcare should be appalled at these choices. At best (Dr. Nesheiwat), they’re lightweights and ideologues, while at worst (RFK Jr., Dave Weldon), they’re hardcore antivaxxers, with some in between (Makary, Bhattacharya). UCSF medical oncologist and COVID-19 contrarian Dr. Vinay Prasad thinks he’s all about the evidence and science when it comes to medicine and health, so much so that he loves to remind you of just how devoted he is to evidence-based medicine, in comparison to everyone else who just doesn’t EBM as good as he does. Moreover, as he will happily and contemptuously tell you, unlike us “skeptics,” he doesn’t waste his time dealing with trifling quackery like homeopathy and antivax, because to him they’re so easy to debunk that it would be a waste of his planet-sized brain to bother, just as much as it would be a waste of LeBron James’ talent to dunk on a 7′ hoop. Too bad he can’t see how much his contempt for us mere “skeptics” has predisposed him to falling for the very failures in reasoning we skeptics try to teach people not to fall for.

I’ll now quote a song that is, shockingly (well, to me, anyway) nearly a quarter century old, “Oops…I did it again,” because—oops!—Dr. Prasad did it again, sucking up to RFK Jr. I realize that Prasad’s done this at least once before, when he mentioned that he thought RFK Jr. had some “good ideas” and even fell for RFK Jr.’s “no saline placebo” gambit, an antivax trope so hoary that debunking it felt like wiping dinosaur dung off of an old rotting chestnut. But, hey, I guess Prasad’s gonna Prasad. His planet-sized brain has bigger fish to fry, apparently. In any event, behold Dr. Prasad kissing RFK Jr.’s posterior so embarrassingly fiercely that he likely could see RFK Jr.’s uvula from the inside. His brown nosing RFK Jr. came in the form of a Substack entry that I’ve been meaning to get to for a week now:

• Do other countries do it? A simple litmus test for RFK Jr’s ideas. (“A simple litmus test for RFK Jr’s ideas is do other, sensible nations do it that way.”) Seriously, Dr. Prasad is obsessed with the false concept that there is only one “right” way to do something, failing to acknowledge that, depending upon the circumstances, there can be more than one way to skin a cat.

There are, of course, several other posts by Prasad and his cronies at Sensible Medicine that I would like to take on, but let’s dissect this one first, which is an obvious example of Dr. Prasad sucking up to RFK Jr. Basically, he searches the world desperately to find countries that do a few things that RFK Jr. supports and concludes that this must mean that RFK Jr. is not wrong about those things. As you read, you’ll also note that he’s obsessed with “correctness,” as if there is one way to do things. As I like to say, contrary to Dr. Prasad’s apparent belief, the current CDC-recommended vaccine schedule is evidence-based and science-based; it’s just that it isn’t just evidence- and science-based. One has to take into account real world conditions and what is feasible.

In fairness, I will start by emphasizing the one area about which Dr. Prasad is “bold” enough to disagree with RFK Jr., as I believe in starting positive and giving credit where credit is due:

The MMR vaccine is not linked to autism based on my reading of the literature, with studies excluding an OR of 1.02 or higher, which is quite stringent. All European countries recommend MMR vaccines. Japan says a single dose of MMR. No country that I am aware of us says don’t give it because of autism. Here I think if RFK Jr wants to discourage MMR— that is a bridge too far because no one does that.

Bravo, Dr. Prasad! At least he can admit that there is no evidence that MMR vaccine increase the risk of autism. But what does Dr. Prasad mean by its being “a bridge too far” if RFK Jr. “wants to discourage MMR”? After all, it is inarguable that RFK Jr. does want to do exactly that: Discourage, if not outright ban, the MMR vaccine! He’s been portraying the MMR as poison causing autism dating back at least 15 years, and he’s “discouraged MMR” before—and fairly recently, too! Dr. Prasad apparently conveniently forgets—or, less likely, is completely unaware of—what happened in Samoa in late 2019, around the time that the first cases of a mysterious novel viral pneumonia were being reported in Wuhan China. I don’t forget. I remember very well how RFK Jr. tried to persuade Samoan officials that the MMR vaccine was dangerous—in the middle of a deadly measles outbreak that killed over 70 children, too! He even wrote a letter to the Prime Minister of Samoa blaming the outbreak not on low MMR uptake among Samoan children, but rather on the vaccine itself! He also met with local antivaxxers and helped them stoke fear of the vaccine. Given that (relatively recent) history, what makes Dr. Prasad conclude that RFK Jr. has reformed himself and won’t try to do the same thing now for the entire US?

Please, Dr. Prasad, my brain is not the size of a planet, like yours. I’m just a humble physician-scientist-skeptic who’s been following RFK Jr.’s activities closely for nearly two decades. Perhaps in that time I missed something and need educating that only your genius can provide! Perhaps you can also, while you’re at it, explain why you can’t find it in yourself to condemn RFK Jr. for promoting another antivax propaganda film disguised as as documentary, VAXXED III: Authorized to Kill, which is the second sequel to Andrew Wakefield and Del Bigtree’s VAXXED, which I described as antivax propaganda at its most pernicious.

Let’s move on to other areas. Unsurprisingly, Dr. Prasad doesn’t think that RFK Jr. is wrong to object to the birth dose of the hepatitis B vaccine:

Switzerland and Austria do not recommend hep B vaccination for low risk babies AT BIRTH. In the USA all mothers are screened for Hep B, and there could be some compromises here, as RFK Jr. does not like this vaccine at Birth.

In fact there are lots of differences in global vaccination schedules. You can find that here is a way to compare. schedules.

The point here is that an honest scientists would admit that we have no idea which country has the correct schedule, and some childhood vaccines should re-enter the overton window for debate.

This is just a rehash of a bad argument that Dr. Prasad has made before. To repeat: There are sound scientific and epidemiological rationales to recommend vaccination against hepatitis B shortly after birth, including maternal transmission to the newborn and the observation of hepatitis B transmission in school and daycare settings. Once again, if Dr. Prasad had done the least bit of research or engaged in the slightest bit of intellectual honesty, he would have acknowledged the reasons why the CDC recommends a birth dose of hepatitis B vaccine. Yes, it is true that not all countries have chosen that strategy, but the US has, and there are very defensible scientific reasons to have adopted it. Moreover, it’s not the birth dose of the hepatitis B vaccine per se to which RFK Jr. objects. Like all antivax attacks on the birth dose, RFK Jr’s attack is a feint to hide his objection . Criticizing the birth dose is just an easy way to misdirect parents into wondering why we are vaccinating newborn babies against a disease that is primarily transmitted sexually or by needle sticks and sharing needles. It’s primarily a moral argument, much as objections to HPV vaccines given to preadolescent girls based on claims that such vaccination will encourage promiscuity are moral, not scientific, arguments. The idea is that my baby or child isn’t at risk because my child doesn’t have premarital sex, share needles, or engage in what I consider morally dubious high risk behavior. The subtext, of course, is that those “dirty vaccines” should be reserved for people who need them because they are dirty too.

Prasad also does love him some straw men:

Moreover, doctors who say “vaccines save lives” ‘all vaccines are safe and effective” are usually idiots. They haven’t studied the topic or even thought about it for 1 second. Some vaccines are vital. Some are debatable, and some were net harmful (mrna for young men during covid). Vaccines are like drugs. We need better evidence.

Notice the conflation? Sure, lots of doctors say, “Vaccines save lives,” because as a group, in particular, the CDC-recommended schedule and the evidence-based schedules of other countries, vaccines do save lives—a lot of lives. This can be true, even if not all vaccines are safe and effective. The reason is that vaccines that aren’t safe and effective tend to fall rapidly out of usage, if they make it into the recommended vaccine schedules of various nations at all. As for the straw man I’m hard pressed to find an evidence-based doctor who would ever say that all vaccines are safe and effective. Seriously, I challenge Dr. Prasad to point me to a direct quote from a legitimate vaccine advocate, scientist, researcher, or physician stating that “all vaccines are safe and effective.” He’s set fire to a straw man large enough for the glow to be seen by the crew of the International Space Station as they orbit overhead.

Next up, Dr. Prasad can’t resist Prasading again and going all EBM fundamentalist on us once again to undermine the childhood vaccination schedule. Behold this gem:

A simple way to answer definitively which childhood immunization schedule is best is a cluster RCT in the USA. Randomize different provinces or states or counties to different schedules. This would allow to assess for even additive or combined side effects, a claim that vaccine hesitant folks have made for years. RFK Jr. should do this.

Really, Dr. Prasad? It’s just that easy? How could it be that vaccine experts were so stupid and clueless not to have thought of such an obvious trial? Tell you what: Why don’t you write up an outline of a protocol to describe just how you would go about randomizing different states (or counties within states) to different vaccine schedules? Besides this whole approach being unethical given that, through many epidemiological studies and other lines of evidence, we already know that the current vaccine schedule is safe and effective, is Dr. Prasad unaware that the CDC can’t order individual states to do anything with respect to their vaccine schedules. The CDC advises; the states decide whether to use the CDC-recommended schedule or not. It is obviously true that nearly all states do use the CDC-recommended schedule, but they don’t have to. Think about it, though. How would Dave Weldon (assuming he’s confirmed as CDC Director) and/or RFK Jr. persuade individual states to subject themselves to whatever randomization process that Dr. Prasad—or an RFK Jr. sycophant, toady, or lackey like him—might come up with? Some red states would likely object to being randomized to a schedule with more vaccines or vaccines given earlier; some blue states would likely object to being randomized to a schedule with fewer and later vaccines.

It should be quite obvious that Dr. Prasad’s proposal is deeply unserious and that, unless he’s an utter ignoramus, surely he must know it. It’s just there to fool the rubes. Of course, he can always prove me wrong. He can write a detailed abstract or summary of his proposed trial on his Substack describing exactly how such a trial would be carried out, complete with statistical justification and power calculations. I suspect, however, that he will not. It’s far easier to sound scientifically profound by proposing a vague, likely incredibly expensive and definitely unfeasible, “cluster randomization” trial at the state or county level that will never be done. Of course, such a trial is not meant ever to be done. It’s meant to cast fear, uncertainty, and doubt on the childhood vaccine schedule.

As for what is the “correct” schedule, there is no one single “correct schedule”! Indeed, let me quote a debate that I discussed once before in which reasons why different countries might choose different schedules, reasons that are entirely science- and evidence-based, but also have to take into account local considerations, are discussed.

In Europe and the US:

In nearly every jurisdiction, decisions regarding vaccine schedules are made by formal advisory bodies consisting of experienced practitioners, public health officials, vaccinologists, and epidemiologists. Available data are reviewed, burden of disease assessed, and practical considerations for vaccine delivery evaluated to produce an appropriate schedule for each country. Thus, expert advisory bodies may develop differing recommended schedules, based on local, regional, or national considerations. For example, the second dose of MMR vaccine is routinely given in Germany at 15-23 months of age, while in the US it is administered at 4 to 6 years. Strong trial generated evidence shows that two doses separated by at least 28 days and the first dose administered on or after the first birthday will produce measles immunity in 99% or more of people. The timing of the second dose varies in each country based on the ability to provide the earliest possible second dose that will minimise the burden of measles. Ongoing surveillance of measles cases ensures that the timing of doses remains appropriate to the epidemiology of disease.

In contrast, in Africa:

Consider also the primary vaccination schedule for infants. The EPI schedule recommends immunisation at 6, 10, and 14 weeks in central Africa based on the early burden of vaccine preventable diseases and the need for efficient vaccine delivery when infants are most accessible. In contrast, the primary schedule in North America and much of Europe is 2, 4, and 6 months; in these populations, the lower risk of acquisition of many infectious diseases and better access to care permit vaccination to be incorporated into established well child visits through the first six months of life.

So in other words, it’s important in Africa to get children fully immunized as early as is practical because they are more at risk, which might result in a different schedule because African babies aren’t available for well child visits at 2, 4, and 6 months. These are the sorts of local considerations that result in differences in vaccine schedules, even though all the public health officials responsible for producing these vaccine schedules are looking at more or less the same scientific evidence. Antivaccine warriors never seem to understand that and try to paint any differences in vaccine schedules between nations as evidence of how “unscientific” the process is. This is, of course, nonsense. It is no more unscientific than science-based medicine. The process of selecting vaccines and deciding upon their best timing is a process that is based in science, but this isn’t a perfect world, which means it can’t be based only in science. Other considerations, as I have discussed, come into play and are inextricably linked to the science. The overall goal is to produce the most scientifically rigorous and defensible vaccine schedule possible given the other constraints that impact the decision-making process and the prevalence of specific vaccine-preventable diseases in the countries deciding on a vaccine schedule.

Dr. Prasad, being the EBM fundamentalist that he is, thinks that there must be only one “correct” vaccination schedule and that variability is a sign of the vaccine schedule being unscientific. It’s bullshit, again, deeply unserious and ignorant.

Much of the rest of the post consists of examples where countries do things differently than we do. One is fluoridation:

I am working on a longer essay describing the evidence for fluoride on caries and the papers that claim a decline in cognitive function, but here is the litmus test. Germany, Norway and Sweden don’t put fluoride in water.

Again, we can debate the policy, but it is not conspiracy theory.

Notice that Dr. Prasad neglects to mention things in that Wikipedia article that he cites. For example, while Germany doesn’t fluoridate its public water, it does encourage the use of fluoride toothpaste, as well as fluoride tablets and mouthwashes. Moreover, it fluoridates its salt. In Norway, the Norwegian Directorate of Health has stated that there is no need for water fluoridation due to the low prevalence of dental caries and the availability of fluoride through other means, such as toothpaste and professional dental treatments. Ditto Sweden, which also encourages fluoride tablets, toothpaste, and mouthwashes. To say that these countries “don’t fluoridate their water” without mentioning that they get fluoride to their children and adults by other means is profoundly deceptive. Moreover, as Steve Novella recently discussed and Grant Ritchey discussed din 2015, water fluoridation is safe and effective for preventing dental caries, and most of the objections to it from people like RFK Jr. are conspiracy theories. Not all countries fluoridate their water, but most advanced countries recognize the importance of fluoride when it comes to dental health. Moreover, as he kisses RFK Jr.’s behind, Dr. Prasad surely must know that RFK Jr. is not objecting to water fluoridation based on science or a desire to change strategy and start fluoridating salt or encouraging fluoride tabs or pastes. He’s doing it because he incorrectly views it as poison.

A couple more examples speed by:

Banning pesticides

Some pesticides that RFK Jr wants to ban are banned in the European Union.

Food additives

Some food additives that RFK Jr wants to ban are banned in Europe.

He also goes on about raw milk, which increases the risk of foodborne illness, arguing that because other countries allow the sale of raw milk, RFK Jr. isn’t a nutjub for proposing it. That’s nice. Again, ask yourself this: Are RFK Jr.’s concerns about these issues based in science? For example, he demonizes glyphosate, incorrectly blaming it for the obesity epidemic based on really, really bad science. Does Dr. Prasad think that science is sound? Maybe he isn’t as science- and evidence-based as he proclaims himself to be ad nauseam.

Much of the rest of the post trots out Dr. Prasad’s standard deceptive attacks on masking children, COVID-19 vaccines, and the like, topics I’ve discussed many times before. The only thing that he mentions that RFK Jr. supports that might be worth a conversation is finding a way to slow or minimize the revolving door between the FDA and pharma. Unfortunately, with RFK Jr., you can’t discuss the few reasonable ideas that he has and reforms that he supports without being buried in the antivax conspiracy theories and pseudoscience. It’s the whole package, and if Dr. Prasad thinks he can pick and choose, he’s even more deluded than RFK Jr.

He must be, to write something like this to conclude his post:

Just because another nation does it differently does not mean they are correct. That’s true, but it does mean, it is not a crazy idea to discuss it. The media is covering RFK Jr. poorly and unfairly. They resort to appeal to authority and— just like for COVID19— they seem incapable of asking what is happening in other countries. My simple rule makes sense. If other nations are doing it, we should be able to discuss it, and RFK Jr should not be called a conspiracy theorist for holding that view.

This take seems reasonable, but only if you ignore everything about the last 20 years of RFK Jr.’s antivax activism and conspiracy mongering, as well as his two-decade history of being rabidly antivax and pro-quackery. It’s not just enough to point to “the way other countries do it” to justify a policy. You have to look at the reasons for the policy, and that’s where RFK Jr. reveals himself to be an antivax conspiracy mongered and quack.

But at least Dr. Prasad was willing to state, wimpily, that RFK Jr. is wrong about MMR causing autism. Small victories, I guess, although I rather suspect that, given the chance for a government position under RFK Jr. and the attendant power and grift that come with it, Dr. Prasad would soon enough start to have “doubts” about the evidence showing no link between MMR and autism. He is, above all, an influencer captured by his audience, as well as a flagrant opportunist.