Oct 15 2009
More Nonsense from Dr. Jay Gordon
Dr. Jay Gordon is a pediatrician to a particular subculture of pseudoscientific celebrities, such as Jenny McCarthy. He lends his MD cred to this community. He also appears, in my opinion, to be a shameless self-promoter – one of those pop professionals (Dr. Oz, Dr. Phil) who has sold his soul for some easy celebrity.
Regardless of his motivations, he has been spouting arrogant nonsense about vaccines for years, essentially arguing that his clinical gut feeling and anecdotal experience trump the actual science. This is exactly the wrong approach to science-based medicine.
In a recent open letter on his website, he adds to the anti-vax chorus advising not to get the H1N1 (swine flu) vaccine. It’s almost as if this crowd wants to maximize the morbidity and suffering from this somewhat preventable disease. I know this is not literally true, but their ideologically motivated and confused actions will have the same effect.
Gordon starts his letter with, of course, some anecdotal evidence from his practice, admitting that he is seeing many cases of flu-like illness over this summer, but:
They all felt miserable, and they are all feeling just fine now.
The implication here is that H1N1 is not that bad. In an average flu season, 30,000 Americans die from the flu. By all accounts, we are in for at least a very heavy flu season, and H1N1 has been killing more young and otherwise healthy people as well as pregnant women (while the regular flu tends to kill the old and infirm). Again we see Gordon perfectly willing to substitute his own anecdotes for hard data.
In fact, as we learn more about H1N1 we are finding that it has some unique and worrisome properties. An article that is just being released finds that severe cases of H1N1 are at high risk of pulmonary embolism – a potentially fatal complication.
A Canadian study looking at a series of H1N1 cases concludes:
“Our data suggest that severe disease and mortality in the current outbreak is concentrated in relatively healthy adolescents and adults between the ages of 10 and 60 years, a pattern reminiscent of the W-shaped curve [rise and fall in the population mortality rate for the disease, corresponding to age at death] previously seen only during the 1918 H1N1 Spanish pandemic,” the authors write.
Overall the mortality of H1N1 is similar to the seasonal flu, about 1% – but it is behaving differently and has some concerning characteristics.
Gordon then gets into the meat of his article:
Preventing outbreaks of this “novel H1N1″ influenza may be a mistake of huge proportions. Yes, sadly, there will be fatalities among the 6 billion citizens of the planet. Tens of millions of cases of any illness will lead to morbidity and mortality, but this is completely (tragically) unavoidable. The consequences of not acquiring immunity this time around, however, could be really terrible and far outweigh a mass prevention program.
This paragraph is so confused it is hard to know where to begin. First, he is being awfully dismissive of the fatalities that will result from H1N1. The whole point of the vaccination and prevention campaign is to reduce fatalities – especially since more of those fatalities will be otherwise young healthy people (not that we don’t care about older patients, but younger deaths are generally considered to be more tragic).
He claims that these deaths are unavoidable. Hogwash. We can minimize these deaths by an effective vaccination campaign – the very campaign that he and others are hampering. Also, there are other methods to reduce spread of the flu – good hand washing and hygiene, and staying home if you have the flu.
Then he claims that if we don’t get sick this time around, we will not have immunity to fight what is to come. But the whole point of getting vaccinated is to produce immunity without having to suffer the illness. One thing that is clear is that the flu vaccine produces a good antibody response in most people (especially young healthy people, less so in the old and frail).
He goes on:
Here’s my rationale for not using Tamiflu: If (if, if, if) this virus circles the globe as the rather innocent influenza it now appears to be, but mutates and returns as a very virulent form of influenza, it will be quite wonderful and life-saving to have formed antibodies against its 2009 version. These antibodies may be far from 100% protective, but they will help. This is incredibly important but being ignored in the interest of expediency.
But getting the vaccine will also confer protective antibodies. Also, for some people, they may still get the flu even if they have been vaccinated, but the severity will be less – in which case they get the best of both worlds – antibodies from the vaccine, a milder case of the flu, and a further immunity boost from the flu itself.
He then resorts to a tired anti-vax argument:
Getting many viral illnesses confers lifetime immunity, and very few vaccines do.
This is just bullshit. There is no inherent advantage to getting the illness over getting the vaccine, and vaccines have the huge advantage of producing antibodies without the risk of an illness. It is pure nonsense and a violation of the basic principles of risk vs benefit to recommend getting sick to produce immunity when there are alternatives.
Also, his logic is not valid. If the H1N1 comes around for another pass you won’t need lifetime protection – just about one year’s worth. Who cares if you will have antibodies 50 years from now. By then, whatever flu virus is going around will be a different strain anyway. Talking about lifetime immunity to the flu is profoundly naive of the nature of influenza.
Then he makes his anti-vaccine stand:
I also won’t be giving the flu shot to the kids and parents in my practice unless there are extraordinary risk factors. I anticipate giving none at all this year. I doubt that there will be any really large problems with the vaccine, but I also doubt any really large benefits. As I said, I think that this year’s version of this particular H1N1 is as “mild” as it will ever be and that getting sick with it this year will be good rather than bad. The chances that a new “flu shot” will be overwhelmingly effective are small.
That’s right – he won’t be giving anyone the vaccine – but he insists he is not anti-vaccine. He mentions risk factors – but again this is ignorant of the facts of H1N1, which kills people without risk factors. You cannot treat this like the seasonal flu, where it is reasonable to focus on those at risk from dying and the people who are exposed to them. With H1N1 being young and healthy, or being pregnant, is a risk factor.
This approach also ignores the fact that the benefit of the flu vaccine is probably greatest for the other guy – the person who never gets exposed to the virus because you had immunity from the vaccine. Gordon and others are doing their best to make sure we don’t come near herd immunity for H1N1.
But he has not yet reached his quota of nonsense:
I consider this, and most seasonal and novel influenza A vaccines, as “experimental” vaccines; they’ve only been tested on thousands of people for a period of weeks and then they’ll be given to hundreds of millions of people. Not really the greatest science when we’re in that much of a hurry.
What Dr. Gordon just described is true of every drug on the market – they are tested in thousands and then marketed to millions. Does he have an alternative? Does he prescribe only drugs that have been tested in millions – i.e. none? This is why there are phase IV post-marketing studies of all drugs, and vaccines are tracked more carefully than other drugs on the market. We actively look for complications of vaccines and drugs after they are on the market, so that rare side effects or adverse events can be tracked. It is absurd to dismiss the flu vaccine as experimental. It is a proven technology, used for decades, and carefully studied and tracked.
He concludes:
It sure isn’t “sexy” to suggest handwashing, good nutrition, hydration, extra sleep and so on. It’s not conventional to suggest astragalus, echinacea, elderberry and vitamin C. Adequate vitamin D levels are crucial, too.
He makes it sound like he is taking the high ground by advocating for hand washing. Get in the back of the line, Gordon, the WHO, CDC, and every doctor I know have been recommending this for flu prevention since H1N1 reared its head. Then he launches into a typical list of unproven herbs (echinacea does not work) and vitamins. He falsely claims that the H1N1 vaccine is experimental, then recommends a treatment that we actually know doesn’t work – but I guess that’s OK, because it’s “unconventional.” Vitamin C and D are fine – there is evidence that during the winter months many people may be Vitamin D insufficient (not really deficient). So taking some extra vitamin D is reasonable. But there is no evidence to suggest that you can rely upon this measure to prevent getting the flu or that it will decrease morbidity and mortality from the flu (again we see the double standard for evidence).
In my opinion, Dr. Gordon is simply anti-vaccine. His arguments are confused and factually challenged. But he has a glitzy website and he treats celebrities.
_________
If you want to read a well-reasoned article about why you should get the flu vaccine, here is an excellent post from Effect Measure.
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23 Responses to “More Nonsense from Dr. Jay Gordon”
For the lack of coherent medical advice he seemed to be provide in that open letter, Dr Gordon may as well give up medicine and go into the entertainment industry. Oh wait. . .
One thing I’ll never understand about the anti-vaxers is their dogmatic belief that vaccines are bad. I get why the religious ignore evidence to believe in a god, and why paranormalists do the same for psychics and UFOS, but what is the payoff for thinking that vaccines must be inherently evil? Is it more to do with a conspiracy theory ideology than a religious belief?
Mr. Novella – I’m been reading your blog for about six months, to my great enjoyment and edification. Increasingly, though, I find your tone becoming more and more angry or arrogant, especially with regard to vaccines. Further, you seem to be suffering from confirmation bias in your appraisal of conflicting viewpoints.
My twin six year olds are fully vaccinated with the standard slate of childhood doses. However, we have never given them a flu shot and don’t intend to this year.
Simply, the science on them is thin, at best. I’m not concerned that they are dangerous, but, rather, useless.
However, like often with doctors and scientists, they get behind a piece of information or a study, and ram the data in your face to the exclusion of very important intangibles like experience and instinct (read Jonah Lehrer’s excellent “How We Decide” for an elegant discussion on the shortcomings of data driven analysis).
I’d be interested in your (rational) opinion on this report in the Atlantic: http://www.theatlantic.com/doc/200911/brownlee-h1n1.
Science and numbers are invaluable, but we’re talking about treating people in all their complexities, not repairing robots or computers with their predictable 1’s and 0’s.
David in NYC
So, according to Gordon, you don’t need the vaccine because if you get the flu then you’ll be immune to the flu.
Isn’t there some way this clown can be stripped of his medical license?
Is there any publicly available data about the profiles of swine flu deaths? Over here in Europe, there has been some stir in the media about deaths from swine flu in the “young and otherwise healthy”, only in several cases it later emerges that there usually were risk factors present, such as pregnancy, obesity or severe asthma. This is of course the worst kind of anecdotal evidence, so I’m curious what actual, scientific statistics look like.
(Regardless though, this Gordon character seems to be a hack. And thanks for providing yet another useful read to show the vaccination sceptics.)
Another factor in balancing risks/rewards of vaccination vs. illness is missed time from work. Maybe his clients are posh, but for myself & anyone I know missing days from work due to illness (as opposed to 1hr to get a shot) is a pretty bad situation. That can result in lost pay or even fear of job loss. This, of course, leads many to go to work while sick, which makes things worse.
This may not be the biggest deal (not as severe as dying from the flu) but it’s a real concern in this country.
Likewise, the guillotine is 100% effective in ensuring the subject is not guillotined in the future. Someone should suggest this to Dr. Gordon.
Wow, it’s been hours since you posted this, and Dr. Gordon has yet to find it in his daily ego-surfing and reply. Shocking.
David in NYC:
If you’ve been reading this for months, you might recall that Steve Novella is a Doctor. Hence, the designation “Mister” may not be polite in this case.
The science supporting vaccine use for seasonal flu is hardly thin; the science suggesting they harm or are placebo-like in their effect IS, however thin. That seems to be the issue that Steve has with Jay in the above article. I don’t see a problem in being frank, in calling bullshit. Neither science nor medicine are served by politics and niceties in dancing around the feelings of another practitioner.
Feel that the science is being rammed into your face? Present your data and rebut the allegations, as Dr. Novella has been doing.
As for the suggestion of confirmation bias, please explain how Dr. Novella is suffering from this, but Dr. Gordon is not.
“what is the payoff for thinking that vaccines must be inherently evil? ”
For someone like Dr. Jay, recognition and maybe some extra cash I suppose. You’ll notice he sells some DVDs, gives talks.
David in NYC – My tone definitely gets more pointed when dealing with either personal attacks or with physicians giving bad advice. Don’t confuse passion for bias, however.
Also I find the accusation of being arrogant cheap and easy. What do you define as arrogant? Arrogance is thinking that your gut feelings trump science. I just interpret the data and analyze logic.
And further you are too quick to dismiss my opinions as confirmation bias, and you seem to be relying on a lay secondary source (The Atlantic) for your opinions.
Here is an excellent summary of the evidence for flu vaccine efficacy by an ID expert, Mark Crislip (http://www.sciencebasedmedicine.org/?p=2040)
He is thorough and objective. He points out the complexity and weakness in the evidence (unlike the Atlantic article which had a clear storyline and presented a jaundiced view).
The evidence is unclear, and you can make a case either way. In my opinion the evidence is sufficient to recommend getting vaccinated. Unfortunately, the biggest advantage would likely result from herd immunity, which is unlikely given all the negative press.
But – I am not against doing more studies. This is ethically tricky, because it is unethical to withhold standard effective treatment in order to do a trial. That does not mean vaccines cannot be studied in a controlled setting, however.
Either way, we will never have the perfect study and will have to infer from imperfect data, while trying to improve that data.
Has the idea been put forward that the H1N1 kills a disproportionate number of non-risk group people because the body is mounting a too aggressive response after the virus has set up shop in the lungs? Might explain why the elderly, who cannot mount as effective immune response, fair better.
And do pregnant woman have a much higher mortality because their lung capacity is greatly diminished due to the fetus pushing all the internal organs out of position, hence the same amount of fluid build up in the lungs has a greater impact on the squished pregnant woman’s lungs?
Draal, the mortality rate for pregnant women is highest in the 3rd trimester, for the mechanical reasons you suggest.
More here.
http://www.webmd.com/cold-and-flu/news/20090729/pregnancy-ups-swine-flu-death-risk
Draal,
“Has the idea been put forward that the H1N1 kills a disproportionate number of non-risk group people because the body is mounting a too aggressive response after the virus has set up shop in the lungs? Might explain why the elderly, who cannot mount as effective immune response, fair better.”
I believe a working theory is similar to the working theory on the 1918 H1N1 pandemic, that the virus does cause an overreaction of the immune system and kill via a cytokine storm. (This is not universally agreed upon even for the 1918H1N1 pandemic.)
Indeed. If there’s anything that the article in The Atlantic removed all doubts about for me, it’s that Tom Jefferson definitely has a serious ax to grind when it comes to the flu vaccine.
Thanks Karl and Liz!
Doggerel:
http://rockstarramblings.blogspot.com/2006/07/doggerel-24-arrogant.html
Actually, I’m liking Steve’s tone more and more these days. It’s as though he’s starting to come around to seeing things my way.
Personally, in the past I thought Steve was too nice and too conciliatory to even the most nonsensical and even hostile of pseudoscientists. While I admired him for being able to keep his cool, I also thought that he gave them too much nice-nice when as serious smackdown was in order. I love that he called Dr. Jay for his bullshit–actually using the word “bullshit”–in his post.
Yes!
[...] shit. And to further debunk this point, here’s a quote from Steven Novella’s article, More Nonsense from Dr. Jay Gordon, which talks about a similar statement from another anti-vaxer: What Dr. Gordon just described is [...]
Why does the good Doctor asserts that the use of Tamiflu will prevent immunity from occuring ?
To me, who is not a doctor, the drug Tamiflu will reduce the flu severity, but will still allow the individual a full antibody response ?
So, the doctor is giving nonsense advice once more ?
Yes.
Also, I agree with whomever stated that this Dr. needs to sell his practice and go back to his day job because he obviously has no clue how vaccines work, or the immune system works.
Just saw this
From http://www.cdc.gov/h1n1flu/update.htm
Kind of shoots down the whole, “May not work because the flu is always evolving anyway” hypothesis.
Flu vaccine safety really relies on the millions who got vaccinated in previous years. Serious adverse events are so rare that field trials will almost never have one.
In 1976, there was 1 extra case of GBS (the only serious adverse event) per 80,000 vaccinated and 25 extra deaths among 40 million vaccinated. There was no flu, so no benefit to vaccination.
Based on years since 1976, there’s 1 extra case per million vaccinated. Most patients with GBS recover fully and only 5-10% die. The flu is here and killing and injuring at a much,much higher rate.
If you’re uncomfortable, wait a few weeks. In that time, with millions vaccinated with the same strain any extra cases of very rare conditions will become known.
Re: David in New York
David in New York has it wrong on almost all counts. Sorry if that upsets you.
Medicine didn’t become useful until it started treating people “as robots or computers with their predictable 1’s and 0’s” and ignored “intangibles like experience and instinct.”
I want my medical care to treat me socially as individual. Otherwise, please don’t treat me as individual.
That’s especially true for something as simple as flu vaccination with essentially zero or very, very close to zero serious side effects. David, if you disagree with that, what number do you prefer and how did you determine it?
A/California/7/2009 (H1N1)v is the flu strain used in every vaccine worldwide. If you don’t understand that real safety of this vaccine is really based on the safety of last year’s vaccine, and only looked at the size of field trials worldwide for this vaccine. You might be correct in not getting vaccinated immediately. After all, if you just wait a few weeks , the vaccine’s safety will then rely on the millions of people who’ve been vaccinated and monitoring systems world wide looking for problems.
You complain about that information is rammed at you. I’ve got a couple of responses.
1. I”m sorry you feel that way. Let me explain this to you again in a kinder, gentler fashion.
2. Suck it up. You’re an adult making a serious medical decision for yourself and your kids.
Facts are facts. whether they’re screamed at you or gently and lovingly explained. It’s a lousy vaccination, who cares if it upsets your sense of self-worth and self esteem.
Finally, I’ve been commenting a lot at Huffington-Post on vaccines. There are pro and con regulars. Vaccine supporters are pretty polite and don’t go after character. Not because they’re no nice, but because it doesn’t make much difference to their arguments.
On the other hand, vaccine opponents have precious little evidence they can use. That only leaaves attack on the characters of vaccine supporters, Big Pharma and anyone else they can find. You want vitriol and hate rammed down your throat. you’re looking in the wrong place.