Saturday, February 11, 2012

"Dr. David Gorski, a medical moron."

Dr. David Gorski's Unique Brand of Moronism

FAIL-BUZZER-350x233 By J.B. Handley
“Dr. Gorski’s village called, they want their idiot back.”
- Anonymous
There I go again, another inflammatory, ad hominem headline, serving no useful purpose except alienating doctors and scientists who might otherwise be helping our kids. And, I follow it up with a senseless quote, degrading the debate further.
Whatever.
For those of you who don’t know, Dr. David Gorski is a Doctor and a blogger who posts under the pseudonym “Orac.” In only 23 years as a doctor, he’s already made it to the heights of “Assistant” Professor at Wayne State University, a school that no one has ever heard of and that I had to Google to make sure actually existed (it’s in “the heart of Detroit’s cultural center”—I think there’s an oxy-moron in there somewhere…). Yet, in the blogosphere, perhaps with the added courage that only a keyboard can provide, Dr. Gorski seems to think he’s omniscient, as his writing about me (and many others) reflects--here’s one of many examples:
“Before I dive in, let me just point out right here and right now that J.B. Handley wouldn't be able to recognize good science if it bit him on the posterior. The same is true of bad science, because Mr. Handley simply does not have an understanding of the scientific method or the methodology involved that would allow him to distinguish good from bad science, anymore than I have an understanding of investment banking that would allow me to differentiate between various financial instruments. No, on second thought, strike that. I'm quite sure that I know more about investment banking than J.B. Handley knows about science…In any case, thanks to its arrogance of ignorance, Generation Rescue thinks it can judge the quality of complicated epidemiology and basic science, but such pronouncements are about as valid as Joe the Plumber holding forth on quantum physics. That's why Mr. Handley's claim that he recognized these studies to be bad science by reading them led me to chuckle heartily. After all, Mr. Handley's proven time and time again that he doesn't understand science, the scientific method, or epidemiology…To him, it's not about the science, but winning the P.R. war.”
Man, that really hurts. A childless (more on that later) Assistant Professor from Detroit’s “cultural center”, who used to blog as a girl (“SoCalGal”), says I don’t understand science. (By the way, Dr. Gorski, I have never been nor am I currently an “investment banker”, so you may well know more about investment banking than I do, nice try…)
For those of you concerned that Dr. Gorski’s invective will get him on CNN soon, I wouldn’t worry, as this YouTube clip clearly demonstrates (go to 33 seconds), Dr. Gorski would be well served to avoid speaking in public—pay no attention to the Orac behind the curtain!
OK, enough fun with Dr. Gorski, and I sincerely apologize to all the AoA readers who find my rantings on Dr. Gorski to be immature, mean-spirited and/or unproductive. But, just to be honest in return: I really don’t care what you think. You see, I’m a pissed off dad, someone messed with my kid, and I will keep on leading with my fists and heart. I write what I want to write when I want to write it, and if you don’t like it, get on the keyboard and help in the way you want to.
Which leads me to my first point about Dr. Gorski’s unique brand of moronism. You see, unlike me, Dr. Gorski is actually a medical doctor. He should hold himself, as most doctors do, to a higher standard of professional communication and conduct. How many other doctors use satire, invective, and ridicule in a public domain against parents and other medical professionals? Yes, his equally wildly immature and idiotic commentors on his blog eat it up, but in the realm of how doctors can and should conduct themselves, Dr. Gorski is an adolescent fuck-up. At the end of the day, I’m the father of a special needs and damaged child, and Dr. Gorski’s willingness to treat me with the utmost disdain, ridicule, and mean-spirited satire is reflective of the worst parts of the medical culture, of which Dr. Gorski is a shining example.
Which leads me to my second point about Dr. Gorski’s unique brand of moronism, which is what an over-inflated caricature Dr. Gorski’s alter-ego Orac has become of everything we hate about doctors. The medical school culture, which reminds aspiring doctors at every turn how much smarter they are than the rest of the world, takes hold in different doctors in different ways. For those with a strong sense of personal character, being a doctor can be a humbling experience because of the power you have to do good (or bad) and the influence you have in how people think, and ultimately whether they live or die. For others, with an absence of internal character, the arrogance can consume them, and they walk through the world expecting to be never challenged, and thinking they are always right.
For a reminder of how this looks in real life, I submit Exhibit A, Dr. Travis Stork, a sort of Dr. Gorski in a made-for-TV body, responding to having his ignorance and generalized pronouncements challenged:


For Exhibit B, I offer up the following quote from Dr. Jed Hill (played by Alec Baldwin) in the movie Malice:
“I have an M.D. from Harvard, I am board certified in cardio-thoracic medicine and trauma surgery, I have been awarded citations from seven different medical boards in New England, and I am never, ever sick at sea. So I ask you; when someone goes into that chapel and they fall on their knees and they pray to God that their wife doesn't miscarry or that their daughter doesn't bleed to death or that their mother doesn't suffer acute neural trauma from postoperative shock, who do you think they're praying to? Now, go ahead and read your Bible, Dennis, and you go to your church, and, with any luck, you might win the annual raffle, but if you're looking for God, he was in operating room number two on November 17, and he doesn't like to be second guessed. You ask me if I have a God complex. Let me tell you something: I am God.”
*        *        *
OK, I’ll admit it. So far, I have really only challenged Dr. Gorski’s writing style, his professionalism (or lack thereof), and made fun of his public speaking skills. In the end, all that really matters are the facts, which is where Dr. Gorski takes his mornonism to exceptional heights. In order to keep this post from getting too long, I will simply cite two examples:
Moronism #1: Pedantic Semantics
One of the more comical semantic contortions to come out of both the Hannah Poling and the newly revealed additional 83 court cases is the use of terms like “autism-like symptoms” and “regressive encephalopathy with features of autism spectrum disorder.” It turns out that these cases where these non-medical terms are used all share one common feature: the kids who are the subject of the descriptions ALL HAVE AUTISM!!
Here’s Dr. Gorski writing in his typical, meandering, know-it-all, authoritative style:
“It is not as uncommon as we would like in medicine for conditions and diseases to be defined primarily (or even only) by aggregations of symptoms. Irritable bowel syndrome is an example. Ditto tension headache. Moreover, it is often the context within which those symptoms arise that distinguish one diagnosis from another. In any case, the DSM-IV provides fairly clear diagnostic criteria for autism. If the child doesn't have enough of these criteria to be diagnosed as autistic, that child could have ‘autism symptoms’ but not autism. This is not a difficult concept, except apparently for Holland et al, who seem to be arguing that any child with autism-like symptoms must have autism. This is akin to arguing that anyone who has a belly ache or diarrhea must have irritable bowel syndrome or that someone who experiences a headache must have migraines.”
Let me repeat myself, Dr. Gorski, the kids ALL HAVE AUTISM. This technique that Gorski recently used was something he seems to have honed in initially discussing Hannah Poling’s case several years ago:
“This settlement was based on the fact that Poling had a rare genetic mitochondrial disease that may have been exacerbated by a series of vaccines that she had, after which, among many other problems, Hannah regressed and developed some autism-like symptoms and, months later, a seizure disorder…what was really diagnosed was a regressive encephalopathy that had some features of ASD.”
Compare how Dr. Gorski describes Hannah to what Hannah’s father, a medical doctor and neurologist actually tells us:
On Hannah’s Diagnosis:
“Our daughter, Hannah, developed normally until receiving nine vaccines at once. She immediately developed a fever and encephalopathy, deteriorating into what was diagnosed, based on the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M. IV, as autism.”
On Hannah’s mitochondrial disorder:
“Dr. Shoffner will be presenting his experience with 37 patients with combined autism and mitochondrial dysfunction at the AAN meeting in Chicago this April. 65% of his referrals are positive for mitochondrial dysfunction.  Of course, his yield is subject to referral bias as a mito expert, so the prevalence of mitochondrial dysfunction in Autism is surely less than 65%.

The best estimate to date of the prevalence of mitochondrial dysfunction in autistic patients comes from Oliviera et al. in a population of 120, 5 of 69 (or 7.2%) showed mitochondrial dysfunction.  If this is generalized to the US estimate of 1 million patients with ASDs, then the number of kids like Hannah could be 72,000!  Isn’t this worth further study?”
Dr. Gorski is a serial user of a well-worn strategy known as manufacturing “Fear Uncertainty and Doubt.” He uses his perch as a medical professional to cast doubt on Hannah Poling’s case and the case of the 83 other court cases by making an argument shrouded in medical terminology that turns out, in the words of Mark Blaxill, to be total “Bullshit.”
Dr. Gorski: the kids ALL HAD AUTISM, including Hannah Poling--please stop being a moron.
Moronism #2: Feeding the Hungry Lie
I was inspired to write this particular post by SafeMinds recently released tremdously thorough dismantling of the “Science” that proves vaccines don’t cause autism HERE. For those of you who haven’t heard me say it a million times, the “Hungry Lie” goes something like this:
“It’s been asked and answered, vaccines don’t cause autism.”
Or, in a recent post by Dr. Gorski:
“If there's one thing that cranks routinely do when they can't win on science is to shift to other venues to try to win their case and to convince people that they are not, in fact, cranks. After all, if they stuck to arguing facts, science, and evidence, they wouldn't be cranks. They also wouldn't have a prayer of obtaining influence because the science is so much against them. So, failing at science yet again, what the anti-vaccine movement has done is to move over to law, in essence claiming that legal decisions mean that there is a scientific case to be made in favor of the hypothesis that vaccines cause autism.”
Dr. Gorski’s assertion that “the science is so much against” us, of course, requires a step back into the real world.
The Real World
Dr. Gorski, I know you don’t have any kids. I have three. This means I spend most of my days talking to parents and interacting with children. Most parents are scared shitless of the current vaccine schedule and they hate arrogant doctors like you. Most parents are able to use their brains, so when you tell them the science is overwhelmingly against us, they want to see the details.
Here’s the first detail, the vaccines that children in the US are given:
Hep B, Rotavirus, DTaP, Hib, Pneumococcal, Polio, Flu, MMR, Varicella, Hep A, and Meningococcal.
Dr. Gorski, that’s 12 licensed vaccines. How many of those vaccines have ever appeared in an epidemiological study (the kind you claim I can’t understand even though I graduated from Stanford with honors) comparing the vaccine to autism rates?
One. ONE!! MMR. That means 11 of the vaccines on the schedule have NEVER been studied for their relationship to autism. Yet, you continually assert that the science overwhelmingly shows that vaccines don’t cause autism. This makes you a moron.
Here’s the second detail, the excipients used in vaccines:
Albumin, aluminum hydroxide, aluminum, hydroxyphosphate sulfate, aluminum phosphate, aluminum potassium phosphate, amino acids, ammonium sulfate, ascorbic acid, bactopeptone, beta-propiolactone, benzethonium chloride, brilliant green, calcium chloride, chlortetracycline, cystine, dextran, dulbecco’s modified Eagle medium, EDTA, egg protein, ferric nitrate, formaldehyde, gelatin, gentamicin, glutamine, glycine, histidine, hydrochloric acid, hydrocotisone, lactose, magnesium stereate, magnesium sulfate, MSG, mouse serum protein, MRC-5 cellular protein, neomycin, phenol, phenol red, 2-phenoxyethanol, phosphate buffers, polydimethylsilozone, polymixin B, polyoxythylene9-10 nonyl ohenol, polysorbate 20, potassium chloride, potassium glutamate, serum-bovine, sodium acetate, sodium borate, sodium chloride, sodium citrate, sodium deoxycholate, sodium hydrogenocarbonate, sodium hydroxide, sodium phosphate, sodium pyruvate, sorbitol, streptomycin, sucrose, thimerosal, tocopheryl hydrogen succinate, tyrosine, urea, xanthan, yeast protein.
Dr. Gorski, that’s more excipients than I feel like counting. How many have been considered for their relationship to autism?
One. ONE!! Thimerosal.
Dr. Gorski thinks enough work has been done, and that the science is blindingly against us. At a 2 month appointment, a 2 month old American baby gets the following vaccines:
Hep B, Rotavirus, DTaP, Hib, Pneumococcal, and Polio.
Six vaccines in under 10 minutes. How many of the six have been looked at for their relationship to autism?
ZERO, which is apparently more than enough for a medical moron like Dr. Gorski to declare them safe and that I’m scientifically illiterate. ZERO.
A few years back, I created a website called Fourteen Studies with the purpose of making the point I just made on a much larger scale. At the time, Dr. Gorski wrote a critical piece about the new website. As usual, his post was flowered with comments about “anti-vaccine” and “scientific illiteracy” blah, blah, blah. Another favorite refrain of Dr. Gorski is that it is always about the vaccines and always will be, no matter what the science says, even though he finds the current science overwhelmingly in favor of proving vaccines don’t cause autism. Finally, more than half way through his meandering diatribe, Dr. Gorski actually provided a substantive argument:
“Another study included on the list is an Italian study that came out this year by Tozzi et al, which was published in the February issue of Pediatrics and entitled Neuropsychological Performance 10 Years After Immunization in Infancy With Thimerosal-Containing Vaccines. It's a study that I also blogged about in great detail when it first came out. The study was done in Italy, and one of its great advantages is that the amount of thimerosal to which the infants were exposed was actually known, unlike many epidemiological studies, where sometimes the dose of thimerosal (and therefore mercury) has to be estimated or inferred from the vaccine schedule at the time. The results were unsurprising and very much like the results of a study of thimerosal-containing vaccines as a risk factor for neurodevelopmental disorders other than autism that was published a year and a half ago. Most outcome measures showed no difference between the low and high thimerosal group, and the ones that did were small and entirely compatible with random chance due to multiple comparisons. I knew at the time exactly what antivaccine activists would probably say when and if they get around to attacking this study, and, in fact, that's basically the criticism on Fourteen Studies. (Most depressingly, Generation Rescue even reprints J.B. Handley's scientifically illiterate criticism of the study.) In any case, the main criticism is that there was not a control group receiving no thimerosal. True enough. The authors themselves make that very point. However, if thimerosal in vaccines were associated with autism, one would not expect that it would be different than any other toxin associated with an abnormality, disease, or condition in that it would be expected that the chance of autism or neurodevelopmental disorders would increase with increasing dose.”
Now, Dr. Gorski might be right. It might be true that kids who receive more thimerosal could become more injured than a group of kids who receive less thimerosal.
But, that was never my point. Dr. Gorski simply filled his blog with a specific objection and then everyone linked to it to demonstrate my scientific illiteracy. His hollow post became everyone’s favorite link to prove the Fourteen Studies website was just “anti-vaccine propoganda.”
The point of Fourteen Studies wasn’t to say that studying whether kids get more or less thimerosal in vaccines causes autism is unhelpful, the point of the website was to make a very simple but very obvious observation:
For all the hyperbole around how compelling the science is looking at the relationship between vaccines and autism, the actual science that has been done only considers one vaccine and one exipient. Moreover, the actual questions asked by the studies that have been done and that are often cited by morons like Dr. Gorski don’t come remotely close to asking the question that Dr. Gorski continually claims has been answered.
Here’s an excerpt from Fourteen Studies:
Having spent the time to critically read every study produced to "prove" vaccines don’t cause autism, we were dumbfounded by their inadequacy. We find the comments public officials make about these studies to be even more absurd and unsupportable. Consider, from the studies, some of the actual questions that were asked:
Q: Do children receiving more thimerosal in their vaccines have different neurological outcomes from children receiving less thimerosal in their vaccines?
Q: Are autism rates different for children who received 62.5 mcg or 137.5 mcg of mercury?
Q: Did children who all received DTP vaccine with thimerosal have higher or lower rates of developmental disorders based on when they got the shots?
Q: Do Thimerosal containing vaccines administered to children raise mercury blood levels above safe standards?
Q: Does the use of RhoGam shots during pregnancy have a correlation with autism?
These 5 examples above come from 5 of the most commonly listed studies cited as "proof" that "vaccines do not cause autism." Yet, not one of them comes close to addressing this issue or answering the question we all really care about that goes something like this:
Our children receive 36 vaccines by the time they are five, including 20 by their first birthday. Is the administration of so many vaccines causing autism in certain children?

*        *        *
This is the time in the essay when Dr. Gorski, reading all my rude comments towards him, has his head explode as he yells:
“He’s moving the goalposts! For J.B., it’s always about the vaccines! He hates vaccines, no matter what! We can never win!”
Of course, this is just another “FUD” gambit. The work hasn’t been remotely done. Our kids are getting six vaccines at one time and no one has any idea what the downside to those vaccines administered simultaneously might be.
Is it the mercury? Is it the MMR? I have no idea. What I know, Dr. Gorski, is that the phone calls and the stories about the kids going upside down after the vaccine appointments keep coming. A real doctor would care deeply about these real reports from tens of thousands of real parents with real babies. A real doctor would be asking real questions. A real doctor wouldn’t be satisfied with the paltry science that’s actually been done. A real doctor would realize that studying only one vaccine and one excipient doesn’t come close to understanding what is actually being done to our babies in the real world. A real doctor wouldn’t play word games with “autism” and “autism like-symptoms.” A real doctor wouldn’t assert that vaccines don’t cause autism when only one vaccine has been analyzed.
Of course, Dr. Gorski isn’t a real doctor. He’s a medical moron.
I’ll end with another polite quote from the highly professional Dr. Gorski, and you decide who’s the pot and who’s the kettle:
“J.B. also can't stand strong, principled disagreement with him. Like all people, he doesn't like to be told he is wrong. The difference is that he reacts to criticism by attacking the person doing the criticism, not by refuting him with evidence. That's because he can't use evidence; his position is unsupportable by science.”
Dr. David Gorski, a medical moron.

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