Monday, June 06, 2005

The Huffington Post is still at it

I hadn't planned on writing anything more about vaccines for a while. I figured you might be tired of my harping on one topic too frequently for too long. But, then, in my wanderings across the blogosphere over the weekend, I saw it.

The Huffington Post is at it again. As Michael Corleone said in The Godfather, Part III, "Just when I think I'm out, they drag me back in again!"

Specifically, on Friday, Dr. Jay Gordon, the Post's resident anti-vaccination blogger who has posted articles claiming a link between autism and the thimerosal in vaccines , the one who has so far apparently ignored some of the comments made about a recent anti-vaccination post (see comments), was at it again on Friday. I rather suspect that this latest post may actually be a vague answer to some of the criticisms of his previous post, mine included (here, also, both of which include the links to the relevant posts by Dr. Gordon). In Friday's piece, Dr. Gordon in essence impugns the research of all investigators who accept funding from pharmaceutical companies solely on the basis that it may interfere with their objectivity. While conflicts of interest are certainly a legitimate concern when it comes to evaluating the validity of research sponsored by entities that can profit from the results of that research, Dr. Gordon is quite inconsistent in applying his standard. He in essence tells us we should "ignore the study" he discusses simply on the basis of its funding by Aventis-Pasteur. In direct contradiction to this standard, however, earlier he was quite happy to single out for praise studies by Dr Mark Geier and his son David Geier. He even lamented that the Institute of Medicine "ignored" these studies (not true, as the Geiers studies have been cited for "serious methodological flaws," and the IOM mentioned similar methodologic flaws in its executive summary). Yet, Dr. Gordon considers the Geiers' work "excellent," even though the Geiers have a far more glaring conflict of interest than any scientist I've yet seen Dr. Gordon mention.

Given this, I once again feel forced to respond to Dr. Gordon. I'm not going to respond to him each time he posts more of his dark insinuations, as I don't want his ramblings to control the agenda of my blogging, but today I happen feel like doing so one more time:

Dear Dr. Gordon:

I was very disappointed in your most recent post on vaccines, Dollars Influence Research because it reveals a glaring inconsistency in your position. You state that Dr. Pichicho's study showing the efficacy of a new pertussis vaccine should be ignored based solely on the "appearance of impropriety" due to its having been funded by a drug company. Your logic seems to imply that you should also ignore Mark and David Geier's studies claiming a link between thimerosal and autism (studies that you cited as "excellent" in another post). After all, Dr. Geier is what some have described as a "professional expert witness" in vaccine legal actions (he has participated in at least 100 such cases as a consultant or expert witness, although not always successfully), and finding such a link would likely improve his income potential immensely. His son David runs a consulting company that exists to provide medical and legal counseling to parents seeking to obtain compensation through the National Vaccine Injury Compensation Program and through civil litigation. If that isn't an "appearance of impropriety" when it comes to their research, I don't know what is.

So why do say that you are going to "ignore" Dr. Pichichero's study on the pertussis vaccine and urge your readers to do the same, solely on the basis of the "appearance of impropriety" due to its funding source, when you cited the Geiers' research so approvingly? Why are the Geiers studies not "bordering on being worthless" to you because of the Geiers' clear conflict of interest while Dr. Pichichero's study is? Certainly you present no hard reasons to make such a distinction, nor do you explain why you consider drug company funding to be such a huge conflict of interest while apparently you don't consider making one's living off of lawsuits based on one side of this conflict to be a similar problem.

In actuality, you should look at the evidence in the study itself, how well the study was designed, how well it was executed, and whether the data analysis was appropriate. That's how you should judge this study or any study, not solely on the basis of an "appearance of impropriety." The funding issue can and should color your opinion of the study, as it does for most doctors (including myself) and probably lead you to a more critical evaluation of pharmaceutical company-funded studies, but to dismiss such studies out of hand as you have done is intellectually lazy. And, no, the funding issue alone in and of itself is not a good enough reason; there are many drug company-funded studies that are well-designed and well executed. You have to examine every study primarily on its merits, or lack thereof. Few studies are totally stellar or total crap; all have strengths and weaknesses.

I would take your critique of Dr. Pichichero's study far more seriously if you had actually bothered to tell your readers what, specifically, is wrong with the study to make its results "bordering on being worthless"? So tell us: What specific flaws in the study design do you see? What specific flaws in the execution of the study do you see? What specific flaws in the statistics and data analysis do you see? You conveniently neglect to describe any of these things. Instead, you blithely dismissed Dr. Pichichero's study as "bordering on being worthless" because of its funding source. It makes me wonder if you've bothered to read the study itself, or (as I suspect) you've just read news accounts of it.

I do note that you did make the following two disclaimers:

"Now, I actually believe that the vaccine studied probably works well and that the side effects may not be bad enough to cause a lot of harm.

"I believe that University of Rochester's Michael Pichichero, MD., the lead author of the study is an honest man."

To me, your disclaimers make your criticism of this study appear even more egregiously biased. After all, if you truly believe that the vaccine "probably works" well and that Dr. Pichichero is an "honest man," then don't you owe him (and your readers) a fair evaluation of his study, rather than an out-of-hand dismissal plus an insinuation that Dr. Pichichero and JAMA are biased because of financial support from pharmaceutical companies? (It's possible they are biased; but you haven't provided any evidence to demonstrate it.) If you think we should "ignore this study," don't you owe your readers specific explanations based on science as to why, rather than generalizations based on its funding source? If, as you say in a followup "clarification," you "did not mean to imply that there is something extraordinarily wrong with the manufacturer of the vaccine being studied paying for the study," then how do you justify rejecting this particular study out of hand based solely on such funding?

Inquiring minds want to know!

Sincerely

Orac

Skeptico has also commented on this.

20 example(s) of insolence returned:


At 6/06/2005 1:02 AM, Anonymous Skeptico said...

Well that certainly told him!

 

At 6/06/2005 7:36 AM, Blogger Orac said...

Somehow I doubt it.

 

At 6/06/2005 11:32 AM, Anonymous Skeptico said...

:-)

Did you email him that letter?

 

At 6/06/2005 11:41 AM, Blogger Orac said...

I posted it to the comments section of the relevant article, but it hasn't appeared yet.

 

At 6/07/2005 11:09 AM, Anonymous Anonymous said...

Orac's comment has been posted. Mine as not been posted... but that is perhaps because I pointed out that the mumps resurgence in the UK is based on a "study" that was paid for by a lawyer:
http://briandeer.com/wakefield/wakefield-deal.htm

HCN

 

At 6/07/2005 6:00 PM, Anonymous Skeptico said...

Actually I think they did just publish your comment, HCN. It sometimes takes a while.

I note Dr Gordon has not replied to any of his (growing band of) critics. Rather weak of him, wouldn't you say? Bordering on intellectually dishonest. Perhaps he’s too busy.

 

At 6/07/2005 7:59 PM, Anonymous Anonymous said...

Thank you for pounting that out... yes it is there in all of its link heavy glory.

Do you wonder if he will decide which is a better way to fund research? Pharmaceutical companies or lawyers?

HCN

 

At 6/07/2005 8:20 PM, Blogger Orac said...

Let us know how many hits you get from it. I've only gotten a handful of hits referred from any of my comments on Dr. Gordon's posts and none so far from this particular article's comments. This suggests to me that not very many people read his posts. I wonder if the Huffington Post isn't as popular as Arianna would like us to believe. ;-)

 

At 6/08/2005 5:49 PM, Anonymous Skeptico said...

None so far that I can see. A couple from my comment on the earlier post.

 

At 6/09/2005 4:03 AM, Blogger Jay Gordon, MD, FAAP said...

Doctors Slavin and Orac make sense. But, inherent in the manufacturer paying for the study, paying the researchers, paying the speakers, having a paid consultant write the laudatory comments AND having paid ads for this same drug company all over issue after issue of the journal which publishes the study . . . comprises sigificant conflicts of interest all around.

Dr. Orac, I have discused and linked each study.

Yes, these might be great vaccines and medications, but the research needs to be subject to more rigourous standards. Without that objectivity, vaccine approval is not as safe as it must be to protect children and others.

By the way, if you or anyone believes that this is a vitally importantvaccine, your judgment may be clouded.

Jay Gordon, MD, FAAP

 

At 6/09/2005 4:19 AM, Blogger Jay Gordon, MD, FAAP said...

Your points about Geier and Geier are well taken, Orac and Skeptico.

Thank you for reminding me that paid expert witnesses on either side of an issue must be viewed skeptically.

My HuffPost comments must be better than they have been so far if I really want to challenge conventional notions about vaccines, medical research and more.

Again, thanks for pointing out the inconsistencies.

Best,

Jay Gordon, MD, FAAP

 

At 6/09/2005 6:33 PM, Anonymous Skeptico said...

Dr. Gordon:

You are still missing the point that Orac and I have made regarding financing of trials. If you want to demonstrate that a trial was faulty, then you have to actually demonstrate that the trial was actually faulty. You have to find a problem with the protocol of the trial. Why can’t you do that? Is it because there is no problem? What you are doing here is pure ad Hominem – attacking the person writing the report and not the actual evidence they are presenting. As Orac says, this is intellectually lazy. It is also logically fallacious – the conclusions you draw are not arrived at from the arguments you present.

And regarding “if you or anyone believes that this is a vitally important vaccine, your judgment may be clouded” – neither Orac (that I am aware) or I have made any claims at all about this vaccine. All the claims have been from you. This is just a red herring.

 

At 6/09/2005 11:54 PM, Blogger Orac said...

Thanks, Skeptico.

I plan on writing on the issue that Dr. Gordon brings up, that of whether funding introduces bias. As with most things Dr. Gordon likes simple answers to, the real situation is a lot more complicated. Unfortunately, my notes on a symposium that I attended on this issue at the AACR meeting are in my office, and I need them to make my points. That's why I probably won't write about it before next week. (I'm in Philadelphia, remember?)

 

At 6/11/2005 2:54 AM, Blogger Jay Gordon, MD, FAAP said...

"One wonders why Dr. Gordon felt the need to post this when he insinuates in his previous post that anyone who takes drug company money is hopelessly compromised."

Not "hopelessly" just compromised.

Research this important needs to be funded differently and researchers accepting consulting fees, speaker's fees and so should disqualify themselves from participating. This is not a simple issue and I know you disagree with my bias against the "routine pediatric vaccine schedule" but your ad hominem attacks are unwarranted and interfere with honest discourse.

Best,

Jay Gordon

 

At 6/11/2005 2:57 AM, Blogger Jay Gordon, MD, FAAP said...

"You are still missing the point that Orac and I have made regarding financing of trials. If you want to demonstrate that a trial was faulty, then you have to actually demonstrate that the trial was actually faulty. You have to find a problem with the protocol of the trial. Why can’t you do that? Is it because there is no problem?"

No. Why on earth would I have to demonstarte that the trial was faulty? That's not what I'm saying. The point I want to make is that research funded and performed by the people and corporate entities with the most to gain is worthless or virtually so.

Best,

Jay Gordon

 

At 6/11/2005 9:49 AM, Blogger Orac said...

Dr. Gordon:

Your viewpoint is simplistic in the extreme. There has actually been a fair amount of research on the impact of funding sources and potential bias--which I'll talk about when I get home and get access to my notes. The relationship is not as simple as that. Second, I find your claim that you do not consider investigators who accept drug company money are not "hopelessly compromised" to be disingenuous when your every post implies otherwise, as does your blithe dismissal of research funded by corporate entities with a financial interest is "worthless" or "nearly so." How could it be "worthless" unless there is somehow bias or the researcher hopelessly compromised, I wonder. I stand by my characterization of your across-the-board dismissal of such studies as intellectually lazy, because it is intellectually lazy. Your later denial that that's what you meant or that there is something inherently wrong in drug companies sponsoring trials, if anything, seems even MORE disingenuous in light of what you have just said.

Oh, and BTW, I never claimed this particular vaccine is "vitally important," and even if I did I'd like to know how such a claim would mean my judgment was somehow "clouded." Your use of straw man arguments like that interferes with honest discourse more than anything I've written.

Finally, you ask "Why on earth would I have to demonstrate that the trial was faulty?" Why indeed? Well, for one thing, you have already strongly implied that there must be something faulty about it because a drug company funded it. If you consider it "worthless," then there must be something wrong with it. What, specifically, is wrong with it? You don't say other than the funding issue. More importantly, I wonder why on earth you would dismiss all or most pharmaceutical company-funded trials as "worthless" on vague insinuations of "bias."

Yes, such trials should be looked at more critically, but I repeat again: It is intellectually lazy to lump them all together and dismiss them all because they were funded by pharmaceutical companies. Each study needs to be evaluated critically on its own merits, or lack thereof. Each study needs to be evaluated by the science and study design. Look at such trials much more skeptically because of their funding, yes, but look at them based primarily on the science. You have utterly failed to do that and, worse, you don't even seem to have any interest in doing so.

One last thing that I can't let drop. The Geiers are far more than just "expert witnesses." They make lots of money off their now highly dubious claim of a vaccine-autism link, and would stand to make a lot more if they could prove a link. David Geier's company exists mainly to sue on behalf of parents who believe their children were injured by vaccines. Notice that they've never published a study that failed show a link, in marked contrast to the way the most recent studies are going now. The Geiers are also high-profile activists who frequently speak at events where parents who believe in such a link, at conferences such as the recent Autism One conference in Chicago. No, they are far more biased than from just being mere "paid expert witnesses." Not only do they have a financial interest in this issue, but they are ideologues.Yet you characterized their research as "excellent," rather than applying the standard you use when dismissing drug company-sponsored studies, rather than using their financial and ideological conflict of interest to dismiss their work as well. I'd be a lot less hard on you if you applied your standard consistently, even though I think it's a simplistic standard.

 

At 6/11/2005 3:33 PM, Anonymous Skeptico said...

Re: Why on earth would I have to demonstarte that the trial was faulty? That's not what I'm saying. The point I want to make is that research funded and performed by the people and corporate entities with the most to gain is worthless or virtually so.

I know that is your point, but Orac and I have both shown this is fallacious reasoning. It is nothing but ad Hominem – attacking the messenger instead of the message. If you want to demonstrate there is something wrong with the study you have to demonstrate there is something wrong with the study.

Here’s the thing. If this study was biased from the get go as you imply (due to the funding issue), and if the conclusions of the study are therefore false (as you imply), then it ought to be possible to tell us what the flaws are in the study. Should be easy, right? Since it wasn’t a fair study (according to you), you should easily be able to show what was wrong with it. So why can’t you?

 

At 6/13/2005 1:47 AM, Anonymous HCN said...

Just to let you know Dr. Gordon, I disinclined to reply back when I am asked to verify my email... not in a REPLY. I did post a real email address in your blog, I did not send you an initial email.. of course I only check this one every few days. (though I do understand why you would take a step like that. but NOT to a reply to an email you sent me!)

Also, I am disinclined to take seriously anyone who forgets to unlock their CAPS key.

Just one thing: I hope in your practice that you routinely use the DTaP rather than the older DTP.

Varicella is not so innocent a disease. I have seen it first hand, and do know of one child who almost lost a leg to it. Innocent... yeah, right!

And I really really hope you know where tetanus actually comes from. Gardeners are often reminded to be up on their tetanus shots... you do know why, don't you? Just because you say it is under 50 per year does not mean that those 50 people probably wished they had NOT suffered through "lock-jaw".

And the incidence of measles may be more than 35 with just the 23 plus in Indiana this past WEEK. It is only an airplane ride away. (and for those of us who depend on airplanes for our income, please don't forget them... at least WE help balance the import/export ratio of the USA!!! ... for goodness sake, check which county the public health page I used is! Do you think that county's economy would be impacted if you closed the borders! ... Use a string and globe, which is closer to Asia... that county or Long Beach, CA!)

Measles and mumps were almost unknown in the UK, until a severe drop in MMR uptake. Now mumps and measles have returned. Why do you suppose that happened?

Please DO think harder... and remember to use the shift key on your keyboard.

 

At 9/24/2005 11:24 PM, Anonymous HCN said...

Dr. Gordon in the news, and it is NOT good:
http://ktla.trb.com/news/local/la-me-eliza24sep24,0,2413234.story?coll=ktla-news-1

 

At 9/25/2005 10:53 AM, Blogger Orac said...

Interesting. I wonder how long before we see a CYA piece by Dr. Gordon in the Huffington Post.

 

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