It seems I have gotten under the skin of notorious anti-vaccine crank J.B. Handley, the founder of Age of Autism. He recently wrote an entire article dedicated to the character assassination of yours truly. It seems I had the temerity to critique the latest anti-vaccination propaganda initiative called fourteen studies, an attempt to discredit the scientific evidence against a link between vaccines and autism.

Handley’s attack is an astounding example of hypocrisy, logical fallacies, and tortured reasoning. He really exposes the intellectual bankruptsy of the anti-vaccine movement, which is only reinforced by the supporting comments left by his avid readers.

He begins:

In general, I think the site (fourteen studies) so resolutely exposes the dirty underwear of the mainstream’s weak science on the vaccine-autism debate that most critiques of the site seem to center around the idea that “you have no need to go look at the site, and please pay no attention to the dirty underwear behind the curtain…”

So he starts by saying that those who critique the site are trying to divert attention from it, rather than make a substantive analysis.  This is the central and profound hypocrisy of his article – for then he launches into a series of personal attacks against my credibility and never addresses the substance of my critique (except for one point, which he fails to get right).

His accusation is also false. My blog entry at Science-Based Medicine was a follow up to this one by David Gorski, who wrote an extensive and detailed substantive critique of both the methods and some of the specific conclusions of the fourteen studies site. I then extended David’s critique with some analysis of my own, adding analysis of one more study that David did not address.

At no point did either of us try to discourage anyone from looking at the fourteen studies site for themselves, and in fact we linked to it. This demonstrates that Handley, who cannot engage in a substantive debate on this issue, will rather just make up whatever fake criticisms he can think of.

The personal attacks begin softly:

Looking at his biography on wikipedia (which he undoubtedly wrote himself), he became a doctor 11 years ago and turns 45 years old this July. It doesn’t appear that autism, vaccines, immunology, toxicology, nutrition, or gastroenterology are part of his area of focus, expertise, or study.

I love it when people express certainty about a fact that is demonstrably false.  This is a small point in itself, but it reveals Handley’s intellectual laziness and clear bias. He tries to imply something about my ego by expressing his lack of doubt that I wrote my wikipedia entry myself. Apparently Handley lacks the internet chops or the minimal intellectual curiosity it would have taken to click the “history” tab on my wikipedia page. If he had he would have seen that the entry was contributed to by many people, but not at all by me. This is just more evidence that his diatribe is about character assassination (even if he has to make stuff up), and not substantive analysis or criticism.

He then comments that,  “It doesn’t appear that autism, vaccines, immunology, toxicology, nutrition, or gastroenterology are part of his area of focus, expertise, or study.” This is partly true – these areas are not part of my focus or expertise – nor have I ever claimed that they were. I do treat neuroimmunological disease as part of my neuromuscular focus, so it is not entirely true for immunology (but I am not an immunologist – expertise is relative).

But it is not accurate to say these topics are not part of my study – I have indeed studied all of them in medical school and beyond.  I also have a side career as a popularizer of science and science-based medicine, and in that role I make a point to study any topic I write about.

To be clear – I have never made any argument from authority. I have never asked my readers to accept any of my claims because of my expertise. I discuss logic and evidence and my analysis stands or falls on its own merits. I am also open to substantive discussion from anyone without ever even inquiring into their background or training, taking their arguments at face value.

So why is Handley even bringing up my areas of expertise? He must be making the argument that expertise matters, that we should therefore respect the opinion of experts who do focus in these areas.

Not so fast. He later writes:

I’m not intellectually intimidated by any of these jokers. Their degrees mean zippo to me, because I knew plenty of knuckleheads in college who went on to be doctors, and they’re still knuckleheads (I also knew plenty of great, smart guys who went on to be doctors and they’re still great, smart guys).

I chose a different path and went into the business world. In the business world, having a degree from a great college or business school gets you your first job, and not much else. There are plenty of Harvard Business School grads who have bankrupted companies and gone to jail, and plenty of high school drop-outs who are multi-millionaires. Brains and street-smarts win, not degrees, arrogance, or entitlement.

So apparently degrees and expertise do not mean anything to Handley. Handley should get his story straight.  He does not seem concerned with his self-contradiction. He smoothly transitions from saying I lack expertise to making the “elitism” gambit that expertise does not matter – only street smarts matter.

That is an old ploy we have heard from con-artists for centuries – “don’t listen to people who actually know what they are talking about, listen to me, I have street smarts.” The beauty of “street smarts” as a criterion is that Handley can define that any way he wants, and apparently he defines it as people who agree with him. Handley would have you believe that his utter lack of scientific training is not relevant, but my lack of expertise in autism (even though I am a neurologist) is.

But he’s not done with the elitism gambit:

I have been astonished by the culture of arrogance and elitism that medical schools appear to breed in their doctors and scientists. The culture tends to produce an “us vs. them” mentality, where doctors collectively back each other up on controversial issues, typically without understanding the issue for themselves.

Actually (genuinely) controversial issues are controversial because doctors and scientists fight over them, they don’t back each other up. Handley has apparently never been to a scientific meeting, or wasn’t paying attention as the scientists fought like cats and dogs over their respective positions. My favorite thing about the culture of science is that it is ultimately a meritocracy of ideas and evidence. Yes it is fraught with human failings, but the culture respects logic and evidence more than any other human culture, in my opinion.

Handley accusing scientists of arrogance is also precious – what is more arrogant than thinking you are smarter, more virtuous, and better informed than an entire profession?

Also – please read Handley’s article and the comments and then decide for yourself who is propagating an “us vs them” approach.

Finally we get to some discussion of vaccines and autism:

Children receive 36 vaccines by the age of 5 in the United States. Of those 36 vaccines, 2 have ever been studied for their possible relationship, the two doses of the MMR. But, children receive 23 vaccine BEFORE THEIR FIRST MMR SHOT, and no work whatsoever has been done to consider these other vaccines and their relationship to autism.

According to the CDC’s website, vaccines contain 53 separate ingredients, but only 1 – thimerosal – has ever been looked at in terms of its relationship to autism.

What is Handley saying here – is this tacit agreement that the evidence does not support a link between MMR or thimerosal and vaccines?  Why not admit that openly, if one is being intellectually honest? But he is probably not suggesting that, although he should have been clear that he still thinks MMR and/or thimerosal are the culprits.

But we see here the anti-vaccine strategy, which is deliberately ignorant of history. In the past 15 years or so the anti-vaccine movement was absolutely certain that MMR caused autism. When that hypothesis did not pan out, then they shifted focus to thimerosal. That hypothesis is now dead, so they are moving on to the other ingredients in vaccines. It’s endless, and clearly all they care about is blaming vaccines.

The claim is also demonstrably not true. Vaccine safety is closely monitored, and there are many published studies of vaccine safety – not just for MMR or thimerosal. Here is a list of such studies on the CDC website.

He comes back to me:

Back to Dr. Novella. His critique of FourteenStudies.org seems to be largely based on the naïve idea that his colleagues couldn’t possibly be mistaken on this issue, which means that I must be:

He then quotes me from my SBM blog article saying:

“It is also remarkable that Handley himself quotes many professional, expert, and advisory bodies who also have read the studies and concluded that they overwhelmingly support the conclusion of a lack of correlation between vaccines and autism – including the Centers for Disease Control, the American Academy of Pediatrics, The American Medical Association, the Institute of Medicine, and the March of Dimes. Handley casually and self-servingly assumes that all of the professionals in these organizations are incompetent or they are lying.”

“And keep in mind what it would mean to lie on this issue – Handley believes that many doctors who have chosen the career path of public health are deliberately condemning millions of children to autism simply to avoid admitting past error, because they cannot face the horrible truth, or to receive their Big Pharma kickbacks. It’s no wonder their rhetoric often become hysterical – they really believe this is going on. For some reason it is easier for them to believe this astounding horrible claim than even consider the possibility that perhaps they have misinterpreted the science and that trained experts who have dedicated their lives to understanding the science may know better. This is what we call the ‘arrogance of ignorance.’”

Again Handley is wrong – my criticism of fourteen studies was not based upon the assumption that my colleagues cannot be wrong. My criticism (combined with David Gorski’s) was based upon a thorough analysis of their methods and claims.

My point above was not a criticism of fourteen studies, but rather a criticism of Handley for behavior that he repeats in his new post. I am saying that Handley believes that he must be correct, even if that means that hundreds if not thousands of physicians and scientists are corrupt or inept. I think Handley has again shown that my observation is accurate.

He continues:

Arrogance of ignorance? Dr. Novella asserts, “I personally know of many people, including myself and David, who have both read all the studies and are telling the truth about our opinions that they do not support a link between autism and vaccines.”

He’s read the studies. The ones that cover 2 of 36 vaccines, 1 of 53 ingredients, never consider unvaccinated kids, and are almost all funded by conflicted parties and they clearly show ALL VACCINES don’t cause autism? And I’m the ignorant one?

Yes, Handley, you are. You failed to accurately read or represent what I wrote.  Scientists learn to be careful and unambiguous in their writing. I said the evidence does not support a link between autism and vaccines. Handley interprets this as “clearly show ALL VACCINES don’t cause autism.” This is not being pedantic – a lack of evidence for is not the same as evidence against.

It is not only my opinion but that of the scientific community that the evidence does not support a link between vaccines and autism. You cannot prove a negative, that vaccines play no role in autism, you can only say that the evidence available so far cannot be used to conclude that there is a link. So any link is likely to be smaller than the power of the current evidence to detect.

But I shouldn’t try to confuse Handley with my elitist “sciency” logic.

We’re getting close to Handley’s one substantive point. Be patient. He continues:

And, in making his point, this is the only study Dr. Novella points to. To summarize, Dr. Novella demonstrates an incomprehensible level of ignorance in the following four ways:

1. He argues that I suffer from the “arrogance of ignorance” because many of his self-interested colleagues disagree with me and they must surely be right. Do I really need to cite the thousands of examples in human history where the consensus of the day turned out to be wrong? He calls himself a “skeptic” but I’m wrong because his friends think I’m wrong and surely my brain is not as big as theirs?

He loves the elitism gambit. I never argued Handley is wrong because his views go against the mainstream – I argued he is arrogant because he has more faith in his street smarts than the training and years of dedicated study of thousands of experts.  Handley is wrong because his arguments are factually and logically challenged – his arguments do not stand up under scrutiny. Again – he largely ignores the substantive analysis that David and I did and chooses rather to engage is character assassination.

2. He cites a study that solely looks at the relationship between thimerosal and autism (1 of 53 ingredients in vaccines) as PROOF that “vaccines do not cause autism.” This is a reckless over-generalization that has no basis in fact.

Again – see above. I never said it was proof, just an analysis does not support a link. I also was not relying upon this one study. Handley has to be willfully misrepresenting my entry, in which I sated clearly that it was a follow up to David’s post which discussed the methods and several other specific studies. I also have written about many of these studies in separate blog entries, easily discoverable with a Google search or by searching on this blog.

3. Of all studies, he chooses to defend the Madsen Denmark study (see above) that has without question the most egregious data-trick ever used in a thimerosal-autism study, and a study that has even been discredited by the CDC and NIEHS as “unhelpful.”

I only chose this study because David analyzed many of the other studies. We had agreed to divvy up the analysis.

Handley does not provide a link or reference for his quote. The CDC still lists this study as part of the evidence for lack of an association between thimerosal and autism. In this recent review they write:

An ecological study in Denmark analyzed data from almost 1,000 children diagnosed with autism over 30 years. Thimerosal was used in childhood vaccines from the early fifties until 1992, and there was no trend for an increase in autism up through 1990. From 1991 to 2000, the incidence of autism increased, after thimerosal was discontinued from vaccines, suggesting no relationship between thimerosal and autism in Denmark.

To be clear, this one study does not by itself provide compelling evidence for a lack of correlation – no one study does. The totality of the evidence is what is compelling. And there are legitimate criticisms of this data. But what it shows is that autism rates failed to decrease in Denmark when the total dose of thimerosal was decreased in 1971 (a point ignored by fourteen studies). It also showed that the increase in autism diagnoses in the 1990’s in Denmark could not have been due to thimerosal since thimerosal was removed entirely from vaccines prior to the increase. Therefore something else was responsible for the increase.

4. He states that “autism rates were similar” between the US and Denmark. Yet, a fifth grader could look at the Madsen study he himself cites and read on page 605 of the study that the autism rate in Denmark was under 5 per 10,000, while the U.S. rate is somewhere between 60-100 per 10,000, which means our rate of autism is 12-20 times higher than Denmark’s, which would mean our rates are “similar”, so long as you define similar as the U.S. rate being twenty times the rate of Denmark.

Handley makes two significant mistakes here. The first is that he is comparing the incidence of autism in one age group in Denmark with the prevalence of autism in the US. Incidence is the number of new cases over a period of time, and prevalence is the total number of cases at any point in time. Prevalence for a chronic condition is always much greater than incidence.

Handley’s hypothetical 5th grader might see autism “rates” rather than an incidence or prevalence, because (like Handley) they lack scientific training or careful scholarship.  This is simply a rookie mistake on the part of Handley (so much for street smarts).

In fact, autism prevalence in Denmark is very similar to the autism prevalence in the US (about 80 per 10,000 in 2000). If Handley does not publicly admit or refute his clear mistake here, then that would provide further evidence of his intellectual dishonesty.

He also missed my point – in both the US and Denmark autism incidence were flat until the early 1990s when they began to steadily increase. In the US the vaccine schedule was increasing over this time, and thimerosal would not be removed until 2002. In Denmark thimerosal had just been removed, and vaccine rates were different than in the US, as Handley himself points out. Yet the change in autism diagnoses behaved the same over time, and with similar absolute numbers. The common element was not thimerosal, but rather diagnostic behavior.

After this profound display of scientific ignorance Handley writes:

When it comes to vaccines and autism, his “critique” of FourteenStudies.org demonstrates an unacceptable level of ignorance, non-critical thinking, and parroting of the words of others. My only guess for why Dr. Novella would publish such rubbish is that he knows his friends demonstrating similarly narrow and misguided views will tell him how smart he is.

I think I have clearly demonstrated who is ignorant and who has critical thinking on their side. Handley then conveniently repeats the behavior that I was criticizing above – casually assuming that those who disagree with him suffer from some critical vice – in this case a fragile ego. This is Handleys “only guess.” He really needs to expand his intellectual repertoire.

But wait, there’s more. Handley then includes an appendix:

As an aside, Dr. Novella does appear to have expertise at injecting the botulinum toxin in people’s bodies, as his webpage characterizes this as an area of expertise:

Wow – the Botox gambit.  How pathetic. He then lists the uses of Botox and descriptions of its potential for toxicity, as if this somehow impugns my character or judgment as a phsician. This is really low. First of all, I do not use Botox for cosmetic purposes, only for neurological purposes, for which its use is clearly established as the standard of care. But he tries to make some tortured argument that I use Botox, and Botox is used for cosmetic purposes, and therefore… What, exactly?

He is then impressed with what a toxin Botox is (uh, yes, it’s right there in the name – botulinum toxin). And yes there have been severe side effects (although he missed the fact that they were all in children and I don’t treat children, but this is not really important).

Yes, Mr. Handley, medical interventions have risks and side effects. But those who are familiar with clinical decision making understand that treatment decisions are based upon risk vs benefit. Botox, when used properly, has a very good risk vs benefit profile, and is extremely safe and effective.

This is really one of the most childish and ignorant scare tactics I have seen. And again I point it out to reveal the intellectual behavior of Handley and the anti-vaccine movement. Just astounding.

Finally, I encourage my readers to look at the comments left by readers of Handley’s blog. It reveals the culture of hatred, paranoia, and personal attacks that is being fostered by Handley and his cohorts. But bring a machete to cut through the irony.