Jul 17 2017

The Return of Dr. Gunter

goop screen-shot-2017-07-14-at-10-31-34-amIn my last post I discussed how Paltrow and her people over at goop launched a personal attack against Dr. Jen Gunter, an OB/GYN blogger who has taken the time to point out a lot of the nonsense that goop sells. Goop has been criticized by many science bloggers and mainstream outlets for fearmongering to women in order to sell dubious products.

For some reason “team goop” did not go after Science-Based Medicine, or Tim Caulfield, or Steven Colbert – they went after one humble medical science blogger. This is particularly ironic because Gunter’s blogging career is all about empowering women with science-based information, about advocating for women’s health and autonomy. I can only suppose that goop went after her because they felt particularly stung by her on-target criticism, or perhaps they thought she was an easy target for bullying.

The irony is thickened by including a response from Dr. Steven Gundry, who takes a particularly condescending tone and actually earns the often overused description of “mansplaining.”

The result was the typical litany of alternative medicine tropes, bad logic, and bad science, wrapped in a personal attack against Gunter. But they did leave themselves wide open for poking some additional fun at them, in order to point out how intellectually vacuous and dishonest they are. Dr. Gunter just drove a Mack truck through that opening.

Her reply is worth reading in total. She definitely gets it, and understands how alternative medicine proponents distort reality in order to sell nonsense to their marks, while explaining that they are really on their side, and to ignore anyone trying to point out that they are full of it. One strategy is to claim that any criticism against the con artist is really a criticism of their victims. Therefore, in their view, anyone trying to protect the public from being victimized are really the bad guys. Dr. Gunter sums this up nicely:

I bristle the most at the idea that GOOP are the feminist keepers of the inner goddess and that I am a tool of the patriarchy. Suggesting that goat’s milk can cure parasites or that astrology has a role in mental health care is the exact opposite of empowering. This is subliminal messaging about fear and modern medicine and toxins and it drives people to waste money, get unindicated and often expensive testing, and even delay care. It is also cruel and quite simply makes everyone less informed.

How dare the editors of GOOP promote the idea that I somehow think women “are not intelligent enough to read something and take away what serves us, and leave what does not” when they present half-truths. The classic GOOP playbook is stoke fear with the names of dangerous sounding chemicals and then offer a “natural” cure (often found in their shop).

Exactly – misinformation is not empowering, does not provide real choice, and only enriches the snake oil peddler at the expense of their victims.

Dr. Gundry and Lectins

Dr. Gundry begins with a sickening bit of tone-trolling:

First, Dr. Gunter, I have been in academic medicine for forty years and up until your posting, have never seen a medical discussion start or end with the “F-bomb,” yet yours did. A very wise Professor of Surgery at the University of Michigan once instructed me to never write anything that my mother or child wouldn’t be proud to read. I hope, for the sake of your mother and child, that a re-reading of your article fails his test, and following his sage advice, that you will remove it.

First, Gundry apparently missed the fact that Gunter was quoting Paltrow, who famously said as a challenge to scientists and actual experts, “If You Want to Fuck With Me, Bring Your A Game.” I guess it was OK when Paltrow said it, but when Gunter quotes her it just gives Gundry the vapors.

What is really going on here is a very common ploy by all pseudoscientists, not just snake oil peddlers. They are frequently calling for “respectful discussion” and tone-trolling their critics. The reason, it seems to me, is clear. They often make nonsensical or unscientific claims. Science-based critics, when they care to pay attention, will often respond with appropriate ridicule. The pseudoscience peddler now has two (not mutually exclusive) options, since they have (by definition) failed to earn actual scientific respect. They can respond to the criticism by claiming it is evidence that they struck a nerve with “Big Whatever”, uncovering the conspiracy against them and anyone who just wants to empower people by selling them pseudoscience. Or, they can tone-troll and call for respect. Being treated respectfully is all they need to boost their reputation and sell more pseudoscience. The actual scientific details of the debate don’t matter.

Gundry, as is also typical, then launches into a long rant about his many scientific and medical accomplishments. It is quite an impressive argument from authority. He ignores the fact that sometimes accomplished scientists can fall for pseudoscience and quackery. There are many example, Linus Pauling among them. He even has the scientific tone-deafness to name drop Dr. Oz, as if that increases his credibility (perhaps it does, to his target audience).

Orac also points out (as does Gunter) that his current CV is not that impressive, and recently he hasn’t really published anything in a respected peer-reviewed journal.

Here is the core of Gundry’s ire:

I bring this up because I am writing this on a plane while returning from giving a paper to the 11th annual World Congress on Polyphenols Applications—on the effect of a lectin-limited diet, supplemented with polyphenols with fish oil, on intravascular markers of inflammation in 467 patients with known coronary disease. I won’t bore you, but when we removed high lectin-containing foods like grains, beans, and, yes, nightshades like your beloved tomatoes, their elevated markers of inflammation returned to normal. Great, but I’m not finished. Remember Koch’s postulates that must be fulfilled to prove the agent causes a disease (go ahead, look it up)? Well, once cured, you have to reintroduce the agent and see that the disease returns.  Sure enough, in 57 patients, we reintroduced lectins, and back came the inflammation in all 57 patients’ next blood tests. Finally, you have to remove the agent again; which we did, and all 57 patients numbers normalized a second time, proving that indeed lectins were the cause of this process. Conclusion: Lectins cause human disease.

The last five words are where Gundry gets into trouble. What he has is a preliminary study looking at a biomarker for inflammation. What Gundry either doesn’t understand, or doesn’t want his audience (the people he wants to buy his anti-lectin supplements) to understand, is that biomarkers are often misleading. We cannot conclude from changes in biomarkers that lectin causes disease. Inflammatory biomarkers are particularly misleading.

We now have a vast literature that explores the relationship between biomarkers and actual disease, and the conclusion is unavoidable – the relationship is complex and often misleading. There are compounds that scientists call “pan-assay interference compounds” or PAINS. These are compounds that make biomarker assays go crazy, but don’t actually do anything in the body.

Gundry is making the classic mistake of overinterpreting indirect basic science and not having the follow up clinical science that would be necessary to make actual clinical claims. The vast majority of this basic science does not lead to clinical applications. A clear sign of snake oil, however, is to leap from this preliminary basic science and go straight to books and supplements, without the supporting clinical science.

Then, of course, when people who understand something about science and medicine point this out, call them shills, tone troll their articles, and demand the respect you squandered when you started selling dubious supplements.

You may be able to predict where this goes next:

Earlier I mentioned my research in autoimmune disease and during your diatribe you mentioned a child with thyroid issues. About 50 percent of my patients have, or have recovered from, autoimmune diseases, including a large number of pediatric patients whom I profile in my book. Read about their successes.

That’s right – anecdotes and testimonials. I suspect that if he could reference a peer-reviewed study to make his point he would have, instead of asking her to read his anecdotes.

He concludes:

Fifteen years ago, a guy named Big Ed shook my core beliefs and challenged everything I “knew,” and changed the arc of my life’s work. I was lucky enough, or alert enough to have had my eyes open that day so I could “see” it.  With the belief system that I had in place at that time, I could just as easily have tossed him aside with an F-bomb. My hope for you, if you read my book, is you’ll read it with your eyes wide open! If not, then discourse begins and ends with civility. Think about it. If that still doesn’t work, go show your article to your mother and kids. Really.

I wonder how secure your core beliefs in science-based medicine could have been if “a guy named Big Ed” could completely change your life. There is the usual call for being “open minded,” which is the pseudoscience version of “having faith.” He has to throw in some more gratuitous tone-trolling, just to show what a nice civil guy he is and what a nasty women Jen Gunter apparently is.


There is part of me that is uncomfortable with turning Goop into the standard bearer for the alternative medicine, appeal to nature lifestyle. They are clearly trying to be that, and their attacks against science bloggers and their critics are working. In the end any controversy is likely to be good for their brand, and they almost certainly know this.

That is why we try not to give attention to obscure nonsense, but we have to respond when something is already on the public radar.

Unfortunately, when people are dishonest and deceptive, when their goal is to distort the truth and call science and expertise into question, it is a lose-lose scenario. If you ignore it, the misinformation spreads unopposed. When you criticize it, they use the negative attention to further promote themselves and to promote confusion.

The only real solution is to arm the public with critical thinking, with scientific literacy, and with consumer savvy. We have to go beyond just explaining why specific claims are wrong or misleading, and expose the tactics of pseudoscience.

The Goop article is an excellent opportunity for that, because their writing is particularly transparent. Their personal attacks are also exceptionally ironic, and exposes how vacuous their claims to being empowering to women really are. They actually thought having a snake oil peddler mansplain science and civility to a strong female doctor and science communicator was a good idea.

It will probably be effective to their target audience, just as any propaganda will resonate with existing true-believers. But hopefully anyone whose mind is not already gooped up with nonsense will gain a better understanding of the tactics of sellers of dubious medical products.

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