Conflicts of interest among vaccine advocates: The Law of Contagion

I didn’t think I’d be revisiting this topic again so soon, but damned if Alice Dreger didn’t write something that comes pretty close to demanding that I do so. I tried to resist, but unfortunately could not. Basically, I’m getting really, really tired of Dreger. Why do I say that? It’s because I’m having a harder and harder time not thinking that she has antivaccine proclivities. I don’t want to. I really don’t. But, damn, if she doesn’t keep sounding like a blogger on Age of Autism or The Thinking Moms’ Revolution. The echoes are unmistakeable and appeared again just yesterday.

I first encountered Dreger’s ambivalence about vaccines over a year ago, when I first encountered an article by her entitled What if not all parents who question vaccines are foolish and anti-science? that basically painted those of us who advocate for science and vaccines as frenzied, self-righteous zealots who are incorrect (and disrespectful to parents, to boot) when we point out that most fears of vaccines are rooted in pseudoscience and, for the most part, baseless. More importantly, Dreger painted us as incapable of the nuance that she so clearly thinks she brings to the discussion. In contrast to her recognition that it is not necessarily irrational to have fears about vaccines and her oh-so-”reasonable” refusal to take a side on the issue, she portrayed pro-vaccine advocates as the unreasonable and dogmatic ones.

Oddly enough, she seemed oblivious to antivaccinationists who liken vaccines to the Holocaust, relentlessly attack pro-vaccine advocates like Dr. Paul Offit as “Dr. Proffit” and a “pharma shill.” (More on that a bit later.) Many of these same people declare themselves to be “not antivaccine,” and Dreger seemed to take them at their word. She also seemed oblivious to the fact that most pro-vaccine advocates recognize why many parents are afraid of vaccines, actively try to understand, so that we can allay those fears, and try our best to be respectful to genuine doubters. Unfortunately, she also seemed incapable of distinguishing between parents with fears, who can be persuaded with reason, respect, and patience, and hard core antivaccinationists, who cannot be persuaded and whose beliefs are indeed rooted in pure pseudoscience, along with many of the cognitive quirks we humans have in determining causation.

Then, a mere three weeks ago, Dreger wrote a very misguided post, Beyond Vaccine Exceptionalism. In it, whether she knew it or not, she basically parroted the familiar antivaccine trope that that vaccines cannot be criticized. In fact, she stated it explicitly in a way that would have made her statement quite at home on any antivaccine blog, referring to “the attitude among many science and public health advocates, that approved and recommended vaccines are never to be questioned or doubted,” an attitude that she referred to as “vaccine exceptionalism.” It’s a common trope among antivaccinationists that liken belief in vaccines to religion or ideology more than science. Unfortunately, the level of ignorance on display with respect to the antivaccine movement in her article was simply staggering. At the same time she slimed bioethicist Arthur Caplan as hopelessly compromised because his foundation has apparently accepted grants from vaccine manufacturers. I can’t help but note at the time that the evidence she presented to support her charge that Caplan can’t be trusted or is some sort of massive hypocrite was thin gruel indeed.

Yes, there was the germ of a good point behind her warnings about undisclosed conflicts of interest (COIs). I’ve said similar, but less radical things myself. Unfortunately, her utter lack of a sense of proportion and her dismissal of anyone who’s ever had a commercial or financial interest in vaccines as hopelessly compromised bordered on the pharma shill gambit. So what compelled me to revisit Dreger and her antivaccine-friendly, if not actually antivaccine, ramblings? Yesterday she dropped all pretense of nuance and dove headlong into flinging the pharma shill gambit at two people I admire, Dr. Paul Offit and Dr. Arthur Caplan, while condescendingly lecturing journalists, including one whose work I admire, Tara Haelle, in a post entitled Reporters Need to Avoid Experts with Vaccine Industry Funding; Here's Why, and Here's Help. The premise of her article is that reporters should never, ever interview vaccine experts who have ever received funding from a vaccine manufacturer or that, if they must, they must “disclose” to her standards.

Dreger uses as her jumping off point a story in the New York Times about an article in JAMA Internal Medicine that found that the sugar industry sought to influence the scientific debate over the causes of coronary heart disease (CHD) to play down sugar as a cause and blame the cause on fat. It’s actually a fascinating article. Basically, the authors examined internal documents of the Sugar Research Foundation (SRF), whose first research project resulted in a literature published in the New England Journal of Medicine in 1965 that singled out fat and cholesterol as the dietary causes of CHD and downplayed evidence that sucrose consumption was also a risk factor. This was back in the days before journals required authors to disclose COIs and the ethical standards for disclosure of links to industry were basically nonexistent.

Now, there is no doubt that this is a disturbing story, reminiscent of what the tobacco companies did to try to suppress or counter research showing that tobacco was a major health hazard, the cause of lung cancer and heart disease. To be honest, what surprised me the most about this article is how cheaply some of these researchers were bought, at least initially. For instance:

On July 13, 1965, 2 days after the Tribune article, the SRF’s executive committee approved Project 226,31 a literature review on “Carbohydrates and Cholesterol Metabolism” by Hegsted and Robert McGandy, overseen by Stare.10 The SRF initially offered $500 ($3800 in 2016 dollars) to Hegsted and $1000 ($7500 in 2016 dollars) to McGandy, “half to be paid when you start work on the project, and the remainder when you inform me that the article has been accepted for publication.”31 Eventually, the SRF would pay them $6500 ($48,900 in 2016 dollars) for “a review article of the several papers which find some special metabolic peril in sucrose and, in particular, fructose.”

So we can all agree that this is a deplorable incident, just as what the tobacco companies did to try to counter the growing evidence of just how dangerous tobacco was to public health. It’s also clear that this effort, as disturbing as it was, was nowhere near as extensive and pervasive as that of the tobacco companies. Basically, what the SRF got for its efforts was a single review article. Yes, it was a review article published in the New England Journal of Medicine (NEJM) in 1967 that was highly influential. That’s bad enough, but even the authors state that there is “no direct evidence that the sugar industry wrote or changed the NEJM review manuscript; the evidence that the industry shaped the review’s conclusions is circumstantial.” Reporting of the story makes it sound as though the sugar industry was as bad as the tobacco industry. (It did spend $600,000, or $5.3 million in 2016 dollars over the course of many years.) Whether that’s true or not, it’s impossible to tell from this single historical analysis, which is only about one review article and one industry group. As Steve Novella and Scott Alexander point out, the JAMA Internal Medicine article fails to put its finding into the context of the "diet wars" of 50 years ago, when it was debated whether it was sugar or fat that's the worst culprit in promoting CHD. As Alexander put it:

In any case, claims that the sugar industry sponsored one study back in the 1960s, and this means everything we’ve ever thought is wrong and biased against fat and in favor of sugar, miss the point (especially since there are probably problems with both sugar and fat). Whatever study the New York Times has dredged up was one volley in an eternal clandestine war of Big Fat against Big Sugar, and figuring out who’s distorted the science more is the sort of project that’s going to take more than one article.

I went on this diversion mainly because it is relevant, but also because I found the article describing this incident interesting. So does Alice Dreger, who takes a germ of a reasonable point and runs right off the deep end with it:

This is exactly the kind of history that I am talking about when I write, as I did for New Statesman magazine, about how not all parents who question some vaccines are “anti-vax.” Some are well read; they know about the bad behaviors and troubling power of the pharmaceutical industry, and they know the same industry produces many of our vaccines.

This is why editors should refuse to accept pro-vaccine articles from individuals who have been funded by the vaccine industry without full disclosure of that funding history; better yet, don’t allow them. Get someone who hasn’t been paid by the industry. It is also extremely important that reporters working on stories about vaccines consult physicians, epidemiologists, and ethicists who do not have histories of being funded by the vaccine industry.

This is what I like to refer to as the “contagion” concept of COIs. Basically, Dreger appears to think that it’s not enough just to disclose COIs. (What, exactly, constitutes a reportable COI in any given situation is not even considered carefully—or even really at all.) Rather, to her, just being touched by that evil, evil, big pharma money, particularly if it’s a vaccine manufacturer, is apparently enough to taint forever any expert who partakes of the tainted sustenance, no matter how distant in the past, no matter what the situation was, no matter how much funding was received. None of that matters. To Dreger, if you’ve ever accepted any funding from a vaccine manufacturer, you’re forever blacklisted. She starts out saying that such people should have their COI disclosed, which is generally what is done and should be done. Take Dr. Offit, for instance. I’ve never seen a pro-vaccine article by him that doesn’t mention that he’s a Professor of Pediatrics at the University of Pennsylvania and that he was the co-inventor of a Rotavirus vaccine (RotaTeq), usually with his connection to Merck mentioned as well.

Dreger goes beyond just disclosure, though. To her, disclosure of COIs is not enough. Instead, she advocates censorship—yes, censorship—in the name of “intellectual honesty” and rooting out COIs. Dreger is basically arguing that publications should not accept pro-vaccine articles from any expert with a COI and, even beyond that, journalists should not consult with such experts at all! Helpfully, she provides a list of experts that are acceptable to her because she finds them clean of any taint of vaccine money. I recognize some of them, such as Dr. Daniel Flanders, Dr. Jamie Friedman, and Alison Bateman-House, PhD, MPH, MA. Most of the others, I don’t recognize. The reason, of course, is that most of these doctors and academics, although pro-vaccine, are not actually, strictly speaking, vaccine experts. Dr. Flanders runs Kindercare Pediatrics. Dr. Jaime Friedman is a practicing pediatrician, as well. I worked my way down the list and found precious few whom I’d consider bona fide scientific experts on vaccines. Only a couple appear to have done significant work related to vaccines as part of their professional career. That is not a knock on any of them. After all, I’ve never done significant work related to vaccines either, but I sure have picked up a lot of knowledge about them. I could just as easily been on that list. So could Steve Novella, Harriet Hall, Mark Crislip (who, as an infectious disease doctor, has at least as much claim to expertise on vaccines as any pediatrician), John Snyder, or Clay Jones.

Now, don’t get me wrong. I have nothing against the experts on Dreger’s list. Clearly, they have been active enough for vaccines to have earned plaudits and suggestions. For instance, I’m a big fan of Dr. Jen Gunter and admire her standing up for science. However, Dr. Gunter is not really a vaccine expert, at least not in the formal sense. She is an OB/GYN and a pain medicine physician with an interest and expertise in the HPV vaccine. This is not a criticism. I also point out I’m not a formal expert in vaccines, either. I’m a breast cancer surgeon. Indeed, when journalists contact me, I generally make it a point to tell them that I am an expert in neither autism nor vaccines, although I do know a lot because of my long term interest in combatting antivaccine pseudoscience. Basically, like me, Gunter developed her expertise in writing about vaccines, primarily Gardasil. Let’s put it this way, neither Dr. Gunter nor I are a Dr. Paul Offit. Neither, as far as I can tell, is anyone else on Dreger’s list. Again, that is not a knock, nor is it to say that Dreger’s experts aren’t experts. Dr. Flanders, for instance, is an expert in dealing with parental fears of vaccines. They are all very accomplished experts in many different areas, all with some experience related to vaccines. It’s just that Dreger, in her zeal to find people clean of any perceived taint of big pharma, is willing to throw more compelling experts under the bus.

Like this:

Reporters should always be careful, when reporting on vaccines, to specifically find out whether a source has vaccine industry funding in their history. Avoid people like Arthur Caplan who has said that he doesn’t get vaccine industry funding because “the checks aren’t written to me”; in fact, his Center for Vaccine Ethics and Policy specifically seeks and takes vaccine industry funding. He even offers “development of articles for peer-reviewed journals positioning the underlying issues involved to contribute to the field overall,” but don’t expect Caplan to disclose that when he publishes; he doesn’t. (It’s kind of hilarious the folks at Caplan's center call themselves “an independent voice” on vaccine policy while offering to do political consulting for the vaccine industry. For more on Caplan's troubling history, see the last chapter of Carl Elliott's excellent White Coat, Black Hat.)

I discussed last time the bug up her butt Dreger seems to have for Caplan. For whatever reason, she seems to think he has an irredeemable COI. What stood out about Dreger’s targeting Caplan was a very remarkable absence. Namely, I don’t recall ever having read anything on an antivaccine website about Caplan being a pharma shill (and, make no mistake, Dreger is pulling the pharma shill gambit on Caplan in a way that would make Jake Crosby blush). Given that Caplan is a high profile vaccine advocate, I find it hard to believe that, if he truly had received as much pharma funding as Dreger implies, antivaccinationists wouldn’t have been all over it for years now. In any case, I discussed last time why I found Dreger’s accusations against Caplan rather...underwhelming. In any case, this is what Caplan’s Center for Vaccine Ethics and Policy does:

Beginning in 2008, the Center for Vaccine Ethics and Policy began to respond to request for ethics and policy consultation by state and local government, major NGOs in the public health sphere, vaccine makers and corporations. These consults have included ethical issues around pandemic preparedness planning; H1N1 vaccine deployment; clinical trial design for novel vaccines; informed consent issues around vaccine clinical trials and immunization campaigns; pre-licensure access to vaccines in development, and targeted market withdrawal of specific vaccine products.

These consults are typically confidential in nature but have included PATH, The Wistar Institute; the Commonwealth of Pennsylvania, the City of Philadelphia, Merck, Novavax, and Goldman Sachs, among others.

OK, so Caplan’s group does consulting work for a whole bunch of interested parties, responding to requests. That’s a bit different than what Dreger describes.

Dreger also goes off the deep end here:

The issue of avoiding vaccine commentators with CoI's arose for me anew yesterday after reading Tara Haelle’s astonishing and important account of why the famous Dr. Bob Sears may lose his medical license. (It’s not just that he’s irresponsible around vaccines.)

In that article, Haelle quoted Dr. Paul Offit as an expert—which he most certainly is—but did not mention his history of industry funding. Note: I incorrectly tweeted yesterday that Offit’s center takes industry funding; his current center at Penn, which replaces the one Caplan took with him to NYU, does not. I apologize for that mistake but note that my point about his history stands: for years, Offit helped co-lead Caplan’s Center for Vaccine Ethics and Policy and there’s no question Offit has a long history of industry funding of the sort that leads to skepticism.

Yes, and in her article, Haelle quite appropriately pointed out that Offit is “co-inventor of the rotavirus vaccine, director of the Vaccine Education Center and a professor of pediatrics in the Division of Infectious Diseases at the Children's Hospital of Philadelphia.” Uh, hello. He invented a vaccine! That’s a pretty good indication that he’s invested in vaccines. Could Haelle have disclosed more, such as how Offit sold his interest in the vaccine? Sure. Was it necessary? I’m not sure in this case, because in this case Offit was commenting on Dr. Bob Sears’ history, in particular his “delayed” vaccine schedule), and, compared to every single other of Dreger’s suggested experts, Dr. Offit has way more scientific authority when discussing vaccine schedules.

Haelle, not surprisingly, was not pleased with Dreger’s attack. She launched an epic Twitter storm in which she schooled Dreger. Some of my favorites:


There’s more, much of which echoes what I just wrote above, something like 40 total.

I know Dreger says she’s pro-vaccine. I even believe that she probably is. However, she is even more anti-pharma than pro-vaccine, to the point where it warps her perception and that some of what she writes would be right at home on antivaccine blogs and websites. Basically, her thinking reminds me of the Law of Contact or Contagion in James George Frazer’s The Golden Bough. Basically, the idea behind the Law of Contagion is that, once two people or objects have been in contact, a magical link persists between them unless or until a formal exorcism or other act of banishing breaks the non-material bond. You get the idea. In Dreger’s world, if you’ve ever touched pharma money, even indirectly, a magical link persists forever. You are tainted forever. In my younger days, I accepted pens and the occasional tchotchke from Merck and other pharmaceutical companies that make vaccines. By Dreger's definition, I guess I, too, am tainted forever. At least I'm in good company.

I wonder if the Law of Contagion applies to those on the "vaccine safety" (in reality, almost always antivaccine) side, many of whom make quite a pretty penny from selling various supplements and various quack treatments, ranging from hyperbaric oxygen to chelation therapy, to MMS (a.k.a. bleach) enemas to many others. Many on the antivaccine side have lucrative businesses devoted to speaking, selling books and DVDs, and the like. Dr. Bob Sears, for instance, sells medical exemptions to vaccines based on what parents submit on an online form.If she did, then say goodbye to Dr. Bob, Andrew Wakefield, Del Bigtree, Polly Tommey, and many other antivaccine activists disguised as "autism advocates." There are a lot of other examples just as blatant, if not as militantly antivaccine. One wonders if Dreger applies her same absolutist definition of a financial COI to these people when it comes to vaccines. We don't know. She doesn't say. I wonder why.

As I said last time, with friends like these, who needs enemies?


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What "vaccine industry"? Vaccines are a tiny and not very profitable part of the pharmaceutical industry. They prevent diseases that could be profitably treated with other, much more lucrative drugs.

You're right, though, that anti-vaxers basically believe that the only people whose hands are untainted by filthy pharma lucre are the quacks and charlatans who promote their fraudulent anti-vaccine nonsense. In the mind of an anti-vaxer, Wakefield is as pure as the driven snow because he never took pharma gold. Lawyer gold is fine.

By Guy Chapman (not verified) on 13 Sep 2016 #permalink

Offit is a liar. Look at this statement:

Aluminum is considered to be an essential metal with quantities fluctuating naturally during normal cellular activity. It is found in all tissues and is also believed to play an important role in the development of a healthy fetus.

He should have been flogged by Yale's chem department for this nonsense.

By Lars Ørnsted (not verified) on 13 Sep 2016 #permalink

Yeah, aluminum actually is rare on the planet Stupidia. Alas, we're on earth, where it's quite common and has a biological side-role.
"The data further suggests that a specific consequence of 'aluminum biocompaction' may be particularly important in the condensation of A+T-rich chromatin domains, and in silencing the expression of specific kinds of genetic information."

That's obviously not in all tissues. Only tissues genetic information is silenced or expressed. Genetic information being a rarity in Stupidians, common in earth organisms.

As for the rest, it's a stepwise attack. First, anyone who had any dealings with "big pharma", then anyone who's used a big pharma product, then anyone who obviously is "on the take" (read; wrote positively about any drug or vaccine), etc. Whittle down until only antivax and quacks are remaining, they're the only allowed experts.
All, while proclaiming to be the voice of reason, while being utterly unreasonable and unrealistic.

Interesting Dreger calls for censorship of an expert like Dr. Offit based upon her way, way, way too sensitive perception of a COI--interesting because she resigned in August of 2015 from Northwestern University’s Feinberg School of Medicine to protest, of all things, censorship (… ) :

Dr Dreger, who held a professorship in clinical medicine humanities and bioethics, said that she had been appalled to hear that Atrium’s Bad Girls-themed Winter 2014 edition, which she edited, had been withdrawn online at the behest of her dean Eric Neilson.

The edition had sparked controversy as it included a salacious account of a consensual sexual encounter between Syracuse University professor William J. Peace with a nurse in the 1970s, when he was an 18-year-old hospital patient.

Peace, who had been paralysed, claimed that the sexual favour from a nurse had eased his worries about his ability to perform sexually in future. The journal was reinstated online 18 months after it was removed.

“I could not believe my own dean would censor an article because it recounted a consensual blowjob between a nurse and a patient in 1978,” said Dreger in her resignation letter, calling the episode a “cosmic joke”.

She expressed her unease at the creation of what she called a “censorship committee” for Atrium, which had been set up to monitor future content of the journal.

“An institution in which the faculty are afraid to offend the dean is not an institution where I can in good conscience do my work,” wrote Dr Dreger in her letter of resignation addressed to Northwestern provost Daniel Linzer.

“Such an institution is not a ‘university,’ in the truest sense of that word,” she added.

Dr Dreger said that she could no longer do her work, particularly her research on academic freedom, given the ongoing censorship of Atrium, reported Torch, the publication produced by civil rights pressure group the Foundation for Individual Rights in Education.

“Vague statements of commitment to the principle of academic freedom mean little when the institution’s apparent understanding of academic freedom in concrete circumstances means so little,” wrote Dr Dreger.

(boldening by me, not source article).

You can't have it both ways, Alice Dreger. I believe this is where we say: Professor Dreger: Pot. Kettle. Black.

By Chris Hickie (not verified) on 14 Sep 2016 #permalink

@ Wzrd1 #3-- Agreed re stepwise attack. I'm wondering if someone like Cheryl Atkinson hasn't been slowly sliding Dreger into the anti-vaccinationist camp. Dreger is an academic without an academy, so she needs some sort of patron.

By Chris Hickie (not verified) on 14 Sep 2016 #permalink

@Chris Hickie, that or she's already in the camp, but playing the agent provocateur for the pro evidence based medicine world, thereby undermining it.

By Wzrd1 (not verified) on 14 Sep 2016 #permalink

In reply to by Chris Hickie (not verified)

Would she also exclude anybody with a financial interest in alternative vaccine supplements, selling books with alt schedules or vax criticism, associated with websites that use cliqbait unsubstantiated vaccine horror stories that increase advertisement revenue of the website, helped fundraise for anti-vaccine groups or ever gave paid presentations for anti-vaccine groups. Curious that anti-vax millionaires are excluded from her wrath.

Yes, reporters must avoid contacting any antivaxers who've ever made money from seminars, books or association with websites that get money from sellers of products designed to compete with or "heal" alleged damage caused by vaccines.

Along with banning experts who even indirectly benefited from pharma $$, that'll guarantee safe, if very dull and uninformative articles.

Wonder if Dreger also thinks the CDC should be disregarded as a source of information/recommendations on vaccines, since in other contexts it has accepted industry grants.

Tainted, forever tainted!!!

I can't even pretend to be taken seriously, since as a freshman medical student I accepted a small blue binder intended for taking notes that was donated by Squibb (estimated value at least $1.29). And for years I had a potted palm tree that a drug company sent my M.D. father as part of an antidepressant promotion.

I'll bet Orac has at one time or another used a pen supplied by a drug company.

By Dangerous Bacon (not verified) on 14 Sep 2016 #permalink

Damn. I can't be trusted to give an unbiased viewpoint on anything, as I was turned down for a clinical trial of some drug or other in 1989 (for which I would have been paid had I been accepted).

Clear COI. Bah.

By Rich Scopie (not verified) on 14 Sep 2016 #permalink

COIs should always be revealed, no argument there but Dreger is a hypocrite (thanks Dr. Hickie) and naive at best to call for a ban on anyone with a COI from ever commenting on *gasp* a subject they are an expert in. The point of announcing a COI is to let the reader decide if that COI profoundly impacts the veracity of the statements. I'm not interested in Dreger's demand that editors and journalists become nannies.

By Science Mom (not verified) on 14 Sep 2016 #permalink

BTW, I changed the title of the post. The original title was boring. This one, I think, is better and more related to the actual content of the post.

The point of announcing a COI is to let the reader decide if that COI profoundly impacts the veracity of the statements.

Exactly. Dreger starts out demanding disclosure, but then says even that's not good enough and that any of these vaccine experts with a financial COI, no matter how tenuous or distant in the past, must be blackballed by journalists.

I’m not interested in Dreger’s demand that editors and journalists become nannies.

What struck me the most about Dreger's article is how condescending it was to journalists.

This is why you can't give actual evidence to anti-vaxers. Because of the "CDC whistleblower," ALL studies cited by the CDC were actually paid for and conducted by the CDC (in their minds) and are therefore propaganda. Danish study's 7th author engaged in some unrelated bribery, so toss that one, too. Studies conducted by or for any government agency are clearly suspect. Meta-analyses and Systematic Reviews contain "fraudulent" studies or were written by "for-profit" groups, so flush those as well.

But that chart from a Seneff "study" published in a pay-to-play Hindawi journal? That's real science there for ya, buddy!

Well, looks like I'm one of them COI fraudsters, too. I've got this handy little case thing in my pencil bag where I store a few painkillers in case I get migraines during the day. Got it from one of those stands at a career fair a couple of years back. The logo is barely legible anymore nowadays, but I really can't hide the truth anymore: I'm blatantly, unrepentantly advertising for a medical company! Obviously all the academic work I'm doing is completely fraudulent!
...maybe I should re-check my conspiracy contract, see if I can get some of that filthy lucre everyone else is cashing in for selling their soul to Big Pharma. A half-broken pill case sounds like I might be a bit below the mean in terms of payout.

I'm interested that Dreger's points of reference don't extend beyond industry. How many on her list of apparently untainted experts are, or have been, payrolled by some other group with an interest.

For instance, Andrew Wakefield wasn't just secretly paid by attorneys attempting to sue vaccine manufacturers, but was secretly paid to carry out precisely the program of research that purported to find a connection between vaccines and autism.

In fact, almost the entire body of work which points to a link between the MMR vaccine and autism was executed as a program of research submitted in litigation.

When caught over this, Wakefield claimed that the original sum of money paid for the research wasn't actually spent on the research, and therefore he didn't need to declare it. This argument would be identical to the rationale of a researcher who was funded by industry to go on a golfing vacation, arguing that s/he didn't declare because it wasn't spent on the research on behalf of industry's product.

Then, of course, years after this deception, we revealed that he'd been paid at an hourly rate by the attorneys, meaning that he was contractually incentivized to launch the vaccine scare and keep it going for as long as possible.

Perhaps Ms Dreger would like to say more about COIs.

By Brian Deer (not verified) on 14 Sep 2016 #permalink

Addendum to the above:

Actually, on Ms Dreger's method, one shouldn't quote Wakefield, or one should cite him as someone who has been paid by industry, since his earlier research was funded by vaccine manufacturers Merck and GSK, as well as a great list of other drug companies.

By Brian Deer (not verified) on 14 Sep 2016 #permalink

I'm considered an expert in my field and have much experience having worked in my industry for years. How much sense would it make to disqualify me as a an expert consultant because I worked in the industry? How else would I have become a skilled, knowledgeable, even an accomplished expert in my field?

PS, in my field, a constant challenge is dealing with people who want to take our products and services for free. They think because we create services that are beneficial, they are entitled to our products without payment. They seem to think that we work for free. But of course, we have rent, bills, etc., just like they do.

There's a bit of a disconnect for one person (a journalist?) to get paid for what they do, based on their skill, experience, etc., while criticizing another expert for getting paid. I see this over and over.

So Andy Wakefield claimed there was no COI because the money he was paid by the attorneys wasn't spent on the research itself, huh?
That's like a government beauracrat claiming he wasn't bribed because the money paid to him by a construction company to award them business wasn't spent on the public projects themselves.

@Rob (18)

Similarly, if you work for a big charity (in IT, for example, or HR, or as a librarian) - people assume that you must be working for nothing, and will try and take advantage of that.

By Rich Scopie (not verified) on 14 Sep 2016 #permalink

Her comments on hpv vaccines make it clear she is, in fact, strongly provaccine.

She's still using the pharma shill gbit in the same unsophisticated and badly founded way as anti vaccine activists. Right up to inventing COIs for, for example, Dr. Offit and the VEC.

By Dorit Reiss (not verified) on 14 Sep 2016 #permalink

I'm not sure I entirely agree about Dreger being strongly pro-vaccine, at least not any more. I did before, but after this latest post sliming Dr. Offit and Prof. Caplan, damn. That was low. I don't think Dreger's drifted to the antivaccine side yet, but her rhetoric is becoming more and more indistinguishable from that of the antivaccine movement with respect to pharma, COIs, and the like. On Twitter yesterday, at least one of her preferred experts questioned her definition of a COI and how much disclosure is necessary and when. Maybe she's just more anti-pharma than she is pro-vaccine.

Whatever the case, she seems to think that parents who are just "on the fence" can't assess whether someone who's received funding from the vaccine industry can be a credible source. They can. She also seems to think that presenting experts without any ties to vaccine manufacturers will somehow sway the truly antivaccine. It won't. Basically, Dreger strikes me as exceedingly moralistic, self-righteously holding those on "her side" to simplistic, and, in some cases, impossible standards of freedom from COIs, while at the same time being naive about the antivaccine movement and not at least holding their pseudo-experts to the same standard.

We can all agree that undisclosed COIs are a bad thing, particularly in scholarly publications, such as articles in peer-reviewed journals, where it's good to err on the side of more disclosure. However, her view of COI disclosure is so simplistic and black-and-white (not to mention one-sided when it comes to vaccine manufacturers) that it's painful to read, and her blissful ignorance of the basics of journalism is an embarrassment. I enjoyed watching Tara school her on Twitter, but I doubt that it will stick.

I agree with pretty much everything you said about COIs, and Tara's tweeting was magnificent.

But I see Dreger speak up strongly and clearly for HPV vaccines and take flack for it, and as inappropriate as her attacks on Drs. Offit and Caplan were, that counts too.

I liked your characterization as more anti pharma than provaccine.

Ah, but being for the HPV vaccine is not the same as being pro-vaccine. Bill Maher, for example, is strongly pro-HPV vaccine, yet is very antivaccine otherwise. The reason he is for the HPV vaccine while "skeptical" or even outright hostile towards other vaccines is because religious fundamentalists don't like the HPV vaccine and Maher is an atheist who loves tweaking the religious. I'm not saying that the same sort of dynamic (or a similar dynamic with other motivations than atheism) is going on with Dreger(although her academic work and advocacy in sex and gender issues could play a role here), only that her strong advocacy of the HPV vaccine does not necessarily make her pro-vaccine in general.

And I wasn't implying you suggested in any way her HPV work doesn't count. Since it hasn't come up, I just wanted to put that on the table.

Mercola on his Sept 13th newsletter has gone all frothy on forced vaccinations and the Corrupt Disease Centre. No conflict of interest here!
Real scientific expertise on some topics can be hard to find as noted by Haelle above and as long as nothing is hidden there is no problem citing their expertise.
In my experience (different subject matter, though), there are always a vocal minority that reject all evidence that comes from any source that they deem tainted but somehow their funding sources are no-strings-attached, pure gifts.

Conflict of Interest:

It reminds me of the time in Catholic Grade School when I asked Father Carroll if I could skip confessional because my sins were always the same. He chuckled and said, "Please come again".

@Science Mom (#10),

Your right, always disclose and hope for the best.

By Michael J. Dochniak (not verified) on 14 Sep 2016 #permalink

Worse yet, the lesser the involvement in industry, the stronger the bias on the experts! If they have been properly succussed, that is.

. To be honest, what surprised me the most about this article is how cheaply some of these researchers were bought, at least initially

I've often had the same thought about politicians. When one sees clearly money-influenced behaviour on the part of a politician, it is often for peanuts. Clearly politicians need agents just like actors or professional sports people.

BTW while the Harvard researchers seems to have been totally unethical the sugar vs fat wars back then were much more complicated according Nina Teicholz in her book "The Big Fat Surprise". The suppression of the sugar research may owe more to Ancel Keys' fanaticism as to the sugar industry intervention. Still it does look like the sugar industry was using the tobacco industry's playbook.

Of course, I don't remember any mention of Keys' funding sources. They might be intereresting.

By jrkrideau (not verified) on 14 Sep 2016 #permalink

Dreger is basically arguing that publications should not accept pro-vaccine articles from any expert with a COI and, even beyond that, journalists should not consult with such experts at all!

Why stop with vaccines? One might surmise that Michael Osterholm should not be consulted about public health, because CiDRAP has unrestricted funding from Gilead Sciences.

About five years ago I received $100 from the CDC - with my department's permission -- for completing a questionnaire on radiological accident response (at one point in my professional career I was considered an SME). I used it to buy food for my volunteers.

Irrevocably tainted, I guess.

By shay simmons (not verified) on 14 Sep 2016 #permalink

I'm particularly confused by Dreger's argument that the Center for Vaccine Ethics and Policy has a COI because they do consulting for pharmaceutical companies - isn't that their job? I wonder if she's thought through the rather frightening implications of discouraging bioethicists from working with the pharmaceutical industry - and, inevitably, vice versa.

Good point Sarah A. I don't think Dreger has thought much through except how to clutch her pearls tighter.

By Science Mom (not verified) on 14 Sep 2016 #permalink

Her book Galileo's Middle Finger looks interesting, dealing with the tarnished legacies of scientists whose work was maligned by activists for challenging their narrative. However, her tendency to follow the money as far as the front door and call it a day when it comes to COIs tempers my interest considerably...


That "biological side-role" is probably just a sign of toxicity.

Has anyone ever had an aluminum deficiency. Why does it always seem to make rats and people slow to learn and unable to recall information? Are you from planet Stupidia?

In infants fed intravenously for 10 or more days, those receiving the standard solutions had a major (10 point) deficit in their Mental Development Index and were twice as likely to have a Mental Development Index below 85. These results provide support for our hypothesis that intravenous aluminum may have neurotoxic effects, with longer-term consequences for neurologic development.

Aluminum is the most common metallic element in the earth's crust but has no clear biologic role.

Aluminum Neurotoxicity in Preterm Infants Receiving Intravenous-Feeding Solutions

By Lars Ørnsted (not verified) on 14 Sep 2016 #permalink

I once gave my girlfriend two aspirin tablets. I'd bought the packet for myself, not for her, and I didn't demand payment from her, so obviously I was pushing aspirin upon her with the intent of getting her hooked and thereby endearing myself in the eyes of my great and powerful pharma overlord.

All hail Lord Draconis!

By Rich Woods (not verified) on 14 Sep 2016 #permalink

I guess I've disqualified myself for interviews as an anti-vax mother who finally got my kids vaccinated at the ages of 17, 14 and 12 because I taught English on the phone to people working for pharmaceutical companies and, in my current capacity as a translator, have done pharmaceutical translations. We'll forget the fact that I've never actually been directly paid by a pharmaceutical company. I'm tainted!!!

Her book Galileo’s Middle Finger looks interesting, dealing with the tarnished legacies of scientists whose work was maligned by activists for challenging their narrative. However, her tendency to follow the money as far as the front door and call it a day when it comes to COIs tempers my interest considerably…

That Guggenheim money didn't come from nowhere.

Rich Woods: "I once gave my girlfriend two aspirin tablets."

A few years ago we traveled up through Puget Sound and Straights of Georgia on the Victoria Clipper to and from Victoria, BC. They sold us little packets of Dramamine for just a few cents in case of sea sickness.

Obviously that private ferry service has a huge Big Pharma conflict of interest!

@wzrd #3

Aluminum has no positive biological role. Every essential vitamin and mineral is associated with a corresponding deficiency disease. This is prerequisite in determining essentiality. Without this, aluminum cannot be said to be an essential element.

By Jeff Bollyn (not verified) on 14 Sep 2016 #permalink

Jeff Bollyn: "Aluminum has no positive biological role."

It is ubiquitous in the environment. If humans are not adapted to have certain amounts, they would not exist.

The minerals that comprise soil contain quite a bit of aluminum, and because of that you consume quite a bit per day, every day. It is so much more than what is contained in the few vaccines that have an adjuvant.

So two questions:

1. Where do you find the aluminum free soil to grow your own food?

2. How would you protect a child from pertussis, diphtheria and tetanus without resorting to the DTaP vaccine series?

Jeff Bollyn,

To let you know the the body burden for aluminum is 100mg/70kg body mass with a daily intake of 36.4 mg.

I leave the further implications of what an increase of a mirco or nano gram of aluminum intake will do to a body to you.

@Chris's two questions: 1) I don't grow my own food 2) My child would be protected with natural immunity. Vaccines are for wimps. @Rich Bly

...mass with a daily intake of 36.4 mg.
Really? Not according to the USDA:
Based on the FDA’s 1993 Total Diet Study dietary exposure model and the 1987–1988 U.S. Department of Agriculture (USDA) Nationwide Food Consumption Survey, the authors estimated daily aluminum intakes of 0.10 mg Al/kg/day for 6–11-month-old infants; 0.30–0.35 mg Al/kg/day for 2–6-year-old children; 0.11 mg Al/kg/day for 10-year-old children; 0.15–0.18 mg Al/kg/day for 14–16-year-old males and females; and 0.10–0.12 mg Al/kg/day for adult (25–30- and 70+-year-old) males and females.¹
Factor in the scientifically standard absorption rate of .05% and we have: 0.05 μg Al/kg/day for 6–11-month-old infants 0.15–0.18 μg Al/kg/day for 2–6-year-old children 0.06 μg Al/kg/day for 10-year-old children 0.08–0.09 μg Al/kg/day for 14–16-year-old males and females and 0.05–0.06 μg Al/kg/day for adult (25–30- and 70+-year-old) males and females. Do you get paid to lie Rich Bly? ¹

By Jeff Bollyn (not verified) on 14 Sep 2016 #permalink

If you don't grow your own food, your food certainly has aluminum.

Natural immunity means your child gets pertussis, diphtheria, and tetanus. Even that won't work in this case. You don't get natural immunity from tetanus. Natural immunity from pertussis isn't life long, just as immunity from the vaccine isn't.

I would call a parent who gets a vaccine rather than wanting their child to get pertussis, diphtheria, and tetanus caring and responsible. I don't think wishing dangerous diseases on your child makes you a non-wimp.

By Dorit Reiss (not verified) on 14 Sep 2016 #permalink

In reply to by Jeff Bollyn (not verified)

@Chris's two questions:

1) I don't grow my own food
2) My child would be protected with natural immunity. Vaccines are for wimps.

@Rich Bly

...mass with a daily intake of 36.4 mg.

Really? Not according to the USDA:

Based on the FDA’s 1993 Total Diet Study dietary exposure model and the 1987–1988 U.S. Department of Agriculture (USDA) Nationwide Food Consumption Survey, the authors estimated daily aluminum intakes of 0.10 mg Al/kg/day for 6–11-month-old infants; 0.30–0.35 mg Al/kg/day for 2–6-year-old children; 0.11 mg Al/kg/day for 10-year-old children; 0.15–0.18 mg Al/kg/day for 14–16-year-old males and females; and 0.10–0.12 mg Al/kg/day for adult (25–30- and 70+-year-old) males and females.¹

Factor in the scientifically standard absorption rate of .05% and we have:
0.05 μg Al/kg/day for 6–11-month-old infants
0.15–0.18 μg Al/kg/day for 2–6-year-old children
0.06 μg Al/kg/day for 10-year-old children
0.08–0.09 μg Al/kg/day for 14–16-year-old males and females
and 0.05–0.06 μg Al/kg/day for adult (25–30- and 70+-year-old) males and females.

Do you get paid to lie Rich Bly?


By Jeff Bollyn (not verified) on 14 Sep 2016 #permalink

Fendelsworth/Travis/Morphing sockpuppet: "2) My child would be protected with natural immunity. Vaccines are for wimps."

So you are willing to take the 10% to 20% chance of death from diphtheria and tetanus? You have been breathing too much of your cleaning materials.

Please don't feed the troll and his aluminium obsession. You're doing Travis a favour anyhow considering how badly he reads studies.

By Science Mom (not verified) on 14 Sep 2016 #permalink

Do you know what body burden means?

Do you understand that if the body burden stays relatively level and uptake is at a certain level what that means about output?

Do you understand that food is not the only source? Do you use a deodorant? If so, you are uptaking additional aluminum.

Go take a basic toxicology class and then come back. You have nothing as is.

If you declare all experts to be "tainted" then you will only hear the opinions of non-experts, who by their very nature do not really know what they are talking about, and thus you will have less knowledge, rather than more.

If your first step is to throw out the manual, don't be surprised when it catches fire.

By JustaTech (not verified) on 14 Sep 2016 #permalink

@Rich Bly

You are a joke. You come out with an insanely exaggerated number and tell me that I need to take a toxicology class? You cannot even google a respectable Al intake estimate. Go back to grade school and come back Rich Bly.

The Al content in processed foods and unprocessed foods ranged from 0.40 to 21.7 mg/kg and from 0.32 to 0.54 mg/kg, respectively.¹

How many kilos of food do you eat in one day? I think I might eat about one, and I don't eat processed food. That makes my daily intake about 430 μgs a day. Multiply this my the adsorption factor and I get have 215 nanograms of Aluminum per day!

Did you get your number from Paul Offit? Or did you just make it up?


By Jeff Bollyn (not verified) on 14 Sep 2016 #permalink

@Rich Bly

Yes I know what body burden means you condescending bitch. Look how the body burden of aluminum welders relates to fatigue, mild depression, and memory and concentration problems.

Subjective symptoms showed exposure-related increases in fatigue, mild depression, and memory and concentration problems. Neuropsychological testing revealed a circumscribed effect of aluminum, mainly in tasks demanding complex attention and the processing of information in the working memory system and in the analysis and recall of abstract visual patterns. The visual EEG analysis revealed pathological findings only for aluminum welders. ..Both objective neurophysiological and neuropsychological measures and subjective symptomatology indicated mild but unequivocal findings dose-dependently associated with increased aluminum body burden. The study indicates that the body burden threshold for adverse effect approximates an U-Al [urine] value of 4-6 micromol/l and an S-Al [serum] value of 0.25-0.35 micromol/l among aluminum welders.

Just one study out of hundreds that show Aluminum makes people dumb and forgetful. You can increase your body burden all you want, but I plan on keeping mine as low a fμcking possible.

By Jeff Bollyn (not verified) on 14 Sep 2016 #permalink

Oh, right, another Fendlesworth sock to killfile.

That's it.

Orac, Another Fendelsworth filthy sock clean up on aisle 55.

By Science Mom (not verified) on 14 Sep 2016 #permalink

A vaccine with 800μg of Aluminum is about 4,000 times my 215ng daily absorbed intake.

By Jeff Bollyn (not verified) on 14 Sep 2016 #permalink

Orac, Another Fendelsworth filthy sock clean up on aisle 55.

Did "Lars Ørnsted" actually get banned, or was this just a cry for more attention?

Dreger seems to be the ethical/philosophical muse to Jill Stein.

She may not be anti-vaccine, but every time she opens her mouth anti-vaccine tropes spill out. As with Stein it is probably that she is actually anti pharmaceutical industry and corporatism so dancing with the enemy of her enemy is acceptable.

I'd mumble something about how 'I wonder how far to the left she is' except the far right-wing Libertarian Anarchists are just as anti big business as the far left.

I don't know how these folks keep their biases from cosmic matter-antimatter annihilation.

In infants fed intravenously for 10 or more days, those receiving the standard solutions had a major (10 point) deficit in their Mental Development Index and were twice as likely to have a Mental Development Index below 85. These results provide support for our hypothesis that intravenous aluminum may have neurotoxic effects, with longer-term consequences for neurologic development.

Aluminum Neurotoxicity in Preterm Infants Receiving Intravenous-Feeding Solutions

So, would you trade an almost guaranteed mental deficit for a slight reduction in the odds of contracting Hepatitis B?

By Jeff Bollyn (not verified) on 14 Sep 2016 #permalink

Ya screwed up, Fendelsworth (and Lars Ørsted), and gave up the info I needed to identify you unequivocally. I won't tell you how. Buh-bye again.

#41 Narad - "That Guggenheim money didn’t come from nowhere."

Good point.
Perhaps the boy wonder could do one of his 6 degrees of separation investigations on Dreger to ferrret out her immutable CoIs. My guess is Northwestern University has had many financial contacts with medical/pharma corps thereby contaminating Dreger til doomsday.
That doesn't even consider her other contaminated contacts throughout her academic/writing career.

She should probably voluntarily cease writing on these subjects out of her great concern for ethics.

Orac, Another Fendelsworth filthy sock clean up on aisle 55.

As always, he eventually provided me unequivocal evidence that he a Fendelsworth sock, and I banned the sock. Not sure how this sock got through. I'll have to go back and find its first comment, in order to see if he managed to slip through by starting with an innocuous comment.

Another Fendelsworth filthy sock clean up on aisle 55.

<pedantry>No, really, the 'el' needs to be transposed</pedantry>, before this gets cemented.

No, really, the ‘el’ needs to be transposed, before this gets cemented.

Point taken.

I’ll have to go back and find its first comment, in order to see if he managed to slip through by starting with an innocuous comment.

That's exactly what he did and does pretty consistently. No doubt he'll try to leave some juvenile sound-effect commenty thing on my blog now.

By Science Mom (not verified) on 14 Sep 2016 #permalink

I've never commented on this blog but I feel compelled as I am mentioned in it. I'm not very happy about being on the list. When Alice contacted me I was not familiar with her work. She simply asked if I was pro-vaccine (yes), paid by a pharm company (no) and willing to talk to the media (yes). I never once stated that I was an expert and I was never told I would be on a list. I'm growing my practice and have enjoyed doing more media in the past few years, all stemming from Twitter. Therefore I was looking forward to having a link to the media. Unfortunately I was listed in an article that bad mouths one of my heroes as a pediatrician, Paul Offit. I actually tweeted that fact not too long ago. Furthermore, I have always respected Tara's work and in fact have greatly appreciated her reaching out to me when she needs a pediatrician for an article. I feel I was misled by Ms. Dreger but it cannot be undone.
Thanks for your time.

By Jaime Friedman (not verified) on 14 Sep 2016 #permalink

In her article, Dreger listed Dr. Jamie Friedman as someone who

I’m saying that they seem to be the kind of people reporters should consult, rather than people with histories of vaccine industry funding.

Dr. FRiedman (@drjaimefriedman) just tweeted a series; in short, she feels misrepresented by Dreger.

I don't know where Dreger's getting the idea that Offit's center for vaccine education at CHOP "replaces the one Caplan took with him to NYU," as if it's something Offit had to cook up to not be homeless once Caplan left town. Offit's center has been around since long before Caplan went to NYU. Sloppiness with facts isn't the worst thing about Alice Dreger but it does add a reason to ignore her.

This makes me sad, because I've enjoyed her previous books so much.

By darthhellokitty (not verified) on 15 Sep 2016 #permalink

Someone else may have mentioned that you used the three laws of magic from The Golden Bough which is a good model to explain magical thinking. However in this case you may want to refer to Sanderson's three laws when writing fictional stories about magic
1 An author's ability to solve conflict (cognitive dissonance) with magic is directly proportional to how well the reader understands said magic
- someone full accepting the worldview of whatever is better able to rationalize and dismiss evidence against.
2 Limitations are more important than powers
- don’t attack what science can do, but what it can’t, such as explain everything, predict everything, defend against that which cannot be tested.
3 Expand what you already have before you add something new
- anti-vax has not added anything new in 300 years.

By Robert Blew (not verified) on 18 Sep 2016 #permalink