HE PROBABLY THINKS THIS POST IS ABOUT HIM

The President’s Cancer Panel (pdf here) recently issued a report detailing specific recommendations about potential environmental factors contributing to skyrocketing cancer rates and what we can do to minimize those risks. It’s all sounds pretty familiar to those of us whose experience living in the autism epidemic has caused us to look at the role environmental insults play in the spread and exacerbation of autoimmune disorders, including ASD. Gee, it turns out that organic produce, grass-fed beef and avoiding environmental toxins might actually be good for us. Who’d a thunk it?

The report is a remarkable ⎯ especially as it comes courtesy of the federal government ⎯ 240-page document that’s well worth a read. And it’s gotten praise from a couple of interesting sources.

First, we heard from the New York Times, in an excellent op-ed piece. It is beyond encouraging that the most mainstream of media outlets is willing to say that we just might need to rethink the way we live our lives, even if it means that corporate America might need to live with less profits.

Then I came upon a very surprising commentary on the report. I was not so surprised that the mighty Orac would want to discuss a report about cancer; after all, that is supposedly how he makes a living (as an oncological surgeon and researcher). But much of what he had to say brought a smile to my face.

I have to confess that I’ve always had a bit of an odd fondness for Orac. Not long after the Little Rankster was diagnosed as being on the spectrum, my wife began to attack the problem from a medical standpoint. She eventually became convinced of something that initially struck her as being counter-intuitive to everything she had learned ⎯ that ASD might be triggered by damage from vaccines (or something in them), and that it can be treated biomedically to undo that damage. My wife is one of the smartest people I’ve ever known, so when she became convinced, I knew I had to take a look at the hypothesis. My research led me to the oh-so-dangerous internet, where I became fascinated by the scientific and political debate. And that led me to Orac.

I don’t even recall what post it was at the Huffington Post, but there was a real lively discussion going on in the comments. The two most interesting people commenting, on opposite sides of the question, were both doctors: Alan Clark and Orac. Dr. Clark inspired me with his intelligence, his passion, and his integrity. (It is one of the great regrets of my life that did not get a chance to meet Alan before his untimely death, but I have been lucky enough to have a treasured friendship with his wife, Lujene.) Orac inspired me in a somewhat different way. After a little friendly sparring at HuffPo, I went to Orac’s blog and checked it out. My first thought was, “oh hell, I can do that.”

Despite sharp disagreement on the issues of autism causation and treatment (a dilemma Orac never had to face on a personal level), and the broader issue of vaccine safety, Orac and I stayed on fairly good terms for a couple of years, exchanging thoughts and greetings both on- and off-line. That ended after I declined his suggestion to “disassociate” myself from the instigator of a famous internet prank (in retrospect, it seems even funnier than it did at the time) which targeted Orac (see here and here).

It was probably about time anyway that we dispensed with the trappings of cordiality. By that time, Orac, despite the tongue-in-cheek tone of his blog, had started to take himself way too seriously. His pronouncements of what is and is not science began to take on the clothing (albeit the same cloth used to tailor the emperor’s new clothes) of purported infallibility.

But then again, he always had that white-coat arrogance wherein he refused to recognize any science that did not meet his expectations. Once he had determined for himself what the science of vaccine safety and autism was, no additional data would make him change his mind. And if those who thought differently might expand a hypothesis based on additional observation ⎯ a very reasonable exercise of the scientific method ⎯ such expansions would be laughed away as “moving the goal posts.”

Arrogance like that, though, borders on hubris, and often leads to amazing inconsistencies. And that leads me to Orac’s recent review of the President’s Cancer Panel report (or as Arlo Guthrie once said: “I told you that story so I could tell you this one”).

Orac has always been one to speak of the vaccine-autism controversy as a closed subject. He believes that science has spoken and clearly rejected any connection based on the epidemiological studies that vaccine defenders point to time and again. Like most such defenders, Orac ignores the fundamental flaws in the methodology of those studies as well as the obvious conflicts of interest that weigh against credibility. That’s why I found myself smiling to see the following passage in Orac’s discussion of the President’s Cancer Panel Report:

As tough as biomedical research is in cancer, to my mind far tougher is research trying to tease out the relationship between environmental exposures and cancer risk. If you want complicated, that’s complicated. For one thing, obtaining epidemiological data is incredibly labor- and cost-intensive, and rarely are the data clear cut. There’s always ambiguity, not to mention numerous confounding factors that conspire to exaggerate on the one hand or hide on the other hand correlations between environmental exposures and cancer. As a result, studies are often conflicting, and making sense of the morass of often contradictory studies can tax even the most skillful scientists and epidemiologists.

So let me get this straight. When one is trying to determine the relationship between environmental insults (including vaccines) and the triggering of autism spectrum disorders, even badly designed epidemiological studies can prove conclusive, no matter how provocative findings in clinical and laboratory settings may be. But in the case of cancer, it’s “complicated.”

That very same paragraph compounds the intellectual inconsistency:

Communicating the science and epidemiology linking environment and cancer to the public is even harder. What the lay person often sees is that one day a study is in the news telling him that X causes cancer and then a month later another study says that X doesn’t cause cancer. Is it any wonder that people are often confused over what is and is not dangerous? Add to this a distinct inability on the part of most people, even highly educated people, to weigh small risks against one another (an inability that has led to phenomena such as the anti-vaccine movement), and the task of trying to decide what is dangerous, what is not, how policy is formulated based on this science, and how to communicate the science and the policy derived from it to the public is truly Herculean.

Somehow you just knew, didn’t you, that Orac would get in a dig at what he labels the “anti-vaccine movement.” We differ, of course, on the semantics. I would call it the “safe vaccine” movement, but in Orac’s mind, if you ain’t 100% for the current schedule, you’re an “anti.” Besides, labeling those who disagree with you as “anti-” something makes for a nice, short-hand ad hominem (oh God, I don’t believe I said that).

Beyond the use of an inaccurate label, though, Orac displays arrogance of a truly Offittian magnitude. In his mind, anyone who does not wear a white coat to work is utterly incapable of understanding the subtleties of the scientific method. We are incapable of being able to exercise appropriate judgment in weighing “small risks.” Of course, he simply takes it on face value that the risk of adverse effects from vaccines is small, and any evidence to the contrary is discarded as unreliable.

Orac’s post is rich in irony. One of the recommendations of the panel, seemingly finding favor in Orac’s mind is the following:

The adoption of a new “precautionary, prevention-oriented approach” to replace our “current reactionary approaches in which human harm must be proven before action is taken to reduce or eliminate exposure.” As a part of this approach, it is recommended that the burden of proof of safety should be shifted to the manufacturer, rather than the current burden of proof being upon the government to prove harm.

Really. Would Orac agree that it might be a good idea to apply that same principle to studying the long-term impact of not just individual vaccines and components, but also of the synergistic effect of all of the vaccines on the current schedule? Up to now, he seems to have felt that members of the public, rather than manufacturers or the government, should bear the burden of funding any such research.

I almost shot my morning coffee through my nose when I read Orac’s whole-hearted approval of the Panel’s discussion of environmental factors in childhood cancers:

The report emphasizes quite strongly that what we know about the environmental contribution to cancer has lagged far behind our knowledge of other aspects of cancer. More importantly, one aspect of the environmental contribution to cancer that we often don’t consider strongly enough is that children tend to be more susceptible to environmental insults of many kinds, particularly carcinogenic insults:

An analysis by the National Academy of Sciences found that children are particularly vulnerable to environmental contaminants for several reasons. Due to their smaller size, children’s exposures to toxics are disproportionately large compared with adults. Because their metabolic pathways are immature (particularly during fetal development and in the first months after birth), they are slower to metabolize, detoxify, and excrete many environmental chemicals. As a result, toxins remain active in their bodies for a longer period of time than would be the case in adults. In addition, children have lower levels of some chemical-binding proteins, allowing more of a toxic agent to reach various organs, and their blood-brain barrier is more porous than that of adults, allowing greater chemical exposures to the developing brain. Children’s bodies also are less able to repair damage due to toxic exposures, and the complex processes that take place during the rapid growth and development of children's nervous, respiratory, immune, reproductive, and other organ systems are easily disrupted.

Replace the word “cancer” with your choice of “autism,” “autism Spectrum disorders,” or “developmental delays,” and he sounds like one of us. And wait until you see what Orac had to say about the dramatic rise in childhood cancers, even while the mortality rate dropped:

The reason for this increase is not known, but genetics is an unlikely cause for such a rapid increase. In addition, it is unlikely that better diagnosis due to the introduction of MRI and better CT scanning is likely to be the cause, because the increase is too steady. That leaves environmental factors as one suspect for a major cause.

Gee, Orac, are you sure that the rise in diagnoses was not just due to increased awareness? Or maybe it’s just a lot of parents that want all the services available to sick kids.

It seems that Orac is the perfect example of selective belief in the intractability of scientific “fact.” Because the science suggesting a link between vaccines and ASD is still emerging, the hypotheses are constantly being refined. Orac, and others of his ilk, scoff at that evolution and say that we are “moving the goal posts.” But when it comes to cancer science, his song has a different lyric:

One recommendation of the report that intrigued me was its assessment of how science has generally focused on one compound at a time without considering how they may interact. This reminds me of how in the past we concentrated on one gene at a time as a causative agent for cancer (such as oncogenes); yet over the past ten years it has become increasingly clear that cancer is often driven by many genes, each of which individually plays a relatively small role.

It’s easy to understand how Orac came to the arrogance that shines through his prose. First, it’s not an uncommon characteristic among his profession. Beyond that, however, it cannot be denied that he has become famous through his blog. He writes in a lively style, and his sophomoric humor plays well with jaded grad students. He purportedly gets site visits in numbers that any blogger would envy. That’s enough to give anyone a swelled head.

On a personal level, he’s probably not a bad guy. David Gorski is likely a faithful husband, I certainly doubt that he would kick his dog, and he might even take his turn at buying rounds when he’s at the local tavern. But as Orac, he’s so arrogant as to be completely blind to the inconvenient truth that is hitting him in the face. And he’s not alone.

Orac, and far too many of his ilk, look at things like the report of the President’s Cancer Panel, and they fail to see ⎯ or at least fail to acknowledge ⎯ that what they’re seeing is just one part of a multifaceted picture, showing what we’re doing to the immune systems of the latest generations. I pray that they start hoping their eyes and minds in time to start saving the generations to come.