Friday, March 26, 2010

Guest Blogger: Novella Gets it Wrong...Big Surprise

My good friend Schwartz took the time to write this amazing article about Dr. Novella and his early diagnoses farce. Thanks, Schwartz for your welcome take-down of Dr. Novella.

Several weeks ago, I observed an interesting exchange between JB Handley and Dr. Steven Novella here, here, and here.

Here is a link to the study being discussed.

After reading it all, I decided to perform an analysis of Dr. Novella’s final response. I’ll warn everyone here that this is a long article because we actually drill into the details. What we find is very disturbing although not surprising to some of us. In part I of this analysis we find Dr. Novella’s writing littered with factual errors, misrepresented facts, false logic, and unprofessional prose. It raises a lot of questions as to why Dr. Novella is considered a credible resource when it comes to the questions surrounding vaccines and Autism.

“Science based medicine” comes across as the more “professional” sounding arm of the scienceblogs crew which includes Dr. Gorski who blogs there under the pseudonymn of Orac. Although Dr. Novella does not blog under scienceblogs, he publishes an irreverent podcast which discusses topics in a similar insulting style. When these people want to appear more credible, they tend to publish under the sciencebasedmedicine moniker.

The question of credibility is an interesting topic. Much of the debate surrounding complex health topics such as Autism are subject to considerable opinion given that the problems are complex and very few definitive facts exist. It is quite common to see a majority of arguments in any particular blog or newspaper article on autism and vaccines, based purely on opinion which is inherently founded on an assumption of credibility. I can only assume that’s why Drs Gorsky and Novella started up sciencebasedmedicine because the podcasts and scienceblogs are both filled with rhetoric and personal insult which has no place in professional science.

I prefer to judge credibility based on measuring what someone says against the evidence they present and the evidence they ignore, not the letters after someone’s name. Yes, that takes a lot more work than just trusting smooth talking authority, but real knowledge is gained only through hard work and reading the details.

So let’s get straight to work. I’ll skip the pre-amble from the article move right to where Novella opens with an admission to a single error:

Unfortunately, I made a statement that is simply wrong. I wrote:

Many children are diagnosed between the age of 2 and 3, during the height of the childhood vaccine schedule.”

First, this was a vague statement – not quantitative, and was sloppily written, giving a different impression from the one I intended. I make these kinds of errors from time to time – that is one of the perils of daily blogging about technical topics, and posting blogs without editorial or peer-review. Most blog readers understand this, and typically I will simply clarify my prose or correct mistakes when they are pointed out.”

Ok, the mea culpa. No problems there. However, I think Novella’s excuse is important to make note of, especially in light of the point I made earlier about hard work. A blog is a perfectly valid way to discuss one’s opinion. However, there are many people that treat this material as if it was scientific reference as intended by the author. Novella also makes many statements of fact in his piece. In the comments section someone else pointed this out and Novella responded including this:

“But even then, the rate of errors like this is very low – as a percentage or even total number. And when they crop up, we rapidly correct them.”

We will revisit this one later. Let's continue with his article.

"However, since I often write about topics that interest dedicated ideologues who seek to sow anti-science and confusion, sometimes these errors open the door for the flame warriors. That is what happened in this case."

It’s interesting that Dr. Novella implies that a proper correction is merited because others might “take advantage” of his mistake. I also notice the “air of professional” blog didn’t stop him from slipping in a personal insult as well.

"J.B. Handley, writing at Age of Autism, saw my error as a way to demonize me before his enthralled mobs – and he dives into his task with gusto – although without much care or attention to detail himself, as we will see. Handley also is clearly not interested in what the science actually says, only in grabbing a propaganda opportunity."

He’s throwing more personal insults while complaining about being demonized. Let’s move on to the actual arguments. I’ll skip over the next paragraph where he agrees there are many vaccinations prior to the age of 12 months and move directly to the arguments.

“I wrote that “many children are diagnosed between the ages of 2 and 3. About this statement Handley writes:

“Firstly, the last time I checked, the average age of diagnosis for a child with autism was somewhere between 3-4 years of age, not 2-3.”

"In fact, the average age of diagnosis is 3.1 years (although to be fair other studies give the average at 3.6 – there is some regional variation). This is “somewhere between 3-4 years of age” but Handley’s point is still incorrect. I did not write that the average age was between 2 and 3 but that many children are diagnosed between 2 and 3, which is certainly true if the average age at diagnosis is 3.1. In his exuberance, Handley simply got this wrong."

Novella seems to be splitting hairs here and he is vigorously defending yet another vague, not quantitative statement, so we’ll indulge him and check the reference provided: (here).

3.1 years for Autistic disorder, 3.9 for pdd-NOS, and 7.2 for aspergers. The weighted average is 4.3 years for ASD.

We all know the term "Autism" is ambiguous since it has multiple meanings. If we look at the original study that Novella commented on, it was using the term Autism to refer to Autism Spectrum Disorder (ASD): (here)

ASD actually includes Austistic Disorder, PDD-NOS, and Aspergers.  (Here)

Novella's use of the 3.1 year old number is clearly not accurate. He needs to take the combined average of the three values contained in his reference and that average is a lot closer to Handley’s stated range and his argument. 

I hope that someone correcting erroneous commentary would double check that they got it right the second time especially when they provide a reference. In Novella's reference, the three numbers are listed together so oversight is unlikely but giving him the benefit of the doubt leaves us with three possible conclusions:

1) Novella doesn't really understand Autism

2) Novella purposefully used an incorrect number hoping you wouldn't notice

3) Novella made yet another mistake in his correcting submission

(MySocratesNote: I suspect all three)

All three possibilities are pretty embarrassing. If we consider the assertion that his use of the term “many” is accurate we have to take a look at the graph from the study he referenced to support his average age of diagnosis. (here)

A quick glance illustrates that the majority do not get diagnosed between the ages of 2 and 3. The average survey age from the study was 10. If Novella insists that his use of the term "many" is still technically accurate because it is ambiguous, then his argument is ambiguous. The end result is his argument is either ambiguous, or just plain wrong. In science based medicine, I'm not sure which is worse, but I'm certain neither one is scientific. I’ll just repost his mea culpa from the opening: “First, this was a vague statement – not quantitative, and was sloppily written…”. I’m unclear why he would spend paragraphs trying to defend yet another example of vague poorly written statements while admonishing Handley for quoting an average which is actually a quantitative term?

Novella's reason for making his original statement was to support his hypothesis that the correlation being made by parents between vaccination and Autism was only because the age of the “height of vaccination” corresponded to the age of diagnosis. He used both of these erroneous facts to support his hypothesis that this observation of correlation and subsequent conclusion of causation was an example of “telescoping phenomenon” due to the perceived concurrent timing. As Handley correctly pointed out, the majority of diagnosis is later than Novella stated, and the “height of vaccination”, earlier. Moving on he continues:

"I don’t expect him to make a correction, however. The last time he attacked me, he make a rather amateurish mistake, confusing incidence and prevalence, and used his error as the basis of his criticism. He never admitted or commented in any way on his gross error."

This criticism hinges on this statement from his previous paragraph: "I did not write that the average age was between 2 and 3 but that many children are diagnosed between 2 and 3, which is certainly true if the average age at diagnosis is 3.1. In his exuberance, Handley simply got this wrong."

Reading Novella’s own reference we see that the average age of diagnosis for ASD (which is the criteria for the study in question) is not 3.1 years. Basic examination of the evidence referenced by Novella contradicts his assertion and supports Handley’s point. In light of his continuing lack of rigour and “vague” language, Novella’s rebuke of Handley is all the more ironic. I wonder if he’ll make another correction?

"But onto the substance of his latest attack. The point that I was trying to make, which I did in fact clarify later in my post, is that when parents attempt to date the onset of their child’s autism they typically will date the onset later than the true onset."

This is revisionist. Here is exactly how he makes his point in the original article:

"The authors, however, do not discuss one very significant implication of this study (although an implication already raised by prior studies demonstrating early signs of ASD) – the observation made by many parents that ASD symptom onset correlates with certain vaccinations."

His key point or “significant implication” of the study is that parents are suffering from telescoping phenomenon.

"What this and other studies show is that not only is the assumption of causation fallacious, the observation of correlation is likely flawed as well. The true onset of autism in most ASD children likely began a year or two prior to the vaccines that are blamed as the cause."

Again, he implies quite strongly that the parents are wrong again and he provides two pieces of evidence to support it: the timing argument, and the Cedillo Omnibus case. Since his first argument is fundamentally flawed – and the only argument based on the study under discussion – we’re left with the Cedillo example. We don’t even need to investigate the merits of that case because it is a classic example of an anecdote. Novella is making a strong broad based conclusion purely based on the merits of anecdote. If I remember correctly, that reads like a Plural of Anecdote fallacy. I also note the flying reference to “this and other studies”. No references were provided. I’ll let you decide if you have faith in his assertion. (MySocratesNote: Also keep in mind that the Cedillo case was a trial, not science. Isn't that what they said about the Poling and Banks cases?)

Moving back to the newer post, Novella states:

"As we now know, from multiple studies, true clinical onset (biological onset is likely earlier) is between 6 and 12 months. Parents may not notice this onset until much later, and formal diagnosis is later still. This diagnosis happens within the childhood vaccination schedule, so it is likely that parents will have some recent vaccine to point to when looking for factors that seem to correlate with the onset of autism."

You might not have noticed, but Novella just pulled a couple of really fast ones, one of which he also pulled in the original article. First he revises his argument by saying that diagnosis happens within the childhood vaccination schedule. I think I saw a moving goalpost there. Even still, it is a meaningless statement since a glance at the schedule – referenced by Dr. Novella earlier – shows that vaccination occurs throughout all of childhood from birth so of course it occurs during the vaccination schedule.

The real news is that Novella just discovered that the true clinical onset of ASD was between 6 and 12 months. That statement of fact about the “true clinical onset” is not referenced so I can only assume he's using this latest study as evidence to back it up. This study does not conclude anywhere that the “true clinical onset” of ASD is between 6-12 months. Novella just made a giant leap of assumption. He again provides no other references despite stating they exist.

I’m going to continue on with the analysis of his post now, but I will return to the issue of “true clinical onset” in part II of this analysis. We will soon see that all of Novella’s fundamental arguments rest on his slight of words “true clinical onset” and the completely unreferenced “biological onset is likely earlier”. Let’s move on.

"That was my point – a point that I and many others have made previously. By pushing earlier the true clinical onset of autism this study adds to evidence against the involvement of later vaccines. It is true that many vaccine are given in the first year of life, and of course this study by itself does not let all vaccines off the hook – nor did I say that it does."

Since this study never states that the “true clinical onset” is 6-12 months, his statement is completely unsubstantiated and we must assume is his opinion. Given that he admittedly has no clinical experience with Autism, and that he has now made two basic fundamental errors of analysis, his opinion – unsupported by any scientific reference – isn’t very convincing.

Reading on, Novella continues to the topic of MMR:

"But I did discuss one vaccine in particular – the MMR vaccine. MMR has received more attention than any other vaccine as a potential cause of autism, thanks to the now-discredited work of Andrew Wakefield. The first dose of MMR is given at a minimum of 12 months of age, with the second dose being given between 4 and 6 years. Certainly this study is relevant to the claim that MMR is a significant cause of autism"

Novella goes on:

“There is much evidence to support the conclusion that there is no correlation between MMR and autism. It should be obvious that this study is further evidence against a correlation. If most children with autism show signs by 12 months, then a vaccine which is not given prior to 12 months cannot be to blame.”

If we review the results of the study, there were only 4 parents of the 25 ASD children that actually reported regression. Ignoring the extremely small sample size that Novella’s hypothesis covers, there is no information in the study to indicate at what age those regressions occurred. Consequently, it is not possible to determine whether the reported regressions occurred prior to or after any specific vaccination. Novella is really arguing against a strawman – that all reports of autistic regression occur after MMR vaccination. Either that or he is making the classic error of assuming that the onset of regression for the group applies to each individual case.  (MySocratesNote: I'd also like to interject that the study said that in the majority of cases, onset occurred between 12 and 18 months, with some being seen as early as 6 months. So, he misrepresents the data, omitting that crucial detail)

Novella continues:

“This was not obvious to Handley, however. He wrote:

“In fact, between the ages of 2 and 3, children receive all of 2 vaccines, accounting for 5.5% of the vaccines they receive, while a full 70%, including MMR, come in their first 12 months of life, perfectly matching the time when this new study reported the beginning of a regression into autism!"

"Wrong, Handley. The MMR does not come “in their first 12 months of life.” At the very earliest it comes AT 12 months, which obviously cannot be responsible for symptoms that are present by 12 months. Maybe Handley was just sloppy in his choice of words (but it is odd that he went out of his way to mention MMR by name). Or maybe he is guilty of all the things of which he falsely accused me. This is certainly the same kind of error I made, although more specific. My error was inadvertent and I have readily admitted my mistake and am taking great pains to correct it. Let’s see how Handley responds when this error is pointed out to him.”

Novella is complaining about Handley’s assumption that MMR occurs at exactly 12 months despite the schedule recommending it between 12-15 months. For anyone who has kids (I'm guessing Novella doesn’t because it’s pretty hard to miss the “height of the vaccination schedule” if you do) there will almost certainly be a one year pediatrician visit around the first birthday. For the majority of children, the MMR vaccine will be administered at this time at the age of 12 months. 

If Novella really wants to argue minute details, he might want to take note that the differences between the ASD and ND groups only became significant at the 12 month period and that a 12 month visit – at 12 months of age per the study description – is a point in time occurring within a 30 day period. This means that a statistically significant regression measured at 12 months of age could occur after a 1 year anniversary MMR vaccination. There is not enough detail provided in the study, or in the vaccine records for these children to provide any support for his hypothesis about MMR and autistic regression. If we review Handley’s argument, Novella certainly has not provided any convincing scientific evidence to contradict it.

“The bottom line is that this study does in fact add to the body of evidence against an association between MMR and autism, because of the timing of the onset of autism.”

As we reviewed earlier, Novella’s sweeping assumptions about the onset of ASDs are not supported by the evidence provided.

I have the experience of actually seeing and diagnosing patients, reviewing their histories and comparing them to documented evidence in some cases. So I, like other experienced clinicians, understand this phenomenon well. For example, I see many patients with dementia, like Alzheimer’s disease, and they or their family will often date the onset of symptoms at a point in time some months prior to presentation, often anchored to a specific event (a phenomenon actually known as “anchoring”). But when I probe for specific details, it is apparent that there were signs of dementia for 1-2 years prior to the family’s dating of the onset. Or, I may have the benefit of a documented exam or history, clearly showing onset prior to the memory of those giving the history.”

This section borders on an argument from elitism and the fallacy of intuition. Dr. Novella’s clinical experience does not imply he is right and Handley is wrong. Additionally, Dr. Novella’s own experience with dementia does not allow us to assume he can intuit what parents are experiencing when they observe Autistic regression after vaccination. He’ll have a hard time convincing me that parents pay as much attention to their aging spouses or parents as they do to their newborn infants.

"Handley seems naive to all of this, and rather he is content to grossly mischaracterize my point as calling parents “dumb,” which, of course, I never did. This is because Handley’s purpose, in my opinion, is not to meaningfully explore the evidence, but to demonize scientists and physicians with whom he disagrees. Read the comments to his blog and you will see that his attempts at demonizing me and others are quite successful in the echochamber of his followers. He wrote:" Further, this notion by Novella that we parents are “telescoping” is simply the ridiculous introduction of a new and confusing term to try and explain away the chorus of tens of thousands of parents all screaming the same thing about what happened to their kids."

Since misery begs company, I have to post a comment from Novella’s blog:

“But this won’t carry any weight with the anti-vaxxers, because they are already convinced that it is the vaccines. The details don’t matter, and we’ve already seen that the narrative can shift wildly, so long as it ends up with the finger being pointed at vaccination. They’ll just conclude that perhaps the child had some kind of a “risk factor” to begin with, or else the damage was done by the early vaccines but not recognized, and the later vaccination was the “straw that breaks the camels back” and made the autism worse.”

There isn’t much to say about that is there? Moving on:

"The authors of this study itself applied the concept of “telescoping” or dating autism onset as more recent that it really was. I simply used their term, which they in turn took from the literature. It is a well-described concept, not invented by me or this study’s authors – people remember events in the past as being more recent than they actually were. For Handley’s purposes, however, he wants to characterize a well-known and scientifically established psychological phenomenon as being equivalent to calling people stupid, or spinning reality."

This is serious revisionism. As I covered early on, Novella clearly tried to attribute the correlation of Autistic regression with vaccination to the telescoping phenomenon using his erroneous calculations as evidence. Additionally, Novella implies that the study discussed telescoping without providing a quote. As we recall, a closer inspection of the study doesn’t leave much to discuss about that topic because the vast majority of the parents never reported any regression and the study never discusses its timing. I hope Novella clarifies this problem with his argument.

Further, Handley is now trying to argue that this new study supports a correlation between vaccines and autism. In fact, it does nothing of the sort. It does all but eliminate MMR, varicella, and Hep A as having any potential role in autism, as these vaccines all come after the onset of autism in most cases. Handley, if he were being intellectually honest, should admit this, but he doesn’t, and very dishonestly implies that MMR specifically is still a potential cause.”

This is opinion masquerading as fact. His whole argument rests on his unsubstantiated statement about the onset of autism. (MySocratesNote: Again, I'd like to point out my earlier comment about what the paper really says about onset)

Average age of diagnosis of autism is about 3.1 years of age, and when that was the best information we had to go on the anti-vax movement argued that this showed a correlation with vaccines. Then clinical studies showed that the diagnosis could be reliably made between age 2-3 years of age, but that’s OK, that still correlates with vaccines. Now we know the age of clinical onset is between 6 and 12 months, and Handley is saying this still correlates with the vaccine schedule.”

Novella now uses an argumentum ad logicam – he is implying that errors in previous hypotheses mean that the current conclusion is invalid. He also invokes stereotype which is rhetorical and obviously the “anti-vax” arguments he refers to can’t actually be referenced. Honest debate does not invoke stereotype in an argument. To add insult to injury, he again erroneously uses the wrong average age of diagnosis based on his own scientific reference. He also repeats his unreferenced statement of fact that we know the true age of clinical onset of autism. His definitive conclusion is completely unjustified and unsupported by the evidence he provides. 

There is also nothing about the vaccine hypothesis that led anyone in the anti-vaccine camp to predict that the true age of onset of autism is earlier than it is being diagnosed, and certainly not to within 6-12 months of age. So Handley is just retrofitting – declaring whatever evidence there is as supporting his position.”

In addition to invoking stereotype again, this is an Argumentum ad logicam: Errors in previous hypotheses do not invalidate the current conclusion. From his tone here, I also get the impression that Dr. Novella disagrees with altering a hypotheses based on new information, something that is an integral part of the scientific method. (MySocratesNote: Again, he makes the same error about what the paper actually said)

Since the HepB is given at birth, and other vaccines at 1-3 months, moving the diagnosis of autism up even further would still correlate with some vaccines. Since Handley is willing to blame any vaccines, regardless of type (live virus or otherwise) and ingredients (thimerosal or not) no age of onset would disprove his cherished vaccine hypothesis.”

Novella gets the details wrong again on this one. If we take a trip over to the CDC recommended schedule from his own reference: (Here)

We see that the bulk of the early infant vaccinations occur between 2 and 6 months, not between 1 and 3 months. I’m really surprised at this one, since Handley walked through the schedule is gross detail. This whole section consists of a rant about Mr. Hanley littered with false arguments.

There is also nothing about the vaccine hypothesis that led anyone in the anti-vaccine camp to predict that the true age of onset of autism is earlier than it is being diagnosed, and certainly not to within 6-12 months of age. So Handley is just retrofitting – declaring whatever evidence there is as supporting his position.”

Again, more complaints about a modified hypothesis based on new evidence. This is also ironic because we’ve seen a fair bit of retrofitting in Novella’s single series of two blogs. He again repeats his unsupported assertion that the true clinical onset of Autism is 6-12 months.

Finally, Handley pulls the “pharma shill” gambit on me as part of his smear campaign. He trots out an accusation he has made before, portraying my association with the ACSH as being sinister. As I have already explained, my association with the ACSH is limited to me agreeing to advise them on areas of my expertise. That’s it. I have, in fact, performed zero work for them. I have had no contact with them, other than them sending me their public material, and I have never received any kind of remuneration from ACSH. I have corrected Handley on this before, so I know that he knows what he is writing is wrong, and he has failed to correct his errors.
Further my associations with the pharmaceutical industry are minimal – a couple lectures and consultations for nominal fees years ago (and nothing ever to do with vaccines). I have never received a dime from any company to express an opinion on a scientific topic, or write a particular blog or article. I suppose that Handley believes my many hours of work producing podcasts and blogs and promoting science and skepticism is all an elaborate smokescreen for shilling for industry, all without receiving a dime for my efforts, which makes me the worst shill ever.”

On a side note, the ACSH is an industry funded organization that has dubious credibility given their severe conflict of interest, and some of their questionable positions, but that is a whole blog topic on its own. Any association with that organization is questionable and Novella’s response confirms my suspicion that he knows this based on his desperate attempts to distance himself from them.

However, what is important is that perceived conflict of interest is the standard requirement for declaration these days. Novella does not declare any conflicts in his writing, and thus it is perfectly valid for Mr. Handley to point them out. If Dr. Novella doesn’t like someone else’s portrayal of those conflicts, he should properly declare his own interests with his writing as should everyone at that website. I’m personally curious what he considers a “nominal fee” or “minimal” association. Holding shares in pharmaceutical companies, or your employer receiving research grants are also fair game here. Let’s see if Novella decides to stop appealing to pity and step up by clearly declaring his conflicts of interest in the future.

Actually, I don’t suppose that at all. Rather I think that Handley knows that what he is writing is pure BS, especially since I have called him on it before, and openly challenged him to produce a shred of evidence to support his false accusations. But Handley knows the narrative of the anti-vaccination movement – everyone who denies that vaccines are evil are themselves evil shills for even more evil industry.”

Novella now reduces his “professional scientific” website even further by hurling insulting rhetoric laced with sweeping generalization and stereotype. Those have no place in an honest debate.

Moving on to his closing statements:

“In the end, all that matters is the science, which clearly shows that there is no association between vaccines and autism. This one study has minimal implications for an alleged connection, except that it clears the most often implicated vaccine – MMR. It also supports other evidence that the onset of autism is earlier than many parents observe and much earlier than formal diagnosis, which calls into question any casual observations about the timing of onset to any potential triggers.”

Here again, Novella invokes rhetoric in his first statement. Science can’t “clearly show” a lack of association without providing a definitive cause. He implies that there is no scientific debate which is demonstrably false. Certainly by evidence based medicine standards, the studies done to date are far from the highest quality and there are increasing calls for higher quality study. Additionally, we have the Cochrane report that clearly states the safety and efficacy studies about MMR are “inadequate”. (Here)

That Dr. Novella makes a definitive statement like “clearly shows” based on weak “inadequate” study is telling and a further blow to his credibility. Based on our investigation here, I am skeptical on how much time he spent reading the details.

In the next sentence he again makes an erroneous statement of fact, one that certainly can’t be substantiated by a study that didn’t include any data about the timing of vaccination let alone MMR. Stating fact without evidence based on personal assumption and conjecture is not scientific or logical. He also reiterates his giant leap of faith regarding “clinical onset” again. In the next statement, he makes an unreferenced assertion that there is other evidence that parental observations of regression are delayed from clinical onset. As we discussed earlier, we found no reference in this study as to the timing of parental observations compared to measured regression.

“In my first article on this topic I was sloppy in that one sentence about the vaccine schedule – an error I have now corrected. But that error did not affect the relevant points I made in the rest of the article, which I have also amplified here.”
Our detailed examination has shown that his errors in logic go far beyond one sentence. Even worse, his correction is littered with errors that are just as egregious as we’ve discussed here at length.
 “J.B. Handley thinks he has scored some points for his side by jumping on my error, but he has only shown himself, once again, to be a propagandist with no regard for science, accuracy, or even common decency.”
The irony should not be lost that Dr. Novella invokes rhetoric while in the same breath accusing Mr. Handley of a lack of common decency.

I can only conclude that Dr. Novella's false assumptions and failed arguments are a classic illustration of "inherent bias". Contrary to his pleading here, we have seen that his only admitted error undermined one of his key objectives, to show that parents were falling prey to the telescoping phenomenon.

I may not agree with everything Mr. Handley says, but in this exchange of arguments, the vast majority of logical arguments and balance of credibility sit on the side of Mr. Handley.

What can we take away from this analysis? I’ve observed a few things right off the bat:

* Dr. Novella does not appear to be familiar with childhood vaccination or autism

* Dr. Novella unprofessionally misrepresents opinion as fact

* Dr Novella, is not rigourous in his fact checking or in valid scientific references

* “Sciencebasedmedicine” purports to be a “scientific” reference blog, yet this writing includes personal insults, and classic examples of false logic

* Dr. Novella does not appear to learn from his own admitted mistakes

If we look on the website for sciencebasedmedicine we see the following: “This is meant as a resource for the public, for health care professionals, writers, journalists and other members of the media.”

If you combine this article with the frank admission by Dr. Novella regarding the time invested in his articles it dangerously re-enforces the growing consensus in the public that many Medical Doctors suffer from a god complex. Unlike almost every other profession, their organizations act like they are immune (vaccinated?) to the ever pervasive conflicts of interest and now it seems some of them think they can produce high quality reference material without investing any serious time or effort.

Mark Crislip stated quite eloquently in another blog entry: “Call me arrogant, but if you want to be a legitimate source of information there are dues that have to be paid.” (Here)

Stay tuned for part II.

Conflicts of interest: None declared