By Marika Sboros
Antivaxx! It’s a claim that has dogged South African scientist Tim Noakes for years. When some medical doctors run out of science and nasty things to say about Noakes, they soon claim that he is antivaxx.
Antivaxx is a loaded, pejorative term. Critics use it to silence anyone who even mentions vaccines except in unqualified, glowing terms. It’s pretty serious stuff for a doctor to be accused of being antivaxx.
The Health Professions Council of South Africa (HPCSA) could charge such a doctor with unprofessional conduct. Thus, say legal experts, and depending on the context, calling a doctor antivaxx can be defamatory.
Of course, it’s really only defamatory if the claim is untrue or malicious. That is, if there is a deliberate intention to denigrate and damage the doctor’s standing and reputation.
Yet Noakes has regularly stated that he is not antivaxx. He has also stated publicly and tweeted that he believes vaccination to be one of modern medicine’s “greatest life-saving achievements”. He points out that he has been vaccinated. And so have his children and grandchildren.
So what’s really behind claims that Noakes is antivaxx. And why are so many of his critics who say it from his alma mater, the University of Cape Town.
Leading the latest charge these days is Cape Town paediatrician and UCT graduate Alastair McAlpine. McAlpine regularly tweets attacks Noakes’s medical and scientific credibility and knowledge .
He also recently acquired a new vehicle from which to launch attacks on Noakes: the Medical Brief website. Of six columns he has written since January, McAlpine devotes four to attacking Noakes. (One is an attack on me but includes Noakes.) His latest column repeats his claim that Noakes is antivaxx. (Click here for Noakes’ full response.)
McAlpine’s latest column purports to be about the dangers of doctors who oppose vaccination. However, his major focus is Noakes. Despite that, he has since somewhat disingenuously claimed that the column isn’t really about Noakes.
But what exactly has Noakes said that makes some doctors insist that he is antivaxx? And just why does the HPCSA allow colleagues to defame Noakes with impunity? After all, the HPCSA’s own code of conduct expressly forbids one doctor from denigrating another by name in public.
It all comes down to a single tweet Noakes made on the topic way back in August 2014. And if anything sounds familiar about single tweets getting Noakes into trouble, it is. More below as it’s likely the reason for ongoing “antivaxx” smears.
In August 2014, Noakes tweeted: “Dishonest science. Proven link between autism and early immunisation covered up?” He included a link: bit.ly/1AJvbB3.
Thus, Noakes, makes the point that his tweet is not about vaccines but about bad (dishonest) science. But you’d know that if you were a scientist, which Noakes is and McAlpine is not.
You would also know that Noakes’s National Research Foundation rating is A1 as a scientist. That is a world ranking and it acknowledges him as a world authority.
But back to the tweet. It was deliberately in the form of a question, says Noakes, because he was indicating that he was “uncertain of the validity of the claim (of bad science)”.
Thus, Noakes’s tweet is a question of quality science. He says that he is not encouraging anyone to avoid vaccination – as the job description of a true antivaxxer requires.
Worth noting is that Noakes joined Twitter in 2012 and has tweeted more than 49,000 times. Only one of his direct tweets (August 2014) indirectly included the topic of vaccines. Somewhat ironically, any further tweets about vaccines have been simply reiterating the fact that he is not “antivaxx”.
And all in response to claims Rousseau, McAlpine and others continue to make, Trump-like, to claim that he is.
Noakes says that his interest has and always will be “the disassembling and exposure of bad science”. That is, after all, what he has been doing for more than 40 years in his distinguished scientific career.
Another CDC cover-up?
Thus, the focus of the bad science in the tweet is also clear. It is an alleged cover-up at the US Centres for Disease and Prevention (CDC). If you were a medical scientist you’d know why any hint of a CDC cover-up would raise red flags. You’d know the awful history. In particular, what the CDC got up to in its previous incarnation as the US Public Health Service (PHS).
PHS doctors ran the notorious Tuskegee experiment from 1932 to 1972. One media report called it “perhaps the most enduring wound in American health science”. It is that and more. The experiment also involved hundreds of poor, African-American men who had the sexually transmitted disease, syphilis, without knowing it. PHS doctors recruited them with the promise of free care, told them they had “bad blood” and gave them placebos.
Because the researchers wanted to track the disease’s full progression, they proactively denied the men effective treatment. They did so even after penicillin became available in the 1940s.
As a consequence, the men went blind or insane. Or they experienced other horrific health problems from untreated syphilis. It took a PHS venereal disease investigator to blow the whistle by leaking the story to the media in 1972. The public outrage rightly forced the study to close.
Tuskegee has since rightly become a byword for racist, unethical medical experimentation. Interestingly, the alleged CDC cover-up to which Noakes’ tweet referred also had a racial overtone. There is evidence to suggest, says Noakes, that African-American children appeared to be particularly susceptible to injury produced by the MMR vaccine. That is, that they are more susceptible than “white” Americans.
So what about vaccines?
But just what does Tuskegee have to do with vaccines? Nothing whatsoever. Just as Noakes’ says that his tweet actually has nothing to do with vaccines. Both Tuskegee and the tweet are really about shining light on the darkness of dishonest science. And not just at the CDC.
Stanford University professor of medicine and of health research and policy John Ioannidis isn’t afraid to shine that light. In 2005 in the PLoS (Public Library of Science) One journal, Ioannidis published a searing indictment of the modern research process. Titled Why most research findings are false, it makes disturbing reading.
Ioannidis says that it is “unavoidable that most research findings are false”. A major problem, the impossibility of knowing with 100% certainty what the truth is in any research question. In this regard, the pure “gold” standard is “unattainable”, he says.
So why, when Noakes raises the issue of possible suppression of data, do his critics create a diversion by calling him anti-vaxx?
An aggravating factor in the debate, say some legal experts, is doctors who are not scientists or scientific in their thinking. Another issue in the vaccine debate – and canvassed in our book – is doctors who subscribe uncritically to the pharmaceutical model of disease.
Disease model under the spotlight
It’s a good model and appropriate for acute conditions. It is also very good for bottom lines of pharmaceutical companies and the doctors and scientists in their thrall or pay.
The model’s success rate for chronic non-communicable diseases (NCDs) is at times less than stellar. NCDs, obesity, type 2 diabetes and heart disease among them, are epidemic globally. Doctors have now added dementia to that list. Because of the documented link with diet, they now call dementia type 3 diabetes.
They call NCDs “diseases of lifestyle” precisely because of robust evidence showing the link with diet. In particular, evidence showing that low-fat, high-carb dietary guidelines and processed foods have played a major role in those epidemics.
They say that dietary change can be even more helpful than drugs to treat and prevent these diseases. That’s a message that pharmaceutical and food industries that make a living off the conventional guidelines don’t like to hear.
It’s probably no coincidence, then, that doctors who challenge conventional “wisdom” on diet to treat or prevent NCDs also question bad science within the industry. And that doctors in the thrall or pay of pharmaceutical companies quickly label anyone who raises any health risks of vaccines as “antivaxx”.
It’s that “let nothing go unanswered” strategy if someone mentions vaccines without the requisite standing ovation. It’s not difficult to spot it in action, so transparent are those who use it.
The real target?
And it doesn’t take a forensic medical scientist to work out why the HPCSA won’t act against doctors who defame other doctors. It is far too busy trying and failing to help dietitians silence Noakes on the science for low-carb, high-fat (LCHF) therapies to treat and prevent NCDs.
Which brings me around to why the idea of a single tweet getting Noakes into a spot of bother sounds so familiar:
He made a single tweet earlier, in February 2014. He tweeted that good first foods for infant weaning are LCHF (low-carb, high-fat). That so “horrified” Johannesburg dietitian Claire Julsing Strydom that she reported Noakes to the HPCSA a few hours later.
Strydom was president of the Association for Dietetics in South Africa (ADSA) at the time. She set off a trial against Noakes that the HPCSA has dragged on for more than four years. The public quickly dubbed it the Nutrition Trial of the 21st Century, which Noakes and I have documented in Lore of Nutrition, Challenging Conventional Dietary Beliefs.
Noakes believes that the antivaxx campaign against him is also just another example of academic bullying or “mobbing” he has experienced since his “Damascene moment” in 2010. That was when he publicly changed his mind on the role of dietary carbohydrate, as we document in our book. The mobbing involves doctors, dietitians and academics at three of South Africa’s top universities: UCT, Stellenbosch and Wits. It’s a murky tale involving claims of medical and scientific misconduct.
Click-bait and ‘antivaxx’ power
McAlpine has been on the periphery of that mobbing and bullying but has appeared keen to make new forays. His use of the Medical Brief website is an interesting development.
The site’s managing editor, William Saunderson-Meyer, is probably better known for his Jaundiced Eye syndicated political columns. As a journalist with many years’ experience, Saunderson-Meyer well knows – or should by now – the attraction and numbers that flow from “click-bait” headlines and articles attacking Noakes. Especially those that are negative.
Saunderson-Meyer declined to say if he or anyone else pays McAlpine for his columns. Nor would he say whether his site receives any revenue – advertising or sponsorship – from pharmaceutical companies. He has also said that treatment of Noakes has been “evenhanded” on the website. That’s not strictly true.
Saunderson-Meyer refused to explain preferential treatment allowing McAlpine to see and respond to Noakes’s response to the “antivaxx” column before publishing it. He, therefore, gave McAlpine yet another golden opportunity to attack Noakes as antivaxx without facts recorded in a response at the end.
Another question around Noakes and the antivaxx claim is why critics so often bring up the MMR (measles, mumps and rubella) vaccine? And why they try to link Noakes’s views to that of a “discredited, disgraced” doctor? That’s a reference, of course, to Dr Andrew Wakefield, the UK gastroenterologist who lost his licence to practice medicine in that country.
Wakefield co-authored a study series the Lancet published in 1998. It showed an associational link between gastrointestinal disease, autism and MMR vaccines. The journal eventually retracted the study. And in the fallout, the British regulatory body, the GMC (General Medical Council), stripped Wakefield of his licence to practise medicine.
What Wakefield said
Many continue to report, wrongly, that Wakefield lost his licence because he fraudulently claimed that the MMR vaccine causes autism. Yet the Lancet study does not make that claim. Instead, Wakefield’s sole claim in that study was an associational (thus, not causal) link between the MMR vaccine in a single combination and the subsequent development of autism. And that was in a small case series of affected children.
Wakefield’s take-home message was not that parents shouldn’t vaccinate their children, says Noakes. He suggested that children should not receive the vaccine as a single all-in-one combination. Instead, they should receive the individual vaccines on three separate occasions.
What is interesting to note is that Wakefield, along with Prof John Walker-Smith was one of 12 co-authors of the study who also came under scrutiny for undeclared COIs. The GMC struck both off the medical roll. Walker-Smith took his case to court and the GMC had to reinstate him.
As well, anyone watching the movie, Vaxxed, with the same unjaundiced eye will see that there really are “two tales” about him. Wakefield directed the movie. In one tale, he is “a charlatan, an unethical researcher and a huckster”. And the British medical registry rightly “erased” him from medical practice.
In the other, Wakefield is “a brilliant and courageous scientist, a compassionate physician” whose patients still adore and respect him. It turns out that there’s a good case to be made that Wakefield is ” a champion for families with autism and vaccine injury”.
Which brings us back to why, when Noakes raises the issue of possible suppression of data in medical research, do his critics insist on bringing up Wakefield? And the MMR vaccine? And why do they claim that Noakces believes that the vaccine causes autism when he has said he doesn’t believe it?
Noakes has said that much of the evidence linking vaccination to autism is associational and thus cannot prove causation. That is not the same as saying vaccines cause autism. And as discussed earlier, Noakes’s first tweet in August 2014 wasn’t about vaccines. Instead, it was about bad science.
On the topic of autism, he says that the cause is “clearly multifactorial”. And “perhaps the most important overlooked factor is nutrition, both of the mother and the child”.
Diets too high in carbohydrates, missing essential fats and perhaps too low in vitamin B12, may be factors, he says.
Therein very likely lies the real target of antivaxx claims against Noakes and others.
Voices for vaccines
Of course, there is evidence of efficacy and safety for vaccination programs. The World Health Organisation (WHO), for example, estimates that diphtheria, pertussis, tetanus and measles vaccines save 2-3 million lives annually. And as McAlpine has noted, the Global Vaccine Alliance estimates based on the schedule of paediatric vaccines. Given to a hypothetical cohort of 4 million children born in 2009, it will prevent “approximately 20 million illnesses and 42,000 deaths over that cohort’s life time”.
The authors of a Cochrane report in 2012 also accept that measles, mumps and rubella are “very dangerous infectious diseases which cause severe morbidity, disability and death in low-income countries”. They say that vaccination with one dose of MMR vaccine is “at least 95% effective in preventing clinical measles among preschool children”.
However, they also conclude that the design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are “largely inadequate”. And they say that it’s not possible to separate evidence of adverse events after MMR immunisation from “its role in preventing the target diseases”.
In other words, it’s all very well saving lives from one health problem only to precipitate another. Some doctors still say that it is no longer possible to claim with a straight face that there are no health risks associated with vaccines. Or that there are no documented cases of massive compensation from the US government for children suffering vaccine “injury”.
That’s after the National Childhood Vaccine Injury Act (NCVIA) that the US Congress passed in 1986. It was designed to protect manufacturers of certain vaccines. Under the NCVIA, those claiming a vaccine injury from a covered vaccine cannot sue a vaccine manufacturer without first filing a claim with the US Court of Federal Claims.
The most famous first-ever case is still that of Hannah Poling. Hannah will reportedly receive more than $20 million over her lifetime for vaccine-induced autism. There is ongoing debate about whether that will be exception or precedent-setting, as a Time magazine 2008 report noted.
There’s “no denying” that Hannah’s case puts “a chink — a question mark — in what had been an unqualified defense of vaccine safety with regard to autism”, another Time magazine report said.
That report notes circumstances that make Hannah’s case “a bit unusual”. “For one thing, she received an unusually large number of vaccines in 2000 .” That was when the organic mercurial compound, thimerosal, was still in use. Her case has raised the question why the US government settled the Poling case out of court. And why the materials of the case have been “sealed” from outside scrutiny?
The establishment response to new evidence in the recent 2018 finding is also worrying.
The UK researchers show that a group of children with autism had “some of the highest values for aluminium in human brain tissue yet recorded”. Thus, say the authors: “..one has to question why, for example, the aluminium content of the occipital lobe of a 15-year-old boy (with autism) would be 8.74 (11.59) μg/g dry wt.?”
They conclude that their findings “could implicate aluminium in the aetiology of autism spectrum disorder”. Not surprisingly, the study attracted vociferous criticism.
On its own, the presence of aluminium in the brains of autistic people in a laboratory does not say anything about vaccines. And there are many other sources of environmental exposure to aluminium. However, the study authors claim that the most likely source “may be multiple vaccinations”.
Who are the real ‘patient killers’?
Another strategy in contentious scientific debates is hugely emotive. It is the claim that any doctor who goes against orthodoxy is “killing patients”. And when patients are children that claim can reach fever pitch
That really gets Scottish GP Dr Malcolm Kendrick’s goatBy no stretch of even the most fertile imagination is Kendrick antivaxx.
In a letter to the BMJ in 2008, Kendrick notes that at the time of Wakefield’s study, the Lancet did not request authors to disclose conflicts of interest. “So Dr Wakefield broke no rules,” Kendrick writes.
There’s perhaps a more pertinent issue, he says. A large number of researchers and those who write clinical guidelines for drug use, are more conflicted than Wakefield ever was.
Kendrick also looks at Oxford University’s “most eminent statin expert”, Prof Rory Collins. Collins took great exception to a Cochrane Collaboration paper criticising the benefit of statins in low-risk and primary prevention patients. He called the paper “far more dangerous than … Wakefield’s Lancet paper”.
Less well-known, he says, is Dr Peter Gøtzsche, Danish physician, professor and head of the Nordic Cochrane Collaboration and long a critic of breast cancer screening. Gøtzsche is author of Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare.
He is “regularly accused of killing thousands of women”, Kendrick says.
‘Criminal views’ on medicines?
Critics, particularly cardiologists, have regularly attacked Noakes for “criminal views” (on statins) and claimed that he will end up killing people. On that topic, Kendrick speaks directly to Collins and others who make similar claims: “Hey guys, engage in scientific debate or shut up. Accusing people of killing patients is a terrible and horrible insult… It is the tactic of the playground bully. .”
Kendrick supports vigorous scientific debate. “You would hope it were the very lifeblood of progress,” he writes. Researchers should be able to disagree with each other in frank and open debate, he says.
If you criticise the experts in medical research you can expect “a very rough ride indeed. You certainly risk being stomped into silence,” Kendrick says. Yet there remain doctors, scientists and parents across the globe who claim that there is “a startling lack of actual science that proves (vaccines’) safety”.
They say that a good place to start when looking for evidence of risk with all medicines is with the drug company’s product leaflets. The companies are, after all, legally obliged to be honest about side effects.
The HPV (human papillomavirus) vaccine, Gardasil, is an interesting case study. HPV has the dubious distinction of being the most common STI (sexually transmitted infection). Once you get HPV, you have it for life. There’s no cure. That does make prevention so much better.
The US regulatory body, the Food and Drug Administration (FDA) approved Gardasil in 2008. The original Gardasil side effects that Merck declared were virtually non-existent. On its website, the CDC declares that the HPV vaccine is “very safe” and effective at preventing HPV. It also says that the most common side effects are mild and many people have no side effects.
The Japanese government approved Gardasil but withdrew approval in 2013, citing concerns about adverse effects. Merck has since added a slew of side effects that patients reported, to its product leaflets. Among these is a small but increased risk of Guillain-Barré syndrome as shown in a US 2011 study. A 2017 study by Public Health England researchers refuted the link but concerns continue.
Japanese research in 2016 revealed two cases of acute disseminated encephalomyelitis (ADE) following Gardasil vaccination. ADE is as seriously nasty as it sounds. Doctors define it as an “immune-mediated inflammatory demyelinating condition”. It predominately affects the white matter of the brain and spinal cord.
The NIH website defines it as “a brief but widespread attack of inflammation in the brain and spinal cord that damages myelin. Myelin is the protective covering of nerve fibres.” It also says that ADE “often follows viral or bacterial infections, or less often, vaccination for measles, mumps, or rubella (MMR)”.
So far, the evidence does show that serious outcomes after vaccination are extremely rare. However, that’s cold comfort to victims and their families. And some doctors are concerned that when you vaccinate more than a million children in each school year every year, as in the UK, some lives will be ruined forever.
The shots, autoimmune disease and worse …
And concerns remain about vaccines, autoimmune diseases and worse. A 2009 Israeli study by researchers at the Centre for Autoimmune Diseases at Sheba Medical Centre in Tel-Hashomer looked at the link between 10 cases of systemic lupus erythematosus related to the hepatitis B vaccine. They conclude that the potential association should “alert physicians to its possible long latency period and unique presentations”.
An Italian study in 2006 looked at sudden infant death syndrome (SIDS) shortly after hexavalent vaccination. (Those are vaccinations against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenza type B and hepatitis B.) The study followed investigations by the European Agency for the Evaluation of Medical Products into a possible link between hexavalent vaccines and some deaths.
Then, there’s official data in the US on payouts totalling nearly $4 billion in vaccine compensation cases.
In 2009, Australian doctors and others launched a “citizens’ campaign” to silence public criticism of vaccination. The campaign was unlike anything in other scientific controversies, Australian social science professor Brian Martin says. It involved everything from “alleging beliefs in conspiracy theories to rewriting Wikipedia entries”, Martin says. It involved “an extraordinary variety of techniques to denigrate, harass and censor public vaccine critics”.
Free speech issue
He says his book is for those who “care about free speech and citizen participation in decision-making”. Supporters of vaccines have created “direct censorship”, he says, and documents in his book.
Martin agrees that, depending on the context, calling someone antivaxx can be defamatory. It is an attempt to “stigmatise a person by putting them in a stigmatised category”, he says. One factor stoking the scientific flames is that the vaccine debate includes children’s health.
“Children are seen as innocent, so anything that threatens them is seen as bad,” he says. “Strangely, both sides in the debate are concerned about children’s health. They just have different views about the best way to protect it.”
And because partisans in the vaccination debate denigrate those on the “other side” this discourages open discussion. It also hinders free speech. “Many people are reluctant to express their views because of the possibility of attack,” Martin says.