Category Archives: science

corruption, health, media, politics, science

A Covid cure?

Could ivermectin have ended the pandemic?

The official story on ivermectin. It’s a horse dewormer. There’s no evidence that it’s effective for treating Covid. It’s dangerous. The only people advocating it are loony right-wingers, conspiracy theorists. It should not be used. Only trust medical authorities. They say it’s no good.

            Ivermectin is toxic in another way: anyone who thinks it should be taken seriously as a possible treatment for Covid is suspect. They are deluded. In fact, just by discussing ivermectin, they harm public health by raising doubts about health authorities.

            So by treating positive claims about ivermectin seriously, I’m taking a risk of contributing to the spread of dangerous misinformation.

            Okay, I’m taking the risk. I read The War on Ivermectin by critical-care physician Pierre Kory, and I’m going to say a bit about the book. Kory tells a story so contrary to the official line that it is like entering an alternative reality, one in which health authorities turned away from a cheap, safe drug that could have ended the pandemic and saved millions of lives, indeed a drug that did save millions of lives in parts of the world where it was used extensively.

The Kory story

Medical authorities and the mass media denounced Kory when he publicly challenged the official Covid line, but for many he is a hero, fighting the establishment. I haven’t read all the research papers addressing ivermectin and other treatments for Covid, so I’m not proposing to offer an authoritative evaluation of Kory’s claims. Instead, I will just summarise some of his views and, based on my study of the politics of medicine, comment on whether I think these views are outlandish — or plausible. If Kory’s views are potentially correct, the attack on ivermectin may have enabled one of the greatest medical disasters ever.

            Kory was an emergency care physician, working in the US, handling the most acute cases in crisis conditions. Before Covid hit, he was involved in using intravenous vitamin C for sepsis, following the finding by Paul Marik, a leading figure in critical-care medicine. Discovering an effective treatment is one thing.


Paul Marik

More difficult is convincing practitioners and authorities, and Kory helped win allies to promote intravenous vitamin C.

            In this story, there’s something important to remember later. Doctors regularly prescribe drugs “off-label” when a drug is approved for one condition but is found useful for others. It’s not only legal to prescribe drugs off-label, it’s quite common. For example, doctors might note that a drug approved for heart problems is effective against migraines and prescribe it for migraine years before regulatory approval.

            At the beginning of the pandemic, Kory was one of many doctors putting heart and soul into treating patients on the frontlines, conferring with doctors internationally, learning everything he could about Covid, and especially searching for treatments. He helped form a group called the Front Line Covid-19 Critical Care (FLCCC) Alliance. The group posted a protocol for early treatment of Covid using methylprednisolone, vitamin C, thiamine, heparin, melatonin, zinc and vitamin D. Doctors using the protocol had great results, but the medical establishment and mass media showed no interest.

“The first six months of the FLCCC [in 2020] certainly resulted in better outcomes for many patients, but little did we know that we were teetering on the brink of a revolution. Paul was about to identify ivermectin, an inexpensive, incredibly safe, generic, repurposed drug as an immensely effective and potent therapy against SARS-CoV2. It was a discovery that could and should have saved lives and ended the pandemic — if not for one major problem: Repurposed drugs like ivermectin are generally off-patent, which means the manufacturer has lost exclusive marketing rights. In other words, competitors can make and sell dirt-cheap versions.” (p. 90)

            To cut a long story short, there was more and more evidence that ivermectin was effective against Covid, so effective that it was almost a miracle cure when used early and with strong enough dosages. Patients who were extremely sick recovered quickly. And there was other information. Places where ivermectin was introduced population-wide saw dramatic falls in Covid morbidity and mortality.

Opposition

Many medical authorities, it seemed, didn’t want to know. Rather than enthusiastically exploring possibilities for using and studying ivermectin, some hospital administrators refused to allow it to be used. A common argument was that the drug shouldn’t be offered until it had been proven effective in randomised controlled trials (RCTs).

            Kory kept a record of evidence, and co-authored a paper showing ivermectin’s effectiveness, including evidence from RCTs. He thought the evidence was overwhelming, and that ivermectin was so effective against Covid that it would end the pandemic then and there.

            The opposition grew stronger. There was hostile media coverage and official statements condemning ivermectin. Kory and others were dismissed from their positions. There was a publicity campaign to discredit ivermectin, introducing the label “horse dewormer.”

            Pharmaceutical companies ran their own RCTs, which showed limited benefits from ivermectin. Kory and others examined these studies and discovered serious flaws. For example, the dosages of ivermectin used were too small, or treatment was started too late. However, each negative RCT received saturation media coverage, while critiques of these studies, and RCTs supporting ivermectin, were ignored by the media.

            What was going on? For Kory, this was the most amazing thing he had ever seen. Here was a cheap, safe drug that seemed to work amazingly well against Covid, yet it was attacked, and so were those who advocated it. It even got to the stage that when doctors prescribed ivermectin for patients, some pharmacists refused to fill their orders, something Kory had never encountered in his career.

            When hospital administrators refused to allow patients to access ivermectin, an attorney named Ralph Lorigo took them to court, winning half the time. Kory reports that of 40 cases that Lorigo won, only 2 of the patients he represented died; of the 40 cases he lost, 39 of the patients died.

            The easiest explanation for the attack on ivermectin was that big pharma shaped the entire response to the pandemic. Pharmaceutical companies stood to make billions of dollars from expensive drugs and from vaccines. This massive income stream was in jeopardy if there was a cheap and safe treatment, so it had to be discredited. Big pharma has penetrated hospitals, medical associations, governments, media and tech companies, all of which acted to shut down ivermectin and its advocates.

A revealing table

One table in the book especially impressed me. It lists all the treatments for Covid ranked by treatment benefit. Here I only list a few illustrative items from the table.

ivermectin, 62%, 95 studies, $1
Casirivimab/imdevimab, 52%, 27 studies, $2100
Bamlanivimab/etesevimab, 51%, 15 studies, $1250
diet, 48%, 24 studies, $0
vitamin D, 36%, 109 studies, $1
Paxlovid, 34%, 28 studies, $529

The percentage figures indicate the estimated treatment benefit, 62% for ivermectin (higher is better). The next figure is the number of studies on which the benefit estimates are based, 95 for ivermectin. The final figure is the cost of a full course of treatment. Now guess which items from this list were recommended by the US government during the pandemic. Yep: Casirivimab/imdevimab, Bamlanivimab/etesevimab and Paxlovid. The same pattern holds for the full table. Only high-priced therapies were recommended, with one exception, acetaminophen, whose treatment benefit is negative, -28%.

Is it plausible?

The War on Ivermectin is filled with information, though with two weaknesses: there is no index and all the references are in the form of URLs. Even so, it is not hard to track down sources for most of the points covered.

            The book is also Kory’s personal story, well told in part due to co-author Jenna McCarthy. It is filled with Kory’s rage and anguish: his rage at the forces blocking a treatment for Covid and his anguish over the people who died unnecessarily.


Jenna McCarthy

            But are Kory’s central claims plausible? I haven’t studied the original articles in medical journals, for example to assess Kory’s claim that RCTs showing ivermectin is ineffective were flawed. However, I can assess some of the general claims that underpin his arguments. These are shocking enough.

1. Big pharma corruption To believe that Kory might be right, it is necessary to accept that large pharmaceutical companies are so corrupt and unethical that they will promote their own products and attack cheap alternatives at the expense of large numbers of lives. Some people just can’t accept this, but it’s plausible to me. One revealing bit of evidence is that many of the companies have been fined billions of dollars for illegal actions. Kory cites a book by Peter Gøtzsche, Deadly Medicine and Organised Crime.

Gøtzsche gives extensive documentation of corrupt behaviour by big pharma, and it is eye-opening. I read it and wrote a blog post about it. I had also read Sergio Sismondo’s book Ghost-managed Medicine, which offers a close-up account of big-pharma manipulations, and was so impressed that I wrote a review of it. With this background, believing there could be more criminal behaviour during the pandemic is not a stretch.

2. Fiddling RCTs Kory alleges that six important randomised controlled trials of ivermectin were fudged to give negative results. It is shocking to imagine that companies, and the researchers who work for them, would traduce scientific principles to obtain a desired result. This is shocking for anyone who believes scientists operate on a higher ethical plane than other mortals, but it was not surprising to me, having studied bias in science since the 1970s.

            Ben Goldacre wrote a book, Bad Pharma, in which he described the many ways in which companies manipulate research to give desired results. Reading Bad Pharma, and other similar accounts, gives reason to believe pharma-run ivermectin RCTs might have been fiddled.

3. Mass media partisanship Kory says the US mass media trumpeted every pharma RCT showing ivermectin was ineffective, while ignoring evidence that it is effective. How could the mass media — including prestigious outlets such as the New York Times — be so one-sided? This was no surprise to me. Critiques of the mass media abound, especially of the US mass media. For several years, there was even a magazine titled Lies of Our Times — I subscribed to it —with critical analyses of stories (and the absence of stories) in the New York Times and other US media. You can also turn to Project Censored for media analysis.

            Given the power of the pharmaceutical industry, with its vast profits and sway over the media, mass media partisanship during the pandemic was only to be expected.

4. Censorship Kory tells about having YouTube videos taken down and a host of other actions taken to silence anyone questioning the government line on Covid. There is a large body of evidence for this sort of censorship. I wrote about it, and a group of us reported on interviews with scientists and doctors who were censored. With the release of the Twitter files, more evidence has become available. Kory’s stories of being censored are typical features of this wider picture.

5. Neglect of generic drugs There is plenty of evidence for the neglect of cheap alternatives to drugs. One example is exercise as a way of addressing depression. Many studies show that exercise is just as effective against mild and moderate depression as antidepressants, and furthermore has beneficial side-effects — physical health — rather than negative ones. Yet this finding, rather than being trumpeted by the media and in medical circles, receives relatively little attention. Initially during the pandemic, evidence for the effectiveness of ivermectin was ignored. As Kory recounts, a full-scale attack began when ivermectin began to gain attention.

6. Political retractions When a scientific paper is exposed as fraudulent, for example based on manufactured data, journal editors may withdraw it. It is “retracted” and usually this means it is discredited. Just being wrong is not considered a sufficient reason for retraction, because many if not most scientific papers are wrong. However, in recent years, there has emerged a new sort of retraction, not because of fraud or gross error but because of hostility towards a paper based on disagreement with its findings. Sometimes there is a pretext for such retractions, such as conflict of interest, but these sorts of retractions are quite different from the usual sort. Kory’s claim that retractions of papers supporting ivermectin were unwarranted is compatible with evidence for “political retractions.”

7. Guilt by association One of the most effective attacks on ivermectin was to label it a horse dewormer. This is an example of guilt by association, in which a person or thing is stigmatised by being linked to something with negative connotations. Another example is claiming that scientists advocating ivermectin are right-wing. Kory says he and most of his FLCCC colleagues are liberals politically, yet the only media willing to report on their findings were identified as right-wing. By this association, Kory thus was tarred as right-wing. Ivermectin was caught in US left-right political polarisation.

Conclusion

The War on Ivermectin presents a shocking story. If we are to believe Kory and others in FLCCC, the actions of the pharmaceutical company and its allies — including medical authorities, governments and tech companies — have allowed the unnecessary deaths of millions of people, by discrediting the use of a cheap, safe and effective treatment for Covid, a treatment that could have stopped the pandemic in its tracks.

            I examined general claims underlying Kory’s arguments, for example that pharmaceutical companies are capable of corrupt actions on a large scale. To the extent that Kory’s story seems shocking, it is because such general claims are shocking, yet for every one of them there are ample precedents. In short, Kory’s arguments should not be dismissed out of hand simply because they clash with widespread beliefs, for example that decisions by medical authorities are always in the public interest. Instead, it is worth the effort to independently assess Kory’s claims carefully and systematically. Millions of lives were at stake with Covid, and millions more may be at risk in future pandemics.

            It might seem that Kory is proposing there is a giant conspiracy to serve big-pharma profits, but there is another way of thinking about the story.

The belief system in which salvation from Covid is provided by vaccines and expensive drugs can be likened to a paradigm, a way of understanding the disease and how to respond to it that shapes research priorities and policies. If you believe that only vaccines and proprietary drugs can be trusted and that “natural” remedies are inherently suspect, then claims about the benefits of ivermectin can be ignored, as they are bound to be bogus or, worse, they may discourage people from being vaccinated. This belief system serves the interests of big pharma, but it does not mean those who subscribe to it are consciously conspiring to hide the truth.

            Kory was previously an uncritical believer in the standard view of medicine. Pursuing the wellbeing of his patients led him into an alternative reality in which everything he thought he knew about medicine was turned on its head. He has provided his story so readers can decide whether to venture into this alternative reality.


Pierre Kory

            There is much more to The War on Ivermectin than I’ve been able to cover here, including hospital power plays, mass media bias and the politics of vaccination. One highlight is Kory’s account of the founding and operation of FLCCC in the face of powerful opposition. If you plan to help organise a challenge to a ruthless opponent during an emergency, you can learn a lot from the FLCCC’s methods and efforts. Just be prepared to lose your job and be labelled a conspiracy theorist.

Brian Martin, bmartin@uow.edu.au

Thanks to Tonya Agostini, Kelly Gates, Kurtis Hagen, Anneleis Humphries, Julia LeMonde, Susan Maret and Erin Twyford for helpful comments. None of them necessarily agree with Kory’s views or my own.

health, science

A message from the Turtles

A new book offers the best available critique of vaccination orthodoxy. 

(This is a long review. To skip the preliminaries, go to “Turtles enter the fray.”)

The vaccination debate

In 2010, I began writing about the vaccination debate — the public debate over the benefits, risks, ethics and politics of vaccines. This was long before Covid-19, so nearly all the debate was about childhood vaccines for diseases like polio, measles, diphtheria, and tetanus.

            I came to this issue having previously written about disputes over nuclear power, pesticides, fluoridation, nuclear winter and the origin of AIDS. In the field of science and technology studies or STS, these are called scientific controversies. They typically involve striking disagreements between both scientists and laypeople, and aren’t just about science. They also involve disagreements over ethics, decision-making and values such as freedom.

            In studying the vaccination issue, my purpose is not to take a side but to understand the dynamics of the controversy, including the players, their moves and claims. I also have another purpose, which I’ll come to.

            There are remarkable similarities between different scientific controversies. They typically pit a powerful establishment, supported by governments or corporations and most experts, against citizen opponents, backed by a small number of dissident experts. This at least is the configuration in debates over nuclear power, pesticides, fluoridation, genetically modified organisms, microwaves — and vaccination. There are two important exceptions, where most experts oppose a powerful establishment: smoking and climate change.

            In every controversy, it is possible to examine public campaigning and expert scientific commentary. In public campaigning, it is common to find mistakes, exaggeration, misunderstandings and misinformation. However, judging what is a mistake is not always easy, because partisans on one side or the other may challenge what seems like an obvious statement or assumption. For example, I refer to the “vaccination debate” but some proponents say there is no debate and any disagreement with vaccination is misinformed or worse.

            Before proceeding, I had better explain my own position. I do not have strong views in favour of or opposed to vaccination. As noted, my interest in the issue is as a social scientist, to learn about the way the debate proceeds. My other interest in the issue is to defend free speech on controversial social issues. I believe in the value of open dialogue, discussion and debate. If vaccines are highly beneficial and extremely safe, criticism should be welcomed so that it can be clearly and accurately countered. If vaccines have shortcomings, criticism is valuable for highlighting them, hopefully leading to better products and practices.

Writing about the vaccination debate

I started writing articles about the vaccination debate, in particular about a most amazing attack on an Australian vaccine-critical group. By doing this, I came under attack myself. This was wonderful! As a social scientist studying a public scientific controversy, it is often difficult to obtain first-hand information. Social researchers usually rely on published materials, interviews and surveys, but remain separate from the action. I didn’t just have a front-row seat: I was on the playing field. Some others were treating me like a player.

            In writing scholarly articles, I gradually developed a standard way of introducing the vaccination debate in a few words. Here’s one example, from 2012:

Vaccination against infectious diseases is supported by medical professions worldwide (Andre, et al., 2008; Offit and Bell, 2003), and in most countries there is a standard set of vaccinations given to children. In the face of this medical orthodoxy, a small number of citizens’ groups and professionals present a contrary position, arguing that the benefits of vaccination have been overestimated and that there are significant risks to individuals and society, with recorded cases of seriously affected children (Habakus and Holland, 2011; Halvorsen, 2007).

You can see that for the vaccination-positive view, I gave two references, and likewise for the vaccine-critical view. In each case, I wanted to give solid, credible references. Reflecting on how I proceeded, my implicit criteria were that the source should be comprehensive, reasoned, authoritative and readable.

  • Comprehensive: the source needs to address all or most of the vaccines and the scientific and medical issues in the debate.
  • Reasoned: evidence and arguments should be presented in a careful, logical, systematic way.
  • Authoritative: the authors and the content should be credible.
  • Readable: the writing should be understandable by non-experts.

It’s hard to satisfy all these criteria. For example, there is a vast quantity of vaccination-positive materials in scientific and medical journals, but most of it is specialised (not comprehensive) and aimed at experts (not readable).

Vaccination-positive sources

For the case for vaccination, the book by Paul A. Offit and Louis M. Bell was an ideal reference. Titled Vaccines: What You Should Know, it is aimed at a general audience, covers the full gamut of vaccines and comes across as informative. Paul Offit is a doctor and professor and a prominent advocate of vaccination, and Louis Bell is also a doctor. Some of Offit’s other works include bitter attacks against critics, but Vaccines does not enter this territory.

            A correspondent alerted me to an article by F. E. Andre and eleven co-authors. It is titled “Vaccination greatly reduces disease, disability, death and inequity worldwide,” and published in the Bulletin of the World Health Organization. The title alone suggests the article’s aim to be comprehensive, and the authors are a slew of experts in the field. It scores less on readability.

            Later I cited another source: Vaccines. The seventh edition of 2018 is edited by Stanley A. Plotkin, Walter A. Orenstein, Paul A. Offit and Kathryn Edwards. This is a massive text, aimed at specialists. It is definitely comprehensive, and the editors have high status in the field. It is factual rather than overtly partisan but is not bedtime reading for non-experts. It is good for pointing to the vast quantity of research supporting vaccination.

            No doubt there are other good sources. These were the ones I found most useful. My purpose was to point to credible material supportive of vaccination. I guessed that few readers would bother to look up any of these sources, but they needed to know they existed.

Vaccine-critical sources

To show the existence of a dispute over vaccination at the level of science, I wanted to cite sources that had some parallels with the vaccination-positive ones. That means ones that are comprehensive, reasoned, authoritative and readable. At this point, it is useful to note a crucial asymmetry in the debate. Because nearly all scientific and medical authorities support government vaccination policies and practices, it is unlikely there will be any authoritative critics, because to be a critic is to become a target of attacks on credibility.

            You’ll note that I’ve avoided using the term “anti-vaccination.” It is misleading, and in the shortened form “anti-vax” has been turned into a term of denigration. Anyone who deviates from the official vaccination position may be called an anti-vaxxer. This includes parents who space out their children’s vaccines or choose some vaccines but not others. It includes researchers who raise any questions or reservations about vaccination. To call someone “anti-vax” suggests they are opposed to all vaccines, which is misleading. Therefore, I avoid the label “anti-vaccination” for both its imprecision and its derogatory connotations. Although “pro-vaccination” does not have negative connotations, I’ve also avoided it.

            For vaccine-critical sources, I found a book by Richard Halvorsen titled The Truth about Vaccines.

Halvorsen is a doctor who researched the issues himself. Halvorsen is not opposed to vaccines — he gives them. But he wanted to find out the full story, and so addresses both the history of vaccination and each vaccine in turn, focusing on Britain and its policies and experiences. He provides lots of references. His message is to be aware and consider the evidence, not to make a knee-jerk decision either way. Halvorsen’s book, now in its fourth edition titled Vaccines: Making the Right Choice for Your Child, is comprehensive, reasoned and readable. It somewhat lacks authority in that he is not an established researcher in a relevant field such as virology or epidemiology.

            Another useful critical source is Vaccine Epidemic, edited by Louise Kuo Habakus and Mary Holland. It covers a wide range of issues, ranging from law and ethics to the politics of science. However, compared with Halvorsen’s book, much less of Vaccine Epidemic addresses the scientific evidence about vaccination.

            In 2018, a comprehensive critique of vaccination was published: Mateja Cernic’s Ideological Constructs of Vaccination. It is a revised and expanded version of her PhD thesis at the School of Advanced Social Studies in Slovenia. The book is an intriguing combination of massive documentation and strong statements. It includes a treatment of social aspects of medicine and vaccination, covering discourses, ideologies, representations of vaccination critics, power and abuses of power by medical and state authorities. The longest chapter is a challenge to the orthodox view about the effectiveness and safety of vaccination, covering infectious disease mortality rates, the immune system, adverse events, safety and efficacy studies, contamination of vaccines, monitoring of adverse events, and herd immunity. This would seem to be a powerful challenge, yet it has received little attention, perhaps in part because it is not so easy to read, and the author is a sociologist, someone outside the medical establishment.

Turtles enter the fray

Being on the lookout for good sources on the pros and cons of vaccination, I obtained a copy of a book published in 2022 titled Turtles All the Way Down. The title, at first glance, sounds peculiar. The subtitle is more revealing: Vaccine Science and Myth. For convenience, I will refer to it as Turtles.

            The book arrived with plenty of advance publicity. It was published in 2019 in Israel, in Hebrew, and made a splash. I read that it had received a positive review in an Israeli medical journal, a review written by Ety Elisha and Natti Ronel. Well, well. I knew them: we were collaborating, along with two others, on a paper about suppression of critics of official views about Covid-19. It’s a small world.

            An unusual aspect of Turtles is that its authors are anonymous. They chose not to reveal their identities to avoid ad hominem attacks. Also, if they worked within the health system, they could be subject to reprisals in their careers. That’s exactly what I had been studying for the past decade concerning vaccination, and even longer for other scientific controversies. Remaining anonymous makes a lot of sense to me. Indeed, it’s what I recommend for whistleblowers, whenever possible. The authors call themselves The Turtles Team or TTT.

            Turtles is a frontal attack on the assumption that the standard childhood vaccination programme is both safe and effective. This assumption is at the core of the vaccination paradigm, the framework that guides thinking and research in the area.

            To illustrate the contrast between TTT’s analysis and the official position on vaccination, I found a short article that nicely articulates the orthodox view, an article you can read yourself. Titled “Simply put: vaccination saves lives,” it was published in 2017 in PNAS, the Proceedings of the National Academy of Science, a prestigious long-standing US scientific journal. The authors are Walter Orenstein and Rafi Ahmed, both from Emory University. Orenstein, from the Department of Medicine, is also one of the four co-editors of the text Vaccines, which I mentioned earlier as an authoritative source for the vaccination-positive view. I will refer to Orenstein and Ahmed’s article to highlight assumptions and emphases in the orthodox position on vaccination, the position challenged by the Turtles Team.

Safety

Let’s start with safety. Orenstein and Ahmed do not explicitly discuss adverse events caused by vaccination, but instead implicitly dismiss them by countering concerns that vaccines cause autism. Perhaps their assumption is that if the autism claims don’t stand up, less well-known ones won’t either.

            A prime claim in Turtles is that the safety of standard vaccines has never been established, indeed that assumptions or claims about safety have no foundation. How could this be? TTT begin by examining the vaccine approval process and the randomised controlled trials that are required, clearly and carefully explaining what’s involved. In phase 3 trials, there are two groups of children. One group is given the vaccine, let’s say a vaccine for chickenpox, and the other group is given a placebo: they are injected with a passive or neutral substance. No one, including the researchers and the children, is supposed to know which children get the vaccine and which get the placebo. When testing for safety, the numbers of adverse events — including seizures, breathing difficulties, allergic reactions, paralysis, severe illness and death — in each group are noted. If the frequency of adverse events in the vaccine group is not much higher than the frequency of adverse events in the placebo group then, after other factors are taken into account, the vaccine is assessed to be safe.

            The problem, TTT say, is that the placebos in phase 3 trials of childhood vaccines, before they are licensed for use, are not inert. The researchers doing the safety studies could have used a saline solution for the placebo, but instead they use other vaccines. This would be fine if the other vaccine had been shown to be totally safe but, according to TTT, no vaccines have been tested against inert placebos, and hence the clinical trials don’t actually show how safe the vaccine is. This is a striking claim, and also a daring one given that a single counterexample, a single study, might undermine it. A safer claim by TTT would be that despite extensive searching, they have not discovered a phase 3 trial of a vaccine against an inert placebo.

            Note that TTT don’t make a detailed claim about the rate of adverse events. They just say the clinical trials haven’t shown vaccines to be safe. As they put it, “The true rate of adverse events of routine childhood vaccines is virtually unknown; therefore, there is no scientific basis for claiming they’re safe.” (p. 66)

Undone science

Clinical trials are only one way to examine the safety of vaccines. Another possibility is to undertake biological and physiological research into adverse events. TTT examine studies in this area, or rather their absence. Their conclusion is that the generous funders of vaccine research — there is a vast amount of research in the field — seem remarkably averse to adverse-events research into diagnoses, causal mechanisms, individual susceptibilities, and therapies. By not undertaking studies to better understand damage from vaccination programmes, it remains possible to say vaccination is safe.

            David Hess, an anthropologist and sociologist at Vanderbilt University, and my friend and collaborator, introduced the idea of undone science. This refers to research that could be done, and furthermore that citizen activists say should be done, but which is neither funded nor carried out because the findings might be unwelcome to powerful groups with vested interests. There are many examples, especially on environmental and health topics. For example, the sweetener mannitol may have benefits for treating Parkinson’s disease, but because mannitol cannot be patented, companies didn’t want to research it.

            TTT do not refer to Hess’s analysis of undone science. The team sticks to scientific and medical sources and does not engage with social-science writings. Nevertheless, the team’s examination fits the picture of undone science perfectly.

            What about the reporting of vaccine adverse events? Anyone following this issue will soon hear about VAERS, the Vaccine Adverse Event Reporting System, where harmful side effects of vaccines can be reported. If there aren’t many reports, that should indicate that vaccines are safe. But, according to TTT, there’s a problem, actually several problems. Although reporting of cases of many infectious diseases is mandatory, when it comes to potential adverse events from vaccines, reporting is voluntary, and doctors are not compensated for making them. Furthermore, many doctors are reluctant to make reports, telling patients that their conditions could not be due to vaccines but are just a coincidence. This suggests considerable underreporting. Some estimates are that only one in ten, or one in a hundred, adverse events are reported.

            So why not improve the rate and quality of reporting to determine how accurate VAERS actually is? There was a study to show how this could be done but the CDC — Centers for Disease Control and Prevention, the US body charged with vaccination recommendations — stopped engaging with the researchers, without explaining why. TTT argue that the CDC has shown no interest in improving VAERS.

            TTT’s next target is epidemiological studies showing a low rate of adverse events. Imagine collecting data from a large population about the incidence of a particular condition, let’s say high blood pressure. Then collect data about people’s ages, incomes, diets and anything else you can think of that might be relevant. By looking for statistical relations between the health condition and other factors, you might be able to notice, for example, that people’s blood pressure gets higher as they get older, or that it’s higher for people who eat lots of meat, or whatever. These are correlations, but they don’t prove causation. Maybe people who eat lots of meat get less exercise: it could be that lack of exercise is the main factor responsible for high blood pressure. Or it could be the salt in the meat dishes. You can see this gets quite complicated.

            TTT provide a primer on epidemiology, explaining the basic ideas clearly and simply. They then offer a damning indictment of epidemiological studies about vaccine safety, arguing they are designed to show no correlations between vaccines and adverse events. This is serious. TTT closely examine five major studies. Based on their examination, they suggest the studies are biased by design or execution, using defective research methods, relying on unsubstantiated data, omitting essential data, making meaningless calculations, dismissing unwelcome findings and exaggerating the significance of the findings.

            Remember that Orenstein and Ahmed in their article “Simply put: vaccination saves lives” did not explicitly mention adverse events caused by vaccines, but implicitly dealt with them by dismissing a study by Andrew Wakefield and 12 collaborators about the possible connection between the MMR triple vaccine and autism. One of the epidemiological studies often cited as showing there is no such connection is by Madsen and colleagues. This is one of the “doctored” studies that TTT analyse, showing systematic shortcomings.

More undone science

TTT next examine what they call “the studies that will never be done.” An obvious way to investigate the overall safety of the entire vaccination schedule is to compare the health of two groups of children that are as similar as possible except in one respect: one group receives all recommended childhood vaccines and the other group receives no vaccines at all. Simple! Such a study would gather all the benefits and risks of vaccines, the benefits from reduced incidence of infectious disease and the risks from adverse events, and anything else, including beneficial or harmful effects not normally considered. A study like this showing the benefits of vaccination would be a powerful way to encourage parents to have their children vaccinated. But, perhaps surprisingly, such a study has never been undertaken by medical authorities. (There are some small studies by vaccine critics showing unvaccinated children have better health.)

            This is the most striking example of undone science in the vaccination arena. A plausible reason is that proponents are afraid the results might not support vaccination, or not support it as much as they hope. TTT go further, suggesting that the CDC has the data and therefore comparative studies may have been quietly done but never published because the results do not support vaccination. This is speculative. Another explanation derives from the vaccination paradigm: proponents operate within a framework that assumes vaccines are vital for health.


Historian-of-science Thomas Kuhn introduced the idea of scientific paradigms

Given this belief, there is no need for further studies to see whether vaccines are beneficial. In fact, publicity about doing such studies might generate alarm, by making people think there is some reason to doubt the vaccination programme. Within the assumptions of the paradigm, this is a reasonable concern. However, it does mean that critics can continue to point to the absence of definitive studies showing that the net benefits of receiving all recommended childhood vaccines are greater than having no vaccines at all.

            I’ve referred to the “vaccination schedule.” In guidelines for childhood vaccination, there are targets for particular vaccines at specific ages, for example, in the US, hepatitis B at birth, one month and six months. The schedule is another target in Turtles. For example, in the usual schedule, several vaccines are given in a single visit. Some parents prefer to space out the vaccines. Is there sound evidence for the safety of giving multiple vaccines at the same time? TTT say no.


A vaccination schedule

            Given TTT’s sustained critique of assumptions about vaccine safety, does this mean that vaccines are unsafe? This depends on what exactly is meant by unsafe. Despite statements that “vaccines are safe,” careful vaccination advocates always acknowledge adverse events, but say they are extremely rare. What TTT have done is show that the research behind the claim that risks are extremely low is simply not there. They show that research about adverse events is either flawed or not done at all. But what if studies were carried out to accurately determine the rate and significance of adverse events? One possibility would be that the adverse events would be shockingly frequent, validating the worst fears of vaccine critics. But another possibility is that harmful effects would be modest, perhaps higher than ones currently acknowledged but not high enough to outweigh benefits. TTT may have shown that the science of vaccine safety lacks foundations, but they haven’t attempted to show what the science would say if it did have a solid foundation. By the nature of undone science, no one can know for sure. But we do know who is resisting doing definitive studies.

Benefits

In the usual slogan of “Vaccination saves lives,” the benefits are assumed to outweigh the risks. There is a sleight of hand here in referring to “vaccination” rather than individual vaccines. It is quite possible that a group of vaccines reduces the death rate but some specific vaccines cause more harm than benefit.

            Orenstein and Ahmed’s opening sentence is “Few measures in public health can compare with the impact of vaccines.” The Turtles Team challenges this claim. They provide figures showing that deaths and illnesses from infectious diseases were in rapid decline before mass vaccination was introduced, and argue that most of the decline in these diseases was due to other measures that improved public health, including clean water, good diet, better hygiene and a higher material standard of living.

            Orenstein and Ahmed provide a table showing the decline in annual morbidity (ill health) for vaccine-preventable diseases. It shows, for example, that measles morbidity declined by more than 99%. From what? Their base figure is the “20th Century annual morbidity” which they compare to reported cases in 2016. What they don’t provide is a comparison of morbidity before and after the introduction of mass vaccination. See below for more on this.

            These arguments are not new. They were presented, most prominently, by Thomas McKeown, and have been cited repeatedly by vaccine critics. Despite this, vaccine proponents seldom mention these arguments. Orenstein and Ahmed certainly do not. I wish vaccine advocates would provide a cogent rebuttal of the work of McKeown and others who question the scale of the benefits of vaccination. So far as the public debate is concerned, this might be called an “undone refutation.”

            You can see that the slogan “vaccination saves lives” is suspect if the benefits have been exaggerated and the harms undercounted. But TTT are not finished. There is one more important claim to address.

Herd immunity

Proponents argue that being vaccinated primes the immune system, reducing the risk of catching the targeted disease. They also argue that when most people have vaccine-induced immunity, others — including people who can’t be vaccinated — are also protected. For a virus to spread, it needs to encounter susceptible hosts: others who can be infected. If most people are immune to the virus, the disease outbreak will die out. This process protects the whole population, the “herd,” a collective benefit from sufficiently high levels of immunity in the community.

            Vaccine proponents make a big deal about herd immunity. It provides a moral imperative to be vaccinated and to promote vaccination, including through mandates. Orenstein and Ahmed devote a considerable portion of their short article to herd immunity, complete with a colourful diagram.

They write that herd immunity “provides the rationale for interventions to achieve high population immunity” including “mandates for immunization requirements for attending school.”

            For years I’ve read the arguments for and against herd immunity. Vaccine proponents almost invariably raise it, sometimes at such length that people gain the false impression that the main benefit of receiving a vaccine is not to yourself but to others. The result of this impression is that vaccination is sold, and often perceived, as altruistic, which means those who question vaccination, or are not vaccinated, can be painted as selfish.

            I wondered why herd immunity plays such a high profile in arguments for vaccination but analogous concepts are less prominent concerning other public health interventions. By analogous concept, I mean the idea that health-related behaviours benefiting the individual can also benefit others in the community. The example I find most compelling concerns alcohol. Not drinking alcohol benefits one’s own health by reducing the risk of cirrhosis of the liver, pancreatitis, cancer and other maladies (partially counteracted by a few health benefits). Not drinking also reduces the harm to others caused by drunk driving and domestic violence. A community with less drinking is a healthier and safer community. There is more to be said about the pros and cons of alcohol, and I’m not making an argument for prohibition or abstention. The point is that the collective-benefit argument does not play such a big role in alcohol debates.

            Turning to writing by vaccine critics, it’s possible to find critiques of herd immunity, with arguments that it doesn’t exist or is irrelevant.

            So is herd immunity the most wonderful thing since sliced bread, or fake news? I don’t remember seeing an intermediate view — until reading Turtles. TTT systematically examine the evidence for and against herd immunity for each of 14 vaccines, from tetanus to measles. They conclude that, with sufficient coverage, five of them may confer herd immunity, whereas the others probably will not, or that their protection is not relevant or beneficial to children. It was refreshing to encounter an analysis that independently follows the evidence and doesn’t end up purely in one of the two warring camps.

Remember that Orenstein and Ahmed provided figures showing the measles vaccine reduced disease morbidity by over 99%. TTT agree that the vaccine reduced morbidity through herd immunity, though perhaps not by this percentage. Some vaccine critics may find this assessment unwelcome.

            TTT’s analysis shows the value of making careful assessments of different vaccines, each one with specific considerations and complications. Rather than follow Orenstein and Ahmed in saying “vaccination saves lives,” the question should be whether specific vaccines save lives, and beyond this who benefits and who suffers harm.

            To question vaccine-induced herd immunity is to question the rationale for coercive means to promote vaccination, for example requirements for attending school. Even for vaccines providing herd immunity, an assessment of the overall benefit needs to take into account harmful side effects. As TTT put it, “in the absence of solid evidence for a positive net benefit for individual vaccines, as well as the totality of childhood vaccination programs, there is no moral justification for mandating vaccination, or enforcing it in any other way.” (p. 367)

Polio

In 1990, I began studying the debate over the origin of AIDS. In particular, I became interested in the hypothesis that AIDS could have started as a result of contaminated oral polio vaccines used in central Africa in the late 1950s. Even if this hypothesis is correct, it says nothing about the safety of today’s vaccines, so the origin-of-AIDS debate is not relevant to the arguments in Turtles. Anyway, in the course of studying the polio-vaccine theory of the origin of AIDS, I read various studies of polio, including dissident views about its cause. One of those dissident views is that many or most cases of what we call poliomyelitis, a serious paralytic disease, are due to exposure to pesticides.

            Polio has long had a high profile, first as a disease to be feared and then as one of the great triumphs of vaccine research. In the 1950s, Jonas Salk developed a vaccine that was injected. Then Albert Sabin developed an oral vaccine, typically taken with a sugar cube. I vaguely remember having this vaccine when I was in primary school. The struggle to eradicate polio is one of the longest-running sagas in vaccination lore. As you can imagine, the idea that pesticides are the main cause is not likely to receive a warm welcome from the medical establishment.

            Turtles provides the clearest exposition of this idea that I’ve encountered. In a long chapter, TTT systematically lay out a series of open questions and contradictions in the official story about polio, presenting the standard view and an alternative explanation based on pesticide exposure. For example, they ask “Why did most of the early polio outbreaks occur in sparsely populated rural areas rather than in the large and crowded metropolitan areas?” The standard view about polio, which assumes the contagious spread of the poliovirus, cannot explain this. The alternative view gives this explanation: “Farming communities were the first to be poisoned by the use of toxic pesticides.” All up, TTT list 19 mysteries not explained by the standard view but apparently explained by pesticides being the primary factor in paralytic polio.


DDT spraying in the 1950s

            TTT’s arguments about polio are not essential to their overall critique of the risks and benefits of childhood vaccines, so their polio chapter might be thought of as a provocative supplement, an extra way of showing the limitations of establishment explanations. Without trying to get to the bottom of the polio story, my thought was “I’d really like to see vaccination proponents offer their views about each of these 19 apparent mysteries.”

What next?

In the late 1980s, I made an intensive study of the fluoridation controversy, and came to the conclusion that nothing would resolve the controversy in the short term. No matter what new evidence and new arguments are introduced, partisans on each side maintain their positions. This sort of polarised scientific controversy can be likened to a clash of paradigms, with adherents to each side seeing the world through assumptions almost impervious to new evidence. Contrary information is treated as anomalous, and supportive evidence is intertwined with assumptions about ethics and appropriate methods of decision-making.

            Why should the vaccination controversy be any different? I don’t expect Turtles to turn the tide. However, it will undoubtedly be a potent tool for vaccine critics.

            During the 1980s, US pro-fluoridationists discussed whether to engage in debates with anti-fluoridationists. Those who said yes thought that debates provided an opportunity to show the superiority of the arguments for fluoridation. Those who said no feared that engaging in debates gave anti-fluoridationists too much credibility. In essence, debating meant accepting that there was something worth debating. But there was a problem with refusing to debate: it seemed arrogant, which could hurt the cause. The debate about debating was never resolved.


Water fluoridation debate in Portland, Oregon

            These same considerations are present in the vaccination debate. My guess is that vaccination proponents will studiously avoid engaging with the arguments in Turtles. It is certainly possible that they could counter some of TTT’s arguments but, alas, we will probably never know, because proponents are in the ascendant, having cemented childhood vaccinations as an unquestioned good and stigmatised the slightest reservation or criticism.

            This is a sad state of affairs. There are a great many people who would benefit from an open debate, without ad hominem attacks, with respect for contrary views. Such a debate might lead to some backing down from vaccine mandates and more tolerance for selective vaccination and even non-vaccination. On the other hand, the debate might lead to a more solid basis for the benefits of some vaccines.

            “Debate” is the wrong word. There needs to be deliberation, a calm, rational discussion with the aim of reaching an agreed position, the sort of process used in citizens’ juries to look at all manner of contentious issues. In such a jury, a group of randomly selected citizens addresses a carefully specified issue by weighing up available evidence and reaching collectively-agreed recommendations. But allowing citizens to have input via deliberative processes is unlikely while experts and authorities are in full control.

            However, even deliberation would not be enough, because of undone science. There is too much research that needs to be carried out, too much evidence that needs to be collected, before judgements about vaccination can be put on a solid basis.

Conclusion

Of available critiques of vaccination orthodoxy, I think Turtles is the best yet. It exposes systematic weaknesses in studying the harmful effects of vaccines and challenges the usual claims about the benefits of vaccines for the individual and the community. The book has all the features I look for.

  • Comprehensive: it covers the central scientific and medical issues in the debate.
  • Reasoned: evidence and arguments are presented in a careful, logical, systematic way.
  • Authoritative: the authors, though anonymous, show their knowledge through their grasp of research and through comprehensive citations to medical research.
  • Readable: the writing is remarkably clear, and occasionally high-spirited.

            Two predictions. First, vaccination advocates will try to ignore the book. They are unlikely to engage with the book’s contents, though they might complain about the authors’ anonymity. Second, Turtles won’t end the dispute, which is likely to continue for decades.

Turtles was written before Covid and does not address Covid vaccines. Yet Covid is an important factor in the vaccination debate, because Covid vaccine mandates, and adverse events from Covid vaccines, disturbed large numbers of people, leading some to protest publicly. Concern about and opposition to Covid vaccines led to greater questioning of other vaccines. For those who are energised by concerns about Covid vaccines, Turtles is the ideal source for learning about the evidence and arguments.

Although arguments seldom resolve scientific controversies, events sometimes make a big difference. In the debate over nuclear power, the accidents at Three Mile Island, Chernobyl and Fukushima had immense impacts, serving to discredit the technology. In the vaccination debate, a major vaccine disaster could play a similar role. The full story of the impact of Covid vaccines is yet to play out, but it is reasonable to say that when promoters endorse a vaccine that is widely seen as disastrous, they jeopardise the rest of the vaccination programme. So perhaps my prediction about the continuation of the debate is off the mark. Time will tell!

            There’s much more to be said about Turtles. But enough from me, for now. You can form your own view, let me know what you think and, after you’ve read the book, contact The Turtles Team at the email address given in their book.


A different turtles team

Brian Martin

bmartin@uow.edu.au

For valuable feedback, I thank Steven Bartlett, Lyn Carson, Jungmin Choi, Kevin Dew, Bob Dildine, Kelly Gates, Anneleis Humphries, Olga Kuchinskaya, Julia LeMonde, Natti Ronel, Wendy Varney, Qinqing Xu and others who prefer to remain anonymous. None of them necessarily agrees with the views expressed in this review or by The Turtles Team.

health, politics, science

Who’s afraid of The Real Anthony Fauci?

Robert F. Kennedy Jr.’s book The Real Anthony Fauci has sold over a million copies and was on best-seller lists for weeks. Yet, apparently, it has not been reviewed in the US mainstream media. This intrigued me.

            Since the beginning of the pandemic, I’ve been following arguments from a range of perspectives: the Covid orthodoxy — which keeps changing — and a diversity of critics. It was hard to avoid hearing about Kennedy’s book, published in November 2021, but I thought it probably addressed issues regularly canvassed among sceptics about Covid orthodoxy.

            I read about attacks on Kennedy and his book published in the New York Times and elsewhere, attacks that did not address the contents of the book (Brown, 2022). Still, that wasn’t enough to get me to read it. Then I read a commentary by Phillip Adams (2022), a prominent progressive voice who has a column in The Australian, otherwise a bastion of conservative opinion. Disappointingly, Adams disparaged Kennedy, calling him a “full-time conspiracy theorist,” and dismissed his book as “a long diatribe that would appeal to anti-vaxxers” without saying anything about the book’s contents. That did it: I resolved to read the book myself.


Robert F Kennedy Jr.

            The Real Anthony Fauci is about Fauci, to be sure, but in a wider sense it is about the pharmaceutical industry and its hold over the US and global health system. Fauci is the hook for a more wide-ranging examination.

            I am a social scientist, not a physician or medical researcher, and have not attempted to get to the bottom of claims and counter-claims about Covid and health matters more generally, for example studies of hydroxychloroquine or adverse reactions to vaccines. But based on a long study of the politics of health, it is possible to make some judgements about whether Kennedy’s analysis is compatible with scholarly treatments.

            The Real Anthony Fauci is a lengthy tome, massively referenced. Kennedy acknowledges a “team of researchers and fact checkers who sourced, cited, and fact-checked this manuscript” (p. xii), and indeed there are lots of “facts” in the book, more than a single investigator might expect to verify in a few years. The book is available in electronic form and in print which, due to the small font and narrow margins, is not appealing to the eye. Even so, I preferred to read the print version. There is no index.

            Another issue is the organisation of material. For the most part, the chapters are coherently written, but occasionally there are digressions, some of them reprising themes covered elsewhere. In other words, the book is not as tightly constructed as it might be. On the other hand, it is quite up to date, suggesting it might have been rushed to publication.

            In the following, I look in most detail at Kennedy’s treatment of Covid issues, and then turn to some other parts of The Real Anthony Fauci.

Pandemic matters

Many readers will be most interested in chapter 1, “Mismanaging a pandemic,” a lengthy and up-to-date treatment. Much of the chapter is on treatments for Covid, specifically hydroxychloroquine, ivermectin and remdesivir. Kennedy’s argument is that US health authorities and media followers tried to discredit cheap, safe and effective treatments, meanwhile promoting expensive, dangerous, less effective and inadequately studied responses.

            Here’s the story in brief, as presented by Kennedy. Hydroxychloroquine and ivermectin have been used for decades for a variety of health problems and have well-researched safety profiles. Some doctors and researchers thought they looked promising as treatments for Covid, tried them on patients and obtained positive results, often in protocols also involving zinc, vitamin C, vitamin D, quercetin and other supplements and medications.

            The US medical establishment, in which Fauci played a key role, did not initiate a massive research effort to see whether these protocols were effective. Instead, they poured money into a patented treatment drug, remdesivir, and into the development of vaccines. Then, when some doctors and researchers championed hydroxychloroquine and ivermectin, Fauci et al. mounted an attack on these two drugs and tried to deregister or discredit their supporters. You might have heard ivermectin referred to as a “horse dewormer,” making it seem ill-advised for human use. Media coverage with this sort of depiction seldom mentions that doctors regularly prescribe drugs “off-label.” Calling ivermectin a horse dewormer reminded me of antifluoridationists who call fluoride “rat poison.” Sodium fluoride is indeed used as rat poison but only in doses far greater than can be obtained from the fluoride added to public water supplies to reduce tooth decay. Similarly, that ivermectin is used as a horse dewormer should not automatically discredit its use, in much smaller doses, as a preventive or early treatment drug for Covid.

            Kennedy documents a massive campaign to discredit hydroxychloroquine and ivermectin. This campaign had a research dimension. Some studies of hydroxychloroquine used it only on seriously ill patients when, according to proponents, it is least effective. Kennedy says researchers set up their studies to show hydroxychloroquine didn’t work.

            Then there was a major paper published in the prestigious medical journal The Lancet based on nearly one hundred thousand patients in numerous hospitals, definitively showing hydroxychloroquine was ineffective. It seemed like the coup de grace until it was revealed that the data could not be verified. The company running the study apparently organised a giant fraud. The Lancet retracted the paper.

            Why should there be such a campaign against cheap drugs that showed promise in treating Covid? Kennedy gives an answer: the US Food & Drug Administration, by law, cannot approve a vaccine for emergency use if there is an available treatment. Pharmaceutical companies, then spending vast amounts of money developing Covid vaccines, would not have their vaccines approved quickly if hydroxychloroquine, ivermectin or other therapies were shown to be effective as treatments.

            Kennedy quotes supporters of these two drugs saying that if they had been widely available in the US, hundreds of thousands of lives could have been saved. Instead, according to Kennedy, the CDC (Centers for Disease Control and Prevention), in an unprecedented move, ordered doctors to stop prescribing ivermectin, bought up stocks so they would not be available for sale, and encouraged pharmacists to refuse to fill doctors’ prescriptions.

            Meanwhile, Fauci’s favoured treatment drug, remdesivir, was pushed through the approval process despite studies showing minimal benefits and a high-risk profile. According to critics quoted by Kennedy, the use of remdesivir contributed to the death toll from Covid in the US.

            Then came the vaccines. Kennedy provides figures showing Covid vaccines are far less than fully effective and cause far more adverse reactions than officially reported.

            The underlying motive, or factor, is clear enough: pharmaceutical company interests. Hydroxychloroquine and ivermectin are not under patent, and a course of either one costs only a few dollars, so there is little money to be made from them. In contrast, remdesivir and Covid vaccines were financial bonanzas, offering profits of billions of dollars.

            This story is a damning indictment of the US medical establishment, basically saying that cheap and effective treatments were discredited and made hard to obtain so that proprietary drugs and vaccines, with dubious safety profiles, could become the preferred way to deal with Covid, all at the expense of large numbers of lives. This story is almost a reversal of the views presented by government officials and the mass media, in which hydroxychloroquine and ivermectin are suspect and vaccines the only long-term solution.

            Is Kennedy’s analysis of pandemic politics compatible with viewpoints expressed in the field of social analysis of health and illness? To address this question, I look in turn at four areas: undone science, analyses of big pharma, the role of Fauci, and suppression of dissent.

Undone science

David Hess, professor of sociology at Vanderbilt University and author of many works on science and health, developed the concept of “undone science” (Hess, 2016). It refers to research that could be undertaken, and is called for by civil-society groups, but is not pursued because the findings might be unwelcome to powerful groups. Undone science is most commonly found in the areas of environment and health. Hess focuses on undone science involving environmental risk, but the concept can also be applied to vaccination safety research.

For many years, critics have called for comprehensive studies comparing the health of unvaccinated and fully vaccinated children (e.g., Golden, 2019), but governments have not funded any such studies. It could be that such studies would definitively show the benefits of childhood vaccines but there is a risk they might show harms greater than publicly acknowledged. So this research remains undone except for relatively small studies not funded by governments or vaccine manufacturers.

            The concept of undone science sidesteps debates about the nature of knowledge, focusing instead on research agendas. It can be slightly broadened by referring to topics that companies or governments investigate but then do not publish their findings.

            Kennedy’s account of hydroxychloroquine and ivermectin fits perfectly in the model of undone science. Despite calls from doctors and patient groups for studies of these and other cheap and widely used drugs for Covid, pharmaceutical companies and governments did not urgently pour billions of dollars into studies. They basically ignored these calls, instead channelling their research dollars towards proprietary options. This does not prove that hydroxychloroquine and ivermectin are effective, but it does suggest that the way the medical establishment responded to calls for studying these drugs fits a well-established pattern.

Big pharma

It may seem shocking to imagine that companies making billions of dollars would compromise the health of populations just so they could make more billions. Is this plausible?

            In the 1960s, the German drug company Grünenthal marketed a morning sickness drug, promising wonderful effects. The company began receiving reports from doctors that their patients were suffering serious side effects from the drug, including peripheral neuropathy. Grünenthal ignored the reports and continued marketing the drug, and in some cases tried to discredit the doctors. This might have continued indefinitely, but then reports were published about pregnant women on the drug giving birth to children with serious deformities. This was enough to have the drug withdrawn from sale. Despite the damning evidence, Grünenthal denied responsibility and fought lengthy legal battles to avoid paying compensation (Insight Team, 1979).

            This is the story of the drug thalidomide, which became a famous emblem of corporate culpability. Was Grünenthal’s behaviour an outlier or a sign of things to come?

            Consider the tactics used by Grünenthal: marketing a drug before it had been sufficiently tested, ignoring reports of adverse effects, attacking critics and undertaking protracted legal means to avoid paying compensation — and never admitting wrongdoing. For some, it may be hard to believe companies could act in such a way. After all, they present themselves as supplying valuable solutions to health problems. Could they really be corrupt, enriching the pockets of executives and shareholders at the expense of public health?

            According to a range of critics, the answer is yes. The story of thalidomide became notorious but the same pattern has been repeated many times, except with less adverse publicity: the companies have become more sophisticated in their efforts to make exceptional profits without accountability.

            Ben Goldacre is a doctor and science journalist who wrote a scathing attack on alternative medicine, Bad Medicine (Goldacre, 2008). Then a few years later, he wrote Bad Pharma, an exposé of the pharmaceutical industry, giving example after example of how researchers studying drugs for companies fudge their results, for example by fixing endpoints, ignoring adverse effects and using physiologically active placebos. Bad Pharma provides revealing stories of what might be called systematic scientific fraud (Goldacre, 2012).

            Sergio Sismondo is a prominent figure in the field of science and technology studies, among other things having been editor of the premier journal Social Studies of Science for many years. He undertook a detailed investigation of the publication and marketing practices of pharmaceutical companies, for example attending conferences for pharmaceutical company liaisons and sales representatives, who use various forms of persuasion to encourage doctors to prescribe favoured drugs. In his book Ghost-managed Medicine, Sismondo (2018) documents the process by which company researchers produce papers for publication in top medical journals, finding academics who have had little or no involvement in the research to be the nominal authors, thereby giving the papers greater credibility. After publication, these papers are distributed to as many as hundreds of thousands of doctors as part of well-coordinated marketing efforts. In Sismondo’s picture, medical research is a just part of a marketing enterprise.

            Peter Gøtzsche is a medical researcher who helped set up the Cochrane Collaboration, a network of independent scientists who carry out assessments of drugs and other medical interventions. Gøtzsche himself is a highly energetic investigator and a fierce critic of shoddy research and corrupt practice. In his book Deadly Medicines and Organised Crime, Gøtzsche (2013) gives numerous examples of pharmaceutical companies that market products they know are dangerous. He says the pharmaceutical industry is just like organised crime in knowingly harming people, the main difference being that the industry kills far more people than organised criminals.

            In addition to analyses by Goldacre, Sismondo and Gøtzsche, one can turn to indictments by former editors of major medical journals (Angell, 2005; Smith 2005). Then there are pharmaceutical company whistleblowers who have told about corrupt practices from an inside perspective, as well as about the reprisals they suffered for speaking out (Rost, 2006).

            In this context, Kennedy’s analysis of Covid politics is nothing surprising. It is plausible that companies would promote responses to the pandemic that serve their own interests, even at the potential cost of large numbers of lives.

            But how could scientists and executives do such a thing? For the scientists, it is straightforward: they are part of a larger system, and they can just focus on their own narrow tasks (Schmidt, 2000). For executives and others, belief systems are convenient. They can truly believe that they are serving the public interest — or they can adopt any of various justifications for their actions. It’s not necessary to imagine that those who promote medical interventions as the solution to the pandemic have some secret agenda, scheming to cull the population. There is a well-known precedent, after all: the tobacco industry, responsible for the premature death of tens of millions of people (Proctor, 2012). We don’t need to think big tobacco is run by homicidal maniacs with a secret agenda. Well, they do have secrets, but for the purpose of maintaining and expanding markets for their products and making more money.

The role of Fauci

Kennedy’s book is titled The Real Anthony Fauci so it is hardly surprising that Fauci plays the lead role in Kennedy’s account of responses to Covid. Kennedy says relatively little about the politics of treatments and vaccines outside the US, except in as much as they support his argument. Is it reasonable to blame Fauci personally for so much of Covid policy?


Anthony Fauci

            One alternative is to use a structural analysis, standard in social science, that focuses on institutions and processes and sees individuals as epiphenomena. In this sort of picture, the drivers of the responses to the pandemic include the pharmaceutical industry which created the basis for a Covid paradigm — a hegemonic way of understanding Covid and what to do about it — that serves to support the industry’s interests. Responses to the pandemic were also influenced by political leaders who gained support by implementing tough policies, from the mass and social media that gave saturation coverage of the Covid threat without much historical or social context, and audiences frightened by a Covid hysteria and who looked to authorities for protection.

            Using this sort of structural analysis puts Fauci in a different light. He may have had an outsized influence on developments, but if someone else had been in his position, the outcome may not have been all that different. How to assess the value of a Fauci-centred analysis as compared with a structure-centred analysis is not straightforward. One way to proceed might be to undertake a comparative analysis of Covid responses in different parts of the world, looking at the roles of key individuals and policy decisions. For example, is the Swedish policy, widely seen as a contrast with policies in other European countries, better explained by Swedish history and institutions or by the influence of key individuals, or some combination?

            Kennedy’s focus on Fauci can also be understood as a narrative device, as a way of creating interest in the story. Readers may be more attracted by a story of a scheming individual than by the operations of faceless organisations and sets of ideas. You are reading Kennedy’s story about Fauci, the master manipulator at the centre of a web of influence, and learning about drugs, policies and much else along the way, without having to plough through the sort of prose found in a sociology monograph.

Suppression of dissent

In a revealing passage (pp. 142–143), Kennedy tells how for years he was able to have articles published in major newspapers and was widely sought after as a speaker on environmental issues. Then in 2005 he wrote an article about corruption in CDC’s vaccine branch, published in both Salon and Rolling Stone — and everything changed. His articles were removed, newspapers henceforth refused to publish his articles, and speaking engagements dried up due to complaints to venues or hosts.

            Throughout The Real Anthony Fauci, Kennedy describes how critics of orthodoxy have been suppressed, including losing their funding, being deregistered and being subject to derogatory misrepresentations. For example, in the 1970s, distinguished scientist J. Anthony Morris questioned the promotion of a flu vaccine. Kennedy describes the methods used against Morris: “… enforced isolation, disgrace, prohibiting him from publishing papers, presenting at conferences, or talking to the press, changing his laboratory locks to prevent further research …” (p. 360). I had read about this case earlier (Boffey, 1976).

            Based on my studies of “suppression of dissent” (Martin, 1999, 2015), this aspect of Kennedy’s account is completely believable. What he describes accords with experiences reported by hundreds of other scientists and campaigners.

Pandemic matters: summary

Kennedy provides a hard-hitting critique of US pandemic policy. Contrary to the official narrative that vaccines are the salvation and that hydroxychloroquine and ivermectin are kooky or dangerous, Kennedy argues that these two generic drugs, if used appropriately, are potent treatments for Covid. If they had been recognised and widely used, they might have reduced the US Covid death toll by hundreds of thousands. Accepting them as valid treatments, though, would have meant that Covid vaccines should not have received emergency use authorisations, and the proprietary drug remdesivir would not have been favoured. Behind this scandal, Kennedy says, is Anthony Fauci, the Covid-response kingpin whose actions faithfully served the pharmaceutical industry at the expense of public health. If Kennedy’s account is accepted, it points to one of the greatest scandals in the history of US public health.

            As a way of reflecting on Kennedy’s claims, I asked myself whether his analysis is compatible with analyses in the sociology of health and illness. Overall, it is. It is well documented that the pharmaceutical industry often has pursued profits over patient health, has silenced, discredited and suppressed those who challenge its agendas, and has colonised the medical profession to serve its own ends. Sociologists would probably not place so much importance on a single person, Fauci in this case, as being responsible for abuses, but instead would point to institutional and systemic processes, but this does not change the basic compatibility of Kennedy’s account with scholarly perspectives. This does not mean Kennedy’s account is right, just that it should not be ruled out as implausible. If it is considered a conspiracy theory, it might well be about a real conspiracy. I now turn to some other parts of The Real Anthony Fauci.

AIDS

Kennedy, after looking at Covid, turns to earlier stages in Fauci’s career, especially concerning AIDS. From the 1980s, Fauci was involved in the US response to AIDS, which was first diagnosed in 1981. For treating AIDS, Fauci championed the drug AZT, which turned out to be highly toxic.

            Kennedy, to show Fauci’s intolerance of contrary views, gives extensive commentary on the view that HIV is not responsible for AIDS, or not fully responsible. Starting in the late 1980s, this HIV-AIDS heresy was championed by Peter Duesberg, a highly prominent virologist. Previously he had received generous, prestigious funding for his research; after questioning HIV-AIDS, he was vilified and all his grant applications failed. He had difficulty publishing scientific papers, even in venues where normally he had guaranteed access.

            I have long been aware of HIV-AIDS dissent and the treatment of Duesberg, even citing it as an example of heresy in medicine. However, I never delved into the issue deeply, in large part due to my involvement in another AIDS debate, specifically the theory that AIDS developed from contaminated polio vaccines used in central Africa in the late 1950s. In 1991, I arranged for the publication of a working paper about this view (Pascal, 1991), which led to close contact with several of the key figures in the debate over the origin of AIDS, including the indefatigable investigator Edward Hooper (2000).

            Not long after the discovery of HIV, the human immunodeficiency virus, in 1983, a related virus was discovered in monkeys, simian immunodeficiency virus, SIV. Immediately, scientists speculated that SIV — of which there are many variants — had somehow gotten into humans and become transmissible. The question was how. One suggestion was that it was from people eating monkey meat. Another was that a hunter, in butchering a monkey, got monkey blood in a cut. This view can be called the cut-hunter theory or the bushmeat theory.

            Then there was the polio-vaccine theory. Polio research pioneer Hilary Koprowski ran trials involving polio vaccines that were administered orally to up to a million people in central Africa. These vaccines were cultured on monkey kidneys, offering a pathway for contamination by SIVs. Many scientists intensely disliked this theory. Naturally, the polio pioneers accused of accidentally causing AIDS were strong opponents, and a number of others joined them. I had a front-row seat in seeing the underhanded techniques used to censor and discredit the polio-vaccine theory, including blocking publications, suing for defamation, manipulating a scientific conference and making false claims (Martin, 2010).


Hilary Koprowski

            With this experience, it is easy to say that Kennedy’s treatment of Duesberg and HIV-AIDS dissent fits a pattern of suppressing dissent from AIDS orthodoxy. The question that came to my mind was, why did Kennedy give so much attention to the HIV-AIDS dissent and not even mention the origin-of-AIDS controversy? An obvious factor is that Fauci was centrally involved in the response to Duesberg and his allies but played no role in the response to the polio-vaccine theory.

            Kennedy states that “From the outset, I want to make clear that I take no position on the relationship between HIV and AIDS.” (p. 178). Nevertheless, in writing about HIV-AIDS, he gives extensive explanations of the viewpoint of Duesberg and other dissidents, focusing almost entirely on AIDS in the US. In this perspective, early US AIDS cases were attributable to poppers and other drugs used widely in the gay community, and later cases were due to AZT, the drug widely used to treat AIDS, with toxic consequences. This is a cogent account of the case that HIV is not responsible for AIDS. But it is one-sided. Nowhere does Kennedy mention evidence that might be difficult for Duesberg to explain. Why, for example, are the earliest cases of HIV-positive blood traced to central Africa from 1959 and after? Why did Ugandans recognise Slim, the local name for AIDS, as a new disease at the start of the 1980s, just as HIV appeared there? (Hooper, 2000, pp. 168–169). If HIV is simply a passenger virus, as Duesberg argues, why did it seem to emerge about the same time as the earliest cases of AIDS, and in the same location? I’m aware that Duesberg and his supporters can come up with explanations for anomalies like this. My point is that Kennedy has given only the information that HIV-AIDS dissidents can more easily explain.

A fatal flaw?

One-sidedness is a feature throughout The Real Anthony Fauci. Earlier I described Kennedy’s writing about Covid, specifically about hydroxychloroquine, ivermectin, remdesivir and vaccines. In relation to hydroxychloroquine and ivermectin, Kennedy writes like a lawyer for the defence; in relation to remdesivir and vaccines, he writes like a prosecutor.

            Is this a fatal flaw in his arguments? If it is, the same fatal flaw is present in most of the writing giving the standard, official views about Covid, which offer no acknowledgement of any contrary evidence. For example, official pronouncements about hydroxychloroquine never cite the many studies showing its effectiveness against Covid. In this context, Kennedy is presenting views to counter a one-sided orthodoxy. Furthermore, he is confronting an establishment committed to censorship and suppression. He has taken his opportunity to present a challenging view in as strong terms as he can manage. Nearly all of his readers will be fully aware of the orthodox view, which is dominant in mainstream sources and which shapes policy. So, in a sense, Kennedy might be excused for being one-sided.

            It’s useful to remember that The Real Anthony Fauci has been a bestseller that has received no reviews in mainstream media, only attacks. If Kennedy’s arguments are so dangerous, why not respond to them in a careful manner rather than trying to censor the message and discredit the messenger? One consequence of official intolerance of dissent is that some of those with reservations about the official line will find a well-documented presentation of contrary views persuasive. They might feel their only choices are orthodoxy or a Kennedy-informed heterodoxy.

Gates

The subtitle of Kennedy’s book is Bill Gates, Big Pharma, and the Global War on Democracy and Public Health. Bill Gates, the co-founder of Microsoft, is well known as one of the world’s richest people. He and his former wife set up the Bill and Melinda Gates Foundation which has dispensed billions of dollars for the cause of public health. At the same time, many commentators in the Covid-critical community see Gates as an evil manipulator, one who might even have depopulation as part of a sinister agenda.


Bill Gates

            Kennedy quotes critics of Gates’ so-called “philanthrocapitalism” who point out that the Gates Foundation, while giving away large amounts of money, is becoming even wealthier, as indeed has Gates himself. The explanation is Gates’ investments in pharmaceutical companies and the Gates Foundation’s focus on vaccination as the solution to the world’s health problems, especially those in Africa.

            According to Kennedy, the Gates Foundation, by making generous donations, has colonised international bodies like the World Health Organization, major research bodies and the mass media. In Africa, Gates promotes vaccines while long-time development experts say primary health care is more important. The money poured into vaccines has meant neglect of the basics, including adequate food and clean water. In other words, Kennedy says, Gates’ prioritising of vaccines is serving the interests of pharmaceutical companies rather than those of people in need. Throughout his book, Kennedy makes the point that Fauci, Gates and those in their thrall put disproportionate emphasis on vaccines and drugs while neglecting efforts to build people’s immune systems through better nutrition and hygiene. In summary: “… global public health advocates accuse Bill Gates and Dr. Fauci of hijacking WHO’s public health agenda away from the projects that are proven to curb infectious diseases (clean water, hygiene, nutrition, and economic development) and diverting international aid to wedge open emerging markets for their multinational partners and to serve their personal vaccine fetish.” (p. 323)

            Does this sound conspiratorial? It might, but there is no need to invoke conscious scheming. As studies of paradigms suggest, it is quite possible for Gates to be serving his own interests while sincerely believing that he is playing a life-saving role for hundreds of millions of people.

Intellectual property

A revealing indication of priorities is the role of intellectual property (IP) in public health. The rationale for IP, which includes copyright and patents, is to stimulate the production of new ideas and products by giving a temporary monopoly to the creator. I am one of many critics of IP, on several grounds (Martin, 1995). At the simplest level, the length of copyright terms, now standing at 70 years after an author’s death, is vastly longer than needed to stimulate more creative works. More generally, IP primarily benefits big companies in software, publishing, genetically modified foods, Hollywood entertainment — and pharmaceuticals.

            Intellectual property is a restraint on innovation justified by the need to stimulate more innovation, but big companies regularly use their controls to stymie competitors. This process is institutionalised in global agreements, most famously TRIPS (Trade-Related Aspects of Intellectual Property Rights). The US government has been the most aggressive in pushing to include stronger IP controls in trade agreements, even though for practical purposes IP restrains trade.

            Sometimes IP comes in direct conflict with public health. After AIDS drugs were developed, pharmaceutical companies charged exorbitant prices for them. Governments in low-income countries argued that these drugs should be compulsorily licensed so they could be made available at close to production costs and thereby be used to treat millions of AIDS patients who otherwise would not be able to afford them. The companies, backed by Gates and his entities, vigorously opposed this relaxation of tight IP controls. Gates, in software and drugs, put IP-derived profits above public health.

            Then came Covid and the same scenario, this time with vaccines and public health. The pandemic was proclaimed to be a public health emergency that warranted the most urgent efforts to develop vaccines that would be rolled out for the world’s entire population. But when governments asked for compulsory licensing so manufacturers of generics could provide otherwise unaffordable vaccines, the companies and Gates resisted.

            The willingness of big pharma and its government allies to fight against making their products available at low cost to fight pandemics — AIDS and Covid — is a damning indictment, yet it has received little media attention. Kennedy recounts how the Gates Foundation has made significant donations to media organisations, most of which muzzled themselves when it comes to any questioning of orthodoxy even when, as with licensing of drugs and vaccines, the realities of IP protection clash with public health priorities.

Depopulation?

Perhaps the most outlandish-seeming claims about Fauci and Gates are that they have a depopulation agenda. Kennedy addresses several versions, inadvertent and intentional.

            Inadvertently, some vaccine promotion efforts may lead to higher death rates. Scientist Peter Aaby and colleagues have studied the mortality of children in Guinea-Bissau following various vaccines (Aaby et al., 2018; Kristensen, 2000). The measles vaccine reduces mortality significantly but the DTP triple vaccine (diphtheria, tetanus and pertussis) increases mortality, quite dramatically for young girls. Years ago, the whole-cell pertussis component of DTP was found to be dangerous, so in the West it was replaced by an acellular version, with the resulting triple vaccine denoted as DTaP. However, as Kennedy reports, WHO, supported by Gates, continued to promote the more dangerous DTP version in Africa. This might be called an inadvertent depopulation process.

            Then there is the way vaccine promotion in low-income countries actually hurts population health by diverting money from basic measures such as providing clean water. Kennedy gives the example of the hepatitis B vaccine, promoted in India despite the disease it targets, hepatocellular carcinoma, not being a significant health problem in the country. Furthermore, according to Kennedy, Gates’ entities and allies pushed the WHO to include the hepatitis B vaccine in the mandated list of vaccines worldwide, irrespective of whether it addressed a significant problem. This meant governments paid large amounts to pharmaceutical companies for the vaccines; Gates has large holdings in these companies, so by giving money away he increases his fortune. By diverting scarce funds from more important health problems, this vaccine-promotion agenda could be said to be an inadvertent depopulation process.

            Then there are overt measures to control populations: promotion of anti-fertility drugs. Kennedy presents evidence suggesting that some vaccination programmes in low-income countries were covers for administering anti-fertility drugs, notably one called Depo-Provera. He cites writers who note that the schedule for giving the vaccines was one injection every six months for several years, rather than the usual pattern for the tetanus vaccine. Kennedy also refers to Gates’ longstanding interest in population control.

            The administration of anti-fertility drugs under the guise of vaccination, without proper consent, is obviously scandalous. However, even if true, it is not necessarily evidence of an intent to kill vast numbers of people, as might be suggested by the term “depopulation.” If Kennedy’s claims are correct, they are compatible with Gates sincerely seeking to address the problem of overpopulation, albeit sometimes with unethical means.

Conclusion

The Real Anthony Fauci is an impressive book, covering a wide range of important topics with extensive referencing. There is much more in the book that I have not discussed, including chapters on declaring pandemics and on biological warfare. I have not tried to pass judgement on Kennedy’s claims but rather to comment on whether his general perspective is compatible with some of the analyses by scientists and social scientists who have studied the same issues. For the most part, it is.

            The Real Anthony Fauci is, in parts, far more strident than typical scholarly treatments. In places, it reads like a diatribe, especially against Fauci and Gates. For example, Kennedy writes, “Blind faith in Saint Anthony Fauci may go down in history as the fatal flaw of contemporary liberalism and the destructive force that subverted American democracy, our constitutional government, and global leadership.” (p. 231). Many scholars would look less at the role of individuals and more at social structures, in particular at social systems that allow certain individuals to have an inordinate role in decision-making.

            A serious criticism of The Real Anthony Fauci is that it is one-sided. It presents lots of damning information but seldom attempts to present the other side, except to attack it. Discerning readers need to be aware that this is a critique of Covid orthodoxy and of the actions of the pharmaceutical industry and its most powerful supporters in government, science and philanthropy.

            The one-sidedness of the book might be considered, in context, a counter to the one-sidedness of the orthodox position concerning the pharmaceutical industry, Covid and vaccination. There is a certain symmetry here: both defenders and critics of orthodoxy give insufficient recognition to the other side. But there is a big difference. The defenders of Covid and pharmaceutical orthodoxy are backed by vast wealth and power, including the power to censor critics. The New York Times published attacks on Kennedy, meanwhile refusing to run an advertisement for his book (Lyons, 2022).

            There is one other difference between The Real Anthony Fauci and the many scholarly critiques that raise similar concerns: Kennedy’s book has sold over a million copies. In the age of Covid, it testifies to a widespread interest in seeing a well-documented perspective that questions the official line. That mainstream media decline to review the book or to address its claims shows the importance of a critique that reaches a wide audience.

Acknowledgements

For valuable comments on drafts, I thank Kevin Dew, Bob Dildine, Kurtis Hagen, Ed Hooper, Olga Kuchinskaya, Susan Maret and Sergio Sismondo. None of them necessarily agrees with Kennedy’s views or my own.

References

Aaby, Peter, Søren Wengel Mogensen, Amabella Rodrigues and Christine S. Benn. 2018. “Evidence of increase in mortality after the introduction of diphtheria-tetanus-pertussis vaccine to children aged 6–35 months in Guinea-Bissau: a time for reflection?” Frontiers in Public Health 6(79), 1–10.

Adams, Phillip. 2022. “Conspiracy of fools,” Weekend Australian Magazine, 19 February, 42.

Angell, Marcia. 2005. The Truth about the Drug Companies: How They Deceive Us and What to Do about It. New York: Random House.

Boffey, Philip M. 1976. “Vaccine imbroglio: the rise and fall of a scientist-critic.” Science 194 (December 3), 1021–1024.

Brown, Steve. 2022. “RFK, Jr.’s ‘The Real Anthony Fauci’ is a record-smashing bestseller — but mainstream media pretends it doesn’t exist.” Children’s Health Defense, February 17. https://childrenshealthdefense.org/defender/rfk-jr-the-real-anthony-fauci-record-smashing-bestseller/

Goldacre, Ben. 2008. Bad Science. London: Fourth Estate.

Goldacre, Ben. 2012. Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients. London: Fourth Estate.

Golden, I. 2019. “Reluctance to vaccinate: reasons and solutions.” Journal of Translational Science 5, 1–6.

Gøtzsche, Peter C. 2013. Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. London: Radcliffe.

Hess, David J. 2016. Undone Science: Social Movements, Mobilized Publics, and Industrial Transitions. Cambridge, MA: MIT Press.

Hooper, Edward. 2000. The River: A Journey to the Source of HIV and AIDS. Boston: Little, Brown. http://www.aidsorigins.com/the-river-a-journey-to-the-source-of-hiv-and-aids-2021-edition-by-edward-hooper/#more-3529

Insight Team of The Sunday Times (Phillip Knightley, Harold Evans, Elaine Potter and Marjorie Wallace). 1979. Suffer the Children: The Story of Thalidomide. London: André Deutsch.

Kennedy, Robert F., Jr. 2021. The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health. New York: Skyhorse.

Kristensen, Ines, Peter Aaby and Henrik Jensen. 2000. “Routine vaccinations and child survival: follow up study in Guinea-Bissau, West Africa.” BMJ 321 (December 9), 1–8.

Lyons, Tony. 2022. “We tried to run an ad for ‘The Real Anthony Fauci’ in The New York Times. Here’s what happened.” Children’s Health Defense, March 13. https://childrenshealthdefense.org/defender/ad-the-real-anthony-fauci-the-new-york-times

Martin, Brian. 1995. “Against intellectual property.” Philosophy and Social Action 21(3), 7–22. https://www.bmartin.cc/pubs/95psa.html

Martin, Brian. 1999. “Suppression of dissent in science.” Research in Social Problems and Public Policy 7, 105–135. https://www.bmartin.cc/pubs/99rsppp.html

Martin, Brian. 2010. “How to attack a scientific theory and get away with it (usually): the attempt to destroy an origin-of-AIDS hypothesis.” Science as Culture 19(2): 215–239. https://www.bmartin.cc/pubs/10sac.html

Martin, Brian. 2015. “On the suppression of vaccination dissent.” Science and Engineering Ethics 21(1), 143–157. https://www.bmartin.cc/pubs/15see.html

Pascal, Louis. 1991. What Happens When Science Goes Bad. The Corruption of Science and the Origin of AIDS: A Study in Spontaneous Generation. Working Paper No. 9, Science and Technology Studies, University of Wollongong, Australia. https://www.bmartin.cc/dissent/documents/AIDS/Pascal91.html

Proctor, Robert N. 2012. Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. Berkeley, CA: University of California Press.

Rost, Peter. 2006. The Whistleblower: Confessions of a Healthcare Hitman. Brooklyn, NY: Soft Skull Press.

Schmidt, Jeff. 2000. Disciplined Minds: A Critical Look at Salaried Professionals and the Soul-Battering System that Shapes their Lives. Lanham, MD: Rowman & Littlefield.

Sismondo, Sergio. 2018. Ghost-managed Medicine: Big Pharma’s Invisible Hands. Manchester: Mattering Press. https://www.matteringpress.org/books/ghost-managed-medicine

Smith, Richard. 2005. “Medical journals are an extension of the marketing arm of pharmaceutical companies.” PLoS Medicine 2(5), e138. https://doi.org/10.1371/journal.pmed.0020138

********************
Brian Martin
bmartin@uow.edu.au

health, science

Making a vaccine in record time

Did you ever wonder how Covid-19 vaccines were developed so quickly? Usually it takes five or ten years to develop and approve a new vaccine, but in 2020 several vaccines were ready in less than a year. This speed led to suspicions about quality and safety being compromised.


Sarah Gilbert

     For an explanation, turn to the new book Vaxxers by Sarah Gilbert and Catherine Green. They are key members of the team at Oxford University that developed the AstraZeneca vaccine. Vaxxers is an engaging first-hand account that contains many insights.

Gilbert and Green had been working on vaccine development for a great many years. They and their collaborators sought ways to prevent diseases such as Ebola, malaria and MERS. One of their accomplishments was development of a vaccine platform, a cell structure that could be used to enable new vaccines to be created very quickly.

People sometimes say, “Why wasn’t anyone preparing for a new pandemic?” Gilbert and Green say, with some exasperation, that is exactly what they were doing. The trouble was that they found it exceedingly difficult to obtain funds to make better preparations.


Catherine Green

Nonetheless, when Covid arrived on the scene, they were far better prepared than they might have been. The initial challenge was to recognise that the first reports of a new infectious disease in Wuhan, China, represented an urgent priority. Gilbert and Green had other projects under way, and a variety of personal and professional commitments. They started monitoring the reports of the new disease. It took some time before they decided to act. When they did, progress was rapid. As soon as they obtained the genetic structure of the new coronavirus, later named SARS-CoV-2, they used their platform to create a vaccine.

“This meant that before we even knew the pathogen’s genome, we knew the design for our vaccine — the gene coding for the SARS-CoV-2 spike protein, plugged into ChAdOx1 — and once we did receive the genome, we were able to design the exact DNA sequence we needed within forty-eight hours. Less than four months after that we had the first doses made, quality-assured, and ready to use in clinical trials.” (pp. 153–154)

They make it sound easy!

As it became clear that the new disease, called Covid-19, would require full attention, they gradually mothballed their other projects and put their full energy on developing and testing a vaccine for Covid. Having a small quantity of a vaccine was just the beginning.

A personal story

Each of the chapters of Vaxxed is told either by Gilbert or Green, giving a personal perspective labelled as Sarah or Cath. The result is in part a sort of scientific autobiography. They each tell of their personal lives, their families and difficulties, their eating habits and especially their anxieties about producing the vaccine.

They put themselves under immense pressure to do everything required to make a high-quality vaccine in record time, knowing that every day shaved from the usual development schedule could make the difference to people’s lives and also knowing that mistakes could make the whole process come unstuck. At crucial stages, such as purifying the vaccine and unblinding trial results, they were confident due to having been through the same stages with previous vaccines, but they were also on tenterhooks because so much hinged on the outcome.

Scientists spend much of their time in labs and with their colleagues, and non-scientists can have a hard time appreciating what goes on. In Vaxxed, we are offered an inside look into everyday science, though in this case undertaken at high intensity and with high stakes. Gilbert and Green show they are humans just like the rest of us, with cares, hopes, distractions and lives outside of science, and with great experience and dedication in their research roles.

It is amazing that such a story has been told so soon after the events, indeed told at all. Scientists working for governments or pharmaceutical companies would have a hard time gaining approval to write such a revealing memoir. For scientists used to writing technical papers for journals in their fields, adopting a style aimed at a general audience is no mean feat. That Vaxxed is so readable may be attributed in part to excellent editorial support. At the bottom of the title page, in small print under Gilbert and Green’s names, is “Written with Deborah Crewe.”

The Oxford lab was set up to develop vaccines, not for mass production. At a crucial time, the pharmaceutical company AstraZeneca was brought on board to collaborate with the Oxford scientists and produce the vaccine in commercial quantities. Rather than using laborious lab methods to produce dozens of doses, AZ could scale up production to millions or even billions of doses.

Unlike other companies producing Covid vaccines, AZ made the magnanimous decision to provide its vaccine at cost, namely with no profit, for the duration of the pandemic, and indefinitely for low and middle-income countries. It is far cheaper than the Pfizer or Moderna vaccines.

The media

Few scientists have a high media profile, nor do many seek media attention. University administrators now encourage scientists to showcase their research, providing support from professional units that help write media releases. Gilbert and Green had been working for many years with this sort of limited interaction with journalists. Vaccines for diseases in foreign countries are seldom newsworthy. With the pandemic, suddenly there was intense interest in vaccine development for a disease affecting people in their daily lives.

Gilbert and Green tell about their steep learning curve doing media interviews, for example learning that an off-the-cuff comment, taken out of context, could become a misleading headline. They were pleased that so much coverage was supportive but then upset when a routine occurrence — pausing the trial while an adverse event was investigated — was misinterpreted and blown out of proportion. Before long, they referred all enquiries to the university’s media unit, as it was impossible to handle all requests and to do so would have meant slowing their work on the vaccine.

Gilbert and Green sometimes had to push back against media intrusions, especially when film crews in the lab caused work to be compromised. On the other hand, they appreciated the opportunity, provided by the media, to publicise the vaccine and, more generally, to enable them to get out messages they thought were important.

Lab life under a media microscope

Quite separately from its contribution to understanding vaccine development, Vaxxers is a valuable contribution to writing by scientists about their own work. The classic book in this genre is James Watson’s book The Double Helix, his account of unravelling the structure of DNA, an account criticised for male chauvinism, in particular downgrading the role of Rosalind Franklin. Vaxxers, in contrast, is written by two women scientists who explicitly deny being pathbreakers or heroes. They repeatedly acknowledge the others in their team and explain how their work on the vaccine built on years of prior work and experience. They worked extraordinarily hard not so they would be recognised as elite scientists but because they wanted to do what they could to save lives.

“Before 2020, no one had ever developed a vaccine in a year. But that was not because it could not be done. It was because it had never been tried. We were able to go faster in 2020 not because we cut any corners or took risks with our product. We still did every single thing that needed to be done to develop a vaccine safely. We did not miss out any steps. Nor was any individual task — filling a vial, vaccinating a volunteer, analysing a graph — done with less than the usual care and attention. We went faster because we had to this time — the world needed the vaccine as soon as possible and, as we know from seeing the daily death rates, every day counts.” (pp. 160–161)

Vaxxers is also different from most books in the first-person scientist memoir genre in consciously being an intervention into the debates surrounding the research. Gilbert and Green are acutely aware of concerns about the safety of Covid vaccines developed at such great speed and want to explain how they were able to move so quickly without compromising quality or safety. In this they have undoubtedly succeeded. What they cannot do, of course, is to provide the same sort of reassurance about other Covid vaccines. We can read Vaxxers but no equivalent story written by government or pharmaceutical company insiders is ever likely to be published.

While Vaxxers addresses some of the concerns about Covid vaccines, it cannot deal with all of them. The full story of the health effects of the vaccine remains to be told, as does the comparison between risks from vaccines and Covid itself, for different demographics. Nor is the story over, because new variants of Covid continue to appear, meaning that new versions of vaccines may be developed.

The only time Gilbert and Green’s treatment loses authenticity is when they write about vaccine hesitancy, about which they rely more on others’ treatments than their own research and experience. For example, Gilbert writes, “I don’t understand anti-vaxxers” (p. 192). This is understandable given that she’s not a social scientist who has spent years interviewing parents and trying to learn about vaccine hesitancy.

Regarding blood clots from the vaccine, Gilbert makes a comparison with the risk of blood clots from having Covid or from taking the contraceptive pill. This is reasonable on the surface, but Gilbert is not an expert on the science and politics of risk assessment, about which there is a vast body of research addressing complexities and value judgements.

Final comments

Supporters of vaccines can learn from Vaxxers about how the substance injected into their arms was developed. Critics of vaccines can learn this too. All their criticisms will not be answered, but at least they can be better informed.

Gilbert and Green worked exceedingly hard and long for many months, and desperately needed a break. They write about what they will do after Covid priorities recede. It’s good they decided to take the time to write Vaxxers.


Sarah Gilbert with the Barbie doll modelled on her

Brian Martin
bmartin@uow.edu.au

Disclosure: I had the AstraZeneca vaccine — hence my special interest in Vaxxers — and had no side effects.

Brian’s posts and articles about Covid

Comments from Robyn Gardner

Your review of Gilbert and Green’s work seems very balanced to me. My only reservation concerns the rush to autobiographical disclosure by scientists, which seems so common now in all fields, in government, media and the military. The speed of publication indicates that at some point it becomes part of the potential framework of research or design in any career-sensitive lab. The ‘confession’ is a kind of promotional agency, akin in some ways to pharmaceuticals’ harnessing of patient groups/parents/human interest stories for their own profits. The result is an erosion of the integrity we may imagine of/in science, pre-empting and incorporating the earlier systems of external critique and history of science.

It seems to me that popularizing and personalizing of research via the highly marketable and more inclusive representation of women is as risky in its way as the effacing of women  earlier was, which was, let’s face it, probably no different or inexorable as the effacing of many, many men – there being more men, in earlier periods, so that women may actually have had more ease of access, if only by dint of a family connection or their exception.

We still await some highly nuanced outside assessments of this cultural history and the very problematic politics of vaccine production, something akin to David Oshinsky’s Polio: An American Story which examines  the wider cultural context of a pandemic. Oshinsky’s book addresses the ‘boosters’ and marketeers of that first wave of public image harnessing as well as the personal volatile histories of Salk and Sabin. Furthermore, it addresses the upscaling of vaccine production by the moves from research and laboratory science to outsourced not-for-profit production (by the same agencies as for-profit ones or harnessed with them)  through the process of ‘gifting’ to middle tier as well as third world countries. Then there’s the old story of poorer places being used for testing in an era when you can’t as easily inject into the bodies of the disabled or the ‘isolated’ cultures of poor countries – unless you redefine them loudly and publicly as ‘most vulnerable’ and needing to be ‘included’.

We rapidly approach the place in which we are all included – so where precisely is the control group, of the unvaccinated? And what, historically, does this serve to cover over, if we’ve all been injected with so many and variable (including simian viral) and DNA active or lipid adjuvant substances, and what levels of biosecurity can possibly pertain given the places and speed of outsourcing in manufacture?


Robyn Gardner

I think of the silencing, and self-silencing, of any possible response, and of the wholesale ‘turn away’ from the polio vaccine origin-of-AIDS thesis by even those scientists who found it highly plausible, and on the part of  those who  could have been and should have been most active in inquiry. 

My concern about AstraZeneca is not the reporting of side effects in the short term, but the widely mediated hijacking of this possibility by labs and agencies and ghost-written preprints focussing on the ‘rare’ clotting events of the disease itself. The possibility of long term and highly likely slower vascular changes, not reversible, but activated – a ‘forever’ event – in vaccinated subjects will tend to get deluged and overwritten, buried, by the usual facile response of Covid causing the same or greater risk. So it goes. I guess this is science and business as usual, and the post-war scepticism about biological research, and rise of ethics, is now in reversal. We are all in thrall again to something called ‘the science’ – which is seen as pure again, and all inclusive, whilst any postgraduate qualification in the human sciences, which might include historical awareness and critical thinking, if not always clear, will cost a leg and an arm.

health, science

On not making up your mind

I’m finding it extremely difficult to remain open to a range of possibilities. On Covid in particular.

            I’ve read a large number of articles about Covid and talked with lots of people. There are articles about the urgent need for vaccinations and others about the risks of adverse reactions. There are articles about lockdowns and wearing masks, with different viewpoints. There are articles about the origin of Covid, some saying it came from wet markets and others saying it was from a lab leak.

When I read a well-documented and well-argued analysis, I think, “That’s persuasive.” Then I read another from a different perspective and think, “That sounds persuasive too.”

            Some time after the beginning of the pandemic, I decided to try to remain open to different views rather than reaching a firm conclusion. For example, there are claims for and against using ivermectin as a prophylactic, to reduce the risk of getting Covid. I don’t want to decide definitively one way or the other, at least not yet.

The trouble with reaching a firm conclusion is being trapped by confirmation bias. If I decide that mask rules are right or wrong, then I am likely to pay attention to material that supports my belief and to dismiss contrary information. I might find myself in an echo chamber.

This doesn’t mean I can’t make decisions. As soon as the AstraZeneca vaccine became available, I had my shots. That was a personal choice. But since then I’ve tried to remain open to information about the hazards of vaccines, for example from a rare blood clotting condition. Maybe it’s more common than official figures indicate.

            You see, I’m a social scientist, and I’ve studied numerous public scientific controversies, including ones over nuclear power, pesticides, fluoridation and the origin of AIDS. On some of these issues I have a strong personal view but on others I don’t. For social analysis, it sometimes can be helpful not to care strongly about the topic under investigation, as this enables looking at the dynamics of the controversy from a less emotional perspective.

A decade ago, I started studying the vaccination debate. For me, vaccination was not a personal issue, having no children and no particular problem with vaccines; I’ve had the flu vaccine for the past five years. My angle was to support free speech for vaccine critics, because I believe free and open discussion of contentious issues is better than trying to silence contrary views.

            Being open to different perspectives on vaccination was like a warm-up for being open to different Covid viewpoints. Dominant perspectives are presented by the World Health Organisation and the Centers for Disease Control and Prevention as well as by various governments and health authorities. The mainstream media mostly report the views of authorities. But then there are contrary views, some of them supported by a few doctors and researchers, readily available on social media. By subscribing to newsfeeds giving different perspectives, the volume of commentary soon becomes overwhelming. Even to try to understand the subtleties of a single issue, for example hydroxychloroquine, becomes a bottomless pit of claim and counter-claim.

Sometimes official recommendations change, for example on mask-wearing. That should encourage remaining open to different views, because you never know when a dissident view might suddenly become the orthodoxy. What I’ve learned through my studies of scientific controversies, though, is that many people, especially campaigners, adopt a view and stick with it regardless of new evidence.

            A neighbour told me that her young daughter was in hospital with a mysterious illness. It developed shortly after a routine childhood vaccination, but her doctors were adamant that the illness was not connected with vaccines. My neighbour wasn’t sure. I thought, how can the doctors be so sure? Why couldn’t they be open to the possibility, however slim, of an adverse reaction? Thankfully, her daughter recovered.

I’ve talked with colleagues who are passionately pro-vaccination and condemn anyone who is hesitant as misinformed or worse. These colleagues do not work in any field related to health, so I think, “How can they be so sure?” Are they confident because their view is the same as that of health authorities?

I’ve also talked with passionate critics of vaccination orthodoxy. Some of them have studied the issues extensively but others less so. How can they be so sure? Doesn’t anyone have doubts about what they believe?

            Trying to keep an open mind has been challenging, especially when talking with others who have strong views and think anyone who disagrees is foolish or even dangerous. It seems everyone has an opinion, even those who know little about the issues. Am I being foolish by trying to remain open to different ideas?

Some views seem so extreme or peculiar that I tend to dismiss them out of hand. Some of the claims in the “Plandemic” videos seem implausible to me. But I haven’t studied the topic in depth, so should I be confident about my judgement? Perhaps I can just ignore Plandemic claims, assigning them a tiny probability, at least until more people start taking them seriously.

            Ah, here’s a clue. When others take an idea seriously, it’s tempting to go along with them. This is influence via what is called social proof. Anyone trying to be a rigorous thinker presumably should be alert to this influence and attempt to counter it, or at least to examine the evidence used to support the idea. But this leads back to the beginning. It’s impossible to investigate all the evidence on all facets of Covid, or indeed any other controversial topic.

As I’ve persisted in trying to remain open about Covid issues, while still making decisions, I’ve noticed something else. On other issues, especially ones I haven’t studied in depth, I’m more likely to question my views. Will this lead to a state of precarious uncertainty? Or will it be a refreshing and invigorating alternative to the usual rush to judgement?

For helpful suggestions and thoughtful comments, thanks to Tonya Agostini, Paula Arvela, Kathy Flynn, Suzzanne Gray, Julia LeMonde, Monica O’Dwyer, Dalilah Shemia-Goeke, Jody Watts and Qinqing Xu.

Brian Martin
bmartin@uow.edu.au

Brian’s posts and articles about Covid

health, science, tactics

The glyphosate chronicles

Glyphosate is the world’s most widely used herbicide. Is it as safe as its manufacturer claims?

Glyphosate is the principal ingredient in the herbicide named Roundup. It seems miraculous. It is deadly to weeds, yet harmless to humans, or so says Monsanto, the massive chemical company that manufactures it. (In 2018, Monsanto was purchased by Bayer.)

Glyphosate is used on crops such as soybeans, corn and canola. It is used by local governments to control weeds in public areas. It is used on golf courses. It is used by householders to maintain beautiful lawns.

The biggest use is on crops. Glyphosate is deadly to all growing things, so initially Roundup had to be applied to the weeds but not the crops. However, when the patent on Roundup was about to expire, Monsanto developed a brilliant way to maintain sales. Using genetic engineering techniques, it spliced a gene into crops, such as soybeans, that made them resistant to glyphosate. As a result, Roundup could be sprayed directly on the crops. Weeds would be killed, but genetically modified crops would not be harmed. Such crops are called Roundup Ready.

What happened when farmers started reporting disease and scientists started finding problems? If you want the inside story, get Carey Gillam’s book Whitewash: the story of a weed killer, cancer, and the corruption of science. Gillam is an experienced journalist who was put on the agriculture beat and began looking behind the scenes. The picture isn’t pretty. She is now research director at U.S. Right to Know.

The victims and the regulators

Monsanto claimed that Roundup was safe, so safe that you could probably drink it without harm. But what about farmers who had used Roundup for decades and then developed non-Hodgkin’s lymphoma? There seemed to be a pattern, especially given experiments with mice.

What about government regulators? The US Environmental Protection Authority (EPA) is supposed to be protecting the health of both people and the environment. Yet the EPA has seemed to be in the pocket of Monsanto, in all sorts of ways.

The EPA can set upper limits to the intake of chemicals. However, when it came to glyphosate, the limits it set were high, and were increased in line with increased use of the herbicide. This was despite the applications of glyphosate becoming ten times as great over a period of two decades.

You might expect that with glyphosate being the most heavily used herbicide in the world, there would be numerous studies of its prevalence and its impacts. Quite the contrary. For years, no figures were collected of the levels of glyphosate in different crops. The reason: because it was presumed to be safe, there was no need to see what levels were appearing in foods. For years, studies were not carried out on glyphosate’s possible health hazards. Again, the rationale was that it was so safe that there was no need for testing.

Much that Gillam reports relies on documents obtained using the discovery process in court cases, in which parties are required to provide relevant documents to the other side. Monsanto’s activities in subverting scientific research have been remarkable.

Monsanto cultivated allies within the EPA and used them to block introduction of regulations. It cultivated tame scientists who would go on the attack against anyone who criticised glyphosate. These tame scientists were given “talking points” so they would know what to say, and given guidance on venues for giving talks and submitting articles. These tame scientists did not reveal their links to Monsanto. In this way, Monsanto could get out its message via seemingly independent scientists.

Resistance – by pests

According to its promoters and defenders, glyphosate is a miracle chemical, so safe to humans that it can be used widely with little or no impact on human health. However, it is not pure glyphosate that is applied to crops, gardens and walkways, but Roundup, which contains additional chemicals, including one called polyethoxylated tallow amine or POEA. The combination of glyphosate and POEA is what needs to be tested, but this is hardly ever done.

However safe Roundup might be, there’s another problem. Pests can develop resistance to it. This is evolution in action: a few pest species have or acquire resistance to the pesticide, so they are the ones that start growing and spreading.

Because Roundup has been so remarkably effective in eliminating pests, farmers have become complacent. Instead of rotating crops – a traditional practice that reduces pest problems and replenishes the soil – farmers have planted the same crops year after year, relying on Roundup rather than other methods to keep pests at bay.

When Roundup-resistant pests started appearing, what was the solution? Farmers turned to other pesticides, using them in addition to Roundup. Some of these other pesticides are more highly toxic. This is the pesticide treadmill, in which the only solution to pests, even when they become resistant, is more pesticides.

Pesticide treadmill

Some farmers had nearly forgotten how to grow crops in traditional ways. Others, though, have turned towards alternatives, including organic agriculture.

History repeats

Is Gillam’s treatment of the glyphosate saga accurate? Her account rings true, because it is history repeating. Monsanto’s response to criticisms of Roundup is remarkably similar to the response by earlier pesticide manufacturers to criticisms.

Rachel Carson

Rachel Carson’s famous book Silent Spring, published in 1962, raised the alarm about the effect of pesticides on wildlife and, tentatively, on human health. Many people have heard of Silent Spring, which is often credited with inspiring the modern environmental movement. Less well known is that Carson and Silent Spring came under fierce attack by chemical corporations. This is documented in a revealing 1970 book by Frank Graham, Jr., titled Since Silent Spring.

In 1978, biologist Robert van den Bosch’s book The Pesticide Conspiracy appeared. Van den Bosch told about the strong-arm tactics of the pesticide manufacturers, recounting case after case of scientists whose research and careers were attacked after they reported findings critical of pesticides.

Gillam’s story of Monsanto’s tactics to attack any threat to its highly profitable Roundup is eerily similar to the tactics used by pesticide companies since the 1960s. It seems little has changed since, decades ago, I investigated suppression of scientists who questioned pesticides. Given that the tactics are predictable, it is plausible to work backwards and assume that presence of these tactics indicates the likelihood of shortcomings in the pesticide paradigm. So what are the tell-tale tactics?

* Attacks on scientists who report research results showing dangers or limitations of pesticides.

* Regulatory agency dependence on industry testing of pesticides.

* Testing only of the active ingredient, not of the pesticide actually used.

* Corporate ghostwriting of research papers.

* The failure of companies to release documents except through freedom-of-information requests or court discovery processes.

* A revolving door between company jobs and jobs in the corporate regulator.

* Presence on expert panels of members with conflicts of interest.

* Failure to carry out relevant research or collect relevant data, such as amounts and locations of pesticides used.

The presence of these tell-tale signs does not prove that a pesticide, or some other product or practice, is dangerous, but it does point to areas where extra scrutiny is warranted.

If you start investigating the likelihood that corporations and regulators are not serving the public interest, be prepared to be ignored or, if you start having an impact, being the target of dirty tactics.

Carey Gillam

“Monsanto Company and many leading chemical industry experts tell us that we should trust them and that more research is not needed. The safety of glyphosate and Roundup is proven, they say. But trust is hard to come by when the government does not require robust long-term safety data for a finished product such as Roundup, only for the active ingredient. There have long been concerns that the end product is more dangerous than glyphosate alone, and scientists say it is well-known that extra ingredients in pesticide products not only may themselves be toxic but also may enhance or supplement the toxic effects of the active ingredient. Extra ingredients in pesticides commonly include surfactants that help chemicals stick to the leaves of plants, antifoam compounds, and more. Yet the bulk of industry-sponsored toxicology tests are done using only the active ingredient. As well, there is very little long-term epidemiology data on glyphosate exposure, and there is no established base of information about just how much of the pesticide is in the products we eat and drink because the U.S. Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA) have so steadfastly avoided including glyphosate in their testing regimes. And despite industry assurances of safety, there is an international body of published research that contradicts those claims.” (pp. 79-80)

Brian Martin
bmartin@uow.edu.au

health, science, social dynamics

An HIV mystery in Africa

According to mainstream scientists, HIV transmission in Africa operates differently than elsewhere. An alternative view has been systematically ignored and silenced.


HIV prevalence in Africa

AIDS is the most deadly new disease in humans, with the estimated death toll exceeding 30 million. In order to restrain the spread of the infective agent HIV, scientists have tried to figure out how it spreads. The consensus is that HIV is most contagious via blood-to-blood exposures, such as through shared injecting needles, and in comparison the risks of transmission via heterosexual sex and childbirth are small.

However, there’s a mystery in relation to Africa. The scientific consensus is that in Africa, unlike elsewhere, HIV spreads mainly through heterosexual sex. Why should this be?

John Potterat is a public health researcher who spent decades tracking the spread sexually transmitted diseases in the US. He became interested in the African mystery and developed an alternative hypothesis. He and colleagues wrote many scientific papers about it, but were rebuffed by mainstream scientists. Here I will tell about Potterat’s experience drawing primarily on his engagingly written book Seeking the positives: a life spent on the cutting edge of public health, in particular the chapter “Why Africa? The puzzle of intense HIV transmission in heterosexuals”.

Some background

My own interest in research on AIDS derives from a different controversy, the one over the origin of AIDS. The standard view is that AIDS first appeared in Africa and was due to a chimpanzee virus, called a simian immunodeficiency virus or SIV, that got into a human, where it was called a human immunodeficiency virus or HIV. Chimps have quite a few SIVs, but these don’t hurt them presumably because they have been around long enough for the population to adapt to them, in the usual evolutionary manner. There are various species of chimps, and when a chimp is exposed to an unfamiliar SIV, it can develop AIDS-like symptoms.

            So the question is, how did a chimp SIV enter the human species and become transmissible? The orthodox view is that this occurred when a hunter was butchering a chimp and got chimp blood in a cut, or perhaps when a human was bitten by a chimp, or perhaps through rituals in which participants injected chimp blood.

In 1990, I began corresponding with an independent scholar named Louis Pascal who had written papers arguing that transmissible HIV could have entered humans through a polio vaccination campaign in what is present-day Congo, in which nearly a million people were given a live-virus polio vaccine that had been grown on monkey kidneys. The campaign’s time, 1957 to 1960, and location, central Africa, coincided with the earliest known HIV-positive blood samples and the earliest known AIDS cases.

            Despite the plausibility and importance of Pascal’s ideas, no journal would publish his articles, so I arranged for his major article to be published in a working-paper series at the University of Wollongong. Independently of this, the polio-vaccine theory became big news. Later, writer Edward Hooper carried out exhaustive investigations, collected much new evidence and wrote a mammoth book, The River, that put the theory on the scientific agenda. Over the years, I wrote quite a few articles about the theory, not to endorse it but to argue that it deserved attention and that scientific and medical researchers were treating it unfairly.

In the course of this lengthy controversy — which is not over — I became increasingly familiar with the techniques used by mainstream scientists to discredit a rival, unwelcome alternative view. I had been studying this, on and off, since the early 1980s; the origin-of-AIDS saga made me even more attuned to how dissenting ideas and researchers can be discredited.

With this background, when I read John Potterat’s chapter “Why Africa?” it was like he was providing a front-row seat for a tutorial on how an unwelcome view can be marginalised. I saw one familiar technique after another.

I’m not here to say that Potterat’s view is correct. Furthermore, unlike the origin-of-AIDS debate, I haven’t studied writings about HIV transmission in Africa. What I do here is outline Potterat’s account of his experiences and comment on the techniques used to dismiss or discredit the ideas he and his collaborators presented to the scientific community.


John Potterat

Contact tracing

HIV is infectious, so it is important to know exactly how it gets from one person to another. Knowing transmission routes is the basis for developing policies and advice to prevent the spread of the virus.

In Seeking the Positives, Potterat tells about his personal journey in scientific work. It was unusual. With a degree in medieval history, he ended up with a job in Colorado Springs (a moderate-sized town in Colorado) tracking down networks of people with sexually transmitted diseases (STDs). Learning from his mentors, the approach he developed and pursued with vigour was to interview infected individuals, find out their sexual or injecting-drug partners and proceed to build up a database revealing the interactions that spread the disease. The military base near the city meant there were lots of prostitutes (some permanent, some seasonal) and STDs to track. This sort of shoe-leather investigation (seeking those positive for disease) led to many insights reflected in a vigorous publication programme. For the Colorado Springs research team, AIDS became a key focus from the 1980s on.

When submitting a paper to a scientific journal, editors and reviewers are supposed to assess it on its merits. It should not matter whether an author has a PhD in epidemiology from Oxford or no degree at all. The test is the quality of the paper. Potterat became the author of dozens of scientific papers. However, his unusual background may have been held against him in certain circles.

In Seeking the Positives, Potterat doesn’t tell that much about his team’s clients/informants. Sensitively interviewing prostitutes, partners of prostitutes, drug users, gay men and others would have been a fascinating topic in itself, but Potterat focuses on the research side of the story.


A diagram from one of Potterat’s papers

            You might think that contact tracing is an obvious way to study the transmission of disease, especially a new disease for which the patterns of contagion are not fully understood. But what Potterat’s team was doing was unusual: mainstream AIDS researchers pursued other approaches. Because the mainstream researchers had lots of research money, they didn’t take kindly to a small, non-prestigious team doing something different.

Mainstream groups, both researchers and activists, raised a series of objections to HIV contact tracing. First they said there was no reason for contact tracing unless there was a test for HIV. Second, after a test became available in 1985, they said tracing would allow the government to compile lists of homosexuals. Third, they said that without effective treatment, notifying individuals would distress them and lead to suicides. Fourth, after the drug AZT became available in 1987, they said contact tracing would be too expensive.

            The interesting thing here is that none of the objections was backed by any evidence. Potterat says that in his team’s studies nearly all of those approached for contact tracing were very helpful.

“Contact tracing was generally opposed by AIDS activists, by civil libertarians, and (disappointingly) by many public health workers, who were often influenced by political correctness and by not wanting to offend strident constituencies.” (pp. 68-69)

Later, mainstream public health officials in the US took the line that AIDS was a danger to the heterosexual population, not just to gays and injecting drug users. If HIV was highly contagious in the wider population, this lowered the stigma attached to gays and injecting drug users, and coincidentally made it possible to attract more funding to counter the disease, a worthy objective. However, contact tracing showed that HIV transmission was far higher in specific populations. This was another reason the research by Potterat’s group, published in mainstream journals, didn’t lead to changes in research priorities more generally.

HIV transmission in Africa

In 2000, Potterat was approached by David Gisselquist about the spread of AIDS in Africa, questioning the usual explanations for why the mechanisms were claimed to be different from those in Western countries. After his retirement the following year, Potterat and some of his collaborators joined with Gisselquist in examining the studies that had been made.


David Gisselquist

            The orthodox view was that in Africa, uniquely, HIV transmission occurs primarily through heterosexual sexual activity. This, according to Potterat et al., was based on assumptions about high frequencies of sexual interactions and high numbers of partners, neither of which were supported by evidence. They said the evidence suggested that sexual activity in Africa was much like elsewhere in the world.

In this was the case, the orthodox view couldn’t explain HIV transmission in Africa, so what could? The answer, according to Potterat and his collaborators, was skin-puncture transmission that occurred when contaminated needles were reused during health-care interventions such as blood testing, vaccinations and dental work, plus tattooing and traditional medical practices. This was heresy. It was also important for public health. Potterat writes, “Only when people have accurate knowledge of HIV modes of transmission can they make good decisions to protect themselves and their families from inadvertent infection.” (p. 200)

Potterat’s team wrote dozens of papers, but they had a hard time getting them published in top journals, where orthodoxy had its strongest grip. Nevertheless, they were quite successful in publishing in reputable journals of slightly lower standing.

Responses

The most common response was to ignore their work. Even though Potterat et al. had poked large holes in the orthodox view, orthodoxy was safe if the critique was given no attention.

Another response was to try to prevent publication of orthodoxy-challenging research. One study was by a team, not Potterat’s, involving Janet St. Lawrence, then at the Centers for Disease Control and Prevention (CDC), and her colleagues. According to Potterat, St. Lawrence’s CDC superiors asked her not to publish the paper, but she refused. The paper was rejected by several journals, and then submitted to the International Journal of STD & AIDS. After peer review and acceptance, the CDC applied pressure on the editor to withdraw acceptance, but he refused. This is just one example of efforts made to block publication of dissenting research findings.


Janet St. Lawrence

“… it does not engender trust in the official view to know that our informal group has solid evidence of several instances by international health agencies actively working to suppress findings supportive of non-sexual transmission and to discourage research into non-sexual transmission.” (p. 221)

Another tactic was to misrepresent views. On 14 March 2003, the World Health Organisation held a meeting of experts to, as stated in a memo to participants, “bring together the leading epidemiological and modeling experts with Gisselquist and Potterat.” Potterat was dismayed by the consultation: data disagreeing with the orthodox view was dismissed. After the meeting, a statement was put out by WHO presented as representing a consensus. Actually, this so-called consensus statement did not represent everyone’s viewpoints, and was actually finalised prior to the conclusion of the meeting. (This was an exact parallel to what happened at an origin-of-AIDS conference.)

Potterat was surprised and disappointed to be subject to ad hominem comments, otherwise known as verbal abuse. He writes:

“Among other, less printable, things I was called ‘Africa’s Newest Plague’; ‘Core Stigmatizer’; ‘Linus Pauling—in his later years’ (when Pauling was thought to be advancing crackpot ideas); and [a reward being offered] ‘for his head on a platter’.” (pp. 193-194)

Potterat was surprised at this invective because none of his team had imagined the resistance and anger their work would trigger among mainstream agencies and researchers. He was disappointed because many of the comments came from colleagues he had previously admired.

Undone science

Researchers into the dynamics of science have coined the term “undone science” to refer to research that could be done and that people are asking to be done, but nevertheless is not carried out. A common reason is that the findings might turn out to be unwelcome to powerful groups. Governments and industry, through their control over most research funding, can stifle a potential challenge to orthodoxy by refusing to do or fund relevant research.

            Undone science is most common in areas where citizen groups are calling out for investigations, for example on the environmental effects of mining in a particular area or the health effects of a new chemical. Three research students who I supervised used the idea of undone science as a key framework for their theses, on drugs for macular degeneration, on vaccination policy, and on the cause of the cancer afflicting Tasmanian devils. My former PhD student Jody Warren and I, drawing on our previous work, wrote a paper pointing to undone science in relation to three new diseases. With this experience, I was attuned to notice cases of undone science in whatever I read. In Potterat’s chapter “Why Africa?” there were many striking examples.

In their papers, Potterat and his colleagues presented findings but, as is usual in scientific papers, acknowledged shortcomings. In one case, to counter criticisms, they reviewed research on the efficiency of HIV transmission by skin-puncturing routes, while admitting that new studies were needed to obtain better data. Potterat concludes, “To my knowledge, such studies have not been fielded.” (p. 199)

In another study, on discrepancies in studies of Hepatitis-C strains and patterns, Potterat writes, “In the intervening decade, however, no studies had been fielded to resolve these uncertainties.” (p. 199)

Potterat and his collaborators were unable to obtain external funding to carry out studies to test their hypotheses. So Potterat used his own money for a small study of HIV transmission in Africa. “Yet this pilot study supported our contentions and should have provoked the conducting of larger studies to confirm our findings. Regrettably, this did not happen.” (p. 205)

Similar responses

As stated earlier, I am not in a position to judge research about transmission of HIV in Africa. I approach the issue through Potterat’s account of the tactics used by supporters of orthodoxy against a contrary perspective. The tactics, according to him, included ignoring contrary findings, denigrating the researchers who presented them, putting out a misleading consensus statement, and refusing to fund research to investigate apparent discrepancies. I was struck by the remarkable similarity of these tactics to those used against other challenges to scientific and public-health orthodoxy. This does not prove that the dissident viewpoint is correct but is strong evidence that it has not been treated fairly. To be treated fairly is usually all that dissident scientists ask for. The hostile treatment and failure to undertake research (“undone science”) suggest that defenders of orthodoxy are, at some level, afraid the challengers might be right.

Potterat nicely summarises the multiple reasons why the findings by him and his colleagues were resisted.

“By their own admission, the international agencies feared that our work would cause Africans to lose trust in modern health care, especially childhood immunizations, as well as undermine safer sex initiatives. (Recall that their condom campaigns were also aimed at curtailing rapid population growth in sub-Saharan Africa.) We speculate that disbelief on the part of HIV researchers that medical care in Africa could be harming patients may have been a significant factor in their defensive posture. We were also impugning the quality of their scientific research and potentially threatening their livelihoods. In addition, our analyses also directly threatened the politically correct view that AIDS was not just a disease of gay men and injecting drug users, but also of heterosexuals. Lastly, our data were undermining the time-honored belief about African promiscuity, a notion that may well have initially contributed to the (pre)conception that AIDS was thriving in Africa because of it.” (p. 194)

The depressing lesson from this saga, and from the many others like it, is that science can be subject to the same sorts of groupthink, intolerance of dissent, and defence of privilege that afflict other domains such as politics. To get to the bottom of long-standing scientific disputes by trying to understand the research is bound to be time-consuming and very difficult, something few people have the time or interest to pursue. I aim at something easier: observation of the tactics used in the dispute. This doesn’t enable me to determine which side is right but does give a strong indication of whether the dispute is being pursued fairly.

Brian Martin
bmartin@uow.edu.au

Thanks to Al Klovdahl for valuable suggestions.

Obtain free downloads of John Potterat’s chapter “Why Africa?” or the entire book Seeking the Positives

health, science, social dynamics

Vaccination in perspective

To understand debates over vaccination, it’s valuable to look at the history and politics of vaccine development and policy-making.

Australian government health departments and leaders of the medical profession are united in supporting the standard programme of childhood vaccines. Vaccination rates in Australia are high and stable. However, a small number of citizen vaccination sceptics continue to raise concerns.

In the 1990s, Meryl Dorey set up what became the Australian Vaccination Network (AVN), around the same time as vaccine-critical groups were formed in several other countries. Then, in 2009, some citizen vaccination proponents set up Stop the Australian Vaccination Network (SAVN), dedicated to discrediting, silencing and destroying the AVN. There has been a ferocious struggle between SAVN and the AVN. SAVN’s campaign was instrumental in politicians bringing in measures to pressure parents to have their children vaccinated, even though some pro-vaccination researchers opposed the measures.

            SAVN is strident in its advocacy, with the mantra “Vaccination saves lives.” AVN members, and quite a few others, remain sceptical. They continue to question the effectiveness of vaccination, raise the alarm about adverse reactions, and suggest vaccination may be implicated in diseases such as autism.

Both sides adopt the mantle of science, claiming the evidence supports their viewpoints. SAVN denigrates vaccine sceptics as deluded or ignorant. Some vaccine critics say proponents are in the thrall of the pharmaceutical companies.

In this highly polarised debate, there is little room for anyone to take an intermediate position, for example saying that many vaccines are worthwhile but others are unnecessary. However, this might well be the view of some parents, though they are given little support to express their views. Any reluctance about vaccination can lead to the stigma of being called an “anti-vaxxer.”

Immunization: How Vaccines Became Controversial

Stuart Blume is emeritus professor of Science and Technology Studies at the University of Amsterdam. He has a lifetime of experience researching the politics of science and technology, and two decades ago began studying the vaccination issue. His approach can be called social history: a study of history taking into account social and political dynamics. Blume brings to the issue the perspectives of science and technology studies, seeing science and technology as subject to social processes.

            Blume decided to write a book summarising insights from his research. The result is Immunization: How Vaccines Became Controversial, recently published. I wrote one of the endorsements on the book jacket.

There is much here to ponder. The book does not mesh neatly with either the pro or anti positions in the usual public debate.

Blume tells two sorts of stories, one about vaccines and one about vaccination policy, and neither is a just-so story. Many traditional histories present science as a continual upward trajectory of discoveries and the overcoming of misguided beliefs. Blume, though, follows the path of historians of science who report on uncertainties, mistakes and unproductive paths. The implication is that present knowledge may be just as precarious, in its own way, as past knowledge.

Knowledge about vaccines and the immune system developed gradually, and for many decades there was no assumption that vaccination would prove to be a major route to public health. Smallpox was the initial target for vaccination, but there were many other killer diseases, such as diphtheria and tuberculosis, and other ways to address them besides vaccination. Today, with the focus on vaccination, it is sometimes forgotten that infectious disease can also be addressed through quarantine, sanitation, improved diet and general increases in the standard of living.

Vaccination campaigns are not always the best strategy to improve health. Blume highlights a problem with the polio eradication campaign. In a number of poor countries, resources for public health interventions were siphoned off to support polio eradication, which meant that impoverished people, needing basic medicines, were instead offered polio vaccinations, something less important for their own health.

A related tension permeated vaccination development beginning in the 1980s, when commercial considerations became paramount. Effort was put into developing vaccines for problems in affluent countries, where money could be made, while major illnesses in impoverished populations were left unaddressed.


Stuart Blume

            Blume notes that vaccination is often treated in isolation, as a special method of promoting public health, and not compared with other methods. To counter this tendency, he presents vaccination as a technology, in the broad sense of a set of techniques and artefacts, that can be compared to other public health technologies such as sanitation. He sees vaccination as a socio-technical issue, as having both scientific and policy dimensions, and as shaped by social, economic and political influences in both these dimensions.

Blume addresses vaccines separately, rather than as a group. As a result, he does not make a universal judgement about vaccination, as a good or bad thing. In these ways, Blume offers a different perspective than the one taken by most of the campaigners for or against vaccination.

One of the peculiarities of the vaccination debate is that nearly all the disagreement is about whether vaccination is beneficial or harmful, for example whether it has led to declines in infectious disease or whether there are significant numbers of adverse effects. Seldom are comparisons made with other ways of improving health, in particular children’s health, for example addressing poverty. Blume notes some of the disagreements about early vaccines.

As many infectious-disease killers were brought under control in western countries, while others such as HIV were proving too difficult, vaccine developers turned to other diseases, seeing opportunities for profits. Blume writes that the rise of neoliberalism led to significant shifts in the rationale for new vaccines. Whereas previously companies and scientists had freely shared information and vaccines in a common commitment to public health, from the 1980s onwards the pharmaceutical industry became more dominant and less public spirited.

Government health departments in different countries responded to industry pressure in different ways. It became more common to use cost-benefit analysis, especially given that many new vaccines were highly expensive. Health departments sometimes approved new vaccines without as much evidence as they might have required earlier.

            Cost-benefit analysis is not a good way to promote vaccines to the public. In several cases, notably measles and mumps, companies adopted a “rebranding” strategy to convince parents that diseases they had known as a routine and unthreatening part of childhood were actually killers to be feared and thus protected against using vaccines.

Blume believes that vaccines have saved millions of lives. Yet he is also sceptical of many of the latest vaccines, developed not as part of a public health agenda but by pharmaceutical companies whose primary aim is profit. Furthermore, there are dozens of new vaccines under development, many of them targeted at non-infectious diseases such as breast cancer.

Vaccination seems to have become a single-method solution for health problems, overshadowing primary health care that addresses the conditions that cause disease in the first place. Think how much easier it is to sell a vaccine than to address poverty and inequality, or illnesses due to industrial chemicals.

Vaccine hesitancy

For many readers, the most interesting part of Blume’s book will be the final chapter in which he addresses current anxieties about vaccination, especially in the west. He dismisses the idea, common among vaccination promoters, that the source of the anxieties is vaccine-critical groups such as the AVN. Sociologically, this explains neither the existence of the groups nor their alleged influence. It is like saying the reason people are concerned about economic inequality is because of protesters.

Blume cites research into the attitudes of parents that suggests something deeper is at play. Rather than dividing people into vaccine-acceptors and vaccine-refusers, Blume addresses a widespread vaccine hesitancy that affects many parents, especially well-educated ones, even when they adopt all the standard vaccinations.

Rather than vaccine-critical groups being the cause of vaccine hesitancy, it is better to understand them as a result of changed perceptions. Blume says vaccination has, for many people, become symbolic of a more general unease and sceptical attitude about the role of pharmaceutical companies and the medical profession. He notes that the usual survey research carried out by vaccination proponents can pick up demographic variations in parental concerns but does not get to their source.

It is perhaps relevant that citizens have no say in the development of vaccination recommendations, and even politicians are usually left out of the picture, as decisions are made by international organisations subject to corporate lobbying. This does not mesh well with people’s increasing knowledge about health matters. The experts might be right but nonetheless be distrusted.

Immunization: How Vaccines Became Controversial provides great insight precisely because it eschews the easy generalisations made by vaccination partisans. Vaccine development was not a straightforward linear process, and vaccination policy has been subject to a variety of influences. Vaccination is usefully seen as a technology, as just one of several approaches to promoting health, and thus judged in a wider context than a narrow calculation of benefits and risks. The contemporary vaccination debate is not just a matter of pro and anti, but should be seen in the wider context of attitudes towards social institutions and citizen participation in decision-making.

Blume does not offer easy answers, but more usefully points to the complexities and contradictions in the history and social dynamics of vaccination. It is essential reading for anyone who wants to get beyond the usual partisan positions in the vaccination debate.

Brian Martin
bmartin@uow.edu.au

academic freedom, health, science

When activists attack scientific dissent

Doing research on some topics can get you in trouble.


Alice Dreger

Alice Dreger was the ideal person to become an activist on issues of intersex and transgender. She was white and straight and hence could be a firm ally without being accused of self-interest or personal animus. She was an historian of science and able to research the issues as well as speak out about them. And she was articulate.

In the US in the past two decades, intersex and transgender have become hot topics. Dreger became involved, almost by accident, through a suggested PhD topic: the history of biomedicine and what, a century ago, was called hermaphroditism.

Intersex refers to people whose bodies do not conform to the conventional ideas of normal female or male. For example, some individuals have versions of both a penis and vagina. Others have an extra large clitoris. There are many variations. Dreger found that in many cases such individuals were brought up as one gender or the other and most people didn’t know the difference. But in some cases, doctors decided that babies with ambiguous genitalia needed to be “fixed” by surgery, for example their clitorises reduced in size. This sometimes caused physical damage and led to emotional problems.

From a human rights perspective, it can be argued that surgery for intersex should only be undertaken when a person can give informed consent. Even the assignment to one gender or another at birth needs to be undertaken with care.

After researching the history of medicine and intersex, Dreger obtained visibility on the issue, was contacted by activists and was drawn into campaigning for intersex rights. She voluntarily relinquished her tenured academic job to become an activist, and for a decade she used all her skills on behalf of those who were being harmed by the imposition of a medical-sexual orthodoxy on people’s bodies.

Scientific research and gender politics

By another set of accidents, Dreger entered an even more contentious domain: defending scientists who challenged conventional ideas about sexual identity. Michael Bailey argued that transgender is shaped by both biology and culture. He distinguished between two types of male-to-female transsexuals: “transkids” (Dreger’s preferred term) who are males attracted to other males, and “amour de soi en femme,” males who dream of being females. Only some change their bodily sex, depending on cultural conditions. Bailey drew on previous work by Ray Blanchard.


Michael Bailey

As well as publishing papers in scholarly journals, Bailey wrote a book, The man who would be queen, which received some publicity and also generated hostility from a few transgender campaigners who were offended by being characterised as “amour de soi en femme.” The hostility went beyond expressing disagreement. Bailey was targeted as a scholar and a person, for example with complaints made to his university about ethics violations.

Some people who knew Dreger urged her to look into the Bailey story. She did, using her skills as a researcher. She concluded that Bailey’s research work was solid. She also arranged to meet Bailey, to judge for herself claims that he was anti-gay and anti-trans. To her surprise, she discovered that he was totally comfortable with gay and trans people, and highly sympathetic to them.

Dreger wrote a long analysis of the Bailey saga and arranged for it to be published in an academic journal. It amounted to a defence of Bailey against his attackers.

“After nearly a year of research, I could come to only one conclusion: The whole thing was a sham. Bailey’s sworn enemies had used every clever trick in the book — juxtaposing events in misleading ways, ignoring contrary evidence, working the rhetoric, and using anonymity whenever convenient, to make it look as though virtually every trans woman represented in Bailey’s book had felt abused by him and had filed a charge.” (p. 100)

As a result, Dreger herself became a target. This experience set Dreger on a course of action: defending scholars who unfairly came under attack.

She tells of her experiences in an engaging book titled Galileo’s middle finger: heretics, activists, and the search for justice in science. It is a candid account of her personal trajectory, with extended treatments of several case studies, of which Bailey’s is one.

Dreger addresses the damaging potential of political correctness in sexuality studies and anthropology. Political correctness here refers to adherence to a particular viewpoint that is linked to fair treatment of disadvantaged groups, for example sexual minorities and indigenous groups. A classic example is the study of race and IQ. The politically correct view is that there are no systematic differences in innate intelligence between different ethnic groups, with measured IQ variations due to cultural factors. Anyone who studies race and IQ enters a treacherous terrain in which the “wrong” findings can lead to being attacked. Most researchers steer clear of such topics.

Dreger is critical of subordinating scientific research to belief systems. She believes that doing good research is vital, and those who do good research should be defended against ideologues. Furthermore, she made it a personal duty to become a defender in a number of cases.

The mirror side of this position is a concern about bad research used to bolster harmful practices. Dreger became alarmed about the use of a steroid during pregnancy that was supposed to reduce the risk that a child would be intersex. This drug was being dispensed by a senior scientist, Maria New, to numerous mothers. Dreger began investigating and concluded that the research justifying this intervention was thin and that mothers were not being properly warned that the drug was experimental.

In this case, Dreger became involved to promote good science by trying to expose what she believed was bad science. She thought the solution was to get government regulatory bodies – one of them was the Food and Drug Administration (FDA) – to examine the evidence, but to her dismay the FDA’s assessment was that all was okay. Dreger learned that regulators can sometimes give the stamp of approval to bad practice.

Suppression of dissent

Since the late 1970s, I have been researching what I call “suppression of dissent.” In a typical case, a scientist does research or speaks out on an issue and challenges the interests of a powerful group, and as a result comes under attack. In some fields, including forestry, nuclear power, pesticides, fluoridation and vaccination, there is a pattern of suppression, with numerous scientists, engineers, doctors, dentists and others being penalised for expressing their views.

In some of these areas, there are key works describing numerous cases of suppression of dissent. George Waldbott, a US doctor critical of fluoridation, documented many cases of suppression of fluoridation critics in his 1965 book A struggle with titans. Robert van den Bosch, a US scientist, recounted case after case of reprisals against scientists who questioned the orthodoxy on pesticides in his 1978 book The pesticide conspiracy. David L. Lewis, yet another US scientist, tells of numerous suppression cases in his 2014 book Science for sale. To this list must now be added Dreger’s book Galileo’s middle finger.

(Suppression doesn’t only occur in the US! The 1986 edited book Intellectual suppression reports on numerous Australian cases and gives references to cases in other countries.)

There are many similarities between Dreger’s approach to suppression of dissent and my own experience. Both of us address challenges to scientific orthodoxy, often linked to influential groups, and attacks against dissidents. Each of us, in addition, became involved in a critique of establishment figures. In my case this involved analysis of the pro-nuclear positions of Sir Ernest Titterton and Sir Philip Baxter.

There are also some differences between our experiences and approaches. Most obviously, Dreger has addressed identity issues and taboo topics and encountered hostility from a particular group of activists. This is a different sort of configuration than the patterns I’ve mainly looked at, which involve vested interests of industry or government groups.

Another difference is that Dreger investigates research and researchers in considerable depth in order to determine who is right, scientifically. If, by her assessment, a scientist is doing good research, indeed better research than others, then it is unfair for the scientist to come under attack. This is a sound approach.

My usual approach is somewhat different. I do not seek to determine who is right, scientifically, for example whether a researcher’s findings on pesticides or vaccination are superior to others. My concern is that researchers should not be penalised just because their findings challenge orthodoxy or threaten vested interests. For this, the double standard test is useful. If two scientists do research on pesticides or vaccination, and one reaches conclusions supporting the orthodox view and one reaches conclusions challenging it, are they treated the same way? If the dissent-supporting scientist suffers reprisals but the orthodoxy-supporting scientist does not, this suggests suppression of dissent.

Galileo’s middle finger is an important book. Dreger learned from her journey:

“how badly most people want simple stories of male and female, nature and nurture, good and evil; how the Internet has gutted the Fourth Estate; how the government is made up of fallible and occasionally disappointing humans; and why, more than ever before, democracies must aggressively protect good research.” (p. 189)

Dreger has forged a vital path in a highly contentious area, and told of her experiences in a revealing and perceptive way. Anyone interested in science in a free society should pay heed.

Brian Martin
bmartin@uow.edu.au

Thanks to Anneleis Humphries, Michael Matteson, Ben Morris and Tracey Woolrych for helpful comments.

democracy, politics, science, social dynamics

Mathematical models: the toxic variety

Job applications, credit ratings and the likelihood of being arrested can be affected by mathematical models. Some of the models have damaging effects.

usnews-best-colleges

In 1983, U.S. News & World Report – then a weekly newsmagazine in competition with Time and Newsweek – published a ranking of US universities. For U.S. News, this was a way to increase sales. Its ranking system initially relied on opinions of university presidents, but later diversified by using a variety of criteria. As years passed, the U.S. News ranking became more influential, stimulating university administrators to seek to improve rankings by hiring academics, raising money, building facilities and, in some cases, trying to game the system.

One of the criteria used in the U.S. News ranking system was undergraduate admission acceptance rates. A low acceptance rate was assumed to mean the university was more exclusive: a higher percentage of applicants to Harvard are rejected than at Idaho State.

US high school students planning further study are commonly advised to apply to at least three prospective colleges. Consider the hypothetical case of Sarah, an excellent student. She applies to Stanford, a top-flight university where she would have to be lucky to get in, to Michigan State, a very good university where she expects to be admitted, and to Countryside Tech, which offers a good education despite its ease of admission.

Sarah missed out at Stanford, as expected, and unfortunately was also rejected at Michigan State. So she anticipated going to Countryside Tech, but was devastated to be rejected there too. What happened?

The president of Countryside Tech was determined to raise his institution’s ranking. One part of this effort was a devious admissions policy. Sarah’s application looked really strong, so admissions officers assumed she would end up going somewhere else. So they rejected her in order to improve Tech’s admissions percentage, making Tech seem more exclusive. Sarah was an unfortunate casualty of a competition between universities based on the formula used by U.S. News. 

ranking-dataset-share

            In Australia, the U.S. News rankings are little known, but other systems, ranking universities across the globe, are influential. In order to boost their rankings, some universities hire academic stars whose publications receive numerous citations. A higher ranking leads to positive publicity that attracts more students, bringing in more income. Many students mistakenly believe a higher ranking university will provide a better education, not realising that the academic stars hired to increase scholarly productivity are not necessarily good teachers. Indeed, many of them do no teaching at all. Putting a priority on hiring them means superb teachers are passed over and money is removed from teaching budgets.

WMDs

The story of U.S. News university rankings comes from an important new book by Cathy O’Neil, Weapons of Math Destruction. O’Neil started off as a pure mathematician teaching in a US university, then decided to enter the private sector where she could do something more practical as a “data scientist.” Working for a hedge fund and then some start-ups, she soon discovered that the practical uses of data analysis and mathematical models were damaging to many ordinary people, especially those who are disadvantaged. She wrote Weapons of Math Destruction to expose the misuses of mathematical modelling in a range of sectors, including education, personal finance, policing, health and voting.

A model is just a representation of a bigger reality, and a mathematical model is one that uses numbers and equations to represent relationships. For example, a map is a representation of a territory, and usually there’s nothing wrong with a map unless it’s inaccurate or gives a misleading impression.

mathematical-modelling-calibration-of-dip-stick-4-638

            The models that O’Neil is concerned about deal with people and affect their lives, often in damaging ways. The model used by U.S. News, because it was taken so seriously by so many people, has distorted decisions by university administrators and harmed some students.

“Our own values and desires influence our choices, from the data we choose to collect to the questions we ask. Models are opinions embedded in mathematics.” (p. 21)

Another example is a model used to allocate police to different parts of a city. By collecting data about past crimes and other factors supposedly correlated with crime, the model identifies areas deemed to be at risk and therefore appropriate for more intensive policing.

predpol

This sounds plausible in the abstract, but in practice in the US the result is racially discriminatory even if the police are themselves unprejudiced. Historically, there have been more crimes in disadvantaged areas heavily populated by racial minorities. Putting more police in those areas means even more transgressions are discovered – everything from possession of illegal drugs to malfunctioning cars – and this leads to more arrests of people in these areas, perpetuating their disadvantage. Meanwhile, crimes that are not geographically located are ignored, including financial crimes of the rich and powerful.

intelligence-led-policing

Not every mathematical model is harmful. O’Neil says there are three characteristics of weapons of math destruction or WMDs: opacity, damage and scale. Opacity refers to how transparent the model is. If you can see how the model operates – its inputs, its algorithms, its outputs – then it can be subject to inspection and corrected if necessary. O’Neil cites models used by professional baseball clubs to recruit players and make tactical choices during games. These models are based on publicly available data: they are transparent.

In contrast, models used in many parts of the US to judge the performance of school teachers are opaque: the data on which they are based (student test scores) are not public, the algorithm is secret, and decisions made on the basis of the models (including dismissing teachers who are allegedly poor performers) are not used to improve the model.

The second feature of WMDs is damage. Baseball models are used to improve a team’s performance, so there’s little damage. Teacher performance models harm the careers and motivation of excellent teachers.

The third feature is scale. A model used in a household to decide on when to spend money can, at the worst, hurt the members of the household. If scaled up to the whole economy, it could have drastic effects.

cathy-oneil-342-500px
Cathy O’Neil

O’Neil’s book is engaging. She describes her own trajectory from pure mathematician to disillusioned data scientist, and then has chapters on several types of WMDs, in education, advertising, criminal justice, employment, workplaces, credit ratings, insurance and voting. Without a single formula, she tells about WMDs and their consequences.

The problems are likely to become worse, because data companies are collecting ever more information about individuals, everything from purchasing habits to opinions expressed on social media. Models are used because they seem to be efficient. Rather than reading 200 job applications, it is more efficient to use a computer program to read them and eliminate all but 50, which can then be read by humans. Rather than examining lots of data about a university, it is more efficient to look at its ranking. Rather than getting to know every applicant for a loan, it is more efficient to use an algorithm to assess each applicant’s credit-worthiness. But efficiency can come at a cost, including discrimination and misplaced priorities.

My experience

Earlier in my career, I did lots of mathematical modelling. My PhD in theoretical physics at the University of Sydney was about a numerical method for solving the diffusion equation, applied to the movement of nitrogen oxides introduced into the stratosphere. I also wrote computer programmes for ozone photochemistry in the stratosphere, among related topics. My initial PhD supervisor, Bob May, was at the time entering the field of mathematical ecology, and I helped with some of his calculations. Bob made me co-author of a paper on a model showing the effect of interactions between voters.

During this time, I started a critical analysis of models for calculating the effect of nitrogen oxides, from either supersonic transport aircraft or nuclear explosions, on stratospheric ozone, looking in particular at the models used by the authors of two key scientific papers. This study led eventually to my first book, The Bias of Science, in which I documented various assumptions and techniques used by the authors of these two papers, and more generally in scientific research.

While doing my PhD, some other students and I studied the mathematical theory of games – used for studies in economics, international relations and other topics – and ran an informal course on the topic. This enabled me to later write a paper about the social assumptions underpinning game theory.

In the following decade, as an applied mathematician at the Australian National University, I worked on models in astrophysics and for incorporating wind power in electricity grids. Meanwhile, I read about biases in models used in energy policy.

I had an idea. Why not write a book or manual about mathematical modelling, showing in detail how assumptions influenced everything from choices of research topics to results? My plan was to include a range of case studies. To show how assumptions affected results, I could program some of the models and then modify parameters and algorithms, showing how results could be influenced by the way the model was constructed and used.

However, other projects took priority, and all I could accomplish was writing a single article, without any detailed examples. For years I regretted not having written a full critique of mathematical modelling. After obtaining a job in social science at the University of Wollongong, I soon discontinued my programming work and before long was too out of touch to undertake the critique I had in mind.

I still think such a critique would be worthwhile, but it would have quite a limited audience. Few readers want to delve into the technical details of a mathematical model on a topic they know little about. If I were starting today, it would be more illuminating to develop several interactive models, with the user being able to alter parameters and algorithms and see outcomes. What I had in mind, decades ago, would have been static and less effective.

What Cathy O’Neil has done in Weapons of Math Destruction is far more useful. Rather than provide mathematical details, she writes for a general audience by focusing on the uses of models. Rather than looking at models that are the subject of technical disputes in scientific fields, she examines models affecting people in their daily lives.

Weapons of Math Destruction is itself an exemplar – a model of the sort to be emulated – of engaged critique. It shows the importance of people with specialist skills and insider knowledge sharing their insights with wider audiences. Her story is vitally important, and so is her example in showing how to tell it.

“That’s a problem, because scientists need this error feedback – in this case the presence of false negatives – to delve into forensic analysis and figure out what went wrong, what was misread, what data was ignored. It’s how systems learn and get smarter. Yet as we’ve seen, loads of WMDs, from recidivism models to teacher scores, blithely generate their own reality. Managers assume that the scores are true enough to be useful, and the algorithm makes tough decisions easy. They can fire employees and cut costs and blame their decisions on an objective number, whether it’s accurate or not.” (p. 133)

weapons-math-destruction

Cathy O’Neil, Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy (London: Allen Lane, 2016)

Brian Martin
bmartin@uow.edu.au