The history of medicine is replete with theories that reflect religious beliefs rather than scientific facts. One of the most interesting, and most instructive examples of this phenomenon is the claim that masturbation causes insanity.

Masturbatory insanity pre-occupied medical professionals for almost 250 years. It arose apparently de novo in Europe in the early eighteenth century, and was not finally put to rest until the middle of the twentieth century. Its history of the idea is recounted exhaustively in the scientific paper Masturbatory Insanity: The History of an Idea by E.H. Hare published in the Journal of Mental Science in January, 1962.

Classical medical professionals made no reference to any harmful effects of masturbation. It was not until the early eighteenth century that the idea gained currency upon publication of the book Onania, or the Heinous Sin of Self-Pollution. The author is believed to have been a “clergyman turned quack” and not a reputable medical professional. Like most quacks he advertised an extremely expensive secret remedy.

The assertions gained wide popularity, though. Voltaire, writing in his Dictionnaire Philosophiqe in 1764 reports that the book was then in its 80th edition.

The idea passed into the realm of official medical thought with Tissot’s Onania, or a Treatise upon the Disorders produced by Masturbation in 1758. According to Tissot:

…[L]oss of semen … occasions general debility and so opens the way to consumption, deterioration of eyesight, disorders of digestion, impotence, and so on…[T]he more serious effects are on the nervous system and this is due to the sexual act causing an increased flow of blood to the brain. “This increase of blood explains how these excesses produce insanity. The quantity of blood distending the nerves weakens them; and they are less able to resist impressions, whereby they are enfeebled.”

During the following years anatomical and pathological study revealed that disease was caused by structural abnormality or derangement, and the claim that masturbation could cause “deterioration of the eyesight, disorders of digestion, etc.” lost currency. But medical professionals refused to give up the idea that masturbation was harmful and the locus of harm became mental health.

According to Esquirol, writing in 1838:

… it (masturbation) may be a forerunner of mania, of dementia and even of senile dementia; it leads to melancholy and suicide; … it is a grave obstacle to cure in those of the insane who frequently resort to it during their illness

The view that masturbation causes insanity was refined over time to a specific form of insanity. In his classification of mental disorders written in 1863, Skae asserts:

The third natural family I would assign to the masturbators… I think it cannot be denied that that vice produces a group of symptoms which are quite characteristic and easily recognized, and give to the cases a special natural history: the peculiar imbecility and shy habits of the very youthful victim; the suspicion and fear and dread and suicidal impulses and scared look and feeble body of the older offenders, passing gradually into Dementia or Fatuity.

This theory was elaborated by Spitzka (1887):

… the typical age of onset of masturbatic insanity is between 13 and 20 years; it is at least five times as common in males as in females because of the greater rarity of masturbation in females; in the majority of cases there is a rapid decline into agitated dementia, but where deterioration is less rapid “the obtrusive selfishness, cunning, deception, maliciousness and cruelty of such patients” is such that “the [doctor] may find it impossible to reconcile himself to regarding them as anything else than repulsive eye-sores and a source of contamination to other patients, physically and morally.”

In retrospect, Spitzka and others were describing schizophrenia. As Hare explains how masturbation came to be associated with a specific form of insanity:

Nor is it difficult, from our present standpoint, to see how this came about. Masturbation is most commonly and most frequently practised during adolescence and therefore most likely to be observed when mental disease insidiously deprives an adolescent of his normal social inhibitions.

As the field of psychiatry developed, it was recognized that excessive or public masturbation was a symptom of serious psychiatric illness, not its cause. Even then, the psychiatric profession only gradually gave up the notion of masturbation as harmful, downgrading it from psychosis to neurosis and ultimately acknowledging it as normal behavior.

The story of masturbatory insanity is a cautionary tale. It reflects the injection of religion into medicine, characterizing a behavior as harmful because religion says it is harmful, rather than relying on scientific evidence. We may imagine that, in our purported sophistication, we would never fall prey to such ludicrous theories. But, in fact, similar efforts are ongoing, with religious conservatives trying to persuade the public that homosexuality is deviant behavior and that abortion is physically harmful.

The story of masturbatory insanity should remind us to be aware of the intersection of religion and culture with contemporary medicine. Great harm can occur when religion is confused with medicine and medicine is harnessed for religious ends.

A pervasive theme in “alternative” health is the notion of the brilliant heretic. Believers argue that science is transformed by brilliant heretics whose fabulous theories are initially rejected, but ultimately accepted as the new orthodoxy.

Alternative health practitioners, with no embarrassment at their own presumption, routinely liken themselves to Galileo and Darwin. Today their brilliant theories of homeopathy, therapeutic touch and the like are rejected but ultimately they will be acknowledged as truth. As usual, their claim is based on a lack of knowledge about science, and ignorance of history.

As explained in The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession by Paul Wolpe, alternative health practitioners believe:

[Alternative health] is the inevitable (or desirable) next step in the history of medicine, and like other heroes of medical history who were initially rejected by the orthodoxy of the day … the [alternative health practitioner] is simply ahead of his time. Innovation is always initially resisted … Holistic heretics portray themselves as mavericks, leaders, with every expectation that soon all of medicine will, by necessity, follow in their footsteps.

It is a breathtaking conceit, and it betrays a profound lack of understanding of the history of science.

1. The conceit rests on the notion that revolutionary ideas are dreamed up by mavericks, but nothing could be further from the truth. Revolutionary scientific ideas are not dreamed up; they are the inevitable result of massive data collection. Galileo did not dream up the idea of a sun-centered solar system. He collected data with his new telescope, data never before available, and the sun-centered solar system was the only theory consistent with the data he had collected.

Similarly, Darwin did not dream up evolution. He collected data during his years of exploration on the Beagle, much of it previously unavailable. A theory of evolution was the only theory consistent with the data that he had collected.

In contrast, belief in alternative health has no basis in scientific fact. It has been dreamed up by its various adherents and practitioners. Far from depending on scientific evidence, it eschews the need for scientific evidence.

2. The notion of the heretical maverick betrays a lack of historical knowledge. Galileo and Darwin were considered heretics by religious leaders, not by other scientists. Their ideas swept across the scientific world precisely because of their explanatory power and the data that they had to back them up.

In the world of science, it was already well established that the orthodoxy could not explain what everyone had observed. Long before Galileo, scientists understood that the Biblical theory of the earth-centered universe did not accord with astronomical evidence. Long before Darwin, fossil discoveries had called into question the Biblical creation story.

Mainstream medical science has been astoundingly successful in both theory and practice. The power of the germ theory of disease or the molecular structure of DNA rests on their ability to explain what we observe, are confirmed by experimental data, and result in highly effective treatments and cure.

In contrast, alternative medicine exists independent of scientific observation. Its theories have poor explanatory power and are directly contradicted by copious scientific evidence. The treatments of alternative health are notoriously ineffective. Although anecdotes abound, scientific studies of “alternative” health treatments have yet to identify a single one that works.

3. New theories may be resisted by older scientists because they upset the orthodoxy, but they are not resisted by the scientific world. That’s the point of peer reviewed scientific journals. Scientists present their evidence, and other scientists decide whether that evidence supports a new theory.

For example, early in my medical career a scientist claimed that ulcers were caused not by acid, but by the H. pylori bacteria. The initial reaction of the medical world was disbelief. However, when doctors saw the data, and when the original studies were quickly reproduced by other scientists, doctors accepted the theory, created treatments based on the discovery and moved on.

In medicine, as in all science, the data comes first, the theory follows. In “alternative” health, the theory exists independent of the evidence, and no one even bothers to collect evidence. The idea that alternative health will ultimately be accepted as true is ludicrous.

The idea that heroic geniuses dream up new scientific theories that are initially rejected but ultimately embraced by other scientists is a fairy tale. It betrays a lack of understanding about how science works, and a lack of knowledge about what actually happened to people like Galileo and Darwin.

The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession, by Paul Wolpe, is about doctors who promote “alternative” medicine, but it applies to any practitioner who challenges the fundamentals of any branch of medicine. According to Wolpe, an attack on an established discipline in medicine includes four specific elements. The critic:

must portray the discourse as in crisis, must provide an alternative ideology to rescue the discourse, must legitimize their ideology through appeal to a reframed historical myth, and must portray the orthodoxy as a betrayer of the discourse.

The authors applies his analysis to “alternative” medicine in general, but we are will look at homebirth midwifery in particular.

The first step is to portray the particular discipline as “in crisis”.

… Modern medicine’s conquering of infecious disease set up a quasi-religious belief in its ability to reduce suffering and disease now seems stalled by a of medical economic, organizational, and social problems. [Critics try] to portray the biomedical orthodoxy as responsible for the problems confronting organized medicine .., and suggests that orthodoxy is ill suited to solve the developing challenges to care…

This is certainly the tactic adopted by homebirth midwifery. The “crisis” is the rising C-section rate, which is portrayed as unjustified, intolerable, unaffordable and injurious. A secondary “crisis” (which is fabricated) is the rate of infant mortality (the wrong statistic) and the rate of maternal mortality (which is falsely portrayed as rising).

As Wolpe points out, the critic “rarely paints its opponent in terms of benign neglect”, but, rather, claims that it is evil. Therefore, the rising C-section rate is never portrayed by homebirth advocates as the regrettable but inevitable result of the desire to prevent all possible neonatal death and injury, but, instead, is characterized as the result of the obstetrician’s desire to get rich, to “get home for dinner”, or simply to ruin a woman’s birth experience.

Next, the critic offers the new philosophy, positioning it as the replacement for the old:

… The heretical ideology is drawn as much as possible from existing strains in the discourse, strains usually ignored, slighted, or marginalized in the orthodox ideology… The heretic draws from the marginalized or folk knowledge of the tradition and elevates the constructs found there to primary importance…

… [G]reat pains are usually taken … to show that the alien ideas are not in fact alien at all, but have existed in the discourse in a different form. [Critics] often import foreign, folk, and traditional forms of healing into their practices, [carefully describing] them as wholly compatible with Western medicine, scientifically valid, or historically present in other forms. (The ‘placebo’ effect, for example, is elevated to a central place in holistic medicine, and described as demonstrating the ‘power of the mind’, which is in turn said to be a central tenet of Eastern and Native healing forms. The orthodoxy is censured for slighting this most important healing modality.) …

What does the critic offer instead?

The [critic] blurs the line between disease and health as it is usually drawn in Western medicine, and extends the range of therapeutic intervention beyond the bounds of manifest pathology. At one end is a concentration on pre-morbid states, or prevention…

Attention to the pre-morbid state is complemented by an expansion of the post-morbid state. The goal of holistic health is more than the absence of disease; it is a state of optimal functioning, often referred to as ‘wellness’… [which] greatly expands the role of the HMD in medical intervention …

In the words of homebirth midwifery: pregnancy is “not a disease”, but nonetheless it requires extensive prenatal visits, preparation and education. In addition:

The [alternative practitioner] caters to the consumer; the customer is always right, and the seller does not know better than the buyer what the buyer really want or needs…

And:

The use of touch and intimacy, the central role of patient education, and the use of Eastern and Native American medical forms and philosophies all serve to create a ritualized encounter that opens the way for ideological display. [Alternative providers] try to forge affective connections with patients by sharing their own feelings and experiences and using noninstrumental touching to develop intimacy.

Third, the critic attempts to gain legitimacy by “rewriting” the history of the discipline:

Heretics try to rewrite the discourse’s historiography to emphasize their own ideological positions. In doing so, they make heroes out of the orthodoxy’s secondary players and emphasize heretical themes in the orthodoxy’s heroes.

Hence the rewriting of the history of Semmelweis and puerperal sepsis to make Semmelweis the “discoverer” of puerperal sepsis, and to protray him as the man who could have cured puerperal sepsis if other orthodox physicians had not stood in his way and hounded him to insanity.

Another favored theme:

… Holistic heretics portray themselves as mavericks, leaders, with every expectation that soon all of medicine will, by necessity, follow in their footsteps.

Ultimately:

Biomedicine is portrayed as a bureaucratic juggernaut whose judgments are accepted uncritically by adherents. Technological wizardry is used as proof of sophistication without truly exploring all roads to healing their patients…

Promiscuous use of drugs and surgery represent not cures, but substitutes for curative action. They are distributed without thought and without recognition of their power to do harm…

The heretical attack both blames the orthodoxy for the crisis and for failing to accept the heretic’s remedial ideological position. The orthodoxy has betrayed the discourse through its inaction, and no longer deserves to be its guardian. The heretic is the true keeper of the flame, the savior of the discourse, and should ascend to the position of power in place of the orthodoxy.

Natural childbirth advocates, like many Americans, have trouble evaluating risk. They have difficulty understanding relative risk (how one risk compares to another risk) and they have difficulty evaluating sources for the accuracy of their claims. There is an additional component to risk assessment for natural childbirth advocates. They are often factually misinformed about the actual risks. Nowhere is that more apparent than in their almost complete lack of knowledge about the inherent risks of pregnancy and childbirth.

The first clue to this serious misunderstanding is the claim that childbirth must be safe because it is “natural”. Natural does not mean safe, and we are pretty clear about that in other areas of life. For example, natural disasters, such as hurricanes and earthquakes are 100% natural. Nonetheless, we know that they are responsible for a tremendous amount of death, suffering and destruction. Natural means one thing only: it happens in nature. It tells us absolutely nothing about whether it causes death or other serious effects.

The second clue to this serious misunderstanding is the claim that childbirth must be safe because “we are still here”. This is evidence of basic lack of knowledge about biology. The fact that “we are still here” only tells us that in every generation, the number of people who lived exceeded the number who died. It doesn’t tell us anything about the ratio. So, for example the population will grow at a certain rate if each couple has 3 surviving children. It does not matter whether the couple had 3 children, all of whom survived, or 10 children, 7 of whom died.

We know from the biology of other animals that reproduction has a tremendous amount of wastage. We’ve all seen nature shows about sea turtles who lay hundreds of eggs, with the result that only a few baby turtles survive the treacherous walk across the beach to the safety of the ocean. We know that some animals, like salmon, give up their own lives in the process of reproduction. The fact is, there is a tremendous amount of wastage in human reproduction also. The miscarriage rate for established pregnancies is 20%. That means that 1 in 5 pregnancies will not survive to result in a live birth. Pregnancy and childbirth also have a “wastage” rate. In nature, many women and babies did not survive the process. That is a natural part of human reproduction.

Let’s take a look at historical evidence about death in pregnancy and childbirth. Irvine Loudon is one of the premier historians working to understand the history of human pregnancy and birth. In the article Maternal mortality in the past and its relevance to developing countries today, there is extensive exploration of the historical data on maternal mortality in the United Kingdom. Looking at the maternal mortality data for 1872-1876, we find a maternal mortality rate of approximately 400/100,000 with the following causes:

cause of death %
Puerperal fever 55.5
Hemorrhage 22.5
Eclampsia 11.6
Miscarriage and abortion 4.0
Postpartum psychosis 2.5
Embolism 2.0
Ectopic 0.2
Other 0.8

By contrast, the maternal mortality rate today is in the range of 10/100,000.

What were maternal mortality rates prior to the late 19th century? According to the works of other historians which Louden quotes:

They found maternal mortality rates were certainly higher at 400-500 per 100000 births throughout the 19th century. It was a bit higher at the beginning of the 19th century and was up to perhaps 1000 per 100000 births in the early part of the 18th century. I have a graph in my book [Loudon I. Death in childbirth. Oxford: Clarendon Press, 1992] that shows maternal mortality stretching back in history and, as you go back, it goes up very slightly and then we lose track because there really are no data as yet.

This data is fairly consistent with the maternal mortality rates that we see today in parts of the world that don’t have access to modern obstetrics.

What conclusion can we draw from this data?

Giving birth is and has always been inherently dangerous. From the early 18th century on back, 1% or more of births resulted in the death of the mother. To put a 1% maternal mortality rate in perspective, it is twice as high as the mortality rate for receiving a kidney transplant, and a bit less than half the mortality rate of having “triple bypass” heart surgery.What’s really amazing to consider is that the chance of the baby dying was always dramatically higher.

It’s only a matter of time until Kate begs Jon to come home.

Jon’s finally gotten Kate’s attention. Not by moving out, or gallivanting around with tarty women. She doesn’t care about that. He’s gotten her attention by threatening what she loves most in this world and I don’t mean her children. Jon has jeopardized Kate’s diva-dom, the gravy train she has ridden to celebrity and a bizarre haircut.

The ratings for Jon and Kate Plus Eight have dropped like a rock. From a high of 10.5 million viewers at the end of last season, only 3.5 million viewers tuned in for the most recent episode. People aren’t interested in watching a couple going through a messy divorce, and that’s hardly surprising. As I wrote last spring (Why are we fascinated with big families?):

I suspect we are fascinated because we stand in awe of the commitment required to deliberately choose a large family: the commitment to parenting as a lifestyle choice and the commitment to marriage that lies at the core of the decision to have many, many children.

In contemporary America, such a commitment is not only unfashionable; it is unfathomable.

If contemporary America could be distilled to one imperative, it would be this: The highest calling is self-actualization. Or, more colloquially, “it’s all about me.” In other words, being happy (and being happy is considered the highest state of being) requires doing what you want, when you want to, unfettered by obligations and commitments. Children are an obligation, a temporary detour on the road to a life devoted to self.

By separating and planning to divorce, Jon and Kate have demonstrated that they are just like everyone else. Both of them abandoned their commitment, and decided “it’s all about me.”

Kate put stardom ahead of being with her husband and family. He asked to her to stop traveling and spend more time with him and the kids. She needed the rush of attention, the entourage and the extra money that came from turning the children into an industry, not merely a TV show. The books and the speaking tours were necessary steps in building that industry. Visions of celebrity endorsements danced in her head.

Jon, for his part, has decided to meet this rejection with a startling display of immaturity, self-absorption and naivite. He is relying upon Michael Lohan for advice. You may remember him as the dysfunctional father of Lindsay Lohan, newly released from jail. Perfect! They can trade tips about how divorced dads can still profit from their children’s celebrity while failing to act like real fathers and stick around to raise their kids.

Jon and Kate have destroyed the main appeal of their show by putting their own desires ahead of the needs of their children, and the viewers have been quick to react. The drop in ratings is only a part of it.

While Jon and Kate have been very careful to keep their religious fundamentalism out of the TV show (probably on the advice of the network), the books and speaking engagements directly exploited that element. The books are published by a Christian publisher and are filled with Biblical quotes and testimonials about the role of their faith in their lives. The audiences for their speaking tours were conservative Christians. Needless to say, divorce will kill that market completely.

Kate wanted a divorce because Jon was interfering with the building of her personal celebrity and her financial empire. But forcing Jon out, though good for a temporary boost in ratings, will destroy the show and the money and celebrity that go with it. I suspect that it is only a matter of time before Kate begs Jon to come back.

The possibility of getting back together, with its inherent tension and doubt, would be a ratings bonanza, and the effort to repair their marriage back together would rescue her standing within the conservative Christian community. Imagine the rapturous greeting Kate would get if she claimed that it was their strong religious faith that led to a reconciliation.

Oh, and it might be good for the children, too, but who cares about them?

I used to be saddened by the idea that the mainstream media is dying. I have been a news junkie since I was a child, and newspapers, news magazines and the evening news were fixed points of reference for decades. But in the last few years I have canceled my daily newspaper subscription, almost never read popular news magazines, and have stopped watching the evening news altogether.

Partly this is because so-called news organizations have stopped reporting the actual news. The New York Times fills is Health pages with recipes, Time Magazine devotes more print to book and movie reviews than to international news, and the evening news has degenerated into a series of commercials for Viagra and antacids punctuated by brief interludes of celebrity newscasters pitching heartwarming stories and celebrity updates.

However, the primary reason why I consider the mainstream media essentially useless is because even (perhaps especially) when reporting hard news, the MSM routinely allows itself to be intimidated by the Conservative Right. News organizations like The New York Times and CBS News justify caving in to right wing intimidation by claiming “balance.” In the interests of “fairness” they must report “both sides.” But both sides are not necessarily equally worthy of print, particularly if one “side” is factually false.

Nothing illustrated this better than the media’s treatment of the right wing zealots who questioned the patriotism of presidential candidate John Kerry. The “Swift Boat Veterans for Truth” (a truly Orwellian name) fabricated a story of John Kerrey’s service in Vietnam that had absolutely no basis in reality. Although their claims were immediately identified as falsehoods and acknowledged as such by the mainstream media, the “Swift Boat Veterans” continue to receive extensive media coverage in the interests of “balance.” In other words, the mainstream media were intimidated into giving widespread and continuous publicity to outright lies.

Exactly the same treatment is now being accorded to the Conservative Republican assault against meaningful healthcare reform. Most of the Republican attack is nothing more than outright lies. The mainstream media appears to be well aware of this. Sidebar articles analyzing the claims repeatedly and inevitably acknowledge them to be lies, yet the mainstream media continues to print them.

The mainstream media appears to be so intimidated by the Conservative Right Wing that it won’t describe intimidation for what it really is. Conservatives have vowed to defeat healthcare reform by disrupting efforts of Congressman and Senators to publicly explain the legislation to their constituents. They have made good on their threats to quash free speech and yet the mainstream media offer only the most lukewarm descriptions of their tactics of intimidation.

Today’s New York Times reports “dissent” and a town meeting filled with “rowdy” moments. But the “dissent” was manufactured by political operatives and bare knuckle attempts to intimidate Senators and voters is not “rowdy” behavior, it is a profound threat to the democratic process.

Today’s Washington Post, reporting on President Obama’s most recent efforts to rally support:

President Obama began a personal effort Tuesday to reclaim momentum for his health-care initiative with a direct rebuttal of what he called “scare tactics,” rumors and misrepresentations.

The writer employed scare quotes, as if the efforts to scare the American public had not already been advertised and acknowledged in advance. As to the rumors and misrepresentations of the Republican Right, they are rumors and misrepresentations. The reporters at the Post are well aware of this, yet they shrink from reporting the truth, for fear of offending the very people who are manufacturing the rumors and misrepresentations.

What is wrong with the mainstream media? Why do they accord lies the same status as the truth? Why won’t they acknowledge the concerted effort to derail discussion for what it is, intimidation? Why don’t they exercise judgment instead of channeling the PR representatives of the Republican Right Wing?

I don’t know the answers to these questions, but I do know this: when the mainstream media refuses to call a lie, when it is intimidated into ignoring intimidation, it has sounded its own death knell.

President Obama believes that the primary goal of healthcare reform is to provide access to the millions of Americans who currently have no health insurance. Dr. Andrew Weil, writing in today’s Huffington Post (The Wrong Diagnosis), thinks he knows better, as the title of his article implies.

But what’s missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what’s even worse than its stratospheric cost is the fact that American health care doesn’t fulfill its prime directive — it does not help people become or stay healthy. It’s not a health care system at all; it’s a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly.

It sounds great, but it means nothing. It is widely recognized by healthcare economists that preventive care does not save money. Everyone from the Congressional Budget Office on down has acknowledged this. Preventive care saves lives, but it does not save money.

But there’s a deeper problem with Dr. Weil’s pronouncement. Those who cannot seek even basic care for their “disease management” are suffering horrifically and are not helped by fancy words about “staying healthy.” Instead of worrying about how to get more for those who already have plenty, let’s focus our attention on those who have none.

I wish Dr. Weil could have met my cousin Janet, but it’s too late now. Janet is dead. She died because she didn’t have health insurance. Perhaps he would think twice about pandering to the “worried well” and start thinking about people who are dying because they have no access to any healthcare at all.

My cousin Janet was a lovely, vivacious, and kind person. She would give you the shirt off her back, even when, as was often the case, the shirt on her back was all she had. Janet suffered from intermittent bouts of debilitating mental illness. Although she was bright, educated and hard working, her frequent relapses made it difficult for her to hold a steady job. As a result, she often supported herself by menial work such as cleaning houses. And as a result, she never had health insurance.

Janet was an enthusiastic proponent of alternative health and preventive care. She tried to care for herself every way that she knew how. She had no other choice.

When she called me early one bleak Sunday morning to tell me that she had a lump in her breast, I began calculating how we might get her access to healthcare. Early stage breast cancer is highly curable, and Janet was otherwise young (mid 40’s) and healthy. I started to explain that it was very possible that the lump was benign and might not require any care beyond surgical removal.

But Janet interrupted me. She didn’t think that was likely. Why not? Well, the lump had been there for 5 years. How big was it? The size of a lemon!

“Oh, Janet,” I cried, “why didn’t you go to the doctor?”

“I couldn’t,” she explained. “I didn’t have any health insurance and I had no money to pay a doctor.”

Ultimately, through the efforts of family, we got Janet to a doctor. An evaluation showed that she had stage IV breast cancer, with metastases in her spine and skull. The state where she lived, unlike mine, provided no aid for people without health insurance, but Janet qualified for money from a foundation that exists specifically to help breast cancer patients who have no other means to pay.

Janet found an excellent oncologist, who was honest about her grim prognosis, but felt that with aggressive treatment she could enjoy 3-4 years of high quality life. The oncologist was right. Janet lived almost 4 more years and died at the age of only 50, leaving her mother, family and friends bereft.

It’s a shame that Dr. Weil is ignoring people like Janet. Prattling about wasting time on “disease management” sounds great to people who have no diseases, but is unutterably cruel to those who are suffering and need help now.

As we struggle to reform the healthcare system, provide care for all, reduce disease and hold down cost, there are those who, for the sake of profit, would rather do the opposite. No, I’m not talking about drug companies or entrenched healthcare interests, although they are working mightily to undermine healthcare reform. I’m talking about people like “Dr. Bob” Sears, panderer to vaccine rejectionists.

Vaccination is preventive medical care at its finest, minimizing disease, relatively inexpensive and available to all. Vaccine rejectionists, and those who pander to them, are actively undermining extraordinarily effective preventive care; their actions will inevitably lead to increased disease, increased medical costs, and harm to innocent children. Indeed, in the case of measles, it has already begun to happen.

Even something as apparently harmless as an “alternate” vaccine schedule is dangerous. It increases the interval during which children are vulnerable, it leads to missed vaccination, and it massively increases the time and money required to provide healthcare to all of America’s children. Every minute spent refuting the nonsense of people like “Dr. Bob” is a minute where effective medical care is not being provided to many others in need.

The heart of pediatric care is prevention, so it is not surprising that the American Academy of Pediatrics is alarmed about the growing trend of withholding vaccination and alternate vaccine schedules. They have published a point-by-point refutation of the vaccine-rejectionism of Dr. Robert Sears, a man who has made a fortune by pandering to the fears of vaccine rejectionists.

The paper is entitled The problem with Dr. Bob’s alternative vaccine schedule and the authors are forthright in explaining they wrote the paper:

Many books misrepresenting the science of vaccines or vaccine safety have been published. None has been as influential as that published by Dr Robert Sears, The Vaccine Book: Making the Right Decision for Your Child…

Sears’ book … has already sold more than 40,000 copies… The popularity of Sears’ book centers in part on 2 schedules, called alternative and selective, that offer parents a way to avoid giving their children several vaccines at one time. Sears’ book is unique… Unfortunately, Sears sounds many antivaccine messages.

Dr. Sears makes two types of claims, opinion claims and empirical (factual claims). The opinion claims are designed to undermine trust in medical and public health officials. The empirical claims are factual claims that, in most cases, are false.

Dr. Sears makes two main opinion claims. First, he says that he, as a physician, knows very little about vaccines and it assumes that every other physician knows as little as he. I’m not sure where he went to medical school, but he ought to ask for his money back. It is simply impossible to believe that he didn’t learn about vaccines. Moreover, if he didn’t learn about vaccines in medical school, and he has no formal training in immunology or virology, why should we pay any attention to what he says about vaccines?

The second opinion claims is that public health agencies and pharmaceutical companies are not trustworthy. It is hardly news that pharmaceutical companies exist to make a profit. That tells us nothing, though, about whether a specific product is safe and effective. Moreover, Dr. Sears provides no evidence that public health agencies are not trustworthy. Most importantly, Dr. Sears does not address his personal conflict of interest; why should anyone believe him if he makes a profit on each alternate vaccine schedule that is sold?

Most of Sears’ empirical claims are easy to address. They’re flat out false or disingenuous. For example, Sears asserts that vaccine-preventable diseases are not that bad, though most are deadly, and he asserts that vaccination has eliminated acute diseases but caused chronic diseases. There’s simply no scientific evidence to support that claim.

Sears’ assertion that natural infection is better than vaccination is disingenuous. It’s true for those who survive the natural infection. It’s not particularly relevant for the thousands or millions who die. Moreover, for certain infections, survival may be accompanied by permanent disability such as severe scarring (smallpox) or paralysis (polio). That’s a steep price to pay for natural immunity.

One of the most disingenuous claims is also unethical. As the paper describes:

Perhaps the most disingenuous comment in the book is directed at parents who are afraid of the measles-mumps- rubella (MMR) vaccine. “I also warn [parents] not to share their fears with their neighbors,” writes Sears, “because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.” In other words, hide in the herd, but do not tell the herd you’re hiding; otherwise, outbreaks will ensue…

This is why vaccine rejectionism is unethical. Dr. Sears’ warning implicitly acknowledges that vaccines are highly effective and that their effectiveness is dependent on herd immunity. Those are the benefits of vaccination. But vaccines also have burdens: side effects. Therefore, he advises parents to foist the burdens on others and claim the benefits for themselves … and that’s unethical.

The bottom line is rather straightforward. The only person who benefits from Dr. Bob’s alternative vaccine schedule is Dr. Bob. Children receive less protection, preventable disease is not prevented, and physicians waste massive amounts of time on refuting nonsense when they could be providing care to other children.

“Dr. Bob” should be ashamed, but I doubt he is.