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Wednesday, January 07, 2009

Medical Blogger Orac Skeptical of Obama's Surgeon General Nominee

Read his excellent analysis here.

However, what concerns me most about Dr. Gupta is his relationship with science-based medicine. Being a medical correspondent is a tough job to have and still stay true to science- and evidence-based medicine. The temptation to "sex a story up" or to do credulous puff pieces about the latest "alternative" medicine in order to drive ratings is strong, and it takes a strong commitment to be able to resist them. In this, Dr. Gupta has made some high profile stumbles. Chris Mooney points out how poorly he performed in the Clonaid fiasco. In actuality, this is something about Dr. Gupta that I had not heard about. I do remember the Raelians and their claim, presented without any evidence, that they had cloned a human being. But I either did not see or hear about Dr. Gupta's credulous report on the Raelians. It was truly a low point for medical journalism in the last decade, and he was at the center of it. As Mooney points out, he may not have been a willing participant. He may have been inexperienced then. He may not have been confident enough in his position to say no. However, his involvement with that story does not give me confidence in his judgment.

What concerns me even more that that is that, when it comes to one of the most important threats to public health of our time, the antivaccine movement, specifically the movement that claims that vaccines cause autism, Dr. Gupta has shown a maddening tendency to straddle the fence and play both sides in his reporting. His coverage of the Hannah Poling case, in particular, was distressingly credulous, so much so that the crank blog Age of Autism approved of it heartily. Meanwhile, on his own blog, Dr. Gupta was disturbingly sympathetic to the antivaccine viewpoint:

I want to continue the discussion today. Couple of points. First of all, it seems as if parents bring up concerns about vaccines, they are automatically portrayed as anti-vaccine. Why is that? Is it possible to completely believe in the power and benefits of vaccines, but still have legitimate and credible concerns?
That's not what we're talking about. We are not talking about parents who worry about whether vaccines can cause harm, most of whom wouldn't even think of prefacing their comments with "I'm not anti-vaccine," because it wouldn't even occur to them that anyone is anti-vaccine. I once passed on this pearl of wisdom. Whenever someone prefaces her argument with earnest and emphatic claim that she is not "antivaccine," antivaccine pseudoscientific canards almost always follow shortly thereafter. I'm thinking of calling it the Jenny McCarthy Law of Pseudoscience because, heck, Jenny McCarthy and J.B. Handley insist over and over that they are not "antivaccine" before serving up the most outlandish antivaccine canards. It's a ruse, because they know that if they admitted that they were in fact antivaccine no one outside of the antivaccine movement would take them seriously anymore. That's where the whole "Green Our Vaccines" and "too many too soon" catchphrases came from.

Do I think Dr. Gupta is sympathetic to antivaccine views? Not at all. But he clearly does not recognize them when he sees them, and he seems tainted by the journalistic tendency to "tell both sides" even when there is no scientific support at all to one of the sides. Such a tendency may have served him well as a journalist (although arguably not as a science or medical journalist), but it would not serve the nation well in a Surgeon General, who must persuade the nation with clear, science-based arguments, gravitas, and moral authority. Again, the Surgeon General's influence depends on his gravitas and ability to persuade, both of which he can undermine by even being perceived to give credence to cranks and quacks. Moreover, as Jake pointed out, the Surgeon General does not have the luxury of playing both sides of medical pseudodebates in which cranks are pitted against scientific medicine. He has to choose science- and evidence-based medicine, and he has to articulate firmly, using evidence and political persuasion, why he chose that way. He can't afford to be perceived as lending credence to cranks, as former NIH Director Bernadine Healy has been doing so happily lately. Look at how much the antivaccine loons at AoA point to her as "proof" that scientists take their viewpoint seriously. If they do that when a former Director of the NIH says such things, imagine how much more they would do the same if an actual sitting Surgeon General said something that seemed to be sympathetic to their cause.

I'm not ignoring the considerable strengths that Dr. Gupta could bring to the job as Surgeon General. Again, a Surgeon General rises and falls by his ability to persuade, particularly when he is issuing health warnings to the nation, and Dr. Gupta's experience and skill as a medical reporter could be most useful in that capacity. He is an excellent communicator and very telegenic. Also, from a personal perspective, I can't help but think it would be cool to have a fellow graduate of the University of Michigan Medical School, as well as someone who grew up practically right next door to where I did (Novi, Michigan is very close to Livonia, Michigan, where my parents moved when I was 10). If Gupta can learn to dump his journalistic "tell both sides" mentality when it comes to dubious health claims, he might grow into being a formidable Surgeon General.

Unfortunately, that's a big if.

Good points. Read the whole thing.