Enjoyed this, Eric. Another heuristic that I used for information literacy and that applies equally here is the SMELL test. Source, Motivation, Evidence, Logic, Left Out. Lack of credentials, clear profit motive, specious or selective evidence, incoherent reasoning, and conveniently omitted counterfactuals would all line up with your red flags, yes?
To be fair, as I replied to Joshua, in my 20 years in IE where "The Smell Test" has become a tile on "buzzword bingo" not once had I seen his backronym - he should trademark that! If he could monetize 5 cents every time an MBA uses that phrase he would be a hundred thousandaire!
Joshua, I've been using the phrase "the smell test" for close to 20 years in IE, but never actually seen a backronym for it - congrats! (not even google turned that up). Google still refers to it as "deciding if something is authentic, credible, ethical using common sense" - not a good acronym :)
Be sure to trademark that!
I will say that as a long time reader of YLE, I find that Eric has *perhaps* a selective memory in her posting, as she checks many of the Red Flags he notes as well are your "SMELL" test items. Clear Profit Motive? She makes a magnitude more now than she did as an epidemiologist studying domestic violence. (this also may fall under "Lack of Credentials", as she has no medical background, but I am not a fan of "appeal to authority", I prefer "appeal to arguments"). Incoherent Reasoning, omitting counterfactuals, selective evidence - all mistakes she too makes - I just don't discard her for those human errors. (I made a very lengthy post citing all of this over the last 3 years in these comments).
What I would rather see is YLE engage Vinay, Eric engage Cifu, etc. Instead Substack has just become long-form of Twitter - verbose echo chambers with few reaching across the aisle to engage in a meaningful dialectic.
I'm glad you restacked this, as I had never seen this substack before, and aside from this post, I really enjoy what I have read.
I did find his appraisal of Vinay vs YLE completely one-sided, perhaps indicating he hasn't been following her posts that closely the past 3 years as I point out in my rebuttal. She's a great writer, and I enjoy her work, but I find she too checks many of the "Red Flags", so this piece was one sided.
Awesome, thanks for the recommendation! I've previously enjoyed Dr. Gunter's articles in traditional outlets and social media, will check out her Substack!
I think you mean RFK, Jr in this section: “The goal is not to persuade you to adopt their views, rather they want to make you so confused and frustrated you give up even trying to find the truth. People like Joe Rogan and JFK Jr notoriously deploy this move, as do people who constantly demand scientists debate them; “.
Oof, you are totally right, wow that's an embarrassing typo! 🤦🏻♂️ It never fails to amaze me that little errors can crop up even after proof-reading a gajillion times before publication 😅
I have edited it now, thank you for catching that!
Thanks, Liz! I had fun writing it 😃 Anyone who hasn't checked out Marc Maron's comedy definitely needs to do themselves a favor and binge his last few specials. There's some great bits about conspiracy theorists and anti-science folks. Fair warning: It gets pretty profane at times 😝
This is something I plan to pin - such a great article. I have personally found that as soon as I put blinders on over a belief I’m already in trouble. Staying open minded is so important these days!!! You have a new follower!
Go back and watch all of them - IIRC his 2nd to most recent one is among one of the all time greatest standups I have ever seen - and that's saying something as a comedy aficionado.
A polite critique of Katelyn Jetelina, who you cite as example of delivering “qaulity science”, as opposed to the Drs at Sensible Med (Prasad, Cifu, Mandrola, et al) who you describe as offering “contrarian, anti-establishment views” and “peddle pseudoscience”.
For the record, I have subscribed to YLE at founder level for 3 consecutive years, and also had a paid subscription to Sensible Medicine for a year (set to expire 10/22). I also subscribe to Ryan McCormick (Free, though his restack of this brought me here) and Jeremy Faust (paid) – all writers I enjoy reading.
I also want to say that I find Katelyn to be a great writer, communicator, and compassionate person who has done a fantastic job simplifying complex issues to her audience.
That said, I argue she lacks “rigorous skepticism”, and that has unfortunately lead her to be resistant to the Red Flag you cited: “willing to change their mind or admit when they’re wrong”. All of her skepticism is one directional.
She said cloth masks could [1] “decrease R(t) below 1, leading to the mitigation of epidemic spread.”, and “...is associated with a decline in the daily COVID-19 growth rate” – we now know this is false, yet as recently as last month she still defended them on children [2]
September of 2021 she predicts that “34 million kids will get Covid which will overwhelm PICU capacity by 150%” [3] which was widely shared in FB and struck fear in parents, yet she never apologized for getting this wrong, never went back to figure out where the mistake was. And it may not be surprising, because she regularly uncritically repeats “scary statistics” about Covid’s threat to children she often doesn’t vet nor put into context. [4]
She repeated a claim she took from Das Spiegel that “low vaccinated countries “beautifully” correlate to high covid cases in fall 2021” [5], even though that data was already falsified had she bothered to replicate the Das Spiegel piece as I pointed a week later [6] Where was the “Correcting my post from last week…” you yearn for?
She praises Vietnam and South Korea for their Covid response March 16 2022 [7], yet a cursory check of Excess Deaths in Vietnam suggests she just repeated what a communist government claimed, and damningly, this post was just one month before South Korea would see Covid explode and all-cause mortality double (a feat not even the US had at heigh of the pandemic) – completely reversing their “lead” in excess deaths, placing them middle of the pack. Yet not once has she ever gone back to understand what went wrong in South Korea.
She makes a “sweeping conclusion” that Sweden has the highest death rate in 2020 [8], but in 2023 when they have the lowest it’s suddenly due to their “…incredible level of trust, universal health care, social support, and cohesion” [9]
There are likely many of the same issues with the Sensible Medicine team, but I read them as closely, and I haven’t come across any that come to mind. The most famous “contrarian” position they are taking – that we should be keen to weigh risk reduction and consider targeted vaccination, wound up being the course **every single country in the world** is now following except the US, Canada, and Austria. [10]
And before I close, I do want to point out that I find it odd you denigrate Vinay Prasad as “gone from being a relatively unknown oncologist to a celebrity doctor beloved by the Right”.
As that is a one directional criticism. Why not criticize Katelyn Jetelina as being “a relatively unknown social scientists studying domestic violence to a celebrity science influencer beloved by the CDC and far left”?
I find both uncharitable simplifications, but at least in the former, Vinay Prasad practices evidence based medicine while, in the words of Richard Feynman, Katelyn practices “a science which isn’t a science” [11]
And finally, I find it a bit hypocritical to accuse of Vinay Prasad of a “Cash Windfall” from his views on Covid when it is Katelyn Jetelina who has parlayed her Substack into a revenue stream 5x-10x of what she was making pre-Covid, whereas Vinay Prasad’s substack income is likely equivalent to an extra RVU bonus. This is her cash cow, make no mistake about that unless Substack isn’t accurate in “10’s of thousands of paid subscriptions”.
As I have said, I enjoy reading from both YLE and SM substacks, and hundreds more. I browsed a few of your past pieces Eric and find them interesting as well. I merely wanted to offer the countermeasure to this particular piece as it felt largely one sided to someone who's read YLE closely the last 3 years.
Intellectual curiosity can be expensive! Spent $5,700 on Substack alone since discovering it the end of 2020! Halting all paid subs now though to refocus attention on some other projects.
Eric -- I am a primary care doctor in New York City, and an occasional contributor to the Sensible Medicine Substack. I most recently wrote essays for Sensible Medicine giving my opinions on the CDC’s Covid Booster recommendations and on Peter Attia’s book Outlive.
Not surprisingly, I take issue with your characterization of Sensible Medicine as “quackery.” You give some vague reasons for why you do not like the site, without citing specific examples. Then, you give a list of Red Flags, without giving any examples of how Sensible Medicine demonstrates these red flags. You do speculate that Vinay Prasad is tainted by money, but don’t offer evidence of how his views have been changed by social media earnings or acknowledging that the same flippant comment could be made about Your Local Epidemiologist (and to be clear, barring good evidence to the contrary, I would just assume that she simply believes what she believes).
The truth is that Sensible Medicine simply publishes mainstream views on scientific and policy debates that you disagree with. Your attempt to narrow the Overton window with cries of misinformation is no different than Trump’s ridiculous claims of “Fake News.”
I suspect the point of this essay is to rally the base, but I truly believe that this mentality of not acknowledging uncertainty, and failing to debate different perspectives is precisely the thing that has led to a loss of trust in institutions.
Addendum: I am always open to conversations, if you want to have a dialogue.
Hi Paul, thank you for your comments. As a contributor to Sensible Medicine, I understand why you would take issue with my comments. While engaging here is probably a fool's errand since I can't imagine anything I say will convince you (especially after reading some of your Substack posts and comments), I didn't want to give the impression to other readers that I don't stand by my assertions. So here are some responses:
"You give some vague reasons for why you do not like the site, without citing specific examples."
As you might remember from the post, Sensible Medicine is one of SIX different publications I highlighted as problematic out of the top ten Science publications on Substack, not including the several non-Substack pseudoscientist peddlers I also mentioned (Joe Rogan, Gwyneth Paltrow, RFK Jr). It would obviously take an enormous amount of time to wade through specific examples for each of them, especially Sensible Medicine, which is written by multiple authors.
"Then, you gives a list of Red Flags, without giving any examples of how Sensible Medicine demonstrates these red flags."
OK then, ask and you shall receive. Here are just a few quick ones…
*** Red Flag: Writes in an inflammatory manner
Vinay Prasad is probably the most prominent writer on Sensible Medicine and he writes for several outlets including his own personal Substack. On just the front page of Vinay’s personal Substack, he calls the CDC’s Morbidity and Mortality Weekly Report publication “state propaganda” because he doesn’t agree with it and repeatedly attacks a NYT science reporter (Apoorva Mandavilli) in no less than THREE posts.
Virtually every time I see him on a cable segment or social media he is deliberately provocative and trollish. This is not how responsible scientists and doctors trying to make sound, fact-based arguments communicate.
*** Red Flag: Over-simplifying, not providing context about sources
"Should you test yourself for COVID? No! Of course, you should not test yourself for COVID19. First, there is no specific therapy that is proven to work in 2023 against current strains. As I detailed in a prior post— EPIC SR (paxlovid) is negative in vaccinated people. No trial— for any drug— is for current strains of COVID. All need repeat RCTs."
This is definitely an oversimplification. It really depends on where you work. Do you work in a hospital or nursing home with vulnerable patients? Yeah, you should probably be testing if you feel sick!
The second part about RCTs is deceptive sophistry! Of COURSE we don't have RCTs for the latest strains; new ones emerge and take hold multiple times a year (sometimes every few months) and since RCTs take months to collect data, analyze, and publish, we will be perpetually behind the 8 ball and never actually have data for the most recent strains. Vinay surely knows this but doesn’t provide that context to his readers.
I am all for continually updating RCTs! But with rapidly evolving RNA viruses, this is always going to be difficult to achieve in real time.
It is ALSO ironic considering the whole SM gang constantly appeals to EBM when convenient, but not when it contradicts their preconceived notions. A different writer on Sensible Medicine literally has a post dedicated to throwing out the entire framework titled: “The “evidence pyramid” should be dismantled, brick by ill-conceived brick“ (and they're really miffed at SRs!)
*** Red Flag: Does this person claim to have “secret knowledge” that “the establishment” “doesn’t want you to know”?
Well, he might not literally use those words, but Vinay paywall locks almost all of his personal Substack posts immediately so only people who pay him can read his perspective, which also dovetails nicely with the financial profit motive. Nice two-fer!
That leads me to the final BIG one…
*** Red flag: ??? [Unclear which exactly this falls under, because despite the length of my post, I did not have the foresight to create a specific red flag for “making up total bullshit”]
Vinay recently wrote: “DeSantis and Ladapo Do Not Advise Boosters for <65: Florida is correct and the Biden administration is wrong & more thoughts on Politics and Science. Politics and science are mixing. Because the Biden administration has allowed Pfizer to get an annual vaccine approved without randomized data, and allowed the company to push it even in 6 month old babies [Ed: nice inflammatory line, he likes to cross streams with the flags]“
Well as a matter of fact Dr. Joe Ladapo came to this conclusion by slicing and dicing his own study data to fit his preconceived notions and was rebuked for poor research practices by his colleagues: “Florida’s surgeon general violated his university’s rules against “careless, irregular, or contentious research practices” in recommending against mRNA coronavirus vaccination for males aged 18-39, according to a report by his colleagues at the University of Florida’s faculty of medicine...It does not allege research misconduct—the fabrication of data—but the lesser charge of a research integrity violation, which involves cherry picking or misrepresenting data. Ladapo is accused of basing his recommendation on a single unpublished study commissioned by his health department, without named authors or peer review, which he said showed a statistically significant increase in cardiac related deaths in this age group in the 25 weeks following vaccination. This study would not have shown a statistically significant increase in cardiac deaths if best statistical practice had been used in the analysis of data, the faculty committee said.” (https://www.bmj.com/content/380/bmj.p110)
I wish I could provide more analysis of his “argument,” but again he paywall locked it so I can’t.
——
I could probably keep going on and on and on and on, but I’ve already written about 1,000 words in this comment, which is close to the length of the entire original post. I strongly doubt this will satisfy you, so I guess we’re gonna have to agree to disagree ¯\_(ツ)_/¯
Eric -- Thank you for engaging with my post. I appreciate you taking the time.
You are of course correct. You have convinced me that you don't like Prasad, and you have an axe to grind with him. But you certainly haven't convinced me that he is a peddler of pseudo-science or misinformation.
Incidentally, I don't agree with everything he says. There was a time when it was unremarkable to share an intellectual space with someone whose views didn't coincide 100% with your own. But this current trend of having a low threshold for labeling another's views as misinformation and suggesting they be dismissed out of hand is antithetical to science.
By contrast, I will point out a Sensible Medicine post that your referenced in your comment above, arguing that the evidence-based pyramid be dismantled (https://sensiblemed.substack.com/p/the-evidence-pyramid-should-be-dismantled). Prasad opens the post by admitting that the essay was submitted in response to Prasad appealing to that very evidence pyramid. The fact that Sensible Medicine will post rebuttals to the view of their editor is a testament to the spirit of intellectual curiosity and openness that the stack attempts to cultivate. I strongly urge any of your readers who are smart enough to know that they are fallible to read some of the Sensible Medicine content with an open mind.
He convinced the hell out of me, and Vinay’s trollishness is self-evident even before this thoughtful, labor intensive reply Eric provided. Dwell with it, reread it, and realize that you might be reacting defensively.
Ha Ryan -- "I might be reacting defensively." I don't play armchair psychologists with people I've never met, so I won't speculate about the emotional state that led you to write your message. I'll just give my opinion, which are you free to agree or disagree with.
The position of Vinay Prasad on Covid can be summarized as follows: The Scandinavian countries got it right. That is really everything, more-or-less. To disagrees with this position is completely reasonable. To label this position as "misinformation" is intellectually weak and damaging to a pursuit of truth. The fact that Prasad delivers his messages with a bombastic tone and hyper-confidence has no bearing on the veracity (or lack thereof) of his message -- but I get that many confuse style with substance.
Eric - I think it's great that you directly responded, and took time to give better examples. This sort of dialectic is exactly what I hope to see through Substack.
Quick thoughts on your reply to Paul:
1) I agree with you that Vinay writes in an inflammatory manner *on his personal blog*, but his personal blog is not #3 in the Science section. I think this is an important distinction because your original post criticizes Sensible Medicine where, when Vinay contributes, he uses his "bedside manner" tone and drastically reduces the snark. (And I may be completely wrong - I went through his last few pieces and compared to his personal substack and this affirmed what I suspected).
And I agree with you that condescending attitudes are not helpful in engaging people, changing minds, which is why I was so disappointed to see so many people I previously respected engage in this sort of hostility the last few years. Biden's "I am losing patience in the unvaccinated" remarks, Keith Olbermann's endless tirades calling the unvaccinated stupid, YLE contributor Gavin Yamey mocking a guy who died of a long term chronic illness doctors couldn't solve just because the guy tried treating his illness (which again, western medicine had no answer for) with Ivermectin, etc.
This is one of the traits I enjoyed about YLE - she never got sarcastic, belittled people, or lost patience. I've tried to emulate that in my many discussions on Covid throughout the pandemic which was difficult, because my default mode is/was closer to Vinay's.
That said, of all of the "Red Flags" you listed, I found this one to be arguably the weakest. I'm temporizing, but since this isn't part of the classic Sagan "Baloney Detection Kit", it didn't resonate with me, and, as noted above, both "sides" engage in inflammatory language.
2) I don't think Vinay was saying Lapado was correct in only recommending the vaccine to 65+ because of the analysis Lapado performed, I believe Vinay was saying Lapado was correct because of the external evidence that aligned with this view, and in his paywalled post he cited the respected Dr Paul Offits similar claim (took screenshot of the paywalled part for you, my subscription wont expire for another few months:) https://imgur.com/a/NWzILoh)
YLE/Katelyn's post you shared missed the much larger point I illustrated in her comments - it's not just that the UK is going a different direction than the US, so is Germany, South Korea, Denmark, Portugal, Spain, Japan, and nearly every other country in the world *except* the US, Canada, and Austria.
Her argument "well the US has worse healthcare so it makes sense we are outlier" is easily falsified by realizing that every single country in the world, regardless of interventions (masking, school closure, vaccination) has *zero* excess deaths in children throughout the entire pandemic. It signals that it would be extremely hard to justify the vaccine through RCT, as the NNT would reach infinity. The corollary to this, as I have pointed out to those saying the vaccines are killing kids, is that this claim also isn't represented in population data.
The point is largely moot anyway, as uptake in boosters in young people - even where recommended - has been negligible. The people have largely sided with Vinay/Lapado/every-other-country, indirectly.
3) Regarding the "don't bother testing" argument you are critical of, like masking children, like vaccinating young people, the rest of the world has also moved on from this. The proposal Vinay puts forth is in line with what nearly every country has adopted. Testing has largely ended. Schools, Hospitals, Employers, across the globe, have stopped testing unless the test might impact a clinical decision - exactly what Vinay argues.
This is anecdotal, but speaks of the current situation - last year, when I finally got Covid, my wife, a vascular surgeon, notified her hospital here in Cleveland that I was positive and offered to quarantine and test herself as she was exposed to me, and the hospitals answer was "don't bother, keep coming to work if you aren't sick". This is largely what happened around summer 2022 across the globe.
4) I'm hesitant to talk about Ivermectin, but screw it, let's dive in.
For the record I don't believe it does anything to help with Covid. I also don't believe at the correct dosage it has any negatives.
I base that opinion on the fact the CDC itself recommends Ivermectin tablets to treat lice, despite "not being FDA approved", and despite there being several other FDA approved treatments, because "Given as a tablet in mass drug administrations, oral ivermectin has been used extensively and safely for over two decades in many countries". [1]
I find the "ivermectin panic" surreal for 2 reasons.
First, prior to 2020, Ivermectin was routinely considered a "wonder drug" that could treat everything from cancer [2] to viruses [3] - where was the outrage in 2012-2019? Why wasn't the FDA posting on twitter "you are not a horse" in response to the scientific community investigating so many potential repurposes of the drug?
Second, the double standard hypocrisy was alarming. We "don't have time" to RCT new boosters which may-or-may not have some negative efficacy in young healthy people conflicts with the outrage we dare attempt giving people a potential "wonder drug" (the scientific community's term, not mine) with the safety profile of Tylenol - at appropriate dosage.
Don't get me wrong - I have politely critiqued many arguing of it's efficacy - pointing out that the fact they got better from Covid after taking IVM isn't surprising considering 99% of people get better from Covid whether they took IVM or "tied an Onion on their Belt" (as was the style at the time, to quote Abe Simpson).
I just never understood the hysteria over people trying IVM, even if I thought it did nothing, which lead to made up stories by Rolling Stone [4]
Bottom line, since Sensible Medicine, like YLE, is not paywalled, I would urge you to consider posting your polite critiques to any posts you find checking your red flags in the comments. Sagan famously said "science thrives on errors, cutting them away one by one" [5] so it seems to me, if you find errors, pointing them out would help in the pursuit of science, and as a bonus, you may pick up a few subscribers in the process (as someone who spent close to $6,000 in pad subs the last 3 years here, 90% of my purchases came from finding intelligent commenters with their own substacks)
[5] Full Quote, from The Demon-Haunted World, pg 20 "Pseudoscience differs from erroneous science. Science thrives on errors, cutting them away one by one. False conclusions are drawn all the time, but they are drawn tentatively. Hypotheses are framed so they are capable of being disproved. A succession of alternative hypotheses is confronted by experiment and observation. Science gropes and staggers toward improved understanding. Proprietary feelings are of course offended when a scientific hypothesis is disproved, but such disproofs are recognized as central to the scientific enterprise.
Pseudoscience is just the opposite. Hypotheses are often framed precisely so they are invulnerable to any experiment that offers a prospect of disproof, so even in principle they cannot be invalidated. Practitioners are defensive and wary. Skeptical scrutiny is opposed."
Dr. Prasad's 2015 book "Ending Medical Reversal" I think is enough to show that long before Covid, he was already focused on tackling the complex problem of reducing medical interventions which didn't benefit patient segments (or worse, cause harm). He cites the overuse of coronary stents during his residency as one of the "ah ha" moments that turned him to push for reforms in our approach to EBM.
The coronary stent, like the Covid vaccine, are both interventions Dr Prasad says have great value - to *specific* cohorts. In the case of the former, it was eventually acknowledged we needed to pare down some of the applications, and in the case of the latter, just as Dr Prasad has argued, *every other country* except the US, Canada, and Austria, are no longer recommending Covid vaccines to healthy people under 65.
100%! This is literally the plot of the new Saw movie 😱
“Hoping for a miraculous cure, John Kramer travels to Mexico for a risky and experimental medical procedure, only to discover the entire operation is a scam to defraud the most vulnerable. Armed with a newfound purpose, the infamous serial killer uses deranged and ingenious traps to turn the tables on the con artists.”
Enjoyed this, Eric. Another heuristic that I used for information literacy and that applies equally here is the SMELL test. Source, Motivation, Evidence, Logic, Left Out. Lack of credentials, clear profit motive, specious or selective evidence, incoherent reasoning, and conveniently omitted counterfactuals would all line up with your red flags, yes?
That’s great! I wish I had known about that because it’s a lot more succinct than what I wrote 🤣
To be fair, as I replied to Joshua, in my 20 years in IE where "The Smell Test" has become a tile on "buzzword bingo" not once had I seen his backronym - he should trademark that! If he could monetize 5 cents every time an MBA uses that phrase he would be a hundred thousandaire!
Joshua, I've been using the phrase "the smell test" for close to 20 years in IE, but never actually seen a backronym for it - congrats! (not even google turned that up). Google still refers to it as "deciding if something is authentic, credible, ethical using common sense" - not a good acronym :)
Be sure to trademark that!
I will say that as a long time reader of YLE, I find that Eric has *perhaps* a selective memory in her posting, as she checks many of the Red Flags he notes as well are your "SMELL" test items. Clear Profit Motive? She makes a magnitude more now than she did as an epidemiologist studying domestic violence. (this also may fall under "Lack of Credentials", as she has no medical background, but I am not a fan of "appeal to authority", I prefer "appeal to arguments"). Incoherent Reasoning, omitting counterfactuals, selective evidence - all mistakes she too makes - I just don't discard her for those human errors. (I made a very lengthy post citing all of this over the last 3 years in these comments).
What I would rather see is YLE engage Vinay, Eric engage Cifu, etc. Instead Substack has just become long-form of Twitter - verbose echo chambers with few reaching across the aisle to engage in a meaningful dialectic.
Thanks, Michael, but SMELL is not original to me. I learned it from a librarian!
https://library.nwacc.edu/sourceevaluation/smell
This is one of the best posts I’ve ever read on Substack.
First and foremost, it is a well-informed and comprehensive guide to spotting bad medical information on line, and on Substack in particular.
Thanks for the shoutout, and for calling out Vinay Prasad and others!
Restacking with glee :)
I'm glad you restacked this, as I had never seen this substack before, and aside from this post, I really enjoy what I have read.
I did find his appraisal of Vinay vs YLE completely one-sided, perhaps indicating he hasn't been following her posts that closely the past 3 years as I point out in my rebuttal. She's a great writer, and I enjoy her work, but I find she too checks many of the "Red Flags", so this piece was one sided.
https://allscience.substack.com/p/the-red-flags-of-quackery/comment/41705359
Great post. Thank you!
The Vajenda by Dr. Jen Gunter does a great job taking down quacks in the women’s health/Goop space.
Awesome, thanks for the recommendation! I've previously enjoyed Dr. Gunter's articles in traditional outlets and social media, will check out her Substack!
I think you mean RFK, Jr in this section: “The goal is not to persuade you to adopt their views, rather they want to make you so confused and frustrated you give up even trying to find the truth. People like Joe Rogan and JFK Jr notoriously deploy this move, as do people who constantly demand scientists debate them; “.
Oof, you are totally right, wow that's an embarrassing typo! 🤦🏻♂️ It never fails to amaze me that little errors can crop up even after proof-reading a gajillion times before publication 😅
I have edited it now, thank you for catching that!
Thank you for correcting it!
So good!
Thanks, Liz! I had fun writing it 😃 Anyone who hasn't checked out Marc Maron's comedy definitely needs to do themselves a favor and binge his last few specials. There's some great bits about conspiracy theorists and anti-science folks. Fair warning: It gets pretty profane at times 😝
I’ll check it out!
This is something I plan to pin - such a great article. I have personally found that as soon as I put blinders on over a belief I’m already in trouble. Staying open minded is so important these days!!! You have a new follower!
Welcome, glad to have you! 🥳
P.S. Watching Mark Maron Netflix special now while folding laundry, so thanks for that too :)
Go back and watch all of them - IIRC his 2nd to most recent one is among one of the all time greatest standups I have ever seen - and that's saying something as a comedy aficionado.
A polite critique of Katelyn Jetelina, who you cite as example of delivering “qaulity science”, as opposed to the Drs at Sensible Med (Prasad, Cifu, Mandrola, et al) who you describe as offering “contrarian, anti-establishment views” and “peddle pseudoscience”.
For the record, I have subscribed to YLE at founder level for 3 consecutive years, and also had a paid subscription to Sensible Medicine for a year (set to expire 10/22). I also subscribe to Ryan McCormick (Free, though his restack of this brought me here) and Jeremy Faust (paid) – all writers I enjoy reading.
I also want to say that I find Katelyn to be a great writer, communicator, and compassionate person who has done a fantastic job simplifying complex issues to her audience.
That said, I argue she lacks “rigorous skepticism”, and that has unfortunately lead her to be resistant to the Red Flag you cited: “willing to change their mind or admit when they’re wrong”. All of her skepticism is one directional.
She said cloth masks could [1] “decrease R(t) below 1, leading to the mitigation of epidemic spread.”, and “...is associated with a decline in the daily COVID-19 growth rate” – we now know this is false, yet as recently as last month she still defended them on children [2]
[1] https://www.facebook.com/permalink.php?story_fbid=202002698114314&id=101805971467321
[2] https://yourlocalepidemiologist.substack.com/p/state-of-affairs-parent-edition/comment/39700984
September of 2021 she predicts that “34 million kids will get Covid which will overwhelm PICU capacity by 150%” [3] which was widely shared in FB and struck fear in parents, yet she never apologized for getting this wrong, never went back to figure out where the mistake was. And it may not be surprising, because she regularly uncritically repeats “scary statistics” about Covid’s threat to children she often doesn’t vet nor put into context. [4]
[3] https://yourlocalepidemiologist.substack.com/p/school-outbreaks-and-what-it-means
[4] https://yourlocalepidemiologist.substack.com/p/pediatric-state-of-affairs-april/comment/6293222?s=r
She repeated a claim she took from Das Spiegel that “low vaccinated countries “beautifully” correlate to high covid cases in fall 2021” [5], even though that data was already falsified had she bothered to replicate the Das Spiegel piece as I pointed a week later [6] Where was the “Correcting my post from last week…” you yearn for?
[5] https://yourlocalepidemiologist.substack.com/p/state-of-affairs-europe-should-we
[6] https://yourlocalepidemiologist.substack.com/p/omicron-update-nov-29/comment/3827583
She praises Vietnam and South Korea for their Covid response March 16 2022 [7], yet a cursory check of Excess Deaths in Vietnam suggests she just repeated what a communist government claimed, and damningly, this post was just one month before South Korea would see Covid explode and all-cause mortality double (a feat not even the US had at heigh of the pandemic) – completely reversing their “lead” in excess deaths, placing them middle of the pack. Yet not once has she ever gone back to understand what went wrong in South Korea.
She makes a “sweeping conclusion” that Sweden has the highest death rate in 2020 [8], but in 2023 when they have the lowest it’s suddenly due to their “…incredible level of trust, universal health care, social support, and cohesion” [9]
[7] https://yourlocalepidemiologist.substack.com/p/pandemic-preparedness-s-korea-vietnam
[8] https://yourlocalepidemiologist.substack.com/p/vaccine-update?s=r
[9] https://yourlocalepidemiologist.substack.com/p/house-select-subcommittee-gbd-and/comment/13418186
There are likely many of the same issues with the Sensible Medicine team, but I read them as closely, and I haven’t come across any that come to mind. The most famous “contrarian” position they are taking – that we should be keen to weigh risk reduction and consider targeted vaccination, wound up being the course **every single country in the world** is now following except the US, Canada, and Austria. [10]
[10] https://yourlocalepidemiologist.substack.com/p/pandemic-preparedness-s-korea-vietnam
And before I close, I do want to point out that I find it odd you denigrate Vinay Prasad as “gone from being a relatively unknown oncologist to a celebrity doctor beloved by the Right”.
As that is a one directional criticism. Why not criticize Katelyn Jetelina as being “a relatively unknown social scientists studying domestic violence to a celebrity science influencer beloved by the CDC and far left”?
I find both uncharitable simplifications, but at least in the former, Vinay Prasad practices evidence based medicine while, in the words of Richard Feynman, Katelyn practices “a science which isn’t a science” [11]
[11] https://www.youtube.com/watch?v=tWr39Q9vBgo
And finally, I find it a bit hypocritical to accuse of Vinay Prasad of a “Cash Windfall” from his views on Covid when it is Katelyn Jetelina who has parlayed her Substack into a revenue stream 5x-10x of what she was making pre-Covid, whereas Vinay Prasad’s substack income is likely equivalent to an extra RVU bonus. This is her cash cow, make no mistake about that unless Substack isn’t accurate in “10’s of thousands of paid subscriptions”.
As I have said, I enjoy reading from both YLE and SM substacks, and hundreds more. I browsed a few of your past pieces Eric and find them interesting as well. I merely wanted to offer the countermeasure to this particular piece as it felt largely one sided to someone who's read YLE closely the last 3 years.
Michael -- I just want to applaud your intellectual curiosity. I think more of us need to take your lead and go broader with our Substack diet.
Intellectual curiosity can be expensive! Spent $5,700 on Substack alone since discovering it the end of 2020! Halting all paid subs now though to refocus attention on some other projects.
Eric -- I am a primary care doctor in New York City, and an occasional contributor to the Sensible Medicine Substack. I most recently wrote essays for Sensible Medicine giving my opinions on the CDC’s Covid Booster recommendations and on Peter Attia’s book Outlive.
Not surprisingly, I take issue with your characterization of Sensible Medicine as “quackery.” You give some vague reasons for why you do not like the site, without citing specific examples. Then, you give a list of Red Flags, without giving any examples of how Sensible Medicine demonstrates these red flags. You do speculate that Vinay Prasad is tainted by money, but don’t offer evidence of how his views have been changed by social media earnings or acknowledging that the same flippant comment could be made about Your Local Epidemiologist (and to be clear, barring good evidence to the contrary, I would just assume that she simply believes what she believes).
The truth is that Sensible Medicine simply publishes mainstream views on scientific and policy debates that you disagree with. Your attempt to narrow the Overton window with cries of misinformation is no different than Trump’s ridiculous claims of “Fake News.”
I suspect the point of this essay is to rally the base, but I truly believe that this mentality of not acknowledging uncertainty, and failing to debate different perspectives is precisely the thing that has led to a loss of trust in institutions.
Addendum: I am always open to conversations, if you want to have a dialogue.
Hi Paul, thank you for your comments. As a contributor to Sensible Medicine, I understand why you would take issue with my comments. While engaging here is probably a fool's errand since I can't imagine anything I say will convince you (especially after reading some of your Substack posts and comments), I didn't want to give the impression to other readers that I don't stand by my assertions. So here are some responses:
"You give some vague reasons for why you do not like the site, without citing specific examples."
As you might remember from the post, Sensible Medicine is one of SIX different publications I highlighted as problematic out of the top ten Science publications on Substack, not including the several non-Substack pseudoscientist peddlers I also mentioned (Joe Rogan, Gwyneth Paltrow, RFK Jr). It would obviously take an enormous amount of time to wade through specific examples for each of them, especially Sensible Medicine, which is written by multiple authors.
"Then, you gives a list of Red Flags, without giving any examples of how Sensible Medicine demonstrates these red flags."
OK then, ask and you shall receive. Here are just a few quick ones…
*** Red Flag: Writes in an inflammatory manner
Vinay Prasad is probably the most prominent writer on Sensible Medicine and he writes for several outlets including his own personal Substack. On just the front page of Vinay’s personal Substack, he calls the CDC’s Morbidity and Mortality Weekly Report publication “state propaganda” because he doesn’t agree with it and repeatedly attacks a NYT science reporter (Apoorva Mandavilli) in no less than THREE posts.
Virtually every time I see him on a cable segment or social media he is deliberately provocative and trollish. This is not how responsible scientists and doctors trying to make sound, fact-based arguments communicate.
*** Red Flag: Over-simplifying, not providing context about sources
Vinay Prasad tells people not to test for covid-19 and to send their sick kids to school. (https://sensiblemed.substack.com/p/if-you-are-sick-do-not-test-for-covid19)
Setting aside the fact that it should be obvious that on a basic decency courtesy level people in society shouldn’t want to deliberately expose others to a cold/flu/covid/RSV/etc, he conveniently leaves out nuance from other pages (https://www.nhs.uk/conditions/covid-19/covid-19-symptoms-and-what-to-do/) and that the NHS in the UK still very much recommends masking and vaccination, in contrast to almost every other post on SM and his personal Substack: https://www.nhs.uk/conditions/covid-19/how-to-avoid-catching-and-spreading-covid-19/
(To head off the US vs UK/EU vaccine recommendation debate, I will simply link the YLE post on it: https://yourlocalepidemiologist.substack.com/p/be-careful-comparing-the-us-to-other)
He goes on to state:
"Should you test yourself for COVID? No! Of course, you should not test yourself for COVID19. First, there is no specific therapy that is proven to work in 2023 against current strains. As I detailed in a prior post— EPIC SR (paxlovid) is negative in vaccinated people. No trial— for any drug— is for current strains of COVID. All need repeat RCTs."
This is definitely an oversimplification. It really depends on where you work. Do you work in a hospital or nursing home with vulnerable patients? Yeah, you should probably be testing if you feel sick!
The second part about RCTs is deceptive sophistry! Of COURSE we don't have RCTs for the latest strains; new ones emerge and take hold multiple times a year (sometimes every few months) and since RCTs take months to collect data, analyze, and publish, we will be perpetually behind the 8 ball and never actually have data for the most recent strains. Vinay surely knows this but doesn’t provide that context to his readers.
I am all for continually updating RCTs! But with rapidly evolving RNA viruses, this is always going to be difficult to achieve in real time.
It is ALSO ironic considering the whole SM gang constantly appeals to EBM when convenient, but not when it contradicts their preconceived notions. A different writer on Sensible Medicine literally has a post dedicated to throwing out the entire framework titled: “The “evidence pyramid” should be dismantled, brick by ill-conceived brick“ (and they're really miffed at SRs!)
(https://sensiblemed.substack.com/p/the-evidence-pyramid-should-be-dismantled)
*** Red Flag: Does this person claim to have “secret knowledge” that “the establishment” “doesn’t want you to know”?
Well, he might not literally use those words, but Vinay paywall locks almost all of his personal Substack posts immediately so only people who pay him can read his perspective, which also dovetails nicely with the financial profit motive. Nice two-fer!
That leads me to the final BIG one…
*** Red flag: ??? [Unclear which exactly this falls under, because despite the length of my post, I did not have the foresight to create a specific red flag for “making up total bullshit”]
Vinay recently wrote: “DeSantis and Ladapo Do Not Advise Boosters for <65: Florida is correct and the Biden administration is wrong & more thoughts on Politics and Science. Politics and science are mixing. Because the Biden administration has allowed Pfizer to get an annual vaccine approved without randomized data, and allowed the company to push it even in 6 month old babies [Ed: nice inflammatory line, he likes to cross streams with the flags]“
(https://vinayprasadmdmph.substack.com/p/desantis-and-ladapo-do-not-advise)
Well as a matter of fact Dr. Joe Ladapo came to this conclusion by slicing and dicing his own study data to fit his preconceived notions and was rebuked for poor research practices by his colleagues: “Florida’s surgeon general violated his university’s rules against “careless, irregular, or contentious research practices” in recommending against mRNA coronavirus vaccination for males aged 18-39, according to a report by his colleagues at the University of Florida’s faculty of medicine...It does not allege research misconduct—the fabrication of data—but the lesser charge of a research integrity violation, which involves cherry picking or misrepresenting data. Ladapo is accused of basing his recommendation on a single unpublished study commissioned by his health department, without named authors or peer review, which he said showed a statistically significant increase in cardiac related deaths in this age group in the 25 weeks following vaccination. This study would not have shown a statistically significant increase in cardiac deaths if best statistical practice had been used in the analysis of data, the faculty committee said.” (https://www.bmj.com/content/380/bmj.p110)
This is the same Joe Ladapo who has made a number of other bizarre recommendations that contradict the evidence-based consensus like supporting ivermectin as a covid treatment (https://www.tampabay.com/news/florida-politics/2021/09/22/four-times-floridas-new-surgeon-general-bucked-the-coronavirus-consensus/)
I wish I could provide more analysis of his “argument,” but again he paywall locked it so I can’t.
——
I could probably keep going on and on and on and on, but I’ve already written about 1,000 words in this comment, which is close to the length of the entire original post. I strongly doubt this will satisfy you, so I guess we’re gonna have to agree to disagree ¯\_(ツ)_/¯
Eric -- Thank you for engaging with my post. I appreciate you taking the time.
You are of course correct. You have convinced me that you don't like Prasad, and you have an axe to grind with him. But you certainly haven't convinced me that he is a peddler of pseudo-science or misinformation.
Incidentally, I don't agree with everything he says. There was a time when it was unremarkable to share an intellectual space with someone whose views didn't coincide 100% with your own. But this current trend of having a low threshold for labeling another's views as misinformation and suggesting they be dismissed out of hand is antithetical to science.
By contrast, I will point out a Sensible Medicine post that your referenced in your comment above, arguing that the evidence-based pyramid be dismantled (https://sensiblemed.substack.com/p/the-evidence-pyramid-should-be-dismantled). Prasad opens the post by admitting that the essay was submitted in response to Prasad appealing to that very evidence pyramid. The fact that Sensible Medicine will post rebuttals to the view of their editor is a testament to the spirit of intellectual curiosity and openness that the stack attempts to cultivate. I strongly urge any of your readers who are smart enough to know that they are fallible to read some of the Sensible Medicine content with an open mind.
He convinced the hell out of me, and Vinay’s trollishness is self-evident even before this thoughtful, labor intensive reply Eric provided. Dwell with it, reread it, and realize that you might be reacting defensively.
Ha Ryan -- "I might be reacting defensively." I don't play armchair psychologists with people I've never met, so I won't speculate about the emotional state that led you to write your message. I'll just give my opinion, which are you free to agree or disagree with.
The position of Vinay Prasad on Covid can be summarized as follows: The Scandinavian countries got it right. That is really everything, more-or-less. To disagrees with this position is completely reasonable. To label this position as "misinformation" is intellectually weak and damaging to a pursuit of truth. The fact that Prasad delivers his messages with a bombastic tone and hyper-confidence has no bearing on the veracity (or lack thereof) of his message -- but I get that many confuse style with substance.
Hi Paul - I disagree. Take care and thanks for your reply :)
Eric - I think it's great that you directly responded, and took time to give better examples. This sort of dialectic is exactly what I hope to see through Substack.
Quick thoughts on your reply to Paul:
1) I agree with you that Vinay writes in an inflammatory manner *on his personal blog*, but his personal blog is not #3 in the Science section. I think this is an important distinction because your original post criticizes Sensible Medicine where, when Vinay contributes, he uses his "bedside manner" tone and drastically reduces the snark. (And I may be completely wrong - I went through his last few pieces and compared to his personal substack and this affirmed what I suspected).
And I agree with you that condescending attitudes are not helpful in engaging people, changing minds, which is why I was so disappointed to see so many people I previously respected engage in this sort of hostility the last few years. Biden's "I am losing patience in the unvaccinated" remarks, Keith Olbermann's endless tirades calling the unvaccinated stupid, YLE contributor Gavin Yamey mocking a guy who died of a long term chronic illness doctors couldn't solve just because the guy tried treating his illness (which again, western medicine had no answer for) with Ivermectin, etc.
This is one of the traits I enjoyed about YLE - she never got sarcastic, belittled people, or lost patience. I've tried to emulate that in my many discussions on Covid throughout the pandemic which was difficult, because my default mode is/was closer to Vinay's.
That said, of all of the "Red Flags" you listed, I found this one to be arguably the weakest. I'm temporizing, but since this isn't part of the classic Sagan "Baloney Detection Kit", it didn't resonate with me, and, as noted above, both "sides" engage in inflammatory language.
2) I don't think Vinay was saying Lapado was correct in only recommending the vaccine to 65+ because of the analysis Lapado performed, I believe Vinay was saying Lapado was correct because of the external evidence that aligned with this view, and in his paywalled post he cited the respected Dr Paul Offits similar claim (took screenshot of the paywalled part for you, my subscription wont expire for another few months:) https://imgur.com/a/NWzILoh)
YLE/Katelyn's post you shared missed the much larger point I illustrated in her comments - it's not just that the UK is going a different direction than the US, so is Germany, South Korea, Denmark, Portugal, Spain, Japan, and nearly every other country in the world *except* the US, Canada, and Austria.
Her argument "well the US has worse healthcare so it makes sense we are outlier" is easily falsified by realizing that every single country in the world, regardless of interventions (masking, school closure, vaccination) has *zero* excess deaths in children throughout the entire pandemic. It signals that it would be extremely hard to justify the vaccine through RCT, as the NNT would reach infinity. The corollary to this, as I have pointed out to those saying the vaccines are killing kids, is that this claim also isn't represented in population data.
The point is largely moot anyway, as uptake in boosters in young people - even where recommended - has been negligible. The people have largely sided with Vinay/Lapado/every-other-country, indirectly.
3) Regarding the "don't bother testing" argument you are critical of, like masking children, like vaccinating young people, the rest of the world has also moved on from this. The proposal Vinay puts forth is in line with what nearly every country has adopted. Testing has largely ended. Schools, Hospitals, Employers, across the globe, have stopped testing unless the test might impact a clinical decision - exactly what Vinay argues.
This is anecdotal, but speaks of the current situation - last year, when I finally got Covid, my wife, a vascular surgeon, notified her hospital here in Cleveland that I was positive and offered to quarantine and test herself as she was exposed to me, and the hospitals answer was "don't bother, keep coming to work if you aren't sick". This is largely what happened around summer 2022 across the globe.
4) I'm hesitant to talk about Ivermectin, but screw it, let's dive in.
For the record I don't believe it does anything to help with Covid. I also don't believe at the correct dosage it has any negatives.
I base that opinion on the fact the CDC itself recommends Ivermectin tablets to treat lice, despite "not being FDA approved", and despite there being several other FDA approved treatments, because "Given as a tablet in mass drug administrations, oral ivermectin has been used extensively and safely for over two decades in many countries". [1]
I find the "ivermectin panic" surreal for 2 reasons.
First, prior to 2020, Ivermectin was routinely considered a "wonder drug" that could treat everything from cancer [2] to viruses [3] - where was the outrage in 2012-2019? Why wasn't the FDA posting on twitter "you are not a horse" in response to the scientific community investigating so many potential repurposes of the drug?
Second, the double standard hypocrisy was alarming. We "don't have time" to RCT new boosters which may-or-may not have some negative efficacy in young healthy people conflicts with the outrage we dare attempt giving people a potential "wonder drug" (the scientific community's term, not mine) with the safety profile of Tylenol - at appropriate dosage.
Don't get me wrong - I have politely critiqued many arguing of it's efficacy - pointing out that the fact they got better from Covid after taking IVM isn't surprising considering 99% of people get better from Covid whether they took IVM or "tied an Onion on their Belt" (as was the style at the time, to quote Abe Simpson).
I just never understood the hysteria over people trying IVM, even if I thought it did nothing, which lead to made up stories by Rolling Stone [4]
Bottom line, since Sensible Medicine, like YLE, is not paywalled, I would urge you to consider posting your polite critiques to any posts you find checking your red flags in the comments. Sagan famously said "science thrives on errors, cutting them away one by one" [5] so it seems to me, if you find errors, pointing them out would help in the pursuit of science, and as a bonus, you may pick up a few subscribers in the process (as someone who spent close to $6,000 in pad subs the last 3 years here, 90% of my purchases came from finding intelligent commenters with their own substacks)
__________
[1] https://www.cdc.gov/parasites/lice/head/treatment.html
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888155/
https://www.nature.com/articles/ja201711
https://www.sciencedirect.com/science/article/abs/pii/S0166354215300516
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835698/
https://ar.iiarjournals.org/content/39/9/4837
https://jeccr.biomedcentral.com/articles/10.1186/s13046-019-1251-7
[4] https://www.usatoday.com/story/news/factcheck/2021/09/15/fact-check-oklahoma-hospitals-not-backed-up-ivermectin-cases/8271014002/
[5] Full Quote, from The Demon-Haunted World, pg 20 "Pseudoscience differs from erroneous science. Science thrives on errors, cutting them away one by one. False conclusions are drawn all the time, but they are drawn tentatively. Hypotheses are framed so they are capable of being disproved. A succession of alternative hypotheses is confronted by experiment and observation. Science gropes and staggers toward improved understanding. Proprietary feelings are of course offended when a scientific hypothesis is disproved, but such disproofs are recognized as central to the scientific enterprise.
Pseudoscience is just the opposite. Hypotheses are often framed precisely so they are invulnerable to any experiment that offers a prospect of disproof, so even in principle they cannot be invalidated. Practitioners are defensive and wary. Skeptical scrutiny is opposed."
So incredibly helpful. Thank you Eric.
I wrote a much less well-informed post about Ladapo on Daily Kos, but still reached quite a few people recently:
https://www.dailykos.com/stories/2023/10/6/2197745/-Surgeon-General-Ladapo-and-the-Anti-Booster-Gestapo
Dr. Prasad's 2015 book "Ending Medical Reversal" I think is enough to show that long before Covid, he was already focused on tackling the complex problem of reducing medical interventions which didn't benefit patient segments (or worse, cause harm). He cites the overuse of coronary stents during his residency as one of the "ah ha" moments that turned him to push for reforms in our approach to EBM.
The coronary stent, like the Covid vaccine, are both interventions Dr Prasad says have great value - to *specific* cohorts. In the case of the former, it was eventually acknowledged we needed to pare down some of the applications, and in the case of the latter, just as Dr Prasad has argued, *every other country* except the US, Canada, and Austria, are no longer recommending Covid vaccines to healthy people under 65.
My bad. Do you have your shit together aside from first amendment confusion....😉
100%! This is literally the plot of the new Saw movie 😱
“Hoping for a miraculous cure, John Kramer travels to Mexico for a risky and experimental medical procedure, only to discover the entire operation is a scam to defraud the most vulnerable. Armed with a newfound purpose, the infamous serial killer uses deranged and ingenious traps to turn the tables on the con artists.”