A Cleveland Clinic doctor’s antivaccine rant: Facilitated by a culture of pseudoscience and published with the knowledge of the Clinic’s communications office [Respectful Insolence]

The fallout from the social media firestorm from the antivaccine rant written by the Medical Director of the Cleveland Clinic Wellness Institute and published by Cleveland.com last Friday has abated but far from faded away. The offending physician, Dr. Daniel Neides, was forced to issue an apology, which was one of the least convincing apologies I’ve ever seen, and The Cleveland Clinic issued a statement announcing its commitment to vaccines and that Dr. Niedes would suffer some as yet undetermined “disciplinary action.” Reactions outside of The Cleveland Clinic ranged from the suitably outraged, with an intense desire to refute the specifics of the antivaccine misinformation in Dr. Daniel Niedes’ blog post and his initial reaction to criticism to utterly missing the larger point and focusing on “lessons” from the resulting kerfuffle as an example of how not to do social media, both as an institution and a physician.

I, of course, took the position that an antivaccine rant from the Medical Director of The Cleveland Clinic Wellness Institute should come as no surprise for a simple reason. When an institution embraces magical thinking in the form of quackademic medicine, as The Cleveland Clinic has for the last decade at least, eventually that magical thinking will manifest itself in ways that blissfully oblivious shruggies who view the woo at “wellness institutes” as harmless herbal medicine don’t expect but are entirely predictable to those of us who have been paying attention. When you “integrate” alternative medicine modalities like traditional Chinese medicine, chiropractic, naturopathy, and reiki into real medicine, the affinity for antivaccine views in those forms of pseudomedicine will infect other areas, and you shouldn’t be surprised that many of your “integrative medicine” practitioners will adhere to varying degrees of antivaccine belief.

Indeed, as of this writing, only two mainstream medical journalists, Casey Ross and Eric Boodman of STAT News, have stepped back from the controversy and seen the bigger picture that I’ve been trying to communicate, both here and at my not-so-super-secret other blog. Their article yesterday, Anti-vaccine rant exposes conflict over hospitals’ embrace of alternative medicine is the only article I’ve seen thus far that more or less “gets it,” asking:

But those reactions will not entirely contain the damage caused by the rant, which has already been picked up by anti-vaccine organizations, or address a more fundamental question: Why do hospitals that espouse evidence-based medical care operate alternative medicine institutes that offer treatments with little foundation in science?

And trying to answer the question, quoting Dr. Paul Offit:

Dr. Paul Offit, a professor of pediatrics and director of the vaccination education center at the Children’s Hospital of Philadelphia, said doctors in integrative medicine institutes sometimes “cross the line into this fuzzy, metaphysical thinking, which is what [Neides] did.”

He said Neides displayed a total lack of knowledge about the preservatives and activating agents used in vaccines, and did not even properly distinguish between them in his column. “It’s the usual bull[expletive],” he said, “which is to say that everything with a chemical name is bad for you.”

Offit noted that his own hospital has a division of integrative and holistic medicine. “I too fight this fight internally,” he said. “We all do. Harvard does. Yale does. It’s not uncommon to have this, and the reason is that hospitals cater to a marketplace, and there is a market out there for this kind of medicine.”

I am very fortunate in that the academic medical center for which I work has very little of this “integrative medicine” nonsense. Certainly, it has far less than Harvard, Yale, Stanford, and, yes, The Cleveland Clinic, institutions, that, truth be told, tend to be more highly regarded. For that I am grateful. I am also vigilant, because, to be honest, if anything I’m surprised that there isn’t more or that there hasn’t been a push to bring in more. That’s not to say it’s nonexistent. The medical school teaches some “integrative medicine,” but, then, it has no choice, as the body that certifies medical schools now requires it. Be that as it may, seeing how much woo has infiltrated Yale, I don’t know how, for instance, Steve Novella puts up with it, given that Yale is also the home of David Katz, and his “more fluid” approach to evidence.

Ross and Boodman even note the conflict by pointing out something I hadn’t noticed before. Did you know that the Cleveland Clinic Wellness Institute has a store? I didn’t, but I do now. It sells the usual “wellness” stuff, like exercise plans, mugs, recipe books, Fitbits, makeup and beauty products, and the like, but it sells more than that. For example, it sells something called the BodyAnew 30 Day Detox Box, which is described thusly:

From the Manufacturer… Homeopathic Remedy This product is a kit that contains:

• BodyAnew Fatigue™ Alertness Aid Oral Drops
• BodyAnew Purity™ Urinary Pain Relief Oral Drops
• BodyAnew Rejuveo™ Digestive Discomfort Oral Drops

Relief doesn’t need to come with frequent side effects which can be bothersome or even serious. The healthy way to feel better is to strengthen your body’s own natural defenses. Heel uses ingredients found in the natural world, so you can feel better about feeling better.

Yes, the Cleveland Clinic is selling a homeopathic remedy, containing remedies like Aranea diadema 6X, Calcarea phosphorica 12X, *Equisetum hyemale 4X, Ferrum iodatum 12X, *Fumaria officinalis 4X, *Gentiana lutea 5X, *Geranium robertianum 4X, Levothyroxine 12X, *Myosotis arvensis 3X, Natrum sulphuricum 4X, *Nasturtium aquaticum 4X, *Pinus sylvestris 4X, *Sarsaparilla 6X, *Scrophularia nodosa 3X, *Teucrium scorodonia 3X, *Veronica officinalis 3X, among others. Of course, these are “weak” homeopathic remedies as homeopathic remedies go, given that they are not very highly diluted, but they’re still homeopathy. They’re still quackery.

The Cleveland Clinic Wellness Store also sells vitamins, Metagenics products, orthomolecular products, fish oil supplements, curcumin supplements, essential oils, digestive enzymes, melatonin, resveratrol, antioxidants, aromatherapy, and a wide variety of herbal remedies.

So clearly, woo is a profit center at The Cleveland Clinic.

I suppose this shouldn’t have come as a surprise. If anything, I blame myself for never having noticed the Clinic’s Wellness Store before. After all, I have documented on numerous occasions just how far down the rabbit hole of quackademic medicine The Cleveland Clinic has gone, as you can find out by simply searching for “Cleveland Clinic” on this blog. Basically, The Cleveland Clinic is a foremost center of quackademic medicine, defined as the adoption and study of medical quackery as though it were real medicine, in the US. Its Wellness Center and Tonya I. Edwards Center for Integrative Medicine are packed with woo, and, contrary to the defense of Dr. Delos Cosgrove, the president and CEO of The Cleveland Clinic as being “a very big proponent of vaccination,” apparently Dr. Cosgrove wasn’t so strong in his beliefs that any of this quackery bothered him.

Certainly, as I documented yesterday, it wasn’t enough to prevent him from recruiting functional medicine quack Dr. Mark Hyman to open the Clinic’s Center for Functional Medicine. There’s even a functional medicine store linked to at the Center, although it’s not Cleveland Clinic-branded. (I’m sure the Clinic gets a cut, though.) This store sells more quackery than the Cleveland Clinic Wellness Store, including 10-day detox kits, immune and inflammatory balance products, detoxification support, and more. I didn’t examine the products in detail because the shop makes you log in before you can see any of the products, and I wasn’t about to create a new account just to be able to see what Mark Hyman is selling.

Of course, integrative medicine practitioners were quick to invoke the “no true Scotsman” fallacy:

Plenty of physicians in the integrative medicine community disagree vehemently with Neides’ questionable views on vaccines.

“There’s no one that I know in integrative medicine who would say you should use an alternative approach to preventing communicable diseases in children,” said Dr. Greg Fricchione, the director of Massachusetts General Hospital’s Benson-Henry Institute for Mind-Body Medicine, who added that his daughter is the medical director for immunizations for the city of Chicago.

The Cleveland Clinic Wellness Institute is well-regarded, he said, but he did not worry that Neides’s comments will affect the credibility of integrative medicine as a whole.

“This is one guy, and I’m not sure of what his motivation was,” Fricchione told STAT. “I don’t think it will impair our ability to continue to provide integrated approaches, whole-person approaches, to health care … and I don’t think it will impair our ability to do the best basic and clinical research in integrative medicine.”

Let’s just put it this way, just because Dr. Fricchione claims never to have met an integrative medicine practitioner who is antivaccine doesn’t mean that there isn’t a high prevalence of antivaccine beliefs in integrative medicine. For one thing, he’s at Massachusetts General, which is the very epitome of the ivory tower. I’d be willing to bet that he’s just oblivious, working as he does in his own little bubble. More importantly, he runs a “mind-body” medicine center. Supplements are generally not part of this sort of medicine, and his center’s website doesn’t indicate that it is an exception.

The bottom line, of coures, is that The Cleveland Clinic threw Dr. Neides under the bus, portraying him as, in essence, having “gone rogue” and publishing a blog featuring his affiliation with The Cleveland Clinic, complete with official logo. However, it’s now clear that those initial disavowals were a bit—shall we say?—disingenuous, as evidenced by a story published in Cleveland.com in which Chris Quinn, Vice President of Content, explains how Dr. Neides came to be blogging for Cleveland.com in the first place:

In January 2014, Bridget Peterlin, then manager of public relations for the Clinic’s Wellness Institute, sent me a note asking whether I’d be interested in a column from Neides, the institute’s new director. Neides wanted to write about wellness for the weekly Sun newspapers. Peterlin included a sample column, about the benefits of eating nuts.

We welcome high-quality content for cleveland.com and the Suns, and this column had the benefit of being free. We discussed a title, came up with “Words on Wellness” and set up Neides as a trusted user on the system that feeds content to our website. That gave him the ability to publish columns directly.

Neides did not publish his columns himself, however. The Clinic’s corporate communications staff handled that, using the account we had set up for him. I do not know if the corporate communications staff edited or revised Neides’ columns before publishing them.

You read that right. The Clinic’s corporate communications staff knew what Dr. Neides was doing and actually published his columns for him, and no one at Cleveland.com edits or approves Dr. Neides’ column. What does happen is that Bob Smith in The Cleveland Clinic’s Corporate Communications office, who is a former Plain Dealer reporter, normally sends an email to Linda Kinsey, the editor of the Sun newspapers, to alert her. According to Quinn, Kinsey would often take a look at the column but “never found anything objectionable.” Quinn then explains:

But Smith didn’t send an alert after the column was published Friday. The column is published in the Lyndhurst-South Euclid page of cleveland.com and copied to other community pages. Without an alert from Smith, Kinsey did not know it was there.

If we had noticed the column soon after it was published, I’d like to think we would have had a conversation about it, both internally and with the Clinic. Possibly, before the thing caught widescale attention, we would have unpublished it and sought revisions. That’s hindsight, though, so I can’t say for sure.

There’s definitely more than a whiff of Mr. Quinn covering his posterior, particularly in light of the fact that the column mysteriously disappeared for a few hours on Sunday. Quinn explains:

Around 4:30 p.m. Sunday, I received an email from a reader expressing outrage about the removal of the Neides column from our site. I was surprised by the email, as nothing should be deleted from our site without my approval, and we very rarely remove articles and columns from our site and do so only with much deliberation. We own the rights to everything published on our site, with rare exceptions.

I checked, and the column was not just unpublished, it was entirely gone from our system.

I sent a note to the reader to thank him for the alert, and we set about restoring the column, and the many comments associated with it. We found it in an archive, and within an hour or so, we republished it.

Upon review and after consultation with the Clinic, we learned that Smith was the one who deleted it. As that violates our policy, we have removed the access of Neides and the Clinic staff to the system that feeds content to our site.

So it was The Cleveland Clinic’s communications office, specifically Bob Smith, who removed the post. Now here’s the part I like the best:

Why is the column staying on the site even though the Clinic has disavowed it and Neides apologized for it?

This column has become the topic of a widespread conversation. At cleveland.com, we strive to be the center of conversation, so we are loath to remove something that has become central to a debate.

As I said, if we had learned that Neides was pushing discredited anti-vaccination arguments before the column had become part of a bigger conversation, we might have asked him or the Clinic for revisions. By the time we knew of it, the conversation was raging.

In other words, Cleveland.com loves the traffic the post is getting. That’s what “striving to be the center of conversation” means here. It’s getting a lot of clicks and its leadership doesn’t want to remove the source of those clicks!

So what we have is a situation in which The Cleveland Clinic published Dr. Neides’ blog post with the full knowledge of its communications office of the content of each one. For whatever reason, last week Dr. Neides felt “inspired” to write a well-nigh incoherent antivaccine rant more suitable for NaturalNews.com or Age of Autism than even for Cleveland.com. True, previous columns had contained less—shall we say?—intense rants against GMOs and glyphosate, but a lot of the previous columns had also been fairly benign bits of medical advice regarding eating healthy and exercising. For whatever reason, Dr. Neides’ column didn’t raise any red flags with Bob Smith—or anyone else—until after it had been published and gone viral.

You can look at this as cluelessness on Smith’s part, but I tend to think it reflects just how much a culture of accepting quackery has taken hold in the Clinic, such that even an antivaccine rant like Dr. Neides’ didn’t raise an eyebrow. It also belies the Clinic’s later claims about how pro-vaccine it is, because if that were the case it would have communication policies in place that would never have let Dr. Neides’ article get past Smith.

This whole debacle was a disaster for The Cleveland Clinic, but it was also very harmful for vaccine advocates in general. A major player at a major academic medical center just created a national news story by regurgitating the worst of the worst antivaccine lies. Let’s just put it this way, when the antivaccine crank blog Age of Autism defends you, you’ve screwed up bigtime and potentially done damage to public health. Worse, I can see where this story is going, because, as Elton John put it, I’ve Seen That Movie Too. I can see the evolving narrative, because that, too, is entirely predictable. If Dr. Niedes is fired or strongly disciplined, antivaccine cranks will portray him as being a martyr “persecuted” for speaking the “truth.” (I’m surprised Mike Adams hasn’t done this already. Maybe he’s waiting to find out whether Neides is fired or not.) Antivaccine cranks will point to his story to show that real academic doctors share their views and that The Man can’t stand dissent. It’s coming. Be prepared.

And never forget: When you let quackery in, you can’t control how far it will spread or what it will infect. The Cleveland Clinic would do well to learn from this disaster. I’m also hoping that this is the wakeup call needed to shine a light on quackademic medicine centers at otherwise respectable academic medical centers like The Cleveland Clinic.