A co-author of an antivax study attacks Orac for criticizing it. Hilarity ensues [Respectful Insolence]

I wasn’t planning on revisiting this topic, but sometimes a blogger’s gotta do what a blogger’s gotta do. You’ll see what I mean in a minute. But before you do, I’ll just provide a bit of background. Last week, I came across one of those truly awful antivaccine studies that gets the old Insolence flowing, this time a mix of the Respectful and not-so-Respectful. I’m referring, of course, to a paper that I came across as I was spending some time delving into the deeper darker parts of antivaccine social media. It was a study by Antonietta Gatti and Stefano Montanari in the International Journal of Vaccines and Vaccination entitled New Quality-Control Investigations on Vaccines: Micro- and Nanocontamination, which led to an article being circulated in antivaccine circles by the Children’s Medical Safety Research Institute (CMSRI), an group made up mainly of antivaccine cranks, in an article entitled Dirty Vaccines: New Study Reveals Prevalence of Contaminants. Suffice to say, I laid down the not-so-Respectful Insolence that this awful, awful paper deserved, and didn’t plan on revisiting the topic, even though I learned some things about the authors and thought of some additional issues with the study that I hadn’t thought of the first time I discussed it.

Well, leave it to one of the authors to provide me with an opportunity—nay, an obligation—to do each of those things. Let’s just put it this way. One of the authors, Stefano Montanari, is not happy with me. Not at all. Even though his primary language is Italian, that didn’t stop him from trying to rebut my criticisms in two languages in an entry called Sono troppo forti per me. I was amused right from the beginning:

Naively foreign to the subject, the author of the mess begins badly, showing not only that he hasn’t got the faintest notion of what is declared to be actually contained in vaccines but that he ignores even one of the basic principles of classical toxicology: the different pollutants (that the author hastens to define “harmless”) exert a mutually synergistic activity. Well: even the most culturally backward toxicologist knows that in his field hardly ever two plus two equals four but equals very often a higher number. And he knows also that the higher the number of addenda, the farther from the arithmetic sum and the less predictable is the result. When, then, Mr. Orac, whoever is hidden behind the pseudonym, thinks back of Paracelsus, he exhibits without shame his being foreign to the pathologies caused by micro- and nanoparticles.

Ah, yes. That didn’t take long. It always amuses me when I’m attacked because I use a pseudonym, given that my real identity is one of the worst kept “secrets” in the blogosphere. I do admit that, from time to time, I’ve been tempted to drop the ‘nym, but somehow never do. I think it’s just pure cussedness. (Also, I like the Orac ‘nym.) Be that as it may, these days, I like to think of the ‘nym as an intelligence test. If you complain about the ‘nym and are too stupid or lazy to figure out who I really am, you fail.

Be that as it may, I am not unaware of the possibility of “synergistic toxicity.” However, contrary to what Montanari seems to think, it’s not as common a phenomenon. More importantly, if you’re going to invoke “synergistic toxicity” in the context of vaccines, it would behoove you to—oh…I don’t know—actually demonstrate any toxicity first, something Montanari’s paper utterly failed to do.

I also couldn’t help but think that the whole part about “micro- and nanoparticles” was starting to resemble a couple of things. For one, homeopaths like to invoke “nanoparticles” to “explain” how their quackery works. They even mistake low level contamination for something functional. The other thing it reminded me of is a the obsession of a certain pathologist named Sin Lee, who is obsessed about minimal quantities of HPV DNA that he detected in Gardasil using super, super sensitive polymerase chain reaction (PCR) to detect. What Montanari did is similar (finding inconsequential amounts of scary-sounding contaminants) using highly sensitive techniques and then using that finding to spread fear, uncertainty, and doubt. Basically, Montanari’s is yet another variation on the antivaccine theme of claiming that vaccines are loaded with “toxins” that cause all sorts of harm.

Montanari was also rather defensive about having published in a pay-to-publish predatory journal:

Our scam is evident when Orac reveals how, to be able to publish in the infamous newspaper, you pay money. Evidently, Mr. Orac has never published anything. Had he done that, he would know that there is NO international medical journal that does not ask for money for publication, and the figure is higher, the higher the impact factor, i.e. the grotesquely fraudulent index (see televoting) that the journal boasts.

I’d be happy to send Montanari my PubMed list. Yes, I have published. Perhaps not as much as I would have wished by this stage in my career, but it’s not insubstantial. (I actually have a commentary in the New England Journal of Medicine. Perhaps Montanari has heard of it.) Yes, many journals do charge page charges to publish. That’s not what I was talking about. To repeat, the journal in which Gatti and Montanari published their paper is a MedCrave journal, and MedCrave is included on Beall’s List of Predatory Publishers, basically a list of “pay to publish” open access journals who charge significant sums to authors to publish their work but whose editorial oversite and peer review are—shall we say?—lacking. MedCrave, which was founded in 2014, is thought to be a new brand created by the well-established predatory OMICS group publisher. Interestingly, if you Google “MedCrave predatory publisher,” you’ll find a bunch of links denying that MedCrave is a predatory publisher, all with language quirks so similar that it’s pretty obvious that they’re probably coming from the same source.

No, there is a difference between predatory publishers who specialize in publishing low quality papers and charging for the privilege. I suspect Montanari knows that. He’s also wrong that page charges are usually higher, the higher impact the journal.

Montanari then goes on with this hilarious paragraph:

Soon after, here is the confession: Orac knows nothing of microscopy, but he knows that samples should be viewed in a vacuum. If the ‘”expert” had any idea of the type of microscope we use – data, however, reported in the paper – he would not have done such a comic thud. Nor would he tell that we “evaporate” vaccines, because the methodology is quite another. Even if we did, however, that would have nothing to do with the presence of pieces of lead, steel, tungsten or any other element or combination of elements that appear with evidence in the photographed particles. Then, if Mr. Orac had any specific cultural basis, he would know what is the ” protein corona” and would not shoot naive nonsense in this regard. But all this is not enough and he resumes the thesis of the ” homeopathic quantity ” messing with chemical concepts with which, apparently, he is not familiar but which, no doubt, impress the reader he addresses. If I did not know that the thing is useless, I would invite Mr. Orac to study at least the basic principles of nano-toxicology. This for his own good. Anyway, there is no reason to worry: even tap water might contain filth and no one injecting tap water into his veins, which of course falls in Orac’s habits, ever reported any trouble. And what if the pollutants came from the needle used to transfer the vaccine to the microscope? Oh yes: what if it were so? The fact is that the needle we use is obviously the one of the syringe which contains the vaccine. And if it were the cellulose matrix which filters the sample to be dirty? It’s a pity, however, that we, as an obvious practice, regularly check all the steps including the carbon support on which we deposit the sample without ever having found pollutants. More than 40 years spent on research taught us the basics of the trade.

Montanari might forgive me if I was unclear on how he prepared the samples. The Methods section of his paper was absolutely atrocious and abominable. There was insufficient detail to figure out just what Gatti and he did. Now, maybe someone who speaks Italian can tell if the Italian version of Montanari’s post makes sense, because I consider it unfair to mock the incoherence of the above paragraph if it’s just due to his lack of skill with English. In any case, whether due to lack of facility with English or muddled thinking or both, Much of what he’s saying there makes no sense. I’m particularly amused by his concession that he didn’t use any proper controls and his attempt to reflect it back at me with a jaunty, “So what if the contaminants came from the syringe?” The “fact” is that the needle he used is obviously the one that contains the vaccine? OK. But was it a medical grade, sterile syringe, just like the kind used to inject vaccines into babies? I’d bet it wasn’t. Those syringes are usually 0.5 ml or 1 ml and can’t measure finely enough to accurately and reproducibly deposit 20 μl onto the filters.

I could go on, but let’s just recap the various problems with this study. Nowhere do Gatti and Montanari actually measure or report the actual concentration of the metal particles that they found. I was criticized for using what one commenter viewed as too simplistic an approach to likening the concentrations to molarity, but, as I said before, bloody hell. If Gatti and Montanari don’t report the actual concentrations of the “contaminants” that they found, I did the best I could with what I was given. Another problem is that many of the vaccines tested were past their expiration date. Given that vaccines have proteins in them. Over time, proteins in aqueous solution tend to degrade and precipitate out. That’s part of the reason why vaccines have expiration dates. In any case, another problem with the study is that there was no attempt to quantify the “contamination” in any meaningful way that could be compared and independently evaluated, nor is there any statistical analysis. Then, of course, there is the lack of proper controls, both negative and positive. Negative controls would include things like distilled, deionized water treated the same way as the vaccines and phosphate-buffered saline, which is buffer frequently used in vaccines.

Whether or not Montanari and Gatti are experts in “nanotoxicology” or not, it’s clear that Montanari has some serious pseudoscientific leanings. For instance, Gatti is the editor of a bottom-feeding MedCrave journal, Journal of Nanomedicine Research. Particularly amusing to me:

The in-vitro and in-vivo toxicological studies performed later showed controversial results, as they led to opposite results: some scientists (mostly biologists and molecular biologists) believed that nanoparticles are safe since they do not induce an immediate cell death and there is not a clear dose-response answer. Others (mainly bio-engineers, chemists, etc.) replied that they can have a potential to induce biological, maybe pathological, reactions.

Maybe, that’s because biologists and molecular biologists know what is and isn’t important in terms of what can and can’t cause physiologically and biochemically important changes in living systems. And, of course, Gatti and Montanari find nanoparticles everywhere! For example:

Studying a civilian patient died of lymphoma at the hospital of Sarajevo when the Balkan War was already over; we found the deepest and finest contamination of his lymph nodes by 10nm-sized particles of Carbon-Lead-Chlorine-Bromine. Such a small size, morphology (spherical) and chemical composition induced us to hypothesize an exposure to an important source of high-temperature-produced soot.

They’ve also found nanoparticles in the blood of leukemia patients, in clots forming on filters placed in the inferior vena cava, and even bread and biscuits!

It turns out that Gatti and Montanari have their very own electron microscope. From what I can tell using Google Translate on articles written in Italian (always a dicey proposition), it began in 2006 when the University of Modena stopped them from using its electron microscope to study “toxic emissions.” So someone named Beppe Grillo launched , via his blog, a fundraising effort for the purchase of an environmental scanning microscope, and €378,000 was raised to purchase the microscope. Somehow this all went bad, with Montanari now featuring a drawing of Grillo as literally a werewolf. Hilariously, under this photo, there are references further showing that Gatti and Montanari can find nanoparticles everywhere.

In any case, it degenerated into accusations that Gatti and Montanari are using their microscope in much the way that Mike Adams uses his mass spectrometer, to find contaminants in everything and as a side business. This is actually a credible charge, as a glimpse at the Nanodiagnostic, Ltd. website (Gatti and Montanari’s company) shows, particularly a page on pathologies of unknown origin, which speculates that nanoparticles are cause of—you guessed it—pathologies of unknown origin. Gatti and Montanari countercharge that Grillo exploited them for political gain. Apparently lawyer and defamation suits are involved. (Hat tip: herr doktor bimler.)

In any case, Beppe Grillo is the founder of the Italian political party Five Star Movement and is quite the crank himself. He’s an HIV/AIDS denialist, having called AIDS a “hoax,” perpetuated by pharmaceutical companies and is a rabid antivaccine activist. You might remember Paolo Vanoli, as I’ve discussed him before. He has claimed that vaccines can cause homosexuality and is a member of the Five Star Movement.

Not surprisingly, Gatti and Montanari aren’t without a bit of crank tendencies themselves. For instance, they’ve co-authored a book called Vaccini: sì o no? (Vaccines: Yes or No?) In all my years in the biz, I know right away that any book that even askes this question in the title will be full of antivaccine misinformation, and a Google Translation shows that I’m not wrong here. In their book, Gatti and Montanari include analyzes of the content of the 28 vaccines used in Italy , with photos by electron microscopy. Trully, they are a couple of one-note cranks. In the blurb they also purport to discuss correlations between vaccines and autism, the “cover-up” of negative data, “false epidemics,” the “lack of studies with a control group,” and a lot of other antivaccine tropes.

I’d like to conclude by thanking Montanari for giving me the opportunity to revisit their study. They’re into way more pseudoscience than I thought. That’s the problem with dealing with cranks from non-English-speaking countries. If you don’t speak and read the language, it’s pretty hard to learn a lot about them, even with the almighty Google Translate. Thankfully, I was able to find out quite a bit about Antonietta Gatti and Stefano Montanari. They’d be right at home here in the US with Mike Adams and his mass spectrometer.