What makes a physician become an antivaxer? [Respectful Insolence]

Being a surgeon and physician, I’ve always been puzzled at how my fellow physicians and surgeons can become ensnared by pseudoscience and quackery to the point where they become proponents of various forms of irrational thinking. Examining “docs gone bad” has been an intermittent recurring theme of this blog going all the way back to at least 2005. Leaving aside obvious quacks, such as some of the cancer quacks I’ve discussed over the years, I’ve discussed a number of doctors who don’t accept the validity of evolution, the most commonly discussed being Dr. Michael Egnor, the creationist neurosurgeon who has laid down some astoundingly ignorant nonsense about evolution while trying to refute it. Of course, it can be even worse. Dr. Egnor was known for advocating the “intelligent design” flavor of evolution denialism (or, as I like to call it, creationism). That’s a form of creationism that concedes, at least, that the earth is very old. More disturbing was the time I encountered a medical student who was a young earth creationist. That was 11 years ago, which means that this young earth creationist is now almost certainly a fully trained physician, having finished medical school and residency—and possibly even subspecialist training. How a physician can believe that the earth is only 6,000 years old and that all creatures were placed on earth in their present form then is beyond me. Indeed, so frustrated do such docs make me that for a while I had a bit of a shtick in which I put a paper bag over my head in shame. That bag later turned to a Doctor Doom mask because the stupid became so thick that a paper bag wasn’t enough.

All of this is just a say of first showing how physicians can be as irrational as any other human being as a means of getting to the main thing I want to discuss, which is my continued bewilderment and irritation how physicians can become antivaccine. The list of antivaccine physicians is long and shameful, including, for example, Dr. Suzanne Humphries, “Dr. Bob” Sears, Dr. Mark Geier, Dr. Mayer Eisenstein, Dr. Jeff Bradstreet, and, of course, Dr. Andrew Wakefield, among all too many others. (And don’t go on about how Wakefield isn’t a doctor because he’s had his UK medical license stripped; he still has the degree, and that makes him a doctor, albeit a delicensed one. That’s a pet peeve of mine.) Then there are what I like to call “antivaccine-sympathetic” doctors, doctors who might not be full-on antivaccine but who pander to the antivaccine fringe and express beliefs bordering on antivaccine, if not outright antivaccine. Dr. Jay Gordon is a good example of this latter type of physician.

What’s always interested me about antivaccine and antivaccine-sympathetic doctors is how they got that way. How did they come to abandon what they were taught in science classes and in medical school to come to conclusions about vaccines that are not just contradicted but very strongly contradicted by science. I can sort of understand doctors falling for creationist pseudoscience. As much as I might wish it were otherwise, evolution is not an emphasized topic in medical school, and it’s quite possible to become a physician without knowing much more about evolution than would be taught in a 100-level biology class. Vaccines, however, are another matter. Vaccines only represent the most successful public health intervention in the history of medicine, an intervention that has arguably prevented more deaths than every other intervention combined. The evidence is overwhelming that they do not cause autism, sudden infant death syndrome, autoimmune diseases, or any of the other conditions that antivaxers blame on vaccines.

So it was with some interest that I encountered Dr. Douglas Mackenzie, a plastic surgeon who has aligned himself with antivaxers, so much so that he’s done video interviews for the antivaccine propaganda film VAXXED in which he pontificates about how physicians are “ignorant” about vaccines. (Time to get the paper bag out again.) For example, here is an appearance he made in February:

And here is a more recent appearance, which is of more interest to me because he basically tells his “conversion story” (as I like to call stories about how people embrace pseudoscience, given the religion-like character of many of such stories):

Before I discuss Mackenzie’s “conversion story,” here’s a bit about him now. He describes himself thusly on the most Orwellian-named Physicians for Informed Consent website:

Dr. Douglas J. Mackenzie graduated from Johns Hopkins University School of Medicine in 1989, and completed a general surgery residency at Cedars-Sinai Medical Center in 1994. He received his plastic surgery training in New York City at New York Hospital/Cornell University Medical Center, and then attended Portland’s Oregon Health Sciences University for a hand surgery fellowship. After completion of his training, he stayed on staff as Assistant Professor in the division of Plastic and Reconstructive Surgery at Oregon Health Sciences University. In addition to his busy clinical practice, he was active in teaching plastic surgery residents, conducting clinical and basic science research, and co-directed the hand surgery fellowship.

Dr. Mackenzie is a member of several societies including the American Society of Plastic Surgeons, as well as the American Society for Aesthetic Plastic Surgery. Dr. Mackenzie participates in the American Board of Medical Specialties Maintenance of Certification in Plastic Surgery program. Additionally, he was named to U.S. News and World Report’s Top Plastic Surgeons.

It turns out that Mackenzie is not only the treasurer of the group, but a founding member. In fact, the board and founding members of this antivaccine group include another bunch of physicians who are antivaccine. There he lays down nonsense like this:

A few years ago I began to grow curious about the issue of vaccine safety when I noticed the degree of vitriol that the topic would trigger in many physicians. In addition, doctors never seemed to be able to back up their claims of vaccines being universally safe and effective. One of the first books I read on the subject was Dr. Suzanne Humphries and Roman Bystrianyk’s book, Dissolving Illusions. I was stunned to learn that death and morbidity from vaccine preventable infectious diseases (and the ones for which there were no vaccines as well) plummeted prior to the advent of their respective vaccination programs. Unfortunately, I also found that so many of the vaunted studies that underpin mandatory vaccination legislation are deeply flawed or even fraudulent.

Let’s just put it this way. If you can take anything Dr. Humphries writes about vaccines seriously, you have a serious blind spot, as well as a hole in your critical thinking abilities that you could pilot an aircraft carrier through. This is a woman who routinely describes vaccines as “disease matter” while spewing the most easily refuted pseudoscience about vaccines on a regular basis. Clearly, Dr. Mackenzie has that blind spot, which allows him to provide misinformation like this to antivaxers:

…I think it’s, it’s more that physicians are just simply, they they’ve been brainwashed from the first day of medical school and It’s just that they don’t get the alternative views and they don’t read the huge amount of science that supports the dangers and risk of vaccines and what’s in the vaccines. They just, they just don’t know about this stuff . . . or they’ll, they’ll quote, they’ll just quote the AAP guidelines, or they’ll quote the CDC, or they’ll quote Paul Offit and they’re not doing their own reading or their own analysis of these things . . .

I have to wonder if Dr. Mackenzie is a member of the Association of American Physicians and Surgeons (AAPS), the John Birch Society disguised as a medical professional society that worships being a “maverick” above all and absolutely despises anything that resembles “going along with the herd.” Not surprisingly to the AAPS, part of “not going along with the herd” often includes buying wholesale into antivaccine pseudoscience. Certainly contemptuously describing other physicians as “brainwashed” because they accept that vaccines are safe and effective (and don’t cause autism) is very AAPS-like.

In any case, in the video above describing how he supposedly “weighed both sides” and became an antivaxer because he thought the evidence supports that position, Dr. Mackenzie credulously repeats a number of antivaccine myths, such as the claim that unvaccinated children do not get autism and that there is virtually no autism among the Amish, who don’t vaccinated, the latter of which is a myth created by the late Dan Olmsted. (There is, and the Amish do vaccinate.)

It gets even worse, though. Andrew Wakefield was someone who influenced Mackenzie to become antivaccine. I find it very telling that one of the first things Mackenzie mentions is how the media was “all in a froth” about Wakefield’s claims, which makes me think that what made Wakefield appealing to Mackenzie was that he, too, wasn’t “following the herd.” So Mackenzie read Wakefield’s book (I assume it was Callous Disregard), describing it as “kind of when the lightbulb went off.” This led him down the rabbit hole to reading Suzanne Humphries’ book and its revisionist history.

In fairness, he also says that he read Paul Offit’s books, Seth Mnookin’s books, and blogs such as Science-Based Medicine, leading him to say that he “knows both sides” and that he “doesn’t have a dog in this hunt.” He paints himself as being open-minded, with no ax to grind, but it’s obvious from his statements that he is open-minded to the point of his brain falling out. For instance, he castigates the “bad epidemiology” out there supporting vaccine safety and efficacy. Is he an epidemiologist? How much epidemiology has he studied? He’s a plastic surgeon, and I can tell you that few are the plastic surgeons who have much of a background in epidemiology. Certainly I can’t find much evidence that Mackenzie has been exposed to more than the very, very basics. Near the end, he also pontificates about law, and it’s clear that he doesn’t know what he’s talking about with respect to law, either.

This leads him to repeat yet again his oft-repeated charge that physicians are “brainwashed from the first day of medical school,” while he himself throws around terms like “healthy user bias” while clearly not knowing what those terms mean or how they apply to the epidemiological studies of MMR that he criticizes. Particularly embarrassing is how he has no clue about the rationale for the birth dose of the hepatitis B vaccine. No, wait. Even more embarrassing is how he doesn’t even know that it’s not nearly as easy as he thinks it is to do a “vaccinated/unvaccinated” study, and he doesn’t seem to realize that it’s a myth that such studies don’t exist. (Hint: They tend to show no health differences between vaccinated and unvaccinated children—or, in one case, that vaccinated children have a lower risk of SIDS.) Not surprisingly, Mackenzie is also into conspiracy theories. He buys into the “CDC whistleblower” conspiracy theory and spends a fair amount of time castigating conflicts of interest at the CDC. It’s all basically the usual, run-of-the-mill antivaccine rhetoric.

Reading Dr. Mackenzie’s writings and watching him in action in these videos, what I see is a massive case of the Dunning-Kruger effect resulting in the utter arrogance of ignorance. I’ve discussed this more times than I can remember over the years, but physicians in particular seem particularly prone to the Dunning-Kruger effect, which is the inability to recognize one’s own ignorance and shortcomings in a subject and subsequent overconfidence about one’s beliefs about an issue. Worse, although I don’t have any objective evidence to back up this observation, my impression is that surgeons tend to be prone to the Dunning-Kruger effect than the average physician because the personality type attracted to surgery (action-oriented, self-confident in one’s abilities) is the perfect personality type to be prone to Dunning-Kruger. (As a surgeon, I’d love to be proven wrong about this, but I suspect that I won’t be.)

Think of it this way in Mackenzie’s case. He’s a plastic surgeon. He has little or no expertise in immunology, epidemiology, statistics, autism, neurobiology, or other relevant sciences to vaccines. His practice consists mainly of cosmetic surgery. He is not a primary care doctor; he doesn’t do family practice. Yet he feels confident enough to reject the scientific consensus based on “doing his own research” (four of the most dangerous words in the medical lexicon, after “in my experience”) and to come to the conclusion that his fellow physicians have been “brainwashed” since day one of medical school. He’s basically denigrating his professional colleagues as mindless drones who just accept and do what they’re told, while portraying himself as being so much better than that. That’s what it really boils down to. Those are the personality traits common in doctors that lead them to be seduced by antivaccine nonsense, just as they make physicians prone to creationism, climate science denialism, and a wide variety of other antiscience beliefs. Dr. Mackenzie might be a perfectly competent plastic surgeon—an excellent one, even—but his knowledge of vaccines, immunology, and autism is superficial in the extreme.

Sadly, he doesn’t recognize that. Even more sadly, there are a large number of physicians like Dr. Mackenzie.