Noakes and vaccination: if it quacks like a duck…

On November 29, Professor Tim Noakes was interviewed on the Gareth Cliff Show. Much of the interview focused on his new book, and his reasons for co-writing it (with Marika Sboros). I’ve previously described some of this book’s inaccuracies and falsehoods in respect of its mentions of me, including the assertion that I’m part of some conspiracy against him.

Today, I’d like to briefly focus on a more worrisome theme – vaccine scepticism – that Noakes has tweeted about in the past, and one that he returns to in this interview with Gareth Cliff. The relevant segment’s audio is transcribed below, and embedded at the end of the post. It takes place between 44m07s and 45m37s of the full interview.

The title of this post refers to the “Duck test”, elegantly summarised by Wikipedia as follows:

The duck test is a form of abductive reasoning. This is its usual expression:

If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.

The test implies that a person can identify an unknown subject by observing that subject’s habitual characteristics. It is sometimes used to counter abstruse, or even valid, arguments that something is not what it appears to be.

By the standard of the Duck test, Noakes is at least a vaccine sceptic, but in effect, he functions as a vaccine-denier or an “anti-vaxxer” in using much of the same misinformation they (McCarthy, Kennedy, Carrey, de Niro) do. Because in doing so – even as he asserts that he supports vaccinations – he introduces sufficient qualifications and obfuscations that his pronouncements on the matter could plausibly lead to at least some of his followers choosing to not vaccinate their children.

That choice – to not vaccinate – reliably and demonstrably kills or harms more people than vaccines do, whether or not claims for vaccine safety are exaggerated (and I don’t believe that they are).

So, while the HPCSA hearings against Noakes regarding the infant-feeding tweet were absurd, groundless and a waste of time and money, here we have a legitimate case of a influential figure in public health expressing views that contravene his ethical obligations.

The Interview

Here’s the interview segment, with my comments interspersed.

Gareth Cliff (GC): So, do you believe in vaccination for children?
Tim Noakes (TN): That’s a great question, and the answer is yes, of course I do, if the vaccination has been proven to be safe and effective. And that’s the issue, you see. People… what is (interrupted by GC)
Gareth Cliff (GC): So not like that lunatic Jenny McCarthy, who believes that vaccination results in autism?
TN: But there is evidence for that, you see. But it doesn’t mean that everyone who is vaccinated becomes autistic.

“If the vaccination has been proven to be safe and effective” casts doubt on the fact that the vaccination schedule typically administered has been proven to be safe and effective. Vaccines are an evidence-based medical intervention, even though – as usual – there is debate around what to administer when, as Dr. David Gorski explains at Science-based Medicine.

They are not only safe and effective, they’re an enormously cost-effective way to save lives. Take measles as an example – where according to the World Health Organisation, “measles deaths have decreased by 84% from an estimated 550 100 in 2000 to 89 780 in 2016”.

Why the vaccine-sceptic position is worth exposing as dangerous and unscientific is because we save these lives in part through herd immunity. To eliminate new cases of measles, roughly 95% of children need to be vaccinated – and every non-vaccinated child makes it easier to miss that target.

And, it’s not just about you and your children – some individuals are completely dependent on the protection offered by herd immunity – newborn infants, for example, are too young for many vaccines, and some people are immunodeficient thanks to factors like HIV or chemotherapy. The choice to opt-out, in other words, makes you culpable for causing harms to others.

As for there being evidence that vaccines cause autism, that’s only a claim to take seriously if you count retracted papers (Wakefield, Hooker et al.), discredited authors, and crackpot websites like Natural News as evidence. As Noakes seems to do.

Besides the Wakefield paper, extensively debunked all over the Internet, the Hooker paper that vaccine sceptics cite has numerous methodological flaws, to the extent that the editors of the journal in which it was published expressed “serious concerns about the validity of its conclusions” when retracting it.

There is no disputing the legitimate fears of parents for their children’s safety, and it obviously seems reasonable to them to ascribe their child’s autism to vaccinations. But along with there being no evidence for this notion, autism often develops (or is observably manifest) at roughly the same age as vaccines are administered, so there can be a large measure of confirmation bias at play here also – especially if influential figures like Noakes encourage that.

GC: Because the last thing we want is a whole bunch of Jenny McCarthy’s not vaccinating their children and starting polio again.
TN: No, but but but you have to look into the history you see. And I don’t want to get involved in this debate, but there’s a whole body of evidence…
GC: Okay
TN: … that vaccinations are being over-used and over-prescribed.
GC: But you do believe in vaccination for… I’m trying to clear up a whole lot of things that people have fought with you about before.
TN: Of course. But I would minimise the amount of vaccination you do, because… there’s clear evidence that Thimerosal, which is a… what keeps some of the bacteria… some of the viruses going or ineffective is damaging to your health and the CDC has suppressed information. Do you know that Robert de Niro, who made this film called The Vax or Anti-Vaxx or something, he offered $100 000 to anyone who can prove that vaccination is safe. (Pause) No-one has taken him up on it. There is no evidence that vaccination is safe.

As discussed above, the idea of “over-used” and “over-prescribed” makes no sense here, because we want as many people as possible to be vaccinated. Noakes’s claim that Thimerosal is the problem is, unfortunately, complicated by the fact that it hasn’t been used in childhood vaccines since 2001.

Even when it was used, it was used in the production of vaccines, and then removed, with only trace elements remaining. As for the “CDC suppressing information”, that’s a reference to the “CDC Whistleblower” conspiracy theory, again comprehensively debunked. Myself and others have pointed this out to Noakes repeatedly, but unfortunately, we’ve so far been unable to penetrate his filter bubble.

As for Robert de Niro, his film (it’s titled Vaxxed, and is by Andrew Wakefield) and the $100 000 challenge, it’s easy to win a bet that’s designed to be impossible to lose. You can’t prove that “vaccination is safe”, because that’s an absolutist statement a child would utter, rather than a scientific proposition.

Vaccines are overwhelmingly beneficial to almost all humans, but given that any medication can cause adverse reactions in some humans, de Niro, Wakefield and Noakes can claim a victory. Plus, if you simply ignore the evidence telling you that you’re wrong, you can win via two routes – for example, nobody has yet claimed the prize I’m offering for anyone who can prove that I’m not actually an alien from Mars.

If de Niro cared to weigh the evidence objectively, he’d have paid the money to many, including Daniel Summers of the Washington Post, who provided a good summary of vaccine safety earlier this year. For those curious about Vaxxed, here’s Gorski again, on the lies the movie tells.

There’s plenty of evidence that vaccination is safe, Prof. Noakes, so long as you define “safe” in a sensible manner, rather than “offers a 100% guarantee of zero risk”. Science can’t offer such guarantees, and on that standard, we’d not be able to trust anything to be safe. Meanwhile, we have an enormous preponderance of evidence that vaccines are low-risk and massively beneficial – and that it’s irresponsible to cast doubt on that, as Noakes is doing.

The conversation then moves on to Banting, with Cliff saying “Look I get… again, we can’t be absolute, right? (TN: sure) Would you characterise yourself as an absolutist, now, about the Banting diet?”

Meanwhile, on Twitter, Noakes has been telling people that he can’t share his information about the problems with vaccines publicly, because of the “activists (who have no interest in Truth)”, and how they might call him names. I’d think that getting such an important public health message out would be worth the risk of a little social media mockery, but maybe that’s because I only care about the truth, rather than the Truth.

If any of you request, and receive, this information, please let me know in the comments. But I suspect it will consist of sources he’s linked to previously, like Dr Suzanne Humphries, a source as dishonest as Wakefield and Hooker. Or he’ll point you to the clandestine-but-yet-somehow-very-visible USA programme that pays out for “vaccine damage”, on the very sound reasoning that it’s cheaper to pay people a settlement than waste court time, and money, on litigation that will only serve to drive up the cost of vaccines.

In summary: nothing is risk-free, but vaccines are an overwhelmingly positive health intervention. We all depend on high vaccination rates for herd immunity, and vaccine sceptics undermine that message by giving people “reasons” to decline vaccination for their children.

Because subtle messages are usually lost in short interviews or social media, we need to be unambiguous about the positive value of vaccination, rather than casting doubt on it. Criticising those who express scepticism is not an attempt to silence or censor, but rather to ask Noakes whether “just asking questions” is worth the risk of encouraging irresponsible – and harmful – choices, like opting-out of vaccination.

Also published on Medium.