Hotez v RFK Jr: Showdown in the Vax Corral?

The latest Joe Rogan Experience-inspired vaccine brouhaha has a few lessons for sensible people.

I initially found tiresome the dust-up over calls for bow-tied vaccinologist Peter Hotez and RFK Jr. to “debate” over the latter’s claims about vaccines.

I made myself three promises:

I will not write a piece about the Hotez-RFK Jr. mess.

I will not write a piece about the Hotez-RFK Jr. mess.

I will not write a piece about the Hotez-RFK Jr. mess.

Then a college buddy texted me, “Aren’t you going to write about the Hotez-RFK Jr. mess?” I thought hard, clearly, and deeply for 20 seconds.

Yes, I will write a piece about the Hotez-RFK Jr. mess.

Part of the reason is that, if I don’t, I will have to return to the magnum opus I am preparing on the HPV vaccines, a subject near and dear to my heart. (Read: it has gotten out of hand.) Writing about anything that spins out of a Joe Rogan podcast is guaranteed to keep things on the lighter side. That said, unintentional comedy or not, there are some serious lessons in this exchange, and they become increasingly more important in our fractured society in which facts have become shape-shifting cannonballs to fire at the “other” side. We still need to know who is trying to tell the truth.

In the case of RFK Jr., the assessment does not take long. Not 3-hours-of-a-Joe-Rogan-podcast-long, in any case.

I offer the Twitter thread of Tracy Beth Høeg, someone has earned the scorn of many in the public health community during the Covid-19 pandemic for her questioning of the status quo when it came to things like school closures and vaccine mandates. I consider her to be about as close to center as one can get when it comes to a polarizing figure like RFK Jr., given that she works with and speaks highly of Florida’s Surgeon General, Dr. Joseph Ladapo, who asked RFK Jr. to write the foreward to his book.

She made it an hour, which is perhaps an accomplishment of its own right.

Scoring: point to RFK Jr. for attributing higher mortality to infants in Africa receiving the DTP (Diptheria-Tetanus-Pertussis) vaccine no longer used in the U.S. and Europe; this is a genuine concern arising from multiple studies, including a compelling (albeit observational) study finding a 5-10X increased mortality rate among infants in Guinea-Bissau vaccinated with DTP.

Point off from RFK Jr. for understating the overall effect of vaccines on improving mortality based on the work he cited. Another point off in discussing a theoretical link between neonatal vaccination for Hepatitis B and autism for making the strange claim that a relative risk of two or more is evidence of causation — that one is simply bizarre — although I grant that had he just stuck with the issue at hand, there have been at least two observational studies along those lines, even though I find them unconvincing. Another point off for mentioning a study he claimed showed evidence for vaccines causing autism, despite the authors of the study clearly stating quite the opposite. Yet another point down for still insisting on the connection between the MMR vaccine and autism disastrously promoted by Andrew Wakefield, despite study after study convincingly showing no evidence for this theory.

OK, so RFK Jr. is not scoring very well as a truth-speaker, even in the eyes of a fairly sympathetic judge. But I really think it’s unnecessary to keep score. He gives himself away! Much like a sports aficionado will never take someone seriously who answers the question, “What’s the score?” in the form of “Oh, it’s 3 to 10” (non-sports-fans: at least here in the U.S. of A., we always give the score with the higher number first!), anyone self-identifying as even a half-hearted scientist has a sort of unconscious bar which disqualifies other people from being taken seriously.

Now, I don’t say this to sound like a high-brow physician. When my financier patients hilariously mispronounce a medication name, I recall the very recent occasion on which I pointed out to my financier friend how the website I found showing projected mortgage rates tells me they won’t come down for exactly two years. Right - most of us sound ignorant if we say enough things about subjects outside our area of expertise. HOWEVER - if I write books, head up an influential organization, and appear on famous podcasts discussing an area outside my area of expertise, I damn well better have my facts straight. In the world of science, it’s okay to muff a statistic or two, or flub the occasional calculation, but to make an absolutely brazen claim, it’s essential to be able to back up that claim. If, on the other hand, said claim is patently absurd and indefensible, there is no second chance — your voice gets tuned out, forever. Irrational and indefensible beliefs don’t mesh well with science.

RFK Jr’s statement about vaccines lacking randomized controlled trials is just such a thing. Here is Dr. Høeg’s tweet:

It is far too meek an objection. This is an absurd claim! For starters, perhaps he has already forgotten the recent Covid-19 vaccine trials, almost all of which featured a saline placebo control. Yes, there is the above example of rotavirus, too. The Salk polio vaccine was famously, and fascinatingly, tested in part against a saline control group. The Shingrix shingles vaccine had a saline placebo arm. So did an influenza vaccine trial in infants. Ditto one of the HPV vaccine trials.

It’s a fair criticism of many vaccine trials that they opt to use an “active” placebo, like an adjuvant or existing vaccine. The practice is justifiable — the best placebo is hard to tell apart from the active drug, and saline tends not to cause the local reactions of an adjuvant or vaccine. I happen to disagree with the use of such placebos, though, because they clearly lead to a pharma-friendlier tolerability profile; and, in theory, could hide a safety signal. That would be a legitimate point for RFK Jr. to posit: “many vaccine trials fail to use a truly inert placebo.” OK. But that is absolutely not his claim here. He is clearly stating that none of the childhood vaccines have ever been subject to a placebo controlled study. I had to dig up the transcripts to convince myself he really said something so asinine, but here they are:

There are so many levels of bizarre to this whole outburst — I particularly appreciate the image of Tony Fauci with a stack of manila files on his lap, struggling to find the one which lists the vaccine trials with a control arm! Given that there are, in fact, many examples that can easily be found and verified with an hour or two of free time and a computer with internet access, either RFK Jr. has a tenuous grip on reality leading to spinning tales like the one he shared above, or he is a liar, or perhaps a bit of both.

In either case: this is not the guy anyone should be asked to debate. Not Peter Hotez, Saint Peter, or Pete Rose. Why debate someone who will simply make things up? Someone like RFK Jr. merits refutation, and this can be done without his presence; he does not deserve an audience while in his lawyerly fashion he diverts, distracts, and discredits the efforts of a good-faith speaker.

To return to our sports analogy, we asked RFK Jr. what the score of the Ravens-Steelers game was, and he answered, “3 to 10.” It’s okay. Not everyone has to be a football expert. But I am sure not going to ask him what he thinks of the Ravens’ plan to restructure their defensive secondary.

Now, in the time that has elapsed since I started writing this post, I have been rather struck by the amount of commentary this whole kerfuffle has engendered. The narratives tends to run along either of two predictable lines: “Good for Peter Hotez for standing his ground instead of debating this nutjob!” or “We shouldn’t diminish RFK Jr. and his ideas, palatable or not.”

In the latter category was a piece promoted by Bari Weiss in her The Free Press, written by Dr. Vinay Prasad, someone with whom I usually agree, especially when he is poking holes in poor study designs and intellectually sloppy public health policies. However, here he bends over backwards to afford RFK Jr. the benefit of the doubt of a serious response. By my count, he opens with 10 paragraphs in support of RFK Jr.’s positions (i.e., regarding regulatory capture by Big Pharma, certain risks of vaccines like myocarditis, etc.), followed by 9 paragraphs criticizing RFK Jr.’s less scientific viewpoints on things like the link between childhood vaccine and autism and the value of ivermectin in Covid-19. Prasad’s point is that RFK Jr. is an influential voice who is worthy of engagement rather than scorn.

To return to sports analogies, this is like writing an essay on the now-former owner of the Washington Redskins/Football Team/Commanders, Dan Snyder, with a list of some of his better draft picks (hey, even RGIII looked good for a year) and coaching hires, admission of a fairly poor won-loss record and some workplace indiscretions, and then a mention that he was unpopular in Washington. That is not a reasonable story about Dan Snyder! The only Dan Snyder story that is honest to tell has to lay out, front and center, that he is regarded as one of the worst owners in the history of professional sports in the U.S., and that there is not a Washington football fan alive who professes anything but hatred towards the man. Anything less pointed gives the man far too much credit.

As a political candidate, I don’t evaluate RFK Jr.’s merits; I expect politicians to lie. However, as a voice in the national conversation on vaccines, he does not deserve the stage. To that end, if Joe Rogan wished to be a responsible citizen, he should bolster his homework on guests, or have a real-time fact checker with in-field expertise for certain guests.

I don’t mean to imply that “certain” only means “anti-establishment.” Dr Sanjay Gupta was repeatedly misleading in his 2021 Joe Rogan Experience appearance discussing post-vaccine myocarditis — I think from poor grasp of the subject matter rather than deliberate intent to deceive — but it left Rogan stumbling and confused. If you have a massive platform and want to discuss personal decisions which literally can lead to life and death: do it professionally. Prepare. Or get help.

As to all this debate over whether scientists should be debating lawyers on podcasts, I think enough has been said this past week. A “debate” between ideologues is a performance. If improving the public’s understanding of complex issues is really the goal, find guests with genuine expertise and a track record of speaking truth and ask them hard questions. Genuinely debatable questions remain about our vaccine program in this country, from a few vaccines with lingering safety concerns, to the appropriateness of requiring vaccines which don’t bring about herd immunity, to the best ways to design studies to show efficacy. I’d devote a few hours to Spotify to hear Rogan grill someone truly knowledgeable about vaccines, particularly if that person demonstrated a commitment to understanding science over touting their ideology.

If by some miracle of the modern age, Joe Rogan can find two people like that who have differing opinions — sure, bring them both on. Ask them the same hard questions. Call it a “debate.”

But unless both people are committed to speaking the truth and citing their references, please don’t bother. With the political debate season for presidential candidates mere months away, we don’t need another circus in this country.