By Tara Haelle
In a striking display of anti-science fear-mongering, the Cleveland Clinic's Daniel Neides, M.D., medical director and chief operating officer of the Cleveland Clinic Wellness Institute, regurgitated anti-vaccine talking points on a local news site. Right in the middle of flu season, a medical director board-certified in family medicine is using the Cleveland Clinic platform to harmfully spread misinformation about a vaccine that can reduce people’s risk of a life-threatening illness. By the end of his rant, this family doctor has employed a half dozen anti-vaccine arguments that dangerously misinform readers and undermine the credibility of the Cleveland Clinic.
Cleveland Clinic spokeswoman Eileen Sheil wrote in an email, "Cleveland Clinic fully supports vaccinations to protect patients and our employees. The statements made by our physician do not reflect the position of Cleveland Clinic."* This statement echoes a tweet by Cleveland Clinic earlier this evening: "We fully support vaccines to protect patients & employees. Statements made by our physician do not reflect the position of Cleveland Clinic." However, the article, published in a local outlet, uses the Clinic logo.
It’s one thing for major hospital conglomerates to embrace complementary and alternative medicine techniques that have some emerging evidence backing up their potential benefits, such as mindfulness meditation for treating or preventing hypertension, or potential benefits of probiotics. But Neides’s rant—which is basically what his post is—fully embraces factually inaccurate anti-vaccine mythology that I’ve debunked many times before.
Neides starts by telling his readers he “took the advice of the Centers for Disease Control (CDC)—the government—and received a flu shot.” But he immediately clarifies that he chose to get the “preservative-free vaccine, thinking I did not want any thimerasol [sic] (i.e. mercury) that the ‘regular’ flu vaccine contains.” First, there is no “regular” flu vaccine. The flu vaccine is administered in single doses, which does not require a preservative since the dose is disposed of after it’s given, or from a multi-dose vial, which requires use of a preservative to prevent the introduction of bacteria or fungus to the vial between shots.
Neides is correct that thimerosal is the preservative used in these multi-dose vials—but he refers to it as mercury, then asking, “Why would any of us want to be injected with mercury if it can potentially cause harm?” Except, “mercury” is an element that can come as a component in different molecules. The mercury found in certain fish, such as shark, tuna and king mackerel, is organic methylmercury, a known neurotoxin that accumulates in the body and can cause harm if too much is consumed. (Though it’s worth noting that long-term studies from the Seychelles suggest a very high consumption of fish is needed to cause harm.)
Thimerosal, however, breaks down into 49% ethylmercury, larger molecules which exit the body within a week or two and do not cause harm, even when received in multiple vaccines. Before scientists fully understood the safety of thimerosal, it was removed as a standard ingredient in childhood vaccines in 2000. Today, its safety is well-established, and thimerosal-containing vaccines continue to be used in countries that cannot afford single-dose vaccines.
Exactly how safe is a flu shot with thimerosal? So safe that I demanded my local pharmacy give me one while I was pregnant. I wouldn’t dream of getting any substance injected into myself while pregnant that I wasn’t certain was safe for me and my developing fetus (now a healthy 2-year-old).
But Neides then goes a step further, complaining that even the preservative-free flu shot contains—horrors!—formaldehyde. He’s right—it does—and it’s a good thing because it’s formaldehyde that inactivates the flu virus in the vaccine so that it can’t infect and harm you. Neides calls formaldehyde a “preservative” in his post, but formaldehyde isn’t used as a preservative in vaccines—it prevents the flu virus contained in the flu vaccine from being able to replicate in the body. If Neides wants his flu vaccine without formaldehyde, he might as well inject himself with the flu virus and spend two weeks with a fever, chills and body aches, hoping he doesn’t end up hospitalized.
Formaldehyde is a commonly feared chemical that drives chemophobia, but in fact, it’s everywhere: it occurs naturally in fruits and vegetables, with about 2,000 mcg of formaldehyde in an average banana and anywhere from 8,600 to 13,200 mcg in a pear. Yes, we eat fruits and the flu shot is injected—but the human body produces formaldehyde for a variety of functions, such as making amino acids, and has about 2,600 mcg of formaldehyde per liter of blood. The trace amounts in a vaccine wouldn’t even register in the body. And if we’re going to discuss route of exposure for this “known carcinogen,” formaldehyde has only been linked to cancer when inhaled, typically in massive amounts by workers such as funeral industry professionals and factory workers before OSHA set appropriate limits.
Taking another page out of the anti-vaccine playbook, Neides laments that we are “being lined up like cattle and injected with an unsafe product,” using the “cattle” imagery that anti-vaccine advocates are so fond of. In reality, the flu vaccine has been found sufficiently safe in hundreds of studies. In fact, it’s recommended during pregnancy precisely because it is so safe, reduces the risk of miscarriage and reduces the risk of both mom and baby getting the flu.
To be sure, the flu vaccine is not one of our best medical inventions. It is the most flawed of vaccines, largely because the influenza virus is so tricky to protect against, and some years its effectiveness drops below even 20%. Other years, however, it exceeds 60%—cutting risk of the flu by more than half—and regardless of the year, it remains our best tool for reducing hospitalizations and deaths from the flu. Every year, anywhere from 3,000 to 49,000 people die from the flu, and last year, during the 2015-2016 flu season, the vaccine prevented 5.1 million infections, 2.5 million flu-related medical visits, 70,000 flu-related hospitalizations, and 3,000 deaths.
And contrary to what Neides implies, the flu vaccine does not give someone the flu or any other infection. As I’ve written before, some people experience unpleasant but mild side effects. What Neides describes—“in bed feeling miserable and missed two days of work with a terrible cough and body aches”—does sound like an infection. And because it occurred 12 hours after the shot, it was almost certainly a virus picked up well before he got the vaccine since the influenza virus takes longer to incubate before symptoms appear, something a board-certified family medicine doctor should know.
Neides then goes on to indulge in the kind of chemophobia typically seen on anti-science blogs and discredited “natural health news” sites. He calls our environment a “toxic soup” and rants about “over 80,000 chemicals used in various industries country-wide.” Frankly, I’m grateful for all those chemicals since oxygen (O2), water (H2O), caffeine (C8H10N4O2) and chocolate (C7H8N4O2) are among my favorite substances. I’m fond of a bit of sugar (C12H22O11) now and then, and I tend to prefer meals seasoned with an appropriately moderate amount of salt (NaCl).
The food I feed my children and the air I breathe are chock-full of chemicals—if they weren’t, we’d be dead. Rather, we would cease to exist since we are ourselves nothing but walking, talking bags of chemicals. The “20 or 30 ingredients” that Neides complains can’t be pronounced are naturally occurring in bananas and those antioxidant-filled blueberries, too. Not being able to pronounce something doesn’t make it bad or unhealthy; it just makes the person complaining look ignorant. Even certain ingredients often maligned in personal care products are not harmful, as people suspect. (That said, the cosmetics industry has long needed better regulation for use of compounds that can have adverse health effects.)
Neides also calls to mind the wise words of Inigo Montoya in his repetitive use of the word “toxin,” which actually refers to “organic poison made by plants and animals.” I suspect those aren’t the “chemicals” Neides is thinking of. Even so, he raises the specter of “chronic diseases” caused by “toxins” in the environment. Toxic chemicals in the environment such as car exhaust and tobacco smoke can indeed contribute to heart disease, but it’s important to be accurate and precise in trying to warn people about dangers in the environment. Ranting about “toxins” causing ADHD or diabetes lacks evidence and only causes unnecessary fear and stress.
Fortunately, Neides does appear to have a basic understanding of how biology works: he notes, correctly, that the best detoxification methods are our own organs, the liver and kidneys, so it’s a small comfort that he doesn’t promote the pseudoscience of “detoxing” the body.
But it’s at the end that Neides promotes his most harmful anti-vaccine nonsense, pulling out page after page from anti-vaccine books. “Does the vaccine burden—as has been debated for years—cause autism?” he asks. “I don't know and will not debate that here,” he responds—except it doesn’t matter if he “knows.” Science has irrefutably answered that question with a resounding no, and dozens of studies confirm it. Neides then invokes all-caps (we all know how well all-caps indicate evidence-based rational thought) to say he “will stand up and scream that newborns without intact immune systems and detoxification systems are being over-burdened with PRESERVATIVES AND ADJUVANTS IN THE VACCINES.” The evidence refutes his concern.
The concern about “too many” vaccines “too soon” has been shown again and again to be unfounded. The Institute of Medicine’s comprehensive report in 2013 confirmed that the safest, most effective way to protect children from infectious disease is to follow the CDC’s recommended immunization schedule. In fact, delaying or spreading out vaccines is riskier than following the CDC schedule. The use of aluminum in vaccines is safe and actually essential to ensuring vaccines are effective. Other vaccine ingredients pose no threat to children.
Why does Neides not recall fellow students with IEPs for ADHD or autism? Because special education has improved since he was in grade school, as have diagnostics and identification of those who have developmental conditions or other disabilities. The “increase” in autism is actually a result of changes in diagnostic criteria and better identification of those with autism spectrum disorders (which, by the way, are a developmental disability, not a "disease").
Neides wants to know why babies are vaccinated against hepatitis B, a blood-borne disease that can be transmitted in ways aside from sexual contact. Let this naturopathic doctor explain it—yes, even those in naturopathic medicine can appreciate the importance of the hep B vaccine.
It is difficult to overstate the harm Neides is causing with this article full of misinformation. It's deeply concerning that a large medical institution such as the Cleveland Clinic has a doctor in its ranks promoting pseudoscience. I hope that the Cleveland Clinic takes strong action in response to one of their physicians using their platform to mislead patients.
ETA: Cleveland Clinic provide the following updated statement Sunday morning: "Cleveland Clinic is fully committed to evidence-based medicine. Harmful myths and untruths about vaccinations have been scientifically debunked in rigorous ways. We completely support vaccinations to protect people, especially children who are particularly vulnerable. Our physician published his statement without authorization from Cleveland Clinic. His views do not reflect the position of Cleveland Clinic and appropriate disciplinary action will be taken."
In addition, Neides provided a statement: "I apologize and regret publishing a blog that has caused so much concern and confusion for the public and medical community. I fully support vaccinations and my concern was meant to be positive around the safety of them."
I am grateful that Cleveland Clinic is taking this situation seriously. While Neides' statement is also a step in the right direction, I remain concerned about his interaction with patients. His initial statements reflect an extensive and deep inculcation of anti-vaccine views and talking points, not the kind of offhand remarks that come from a person misspeaking or inadvertently misrepresenting a minor point. The attitudes he expressed form over time, run deep and are not easily dismissed or rejected by someone who believes them. A single apology and disavowal does not undo that damage. I remain unconvinced that Neides has the confidence in vaccines' safety and effectiveness that should be expected of a medical professional.
Agency San Francisco
San Francisco, California
Charles L. Berman
Liz Di Bernardo
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