Sanjay Gupta: Fuck No

This one is for Shannon

I’ve gone from a cautious maybe to “fuck no” on the rumored pick of Dr. Sanjay Gupta in the span of 48 hours. To understand why, we need to know two things:  First, the views of other liberals; second, Clever Hans and Autism.

Starting with the former, I’ll quote Jane Hamsher via Firedoglake » In Defense Of the Sanjay Gupta Appointment.

I believe Gupta would perform that task really well, and do a lot to redeem public health issues from the savaging they’ve received from the anti-science crowd for the past 8 years. But if he does nothing more than help keep public opinion about the health care plan favorable long enough for it to pass, he’ll be worth it.

This was part of my cautious optimism.  Gupta could help the Obama administration get real health care reform passed.  This is something the country desperately needs.  For the past 8 years our country has been anti-science.  Bush & Co has even censured Nasa, the former Attorney General and the NOAA.  We need to get to have a more open and honest debate where science isn’t shut out because of twisted ideological views.

But the science needs to be good science.  This is where we met Clever Hans, a horse that was perceptive enough to pick up on the nonverbal cues of his handlers and answer math questions by stomping his hoof.  It turns out that his handlers would unconsciously provide certain clues as to what the proper answer would be.  If the handler didn’t know the answer to the question, then Hans would only determine the correct answer by chance.

I first met the horse who could do simple math in college during one of my psych classes–my experimental design class–where we learned about pitfalls of certain experimental designs.   Blind and double blind experiments are clearly the way to go.

Which leads us to Facilitated communication (FC), a clearly bullshit method of “helping” children with severe developmental disabilities communicate:

From Wikipedia ((I did add the link from the ABA):

Current position statements of certain professional and/or advocacy organizations do not support the use of Facilitated Communication due to their objections that it lacks scientific validity or reliability. These organizations include the American Speech-Language-Hearing Association, Association for Behavioral Analysis (ABA), American Academy of Child and Adolescent Psychiatry, and the American Association on Mental Retardation. ABA calls FC a “discredited technique” and warns that “its use is unwarranted and unethical.

The Surgeon General of the United States needs to be above board and not support pseudoscience such as FC.  Before posting a blog post on CNN, he really should have looked into scientifically based evidence.  Hell, he could have fucking googled it.

This fundamental error makes me question his ability to be a proponent for any evidence based solution to the health care crisis.

If one looks past the FC, we also see that Gupta is a proponent of the “Obesity Epidemic.”  Junkfood Science has (another) fantastic article on Gupta’s views on health and wellness.  Here’s a snippet, regarding Dr. Gupta’s belief on living a longer, healthier life:

His other lessons for living a longer, healthier life, include unorthodox ideas on “healthy” eating and weight management. These include: eat seven colors a day, along with vitamins and fish oil; stay away from fatty meats and processed sugar; focus on water-dense produce and drink water before eating other foods to fill you up so you’ll eat less; eat slow and eat 20% less so you’re always a little hungry; drink antioxidant-rich green tea for benefits that include lowering cholesterol, improving bone density, anti-inflammatory, and anti-cancer benefits [the FDA has found no credible scientific evidence for such claims]; and amp up your exercise because there’s no reason you can’t do what you did 20 years younger.

In short, in his role as Surgeon General, Dr. Gupta may be promoting policies that have no basis in actual science. We just had eight years of zero to shitty science. It is time to move on. We, as a country, need to use real science, not pseduoscience, to solve our myriad issues. Gupta maybe a fantastic neurosurgeon , and most of us have seen him on TV;  however, the positions he is backing (FC, unorthodoxed “healthy eating,” practical immortality) clearly make him the wrong choice for Surgeon General.

5 thoughts on “Sanjay Gupta: Fuck No

  1. I don’t have cable, so I don’t know if Dr. Gupta’s journalism is really any good, but I can say that I don’t immediately fault a journalist for going with primary sources over, say, Google. I don’t like the idea of a reporter talking to a source and then saying, “but I saw stuff online that contradicted him, so I guess he’s wrong.”

    The larger issue to me, though, is this: it’s not the Surgeon General’s job to conduct scientific experiments. The real value of the Surgeon General, in my opinion, is to communicate science to the people. His responsibilities, his information sources, and hopefully his priorities would be different as SG than they are at CNN. Dr. Gupta is visible, he’s communicative, and he’s connected. That seems like a valuable skill set for the position.

    Tactically, I’m also not sure that a sprint toward hardcore science is the right thing to do after eight years of relative atrophy. I think it’s good for the new administration to launch new scientific initiatives that are far-reaching and quick, like rockets, but you haven’t convinced me that the SG itself needs to be aggressive like this. Part of the SG’s job is to get people on board, to get people comfortable and educated with new medical ideas and policies.

    In other words, the science can push far ahead toward the future, but the SG isn’t a squad leader. The SG should be back here, on the homefront, telling people what’s happening and why it’s for the best.

    Certainly the SG’s work can hold science back if the SG’s personal agenda runs contrary to the needs of practical science. I’m not sure Dr. Gupta’s got that kind of agenda. I may be wrong, but I certainly don’t think you’ve made any argument here that reveals him as “clearly” the wrong choice. It’s a judgment call. I can see how Dr. Gupta could do good.

    I’m a little turned off by your characterization of “unorthodoxed” views as being “clearly” undesirable. It seems to be that someone willing and able to present unorthodox ideas to a catholic (lower-case) body politic would be valuable.

    More to the point, I think that science that concerns itself (or worse, limits itself) with what’s orthodox (that is, “generally or traditionally accepted”) has a good chance of being bad science. The question of orthodoxy always bring with it the corollary question of, “Orthodox to whom?”

    Objections on the basis of, straight up, “He doesn’t think what I do,” are the old game.

  2. Will:
    The Surgeon Generalalso has input into policy decisions, and is responsible for establishing public health research priorities.

    A journalist should have a basic understanding of what he or she is reporting on. This would include opposing viewpoints–and in regards to Dr. Gupta’s handling of FC, he failed miserably. Wikipedia even lists the peer reviewed sources that he should have looked into before posting his blog post.

    This problem extends to his unorthodox views regard diet and supplements. It is irresponsible for a health professional of any kind to recommend treatments that aren’t vetted by some sort of research. For instance, if Dr. Gupta is nominated and confirmed as SG, he’ll probably push the “Obesity Epidemic” as one his priorities. The more I am aware of this topic, the less I am convinced of it being a major issue. Dr. Gupta and others who believe in the Epidemic are currently still debating the nature (and very existence of ) said epidemic. There appears to be a difference between healthy and unhealthy obesity. Additionally, one of the primary determinants of obesity, the Body-Mass Index, appears to have additional short comings in regards towards determining obesity.

    I am extremely concerned that Dr. Gupta would push forward practices and policies that do not have appropriate research. In certain regards, studying the human body is more difficult than studying other complex systems, such as climate. We can observe climate, study it, conduct experiments and make mathematical models to test theories. With the human body we are (rightly) constrained by scientific ethics. We can’t starve people and determine what are the best ways of restoring them to health. Experiments can not do harm to the client. The experiments conducted in the 1940s, cited by Junkfood Science, would probably never be replicated given the harm that these people volunteered for.

    I think Dr. Gupta is more a TV personality than a journalist. I think the SG has to be more than just the Face of US public health efforts.

  3. Sanjay Gupta, for whatever important skills he has, has also spent a lot of time communicating nonsense to the public in the guise of informed medical information. Do we need more?

    Gupta’s promotion of facilitated communication is good case in point. In the 25-plus years FC has been around in the US, the proponents of it haven’t produced a single properly controlled, peer-reviewed study demonstrating that it works. When proper controls are applied, FC fails. The “facilitator” is reliably shown to be the person authoring the messages, and the “communicator” is shown to have none of the cognitive or linguistic skills supposedly revealed by FC.

    The FC advocates have published a few things. But even the “best” FC “validation” studies don’t show the subjects performing even a fraction as well as they supposedly can in other contexts. Thus, we have studies like Cardinal et al. (1996) with 43 subjects, 3870 trials, and just 372 correct answers. That there were more correctly spelled wrong answers than right ones is not mentioned by Cardinal et al.–perhaps because revealing clearly that the results all seemed to come from guessing would underscore the methodological problems associated with telling the facilitators the answers ahead of time and setting up the procedures that even the die-hard ESP enthusiasts would recognize as being full of potential biases. Weiss et al. (1996) entertain us with a single subject who could reportedly do honor-roll-level middle school work who then, using FC, barely seemed to pass a second grade level test after practicing the questions. Weiss et al. dismiss the wrong answers as possibly due to facilitator control, but pronounced the right answers genuine. The scientific term for that is “having it both ways.” We don’t really get told until near the end that the three sessions reported are part of a longer series of failures. That’s known as “quit while you’re ahead.” Sheehan et al. (1996), also showed about 90% wrong, and that was including one subject who already knew how to type on his own, giving the subjects multiple opportunities to answer (with hints), and having the experimenters and facilitators change roles from time to time to ensure that there would be nothing close to blind conditions in the study. Of course, even after they all acknowledged the problem of facilitator control in FC, none of the authors of these “validations” include a test for facilitator control. Thus, there’s no way to know what might be genuine or not–even if there were some genuine communication. There are a few other works like these. They are all pretty much the same or have even fewer controls. Among the many problems with this stuff is that the FC advocates don’t seem to care or recognize that such poor performance on simple tests of memory and object identification undermines any claims that their subjects were actually proficient users of FC. Black is white and up is down in FC world.

    None of this seems to bother Gupta, who is no scientist, apparently loves an anecdote more than evidence, and, when he does list some studies, seems unable to distinguish between quality work and scientistic dreck. He is willing to say that FC doesn’t always work–and so do his minions who are sent off on assignment to promote FC. But, once that is admitted as a formality, it is forgotten as he or his staff members arrange to “interview” and advocate for FC users as though they, being journalists, are somehow personally immune to all the biases and wishful thinking that have caused so many other people, geniuses and fools alike, to believe that the child was typing when it was really the facilitator. If Gupta had any credibility as a genuine science reporter, he would take real steps to ensure that the people he interviewed and lauded on his worldwide CNN stage were not impostors. Then, when his prospective subjects refused a clear, impartial, and public test to show that what he was hearing was genuine, their refusals would end the interviews.

    (Why demand proof? If FC works, it’s a true medical miracle that could change the fate of millions for the better. If not, it’s a cynical, exploitative fraud with the potential to ruin untold numbers of lives. Either alternative calls for at least a little bit of objective verification before someone who aspires to be Surgeon General goes off to promote it all as genuine on CNN and its associated internet sites. This is all theoretical, of course. The sad fact is that if FC worked as its proponents claim it does, we’d know it by now, and be using it effectively in every eligible case. We’d also be awash in carefully controlled, convincing experimental demonstrations. We in science like to say that we don’t disprove anything. We just “fail to reject the null hypothesis.” But sooner or later, we get to the point where we can just have to say that there are no unicorns, fairies, or gnomes. Or no FC either. More than enough work has already been done to show that it doesn’t work.)

    I have said elsewhere that if we make Gupta Surgeon General, we are replacing the climate denialism of the Bush administration with developmental disabilities denialism. Gupta, like the advocates of FC, ignore the vast body of well-done science showing that autism is a disorder that significantly undermines cognitive and social functioning. Gupta and his FC allies would like to believe that autism is a movement disorder akin to Parkinson’s, and promote the false hope that inside every child with autism is a poet waiting to get out. Thus, instead of scientifically proven treatments that might actually help some of those nonverbal children become poets (or scientists or whatever they want to be), someone holds their hands and doesn’t even allow them the dignity of even trying speak for themselves. Are we really ready for a Surgeon General who is apparently willing to accept the outlandish idea that a child who has never once spoken, read, or written a word can suddenly type “I love you Mommy” just because someone applies some physical support? In any other domain, such a thing would be sure sign of a fraud, and a good journalist or responsible doctor or acceptable Surgeon General would be exposing it for what it is, not popularizing it against all science and rationality.

  4. Thank you, Will, for your comment.

    There was certainly no intent to “bring down” so much as to add more information to the mix. Perhaps someone else has something about Gupta to show that he takes a more thoughtful approach to these issues than I believe is the case. I am not so confident in this because I just keep hearing about more problems. My friends who study memory are concerned about Gupta’s apparently outmoded views on recall and multiple personality disorder–the kind of superficial understanding of these things that helped bring us the repressed memory horrors of not so long ago. It might be that I have my own outmoded view of what science journalism should be. I confess that one of my guiding analyses comes from John Burnham’s book “How Superstition Won and Science Lost.” Burnham seems to think it is better when science writers are scientific.

    I will confess a special sensitivity to these things, a motivator really, as I served just last year as an expert witness in a case in which false accusations authored by FC put an innocent man in jail for eighty days for supposedly raping his daughter. His 13-year-old developmentally disabled son, the girl’s brother, was subjected to an extraordinarily coercive police interview in which he was falsely told that the police had photorecords of him participating in the acts. There were no photos, or anything else for that matter, and the case was dropped long after it should have been. In a stunning repudiation of rationality, the judge ignored the science on FC. Indeed, he declared the science legally irrelevant, using guidance from cases over a decade old to rule that FC is a form of interpretation. This occurred despite numerous serious problems with the case, including the fact that the girl and facilitator were unable to answer a single question correctly in two separate in-court, single-blind (message passing) tests of FC. Even the prosecution’s FC-advocate expert testified that that accusations were the work of the facilitators, not the child. It’s pretty unconvincing FC when even the veteran FC believer questions it. It is this sort of horror that Gupta’s work is aiding and abetting. It is chilling enough to consider such things in the abstract. It was sometimes hardly bearable to see up close, when the stakes involved not just what seems to be an abandonment of basic legal standards of justice and evidence, but the totally unnecessary imposition of very real suffering on a real family full of real people.

    I also want to correct to an error, minor and forgivable I hope. The number in the second sentence of the second paragraph should have been “15,” as in “15-plus” rather than “25-plus.” It was a typo. I would have dated the introduction of FC into the US with Biklen’s 1990 Harvard Educational Review article–although I know that there are instances of things like FC scattered throughout history. There are at least a couple other misplaced words and superfluous commas in my posting–the correction of which I will save for another day.

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