Tuesday, December 07, 2010

"Dr." Mercola, enemy of children

Every now and then something comes up that nearly destroys my usual optimism. I had the misfortune of stumbling upon a website by an apparently popular alternative medicine guru, Joseph Mercola.

To put it mildly, the website depressed me. This person makes money by feeding on the paranoia of the uneducated. His advice probably causes a great deal of death and sickness. For instance, he advises parents against vaccinating their children. At the same time he advocates mutilation of baby boys, also called circumcision.

He's one of those salesmen who will say anything as long as his books and snake oil products keep selling. He only cares about money. Except maybe religion. Maybe he's jewish (I don't know, and I don't really care), so he advocates ancient, unnecessary and painful practices such as circumcision, or maybe he is funded by the circumcision lobby. Probably just the money talking.

Vaccines are possibly the greatest achievement of medicine and public health. Vaccines have saved and continue to save millions of lives. Feeding on irrational fears and picking out some rare cases of (mostly uncertain) association between vaccination and some neurological or other complication. Of course, complications occur but the benefits far outweigh the risks.

And in case you don't know what circumcision is, find out here:


Quacks like Joseph Mercola are enemies of civilization. One idiot born every minute, as they say. Too bad a lot people actually believe in his crap.


Tali said...

I stumbled across you blog in my informal research on the brain. As strange as it may sound, I really enjoyed reading your posts. Are you still blogging somewhere?

Stuart Ressler, M.D. said...

Thanks.. Growing family with 3 small kids and work responsibilities can get overwhelming these days and the energy to blog regularly just isn't there. I hope to continue blogging though.

Doc Fadden said...

Mercola is an opportunistic quack, although I am surprised by your objection to male circumcision. As I understand it has been widely advocated by the WHO in African nations where AIDS is prevalent to mitigate transmission rates. Just wondering, as a doctor or otherwise, what your objections are.

Stuart Ressler, M.D. said...

Doc Fadden,

Thanks for the comment. I do not object to circumcision on medical grounds.

It is my understanding that there is no evidence for the benefit of circumcision of baby boys for HIV prevention is less than convincing. The assumption that it is beneficial is based on either case control or some other equivalent study methods on adult males.

Babies and small children are also not sexually active, so we know for sure that the circumcision would not be of benefit to them for at least 10+ years.

Of course - if we determine that circumcising baby boys will actually save lives in Africa, then there is a medical reason and I do not object to that - but then circumcision should only be performed in those African nations where it would actually be helpful.

So even then, circumcision in Europe or America would not be warranted because the overall impact on health would be negative.

I am against invasive procedures on helpless children on non-medical i.e. religious grounds. It is worth remembering that the religion in question is the parents' religion, not the child's religion. Babies are not religious persons until indoctrinated later to their parent's belief systems.

Circumcision is performed as an outdated religious ritual, the original purpose of which is to reduce the ability of the circumcised individual to experience sexual pleasure.

Anyone over the age of 18 can choose to get circumcised if they wish. I do not understand why children are deprived of the power to decide over their own bodies by religious nuts.

Stuart Ressler, M.D. said...

Continuing on this...

I like the European Council (Lisbon Treaty on human rights) stance, which is that "an intervention may only be carried out on a person who does not have the capacity to consent, for his or her direct benefit."

Note that it says direct benefit. In light of this, circumcision of male babies is not OK even in Africa, because there is no direct benefit. The intervention can wait until the child has a say in it, before they become sexually active.

Doc Fadden said...

Thank you for the response. I’m also not a fan of religious ritual being foisted on those that cannot consent or protect themselves. Religious practice not withstanding, would you make the same argument for vaccines? Both require only parental consent for the infant, and both are a means of preventative care against external pathogens or endogenous syndromes that may or may not occur at a future date.

Stuart Ressler, M.D. said...

When considering only the medical indications and leaving the religious aspect aside, the difference is that the evidence supporting vaccines is absolutely overwhelming, whereas for circumcision it is not.

Vaccines are close to 100% effective. Vaccines have virtually eliminated diseases such as rubella, measles, pertussis, polio, diphtheria, and Hib in countries with a solid vaccination program.

The current evidence for male circumcision suggests about 50-60% effectiveness for prevention of HIV.

If vaccines were only 50% effective (a coin toss whether it is effective or not), then the vaccination program would and should be questioned just as well.

Returning to my original point about Mercola, he advocates circumcision on religious grounds. This should be in no way acceptable in a modern society. This was my point. I am open to accepting mass circumcisions on medical grounds, but skeptical about the effectiveness and the evidence so far. I'm also concerned that religious groups use the evidence to put a spin on their agenda.

Stuart Ressler, M.D. said...

Also I was wrong about the studies in that I now see that there have been several randomized trials investigating the effectiveness of circumcision in Africa. That's a good thing. But the effect is still around 50-60% only so it doesn't change anything.

ChrisP citizen of the world said...

Dr. Ressler Almost 70% of all HIV infected people live in sub Saharan Africa. There are many countries in Africa that have HIV infection rates around 20-25% of the entire population. Giving a child a 50-60% boost in immunity is statistically gigantic. The original poliovirus vaccine only had a 60-70% effectiveness rate against the most common strain of polio and the numbers for polio related deaths or paralysis in the US were nowhere close to the number of people with HIV or have died of AIDS in Africa. To me, your arguments align nicely with the the antivaxxers.

Stuart Ressler, M.D. said...

ChrisP you have a point but before getting too cocky and comparing me to antivaxxers, I recommend that you re-read my comments (I am not against adult male circumcision, and have an open mind about mass circumcisions, open mind is not generally something antivaxxers are famous for) and I recommend a critical appraisal of the numbers. The number needed to treat to prevent 1 HIV infection (NNT) of ADULT male circumcision is about 50-100 in subsaharan Africa. This is about the same as for statins for those with previously diagnosed heart disease. So yes, if the science is sound, maybe this procedure is warranted for ADULT MALES in SUBSAHARAN AFRICA. Not babies. Adult males.

The NNT would translate to about 5,000 in modern western countries. Meaning for every 5,000 adult males circumcised we would prevent 1 HIV infection. That's obviously unacceptably ineffective.

To summarize, my main points are the following:
1. There is evidence that ADULT male circumcision may be an effective way to reduce the spread of HIV in subsaharan Africa
2. There is zero evidence that mass circumcision of babies will have the same effect
3. Circumcision is lobbied by religious organisations in the West (you know, thousands of years ago, the Creator appeared and told the people that sorry, he forgot to remove a bit of the penis from the original design so could you please do that for him from now on or go to hell actually)
4. The religious-circumcision lobby twist the subsaharan study results to promote their agenda in a misleading an invalid way
5. The subsaharan study results do not apply to modern western countries
6. Circumcision of babies based on religious grounds is against the UN declaration of human rights