Three weeks ago, I wrote a post that, much to my surprise, went viral, garnering more Facebook "Likes" than any before it, although it only came in maybe third in traffic after the all-time record-holding post from a couple of years ago. Maybe I shouldn't have been surprised. It was, after all, about Tom Price, Donald Trump's nominee for Secretary of the Department of Health and Human Services (HHS). What I noted that apparently caught the attention of many times more people than my usual daily brain droppings usually do was that Tom Price belongs to one of the wingnuttiest of wingnut medical groups I've ever encountered, the Association of American Physicians and Surgeons (AAPS). There's no need for me here to reiterate the group's Ayn Rand-like worship of the brave maverick doctor über alles in detail, as I've done that before multiple times beginning nearly eleven years ago. Basically, to the AAPS, doctors should not accept payment from Medicare (which it views as unconstitutional) and that the autonomy of doctors, who are portrayed as akin to John Galt and other "producers," should never be constrained by pesky, puny things like evidence-based guidelines, because, apparently, every doctor is expert enough to interpret the vast medical literature without any help.

On the other hand, it is worth briefly mentioning the pure antiscience and pseudoscience that emanates from the AAPS, particularly through its house organ, the Journal of American Physicians and Scientists (JPANDS). This journal is a veritable cornucopia of ideology-motivated quackery and pseudoscience, including antivaccine pseudoscience up to and including the despicable claim that shaken baby syndrome is a "misdiagnosis for mercury poisoning" and that sudden infant death syndrome might be caused by vaccines, the bogus claim that abortion causes breast cancer, and anthropogenic global climate change denialism (don't ask what that's doing there). Indeed, Dr. Jane Orient, the executive director of AAPS, denies the very concept of a scientific consensus.

Well, the Winter 2016 issue of JPANDS is out, hot off the presses, digitally speaking, and I can't help but wonder: What does Dr. Price think of some of the articles found therein. In particular, I'm interested in what he thinks of an article by Neil Z. Miller entitled Aluminum in Childhood Vaccines Is Unsafe. Well, you have to say one thing for Miller: He's consistent. Just two issues earlier, Miller published an article in JPANDS entitled Combining Childhood Vaccines at One Visit Is Not Safe. I'm eagerly looking forward to an ongoing series from Miller: MMR Is Not Safe. Thimerosal Is Not Safe. All Those Nasty Toxins in Vaccines Are Not Safe. Not surprisingly, I took notice of Miller's last article in JPANDS and applied a not-so-Respectful Insolence to misinformation and pseudoscience that deserved much worse. Even less surprisingly, once having seen Miller's second JPANDS publication, I can't resist a repeat, particularly now that I know that Dr. Price is a member in good standing of the AAPS. These are the sorts of misinformation-packed articles that need to be thrown into Price's face during his confirmation hearings in order to force him to justify why he belongs to an organization so opposed to accepted medical science.

So let's take a look, shall we?

Not content with just demonizing aluminum, which is used as an adjuvant for some vaccines. Basically, an adjuvant is a substance that, when injected with vaccines, can result in a more intense immune response. Miller has to start with the dreaded mercury-containing preservative thimerosal. There's a method to his madness, of course. It's not a method that makes any scientific sense, but rather is designed to draw attention from the very simple observation that, since the phase-out of thimerosal as a preservative in vaccines in the US, autism prevalence hasn't declined. Quite the contrary, actually. Miller opines:

From 1999 through 2002, several vaccines containing mercury were phased out of the childhood immunization schedule. Manufacturing of childhood vaccines with thimerosal ceased in 2001, but those that were not past their expiration date remained on the market for sale until January 2003.1 They were replaced with low-mercury or “thimerosal-free” vaccines. In the years that followed, autism rates continued to rise, prompting health authorities to assert that autism is not linked to mercury in vaccines and that vaccination policies are safe and appropriate.2-4 (If mercury in vaccines contributed to autism, then rates should have dropped after mercury was removed.) However, in 2002, during this so-called phase-out period, the Centers for Disease Control and Prevention (CDC) actually added two doses of mercury-containing influenza vaccines to the list of inoculations urged for all babies 6 to 23 months of age.5 Two years later, the CDC also added pregnant women in their first trimester to the list of people officially recommended and actively encouraged to receive influenza vaccines, even though a majority of available doses contained mercury.6 In addition to these questionable actions during this highly publicized “phase-out” of mercury, four doses of a new vaccine with high aluminum content were added to the childhood immunization schedule in February 2000 (for pneumococcus) and two doses of another aluminum-containing vaccine (for hepatitis A) were added in 2005.7,8 These changes to the vaccine schedule resulted in a substantial increase of aluminum-containing vaccine doses—from 10 to 16 injections—that babies are still mandated to receive by 18 months of age.

Notice what Miller left out? Well, he left out multiple things. However, the most glaring is a simple matter of quantity. How much mercury was in the childhood vaccination schedule after 2003 compared to before? The answer, of course, is a lot less, even with the addition of the new vaccines. For instance, in an Italian study from the 1990s testing the existing DTaP vaccine versus a then-new thimerosal-free version, children received 137.5 μg of mercury and just eliminating the thimerosal from the DTaP in that schedule cut mercury exposure by more than half. Moreover, while it's true that most flu vaccines then still contained thimerosal, it didn't take long for manufacturers to get rid of the thimerosal, particularly in the childhood vaccines. These days, it's so hard to find thimerosal-containing flu vaccines that when I get my yearly dose, I often joke about asking to add extra thimerosal.

Of course, the narrative that Miller is selling is that the reason autism prevalence didn't plunge a few years after the removal of nearly all the thimerosal from the childhood vaccine schedule by early 2003 is because of an increase in aluminum exposure. This idea is as much a pile of nonsense as the idea that thimerosal was responsible for an "autism epidemic," not the least of which because it would be an incredibly coincidence that, if you accept the rationale of someone like Miller that both thimerosal and aluminum can contribute to autism, just as one autism-containing vaccine ingredient was removed another was added in sufficient quantity to cause autism prevalence to keep climbing at the very same rate that it was climbing before. That's because antivaccinationists have always known that if autism prevalence kept climbing after thimerosal was removed from vaccines it would be a deadly blow against their belief that thimerosal causes autism when it doesn't. So basically, Miller tries to argue that a 25% increase in aluminum exposure due to vaccines was enough to make up for—scratch that, more than make up for—the loss of thimerosal in its claimed evil autism-causing properties.

To demonstrate the "toxicity" of aluminum, Mr. Miller has to do some rather major contortions, so much so that it looks very much as though he's playing Twister with vaccine science, and the construct can't stand:

Aluminum is neurotoxic and has a long history of well-documented hazards.14 For example, as early as 1921 The Lancet described a 46-year-old metal worker in whom “aluminium produced a rather slow intoxication. In this case it caused memory loss, tremor, jerky movements and incontinence of urine.”15 In 1927, Dr. Victor Vaughn, a toxicologist with the University of Michigan, testified before the Federal Trade Commission that “all salts of aluminum are poisonous when injected subcutaneously or intravenously.”16 By 1951, Chusid et al. showed that chronic epilepsy could be induced in monkeys through intra-cerebral administration of aluminum hydroxide cream.17 In 1968, Driver et al. performed a similar experiment by placing aluminum hydroxide cream unilaterally on the posterior parietal cortex of six monkeys.18 From 3 to 8 weeks after surgery, electrical abnormalities could be seen on an electroencephalogram and the monkeys exhibited “episodic twitching of the limbs and face.” The animals were also impaired at learning new tasks and at re-learning tasks first learned prior to the intervention.

Aluminum exposure in a metal worker in the 1920s was due to a much larger exposure than any vaccine or series of vaccines would be expected to produce. Slathering large quantities of aluminum onto the cerebral cortex is much different than injecting tiny quantities into the muscle. Dose and poison, Mr. Miller. Dose and poison. Learn it, live it, love it. The dose makes the poison, and the dose of aluminum in vaccines is quite safe. I also can't help but notice some of the articles referenced by Miller are not exactly from reliable sources. For instance, reference #16 is from David Ayoub's talk to the National Autism Association Conference in 2007. That's a serious antivaccine conference, and David Ayoub is know for his conspiratorial thinking and belief in black helicopters and the Illuminati. It's not for nothing that Ayoub was inducted into the Encylopedia of American Loons. If you don't believe me, just look for yourself at this typical talk by Ayoub:

That's some weapons-grade crazy.

Mr. Miller also liberally cites Lucija Tomljenovic and Christoper Shaw, two antivaccine cranks par excellence whose abuse of science has been discussed many times here and elsewhere. Let's just put it this way: Tomljenovic and Shaw very much believe that Gardasil causes premature ovarian failure (it doesn't, and here's why) and that it kills (it doesn't, and here's why). Mr. Miller even cites one of the most hilariously misbegotten articles blaming aluminum in vaccines for autism, one that so hilariously confuses correlation with causation that it makes blaming global warming on the decrease in number of pirates seem reasonable by comparison. Yes, it's a Tomljenovic and Shaw paper.

The rest of the paper basically defines the term "cherry picked." Mr. Miller lists, in maximally frightening terms, a series of studies that purport to find significant negative health consequences (as opposed, for instance, to injection site pain or complications, something common to all vaccines, regardless of whether they contain aluminum or not), often by antivaccine cranks, and unsurprisingly ignores the vast existing literature on the safety of aluminum adjuvants. These studies often ignore the principle of "the dose makes the poison":

According to the American Academy of Pediatrics (AAP), “Aluminum is now being implicated as interfering with a variety of cellular and metabolic processes in the nervous system and in other tissues.”19 Bishop et al. published data showing that “aluminum accumulates in the body when protective gastrointestinal mechanisms are bypassed, renal function is impaired, and exposure is high.”20 For example, in premature infants, “prolonged intravenous feeding with solutions containing aluminum is associated with impaired neurologic development” by 18 months of age. More recently, Kawahara et al. published research confirming that “aluminum can cause severe health problems in particular populations, including infants.”21 The authors of this paper also declared that “whilst being environmentally abundant, aluminum is not essential for life. On the contrary, aluminum is a widely recognized neurotoxin that inhibits more than 200 biologically important functions and causes various adverse effects in plants, animals, and humans.”

Bloody hell. He's quoting the data for aluminum toxicity in premature infants who have prolonged exposure to aluminum in their parenteral (intravenous) nutrition. We're talking about premature babies who are either too premature or too ill to be fed using their guts and as a consequence have to be fed intravenously and thus receive a lot of aluminum. Comparing this exposure to aluminum to exposure due to vaccines is akin to comparing Mt. Everest to the hill near your house that makes you tired if when you have to climb it.

Unbelievably, Mr. Miller even invokes a favorite antivaccine trope used for any scary-sounding ingredient in vaccines, elaborating on the "injection" aspect of vaccines above:

Moreover, vaccines with aluminum adjuvants are injected into the body, bypassing protective barriers of the gastrointestinal tract and skin. Absorption of aluminum by this mode is more efficient than through ingestion, increasing the likelihood of a toxic outcome. The authors summarized their findings: “Evidence has now emerged showing that autism may in part result from early-life immune insults induced by environmental xenobiotics. One of the most common xenobiotic with immuno-stimulating as well as neurotoxic properties to which infants under two years of age are routinely exposed worldwide is the aluminum vaccine adjuvant.”

At least he refrained from the more common variant of this trope, that vaccines are "injected directly into the bloodstream," when in fact they are usually injected intramuscularly. are talking about small amounts of aluminum injected into the muscle, where they are slowly abosrbed.

I could go on and on. Mr. Miller's paper is what we in the skeptic biz call a "target-rich environment." The reason I brought it up now to discuss has less to do with the misinformation in the article, of which there is plenty, or its unusualness, of which there is none. Rather, it's because, now, less than three weeks after Dr. Price was nominated to head HHS, the organization to which he belongs is still at it, publishing antivaccine propaganda every bit as egregious as it's been doing at least since 2006. I don't know about you, but I want to know how many beliefs Dr. Price shares with the organization to which he belongs. I want to see him have to read this article and explain himself, specifically, whether he shares the AAPS's antivaccine views.

Yes, there are a lot of other areas where Dr. Price's views are very worrisome, but this is one that shouldn't be ignored.