It’s hard to believe that it’s been a full ten days since my talk at entitled Whither the antivaccine movement in the Age of Trump? At the time, I only knew the identity of one of the most important public health figures appointed by President Donald Trump, FDA Commissioner Dr. Scott Gottlieb. As I noted when it was clear that he was going to be Trump’s pick, antivaxers weren’t going to like it. Why? One reason is because Gottlieb is the ultimate pharma shill, if such a thing exists. Another reason is that he is very pro-vaccine. This amuses me when I consider the after his long, sordid history of antivaccine sentiments, his having met with antivaccine “hero” Andrew Wakefield during the presidential campaign, and his having met with another antivaccine “hero,” Robert F. Kennedy, Jr., during the transition period.
Before I get to the details of what raised my concern, let’s start with the reasons to be reassured first before I get into the worrisome history I learned yesterday morning that forced me to make major modifications to this post.
Dr. Fitzgerald: Pro-vaccine and pro-public health
To give you an idea of the relief I initially felt when I learned of Dr. Fitzgerald’s appointment, some of you might recall that, when I heard that RFK Jr. was meeting with Donald Trump, I mentioned that the first thought that popped into my mind was that Trump was considering him for CDC Director or some other high profile public health position in the administration. Yet here we are, six months later, and nothing’s become of the “vaccine commission” that RFK Jr. claimed that Trump had offered him, while the new FDA Commissioner is an ultimate pro-vaccine pharma shill. Now it appears that we have a pro-vaccine, fairly boring, standard-issue CDC Director, the might have been expected to appoint:
Fitzgerald is no newcomer to politics. She served as a health care policy advisor to House Speaker Newt Gingrich and U.S. Sen. Paul Coverdell, both Republicans. She twice ran unsuccessfully for Congress, in 1992 and 1994, both time [sic] as a Republican.
Gov. Zell Miller appointed her to the state Board of Education in 1996 when he remade the board in hopes it would get along with the state’s first Republican state school superintendent, Linda Schrenko. The chairman of that new board was Johnny Isakson, who is now Georgia’s senior U.S. senator.
Perhaps her association with Newt Gingrich should have been a red flag. Still, Dr. Fitzgerald has a record that is quite pro-vaccine. Indeed, as recently as April, she was , but urging parents to vaccinate their children:
During National Infant Immunization Week, April 22-29, the Georgia Department of Public Health and the Georgia Chapter of the American Academy of Pediatrics urge parents to check with their pediatrician to ensure their child is up-to-date on vaccinations.
“Immunizations are the best way to protect infants and children from childhood diseases, like whooping cough and measles that can be life-threatening at young ages,” said Brenda Fitzgerald, M.D., commissioner of the Georgia Department of Public Health. “It is critical for parents to talk to their child’s doctor to ensure they are up-to-date on immunizations, because no child should have to suffer a vaccine-preventable illness.”
She’s even written opinion pieces with titles like “” in 2014 (before the Disneyland measles outbreak), in which she rejects antivaccine pseudoscience explicitly:
I’ve heard all the arguments against vaccination. All have been debunked, including the infamous 1980s study in Europe about a similar vaccine for measles, mumps and rubella, and a supposed link – that we now know to be false – to autism, which shattered vaccine use in Europe. Outbreaks now plague the Continent, and here in the U.S., signs of trouble are building.
Pertussis outbreaks in Oregon and Texas and an ongoing outbreak in California should alarm us. In Georgia right now there are 83 confirmed cases of this disease.
And then makes an emotional appeal:
At the Georgia Department of Public Health, our team in immunizations has been preparing for National Infant Immunization Week, which begins today. The team will work to improve Georgia’s resilience to vaccine-preventable disease through increased immunization rates among siblings, caregivers, grandparents and infants. I want to reach our state’s mothers-to-be.
I am a mother. I am vaccinated. And I ask you to join me. Choose to vaccinate first yourself, and then your new baby. Follow the vaccine schedule, and guard against diseases like whooping cough that only you can prevent before baby is born.
As a board-certified obstetrician-gynecologist, I have seen the devastating and painful effects of whooping cough and other vaccine-preventable diseases. I’ve seen mothers who fear every gasp of air might be their babies’ last.
Get vaccinated. Help spread the truth on vaccines, not the diseases they prevent.
These are not the sort of things that someone who is antivaccine or antivaccine-sympathetic writes. Nor do people who are antivaccine or antivaccine-sympathetic institute a rule requiring that a notarized state-issued form is the only valid way parents can claim a religious exemption to school vaccine mandates, which is the only nonmedical exemption allowed in Georgia. Nor would an antivaccine or antivaccine-sympathetic person allow a blog that , including entries promoting the , if they fall behind, and .
That sure sounded suitably pro-vaccine to me.
Of course, basically anyone who is involved in public health, especially at a leadership level (particularly at a state leadership level) is pro-vaccine. The reason is simple, and it has nothing to do with “dogma,” as antivaxers will claim. It has to do with science and the fact that vaccines work. They are the single most effective public health intervention conceived by the human mind and made by human hands. They do not cause autism. They do not cause all the horrible autoimmune and other diseases that antivaxers claim. They save lives, lots of lives. Sooner or later, anyone in public health who is intellectually honest, regardless of ideological bent, be it liberal or conservative, comes to that conclusion. The “ideological conformity” in public health officials’ belief in vaccines comes not from brainwashing, but from decades—no, hundreds— of years of evidence.
Not unduly ideological
Interestingly, Dr. Fitzgerald has also demonstrated :
Fitzgerald also drew headlines for a decision to rescind a job offer to a California physician initially offered a job as a north Georgia health director after reports surfaced about controversial sermons he made condemning gay rights and the theory of evolution.
I note that this action resulted in a lawsuit by Dr. Erick Walsh, the pastor fired after what he said in his sermons became known. mentions the lawsuit, calling it a violation of religious liberty while conveniently failing to note just what the sermons said, :
- Oprah Winfrey is harboring the spirit of the anti-Christ;
- The prophet Muhammad, founder of Islam, was influenced by Satan;
- The devil set up Catholicism;
- Acceptance of homosexuals is a satanic ploy to destroy America;
- Rapper Jay Z is a disciple of Satan;
- Single mothers are ruining their children;
- Disney movies, which are loaded with violence, sex and magic, are a satanic ploy to split up families;
- Darwin’s Theory of Evolution is a “satanic belief”;
- The distribution of condoms to a public in need leads to higher AIDS rates;
- The pope is the anti-Christ.
OK, I’ll give Dr. Walsh the one about Oprah. Maybe I’ll even give him the one about Jay Z, too. But the rest of the list consists of nonsensical beliefs common among the religious right, several of which could easily interfere with the ability to carry out public health policies.
To be honest, I was rather surprised at Dr. Fitzgerald’s appointment because, unlike her boss, Department of Health and Human Services Secretary Dr. Tom Price (who is a member of a crank medical society that is, in essence, the John Birch Society for physicians, namely the ), she appears to be reasonably competent in public health matters and has a history of very pro-vaccine statements and championing pro-vaccine polices in Georgia. Even better, she appears willing to buck the Republican establishment, as her willingness to rescind Dr. Walsh’s job offer demonstrated. Also, although she opposed federal funding of abortions and supported some restrictions on the practice, she is that the decision for an abortion should be between a woman and her physician. Indeed, when she ran for Congress in the 1990s, anti-abortion activists distributed flyers in church parking lots claiming that she had performed abortions herself.
Initially at least, I couldn’t find anything egregiously disqualifying in her background online, although it is of concern that she has no research background to speak of. (See the next section for what I missed that might or might not be a major concern.) She is definitely pro-vaccine. She doesn’t seem to have the typical conservative Republican hang-ups about sex, the LGBTQ community, and evolution. On the other hand, during her tenure as Commissioner, she and Governor Nathan Deal launched SHAPE, a statewide effort to address childhood obesity through “physical activity before class, physical activity during class, and more structured recess,” . I must admit that one raised my eyebrow, although it is Georgia, where and Coca-Cola wields considerable influence. Few are the Georgia politicians who would have had the temerity to turn down that offer, unfortunately. It’s also another reason why antivaxers might dislike her.
Antivaxers react to Dr. Fitzgerald’s appointment
Right on cue and not unexpectedly, antivaxers who have bothered to say anything let it be known that they hate this appointment. For instance, Ginger Taylor, who is the Dunning-Kruger Effect personified, posted this to Facebook:
What’s upset her? It was Dr. Fitzgerald’s’s “” article that I quoted earlier in this post! The tears of betrayal following Taylor’s post are delicious. Another Trump supporter and antivaxer known to this blog is also .
Perhaps the most hilarious reactions of all came from Patrick “Tim” Bolen, and the antivaccine blogger and activist who goes under the ‘nym Levi Quackenboss, both of whom are Trump supporters and both of whom think that there must be something going on behind the scenes. We’ve met Quackenboss before; she’s the blogger who led the harassment of a twelve year old boy who posted a pro-vaccine video. In any case, Quackenboss, as is her wont, :
Despite the fact that the CDC owns vaccine patents and the CDC publishes the Advisory Committee on Immunization Practices recommended schedule that’s adopted by the states, here’s why I’m not going to lose any sleep over a vaccine zealot being appointed to the CDC:
Dr. Brenda ultimately answers to Dr. Tom Price, and Tom Price, at minimum, doesn’t think the Feds have any business regulating vaccines. I’ve heard that autism-and-vaccines is not Tom Price’s specialty, but I’ve also heard– and one important person made reference to this possibility in a Vaxxed video– that there’s a chance that we’ve got someone coming into the CDC who does specialize in it, and they want to prove it.
So, President Trump can appoint a vax lover to the CDC to appease whomever he needs to appease right now, as long as he tells her “You’re fired” sooner than later.
Then guess what? Other people get to be the head honcho of vaccine safety– maybe one of our people.
Yes, there is reason to be concerned about Dr. Price, but I haven’t been able to find any evidence that he himself is antivaccine. True, he belongs to the AAPS, and that does not speak well of him because, at the very least, he must be more attracted to the Ayn Rand-inspired vision of physicians unshackled by government or anything other than their superman (and woman) abilities as “mavericks” more than he’s repelled by the pseudoscience that the AAPS peddles. However, I’ve been unable to find a record of him saying anything antivaccine. That’s why I’m more concerned about his zeal for cutting medical programs that benefit the poor, such as Medicaid, than I am about any antivaccine proclivities. In any case, Quackenboss is fooling herself here. Yes, it’s true that you never know whom else Trump might try to sneak into the CDC; so we must be vigilant. However, it also makes no sense that Trump would hire a “vaccine zealot,” only to fire her after putting “one of us” (an antivaxer) in another position at CDC, especially given that the CDC director position doesn’t require Senate approval. More than likely Secretary Price knew Dr. Fitzgerald from his days in Congress representing a district in Georgia.
Next up is Tim Bolen. You might remember him as back in the day. His grip on reality hasn’t gotten any better since then, as you will see in his post “” Based on videos of Dr. Fitzgerald discussing early childhood development and advocating for programs to promote early language development and reading, Bolen comes to some rather…amazing…speculations:
In the first 2:30 of this second video you will understand Brenda’s approach to child development – but watch the whole thing. Vaccines were NOT even mentioned, but it is NOT hard to see what a negative role they would play in Brenda Fitzgerald’s, and her friends’, brain-development scenarios.
This candidate for the CDC head, Brenda Fitzgerald MD, is a TOTAL, COMPLETE departure from the usual Big-Pharma-friendly appointments we are accustomed to seeing. This person is WITHOUT DOUBT “Patient-Centered.”
Just look at her attitude…
Listen to her words. Watch her body language. Can you envision this woman pushing a vaccine cart through a hospital looking for innocent children to jab full of brain-stopping crud?
No, neither can I.
No, but I can imagine Dr. Fitzgerald promoting vaccines as a powerful way to keep children healthy. Why? Because that’s what she did in Georgia! I don’t have to picture it.
Bolen concludes with a fantasy imagining that on her first day as CDC Director, Dr. Fitzgerald calls all the CDC division heads, announces that the inspector general of the Department of Health and Human Services will be investigating, and orders them all to cooperate. And then she orders them all to cooperate with RFK Jr.’s vaccine commission, which, Bolen seems to have forgotten, doesn’t exist. Let’s just put it this way. He’s so off-base that even his antivaccine commenters strongly imply that he must be smoking something that’s not tobacco.
So I was feeling pretty good about our having dodged a public health bullet this weekend. Then I saw a news story in Forbes on Sunday morning, as I was proofreading and tweaking this post. D’oh!
Dr. Fitzgerald’s quack past comes back to haunt her
When I originally alluded to my having missed a red flag, here’s what I meant. See if you can spot it in this passage from on the Georgia Department of Public Health website:
Brenda Fitzgerald, M.D., serves as the Commissioner of the Georgia Department of Public Health (DPH) and State Health Officer. Dr. Fitzgerald, a board-certified Obstetrician-Gynecologist and a Fellow in Anti-Aging Medicine, has practiced medicine for three decades.
Can you identify the red flag? Sure, I knew you could. I’m referring, of course, to Dr. Fitzgerald having been a Fellow in Anti-Aging Medicine. This is an enormous red flag that I should have noticed last week while writing a post about her for my not-so-secret other blog. Fortunately for me, , and I noticed her article, allowing me to revise this post before it embarrassed me after going live:
Dr. Brenda Fitzgerald, appointed Friday as director of the U.S. Centers for Disease Control and Prevention, is a board-certified obstetrician/gynecologist who saw patients for 30 years in private practice.
Unlike any OB/GYN I know, Fitzgerald treated men as well as women. That’s because besides being board-certified in obstetrics and gynecology, she is a fellow in “anti-aging medicine.”
I was as disappointed to learn this as Dr. David Goldstein:
“I’m shocked,” Dr. David Goldstein, a professor of obstetrics and gynecology at the New York University School of Medicine and treasurer of the International Menopause Society, said after I told him that Fitzgerald’s biography identifies her as an anti-aging medicine fellow.
Goldstein described so-called anti-aging treatments as “snake oil” that “plays on people’s worst fears about their mortality.”
“If she (Fitzgerald) was one of these people who was marketing anti-aging medicine, that’s scary,” he said.
Here’s the , a year before she was appointed Georgia’s Commissioner of Public Health. Poking around the website, I learned that she was first , which is rather late in her practice career (she would have been 60 years old then) and also only four years before she was appointed Public Health Commissioner.
Particularly damning is this . A couple of choice excerpts follow:
Q. What is the most common aging problem you see?
A. “Middle age spread”. As we age, the hormones that regulate body metabolism decline. The problem may be insulin resistance, nutrient deficiency, thyroid abnormality, or other hormone deficiency. Most people, by the time they are forty, are simply not eating 5000 calories a day in beer and junk food. They are frustrated because they are trying to eat good things or are eating what they have always eaten, or less, and are still gaining weight. We are now able to accurately evaluate the exact cause of weight gain, and recommend a plan to correct it.
Q. How do I know that I am taking the right supplements?
A. We can now measure the vitamins, antioxidants, necessary fats, and proteins in your cells with a simple blood test. If you like the supplements you are taking (Juice Plus, for example), we can tell you what you need to add. If you do not know what to take, we can give you the newest research for the best replacements.
So basically, Dr. Fitzgerald was into weight loss woo as well as anti-aging woo. (The two often go together.) She did a bunch of what were almost certainly unnecessary lab tests in order to figure out what supplements her patients “needed” and then ordered follow-up lab tests to see if she was giving her patients enough supplements. As is the case with nearly all such practices, most of it was cash on the barrelhead:
Q. Will insurance cover anti-aging care?
A. Traditional insurance plans often do not cover preventive medical care. We will try to help you determine if you are covered, but be aware that most coverage changes often and always with less coverage. We will continue to seek those labs that offer the highest quality, best cost tests. We will be happy to arrange monthly payments without additional charges for you. We will always give you our charges before services and we are always willing to look for other ways to get what you need, like labs at the health department.
I also note that Dr. Fitzgerald was into prescribing form of woo, “bioidentical hormones.” Not good. Definitely not good.
The American Academy of Anti-Aging Medicine: A pseudomedical pseudoprofessional society
We’ve mentioned or discussed the American Academy of Anti-Aging Medicine (AAAAM or A4M) multiple times before here on SBM. Put simply, it is what Kimball Atwood used to refer to as a pseudomedical pseudoprofessional organization (PPO). These organizations basically exist in order to provide a veneer of respectability to what is often gross quackery. In this case, A4M offers “fellowships” in a number of “specialties,” including , , , , and, of course, . It also offers a , such as Advanced Metabolic Endocrinology, Weight Management, Brain Fitness, Lifestyle Coaching, Advanced Injectables, Addiction, and Sexual Health and Treatment. Then there are a bunch of offered for quite the sum. The Stem Cell Fellowship, for instance, offers four modules at $2,500 per module. That’s a cool $10,000 to complete the training. The Anti-Aging Fellowship has three modules at $2,500 apiece. The Integrative Cancer Care Fellowship has eight modules at—you guessed it—$2,500 apiece, for a cool $20,000 to complete the course.
It’s not clear to me exactly which fellowship Dr. Fitzgerald finished, as the anti-aging fellowship is now referred to as the “Aesthetic Anti-Aging Fellowship” and now includes a lot of surgical procedures, chemical peels, Botox, hair transfer, and “body sculpting,” but maybe the fellowship was different ten years ago. On the other hand, the module on “” offers:
- Perform body mass index measurements, anthropomorphic measurements, and medical photography to document clinical presentation and results
- Prescribe organic whole foods, low glycemic diet along with appropriate detoxification, hormone balancing, and treatment of food allergy for optimal BMI
- Develop a working knowledge of aesthetic devices and energies used in body contouring including Radiofrequency, Acoustic wave, Infrared energy, a novel chilling device, and lymphatic massage. Gain practical knowledge from aesthetic experts regarding the utility and effectiveness of these devices as well as their specific indications
“Detoxification”? “Hormone balancing”? Treatment of what are almost certainly nonexistent “food allergies”? Use of all sorts of devices that are almost certainly not evidence-based? Yes, there be quackery here, just as there be quackery over at the :
Gain expert knowledge regarding the disease background, statistics, etiology, current standard of care, and issues/controversies surrounding current treatments for many neurological and neurodegenerative conditions, including:
- Parkinson’s disease
- Alzheimer’s disease
- Cerebral palsy
- Traumatic Brain Injury
- Amyotrophic lateral sclerosis (ALS)
- Huntington’s disease
- Spinal cord injury
There is no convincing clinical evidence yet that stem cell therapy improves outcomes in stroke, ALS, Huntington’s disease, or dementia—or any of these conditions, really. Treating someone with autism with stem cells is, in my not-so-humble opinion, not only quackery but utter malpractice. Yet these are the sorts of things A4M teaches its “fellows.”
And don’t get me started on “functional medicine,” training in which is also offered by A4M. It’s quackery, too. The list goes on and on. Dr. Fitzgerald did one of these pseudoscience-loaded A4M “fellowships,” after which she offered what she was taught to women and men, supposedly to help them deal with aging better.
Pro-science versus anti-aging quackery: Where does Dr. Fitzgerald’s balance fall?
By yesterday afternoon, I felt as though I had gotten whiplash from my turnabout on Dr. Fitzgerald. When I first learned of her impending appointment, I started out very relieved and happy at how pro-vaccine she is and how she seemed to hit all the right notes on public health, particularly the importance of early childhood reading. I was also relieved that she didn’t appear to be too dogmatic on culture war issues embraced by conservative Republicans that could interfere with her ability to serve as a science-based CDC director. Then I learned about her anti-aging fellowship and her previous medical practice offering typical dubious anti-aging treatments such as “bioidentical hormones,” detoxification, and supplements galore. Now I’m not so sure.
One thing that interested me was the question of why. Remember, Dr. Fitzgerald had practiced OB/GYN for over 30 years before she did her fellowship in anti-aging medicine. She was clinical faculty at Emory University, and a president of the Georgia OB/GYN Society. Presumably, her practice was evidence- and science-based. By the time she finished her A4M fellowship, she was 60 years old. So why did she do it? On her website, it says:
Q. Why did you become interested in anti-aging medicine?
A. I got older! The life expectancy for women in 1900 was 48. The majority of women never reached the hormone depleted state of menopause just 100 years ago. Now most of us can expect to live half of our lives without natural optimal hormone production. My goal is to have all my patients, and me, be vigorous and vital for essentially their entire lives. I want to be struck by lightning on the golf course at 120…. and I want that for you.
Clearly, Dr. Fitzgerald didn’t understand life expectancies. The reason life expectancy was so low in 1900 was because of infectious diseases that killed children. If a child born in 1900 made it to age 20, meant that they could expect to live an additional 40-45 years, meaning the majority of girls who made it past the high mortality period of childhood to become women did reach menopause. It’s not a reassuring statement, and it almost makes me wonder if Bolen might have been on to something after all.
What partially reassures me is that, since Dr. Fitzgerald became Georgia Public Health Commissioner, she appears not to have engaged in anything resembling quackery. She appears to have supported science and was pro-vaccine. Her one big misstep was that on at least one occasion she failed to stand up to a big corporation (Coca-Cola) whose products are not good for health. That leaves a very important question: Where does the balance fall? The answer is: I don’t know, but I’m echoing some of the :
I asked a couple of women’s health advocates what they thought about having an anti-aging medicine doctor lead the CDC.
“I’m so disappointed that the first female OB/GYN picked to head the CDC is someone who embraces the unproven and anti-scientific claims of the so-called anti-aging movement,” Cindy Pearson, executive director of the National Women’s Health Network, a nonprofit in Washington, D.C., told me.
“The public needs someone who supports public health recommendations that are based on science,” Pearson said, “not someone who tries to scare her patients by talking about ‘the hormone-depleted state of menopause’ and recommending unproven and potentially dangerous bio-identical hormones.”
It’s also been noted that Dr. Fitzgerald isn’t a great pick to head the CDC because she’s not a researcher. For instance, Diana Zuckerman, president of the National Center for Health Research, a nonprofit in Washington, D.C. noted:
“Her pitch as a physician suggests that, in addition to not being a researcher, she was providing treatments to patients that were not based on credible science,” Zuckerman told me after looking at the archived website for Fitzgerald’s former medical practice. “If a patient wants to try such treatments, and a doctor wants to prescribe them—preferably giving informed consent that the benefits are unproven—that’s up to them.
“But putting that doctor in charge of the CDC, a crucial public health agency, doesn’t make sense.”
Dr. Fitzgerald’s case suggests that you can be pro-vaccine and still be a quack. Worse, not being a researcher grounded in science, Dr. Fitzgerald is in danger of not being able to distinguish pseudoscience from science when antivaxers come calling (and they will come calling) to demand an “investigation” into the “CDC whistleblower” manufactroversy and other issues relevant to vaccines. I suppose under the Trump Administration, she’s the best we can hope for, and, more than that, all we can do is to hope that she consistently listens to the scientists at the CDC.
So, am I happy with the appointment of Dr. Fitzgerald? Not nearly as much as I used to be now that I know more about her past, information that I should have discovered when I first read her bio on the Georgia DPH website. (Mea maxima culpa!) She appears now to me to be like the appointment of Dr. Scott Gottlieb as appointed FDA Commissioner. He was basically the least bad of all the known candidates, but he is still a pharma shill who favors deregulation. Of course, we don’t know who else was considered for CDC Director, but Dr. Fitzgerald is similarly compromised. Yes, she is pro-vaccine, but, yes, she also sold quackery during the last four years of her private practice before entering public service with the State of Georgia.
Even if Dr. Fitzgerald turns out to be fine from a scientific standpoint, though, I have no illusions about Trump and vaccine policy. As , Trump’s budget takes aim at critical public health funding. If it passes, there will be less money for the CDC to do its job, less money to distribute vaccines, less money to intervene in the case of public health threats, and in general, less resources to do its critical job. Whether Dr. Fitzgerald can or would oppose such budget cuts, we have no way of knowing. Why anyone who is serious about public health would want to run the CDC under such circumstances, I don’t know. Maybe she’s susceptible to the snake oil that Donald Trump and HHS Secretary Dr. Price sell.