David Gorski is professor of surgical oncology, specializing in breast cancer. A strong advocate of evidence-based medicine, he is known for his criticism of 'alternative medicine', his staunch opposition to the anti-vaccine movement and his digital engagement to counteract disinformation targeted at medical and scientific topics. And this work, has attracted attacks from embattled anti-science groups.
The esanum Global Series is a collection of articles that brings together esanum's German, Italian, English and French-language editorial teams to provide a global perspective on the contemporary issues and stories impacting physicians' lives. In our first series, "Physicians in Social Media, the digital frontline", we interview physicians whose daily work, activism, or social media presence, have sparked a full array of responses from within their own professional communities, media platforms, and beyond. Solidarity, harassment, fame and threats, and the human stories behind the controversies, are the focus of this interview series.
David Gorski is a professor of surgical oncology at Wayne State University (Detroit, Michigan), specializing in breast cancer. His research interests include the role of glutamate receptors in breast cancer growth and metastasis. He is also interested in the problems of overdiagnosis and overtreatment of breast cancer. Some of his work has been published in prestigious journals such as Nature, Cancer Research, Blood or Nature Reviews Cancer. In 2007 he was awarded by the American Society of Clinical Oncology for his clinical research. A strong advocate of evidence-based medicine, Dr. Gorski is known for his criticism of alternative medicine and its promoters. He is a staunch opponent to the anti-vaccine movement.
Since the late 1990s, he has engaged in internet discussion forums. Initially, his digital engagement focused on condemnation to Holocaust-denial statements, but Dr. Gorski quickly became aware of the dissemination of fake medical information online. Under the nickname "Orac", he has been denouncing unscientific falsehoods since 2004 through his blog Respectful Insolence.1 In 2008, under his real name, he participated in the creation of the Science-Based Medicine website2, of which he is now editor-in-chief.
Because of his defense of science, facts and evidence, he is regularly attacked by a spectrum that covers anti-vaxxers, “quacks”, neo-Nazis and beyond. Smear tactics against him have included articles with accusation of pedophilia, legal threats, disinformation over conflicts of interest, or attempts to achieve his firings from various workplaces. Attacks against Dr. Gorski redoubled in 2016, when he criticized the film Vaxxed. Its director, Andrew Wakefield, is a former British surgeon and researcher, and author of a fraudulent study published in The Lancet in 1998 that established a causal relationship between the measles-mumps-rubella vaccine and what Wakefield called "autistic enterocolitis". The study was retracted, and Wakefield was banned from medical practice.
I think I started using it seven or eight years ago. I don't really remember exactly. It sort of crept up on me as I started to get more comfortable with it.
All of the above, and as a sort of extension of the blog, which is how many people started out with Twitter. By now there are some days where I hardly use Twitter at all and others where I might do even fifty tweets or more. On average, is around twenty tweets per day.
Yes, but one good thing about Twitter's quality filters is that if you turn them up high enough, you hardly ever see a lot of the haters because you just don't get notifications for many of their tags or replies. Many of them tend not to provide a phone number, a completed profile, or a photo, leaving what was known as the “egg profile photo”, Twitter’s former default image. I do have a lot of haters, but I don't see many of them unless I want to.
I'm sure it's over a thousand, but keep in mind that this is a total across all years, so per year is probably not such a big number. I've been blocking more lately as I have less tolerance for trolls than before. I also have more followers than before, and proportionally it might be the same percentage of trolls from total followers, but I have a shorter fuse when it comes to blocking these days.
Occasionally. It depends on my mood, and on how much of a troll they are. There are some trolls that from one tweet I can tell they're not worth engaging with and I just block them, and then there are others where I might respond. But if I spend all my time responding to trolls, then I would never post anything original.
Definitely. It happened even before I did much on Twitter. I've had orchestrated campaigns against me, just for my blog work. For instance, as early as 2010, when I rarely used Twitter. A bunch of anti-vaccine activists tried to get me fired from my university; emailing and calling the board of governors about a bogus non-existent conflict of interest that they thought they found against me.
I wasn't happy with the situation but fortunately the dean and my departmental chair had my back. It did cause me some consternation at the time because that was the first time they went directly after my job. Before that I had similar things happen where a random anti-vaxxer would email or call my boss' office.
What are you going to do about it? This is a first amendment, a free speech issue. They [the harassers] don't view it as harassment and there is really nothing I can do about it. There would be no point to filing a complaint unless there were threats of violence.
Back then I was more easily rattled, so to speak. Since then, as it happened again, and again, I have a much thicker skin.
The very first one that complained to me or to my boss was actually a cancer quack3 by the name of William P O'Neill around 2005. He emailed legal threats to my division, department chair, and the Cancer Institute of New Jersey director, where I worked at the time. He was the head of a so-called Canadian Cancer Research Group. This first episode happened only a few months after I started my first blog.
It was quite funny! I didn't even write about him. I just quoted someone else who had written about him, and it was quite a short reference.
Threats in that direction are not common, but they are not non-existent. I'm not that high up on the “food chain” so I don’t worry a lot about them. It's not like for instance, Peter Hotez, a pediatrician, vaccine researcher, and dean for the National School of Tropical Medicine at the Baylor College of Medicine. He was very vocal against the anti-vax movement and COVID deniers. He has sustained a lot of attacks from anti-vaxxers, anti-maskers and from the entire right-wing conspiracy ecosystem. There have been orchestrated campaigns against him recently on Fox News. Attacks from fringe groups and quacks are one thing, but when someone like Tucker Carlson goes after you on Fox News, that's an entirely different level.
On one occasion, two and a half years ago I was at a San Diego conference on a panel about vaccine hesitancy and the anti-vaccine movement. Other people on the panel included Richard Pan, a California state Senator and pediatrician. He is very pro-vaccine and he is one of two senators who introduced Senate Bill No. 277 (SB-277) in 2015, which is a law that eliminated belief exemptions to avoid vaccination mandates for entry into schools and day-care centers in California. Before that bill you could refuse to have your child vaccinated based on personal beliefs or religion. That law eliminated this and only allowed medical exemptions. We were somewhat concerned on being targets of some sort. There was some security at that conference to keep anyone who wasn't a registered attendee. As for actual incidents of attacks, Senator Pan had an anti-vaxxer trying to physically assault him once.
On my professional life maybe. If you had asked me this question five years ago, I would have said for sure. And the reason is that five years ago, there was so much misinformation and lies written about me in social media, websites, and blogs. If you were to Google search my name back in 2016 you would have found a lot of horrible stuff written about me. I used to joke back then that if I ever lost my job and needed to find another one, I would be in deep trouble because when a company wants to hire these days they Google your name, especially in academia. We could try to assess whether smear campaigns have been successful or not, but Google has increasingly clamped down on many websites promoting conspiracy theories and misinformation. A lot of the hateful articles about me, although they still exist, no longer show up in the first pages of Google searches.
I think it does work sometimes. I tend to do it more these days because I enjoy it. There are times when I come close to just walking away, maybe not deleting my Twitter account as some people have done, but just stopping. Yet I somehow always come back, which makes me wonder if there is something to do with what people say about social media being a bit of an addiction.
Something to keep in mind is that I have received numerous legal threats. I would be asked to take down an article or I was once even sued for libel. Say what you will about the US and some of the disadvantages of this context, but the first amendment really does make it very difficult for anyone to successfully sue me for libel, especially if the person that I wrote about is a public figure. When these groups threaten to sue, they are trying to intimidate me. Or when they sue, they are trying to cost me money. The lawsuit will get thrown out eventually, but at the end you do have to spend money on lawyers before it does.
The problem in Europe is that the same libel law protections that the first amendment provides me here in the US are not in place. I recall that over twenty years ago David Irving, a Holocaust denier, ran a libel lawsuit against Deborah Lipstadt. Lipstadt basically wrote in one of her books that Irving was a Holocaust denier, and this was stated with copious documentation. But he sued her in the UK where basically the burden of proof relies not on the person suing to show that what was written was false, but more on the person being sued confirming that what was written was true. In any event, most of European libel laws are a lot less friendly to the defendant than US libel laws. If I lived in UK or Europe, I don't know if I could do what I do. I might give it up because the legal risk gets too high.
You must be careful if you're in Europe compared to me, in what you say. A lawsuit is a big deal. If I was in my twenties, training or getting started at work in my early thirties, a lawsuit would have been potentially devastating compared to now. That´s what I would say to my European colleagues. To those in the US, I would suggest being aware of the potential for harassment, and the occasional legal threats that almost certainly won't go anywhere. Although you would also have situations in Europe like the Dr. Raoult case in France4, where people that criticized him faced a lot of harassment. Overall, if you´re right on the science, and you're right on the facts, and you’re passionate about it, I say go for it.
In other instances it may not even be the libel laws. I wrote once5 about the case where French physicians wrote an open letter criticizing homeopathy, under a group called FakeMed. It wasn't a libel suit that caused them problems. Physicians using homeopathy complained to the Medical Council for an alleged “unprofessional behavior” as you are not supposed to criticize your fellow physicians. However, it is very hard to lose your medical license in both the French and the US context. Here, in the USA, a physician would have to have a problem with substance abuse, or to have sexually assaulted a patient, or have a long history of causing harm to patients through substandard care. Unfortunately, state medical boards are reluctant to enforce a standard of care, and care hast o be really bad before they’ll act. These would be some egregious cases that can lead to a license revocation.
I think misusing language in these platforms gives fuel to your trolls and may turn off people that can be your allies. The style of expression is important. Sometimes I communicate in the way that I speak, and sometimes not. I am pretty informal on Twitter but I do follow the rule that I try not to say things that would embarrass me if my boss or any of my bosses were to read it. And you also have the issue of threatening users in these platforms. That´s part of the reason why I went after Dr. Raoult, from just observing how he used to threaten people on Twitter all the time.
If you´re going to do what I do on Twitter you probably should have a thick skin. But eventually if it is someone I don´t know, or don´t follow, or who is just an anonymous account, I don´t care. It could be a bot for all I know. With regards to what gets me from all this, I don’t think it would be wise to say publicly what sorts of things could get under my skin, or really bother me or get me mad.
It surprises that there hasn't been much, if any violence from the anti-vaccine movement for at least six years now. However, the increasing alignment between the anti-vaxxers and some extreme right-wing groups does worry me. I had a series of posts in the Respectful Insolence blog about the violent rhetoric of the anti-vaccine movement, with examples. I wonder if one of these days someone from that movement, or a group, will get violent.
Some episodes have already taken place. One of their followers pushed Richard Pan, in a luckily mild physical assault. There was a woman who threw menstrual blood at legislators in California when they were passing the SB-277. But until present, there hasn't been any deadly violence. If you look at the rhetoric, it had been getting increasingly violent over the six years before the pandemic.
You have the case of Del Bigtree6, who became quite a famous anti-vaxxer in the US. There was an instance of him publicly calling asking out for the ‘second amendment people,’ "What are you waiting for?" the implication being it might be time to use their guns. In another episode he was attending a Michigan fundraiser event with a local anti-vaccine group, where he went on about how they’ll have to “die for freedom”, but in the context of resisting vaccine mandates.
The first time I saw that was by an American anti-vaxxer some six years ago in the context of the SB-277 legislation and then it waned down. It's not a new thing. Then such practice started taking off again during the COVID-19 vaccine rollout.
Yes, sometimes I do. Recently I had an exchange with a so-called plant-based cardiologist, named Dr. Joel Kahn, who is somewhat famous and goes by the nickname of “America’s holistic heart doc”. Someone pointed out to me that he had been spreading conspiracy theories and anti-vaccine misinformation about COVID vaccines. So, I wrote a couple of posts and tweeted about this. He tried to engage, arguing, and raising concerns. I explained my arguments and my previous analyses on the points he made and sent him documentation and resources. But instead I got excuses not to read the materials and studies I provided. Then another holistic diet doctor joined in over the last couple of days, challenging me to come on his podcast and debate Dr. Kahn. So, yes, it happens from time to time.
We hope to inform, inspire, and encourage our readers with these interviews, and we look forward to sharing more fascinating stories from physicians around the world in the next instalments of our esanum Global Series, a joint editorial effort by the teams from esanum.de, esanum.fr, esanum.it and esanum.com.