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Posted on Aug 12, 2014 in Featured, Medicine, Mental Health, Skepticism, William London | 2 comments

Medical Renegade Paul M. Fleiss, M.D. Dead at 80

By William M. London

Prominent medical renegade Paul M. Fleiss, M.D., best known as father of the “Hollywood madam,” died at home age 80 on July 19th. He had been recovering from injuries he sustained months ago when he was accidentally hit by a car while bicycling. According to his obituary published in the Los Angeles Times:

Fleiss, who was known for having a gentle bedside manner and devoted patients, was still practicing medicine. He was the rare doctor who made house calls, and although he was pediatrician to children of several Hollywood celebrities, he also took on patients whose families could not afford to pay him. Hundreds of supporters crowded into the courtroom for his sentencing in 1995 for the crime that prosecutors said involved Fleiss signing the mortgage on a luxury home his daughter used as a headquarters for her call-girl ring. “I never intended to cheat or lie or steal,” Fleiss said outside the courtroom. “I only wanted to help my daughter.” Heidi Fleiss rushed from the courtroom, saying, “I’m so sorry. He didn’t deserve any of this.” He could have been given a lengthy prison term resulting in a suspension of his medical license, but instead was sentenced to three years’ probation, 625 hours of community service and a fine of $50,000.

Dr. Fleiss’s public record provided by California Department of Consumer Affairs, in U.S. District court-Central District of California indicates that with an effective date of action of May 9th, 1995 he:

PLED GUILTY TO 1 COUNT TITLE 18 U.S.C. SECTION 371 (CONSPIRACY) AND 2 COUNTS TITLE 18 U.S.C. SECTION 1014 (MAKING FALSE STATEMENTS TO A FEDERALLY INSURED BANK)

The record indicates his sentence included in addition to probation and community service, 1 day imprisonment, a $150 special assessment to U.S., and to provide tax returns to “prob office,” but  doesn’t mention a fine of $50,000. The record also indicates that his physician staff privileges were terminated by Children’s Hospital of Los Angeles effective December 23rd, 1996. No reason is indicted for the termination of privileges. The obituary and some tributes published in July about Dr. Fleiss leave out some important details of interest to advocates of healthy skepticism and opponents of quackery about how he practiced medicine and attempted to promote health. I think it’s important to take a closer look.

Clueless About HIV/AIDS

The obituary says nothing about what the Los Angeles Times reported about Dr. Fleiss on September 16, 2006. One of Dr. Fleiss’s patients was Eliza Jane Scovill, who died at age 3 of what the coroner ruled as AIDS-related pneumonia. Eliza’s mother was Christine Maggiore, who became an outspoken denier of HIV as the causal agent of AIDS after she tested positive for HIV in 1992. HIV can be transmitted from mother to child during pregnancy, labor, delivery and breastfeeding. But according to the LA Times report, a Medical Board of California’s investigation revealed:

…Fleiss did not take steps to ensure that Eliza Jane was tested for HIV or, alternatively, note in her chart that her parents had refused testing. The medical board’s own investigation led to an accusation filed Wednesday against Dr. Paul Fleiss, a popular if sometimes unconventional Los Feliz pediatrician. Fleiss also did not offer to treat the girl with antiviral therapy to reduce the risk that the virus would be transmitted through breast milk or recommend that Maggiore stop breast-feeding while the child’s HIV status was unknown. The medical board also cited Fleiss’ care of another child who is HIV-positive in seeking the revocation or suspension of his medical license.

On September 24, 2005, Dr. Fleiss’s cluelessness was revealed in a lengthy Los Angeles Times article about Eliza Jane’s death:

“I don’t understand it,” Fleiss said of Eliza Jane’s death, “because I’ve never seen her sick or with anything resembling what she supposedly died of…. I don’t believe I could have done anything to change this outcome.” Fleiss, who said he could be “convinced either way” on whether HIV causes AIDS, has known the family since before Eliza Jane was born. In 2000, the county Department of Children and Family Services investigated Maggiore and Scovill after a tipster complained that [Eliza's older brother] Charlie was in danger because he hadn’t been tested for HIV and was breast-fed.

On July 12th, 2007, in response to accusations of gross negligence in his treatment of two patients, Dr. Fleiss signed a Stipulated Settlement and Disciplinary Order adopted as the Decision and Order of the Division of Medical Quality of the Medical Board of California. The settlement ordered revocation of his physician and surgeon certificate, but stayed the revocation by placing him on 35 months of probation with various conditions, among them an education course, medical record keeping course, designated monitoring of his practice, and prohibition against supervising physician assistants. The order indicates that Dr. Fleiss  first saw patient “E.S.” on or about December 5, 2001, two days after she was born, and on eight other occasions. On May 18th, 2005, E.S. died of pneumocystic carinii pneumonia due to acquired immune deficiency syndrome (AIDS) and had developed signs of HIV encephalopathy.  The gross negligence accusation from the Medical Board of extreme departure from standard of care of E.S. indicated that Dr. Fleiss failed to:

  1. record or take into consideration during the patient’s course her known high risk of exposure to H.I.V.
  2. recommend or document refusal of testing to establish whether she was H.I.V. positive
  3. advise her mother against breast feeding
  4. obtain or clearly document her developmental milestones and failed to describe in any detail the patient’s history and physical examinations
  5. address her failure to thrive
  6. conduct a diagnostic workup and obtain a chest x-ray  on the last visit of April 30, 2005 when E.S. was documented as having “intermittent history of fever and raspy cough” and “raspy and shallow breathing” and a diagnosis of “bilateral otitis media and bronchitis” and was prescribed Amoxicillin (at an unrecorded dosage)
  7. perform an examination or document a diagnosis of any illness of her mother on or around January 10, 2002, but prescribed or gave her mother a Z-pack (Zithromax)

Dr. Fleiss first saw the second patient, “Z.L.,” a boy age 4, on or about May 17, 2004 for a “second opinion consult” of “treatment options.” The boy and his mother were both H.I.V. positive and the boy had been treated by an HIV specialist at UCSD.  Z.L was seen by Dr. Fleiss three more times and came in one more time for vitamin testing. The Board alleged that Dr. Fleiss’s treatment of Z.L. was an extreme departure of the standard of care because he failed to:

  1. obtain and/or record a relevant history of the presenting complaint, past history of illness, hospitalization, or relevant family history
  2. address the immunocompromised patient’s extremely febrile state on or about the first visit
  3. prepare a growth chart for the patient
  4. perform and/or document a physical examination for the patient
  5. acknowledge and taken into account abnormal laboratory test results and chest x-rays and CT scans
  6. act on an abnormal chest x-ray
  7. order appropriate laboratory tests to enable him to establish a differential diagnosis

Moreover, the Board alleged that on one visit, he ordered vitamin level testing without indication and/or explanation of why this testing was ordered and on a later date, without a visit recorded a diagnosis that the patient’s mother was not neurocognitively impaired without having an empirical reason and that the patient had no signs of a chronic disorder. The Board indicated that Dr. Fleiss said he entered statements into the record at the request of the mother and the statements related to custody of Z.L. Christine Maggiore’s activism in the AIDS community led to the founding in 1995 of Alive and Well AIDS Alternativesa 501 (c) (3) non-profit support, education and health advocacy network that promotes HIV denialism and superstition-based treatments including “nutritional medicine” to treat supposed multiple subclinical deficiencies, naturopathic medicine, Ayurvedic medicine, homeopathy, detoxification & cleansing, acupuncture, Chinese herbology, and mental imagery to cure illness. Among the names of HIV denialists and quackery promoters listed as advisory board members is Paul M. Fleiss, MD, MPH.  In January 2009, David Gorski, MD, PhD provided a detailed discussion about how HIV denialism contributed to the death of Eliza Jane and in 2008 to the death of Christine.

Previous Complaints

On April 9, 1995, in a lengthy feature story about Dr. Fleiss following charges against him in connection to Heidi’s call-girl ring, the Los Angeles Times reported:

Despite his popularity, the doctor was occasionally the object of complaints. Court records show that of five malpractice complaints filed against him, two ended in out-of-court settlements. (The rest were either dropped or won by Fleiss.) In one case that was settled, the parents contended that Fleiss was so insistent that they breast-feed their infant, despite the mother’s difficulty in producing milk, that the child eventually became dehydrated and went into hypertensive cardiac arrest. The baby ended up losing a kidney, said the lawyer who represented the family.

Ironically, on July 21, 2014, Dr. Jay Gordon celebrated Dr. Fleiss’s dogmatic insistence on breastfeeding by posting on his blog a tribute to Dr. Fleiss by Audrey Naylor, MD,DrPH a clinical professor of pediatrics at University of Vermont College of Medicine and CEO of Wellstart International, According to Dr. Naylor, “Paul was a very dedicated pediatrician to his patients and their parents and did not accept any patient/parents excuses for those who were not willing to breastfeed.” Breastfeeding has clear advantages over formula feeding, but that does not make it virtuous for physicians to insist that mothers breastfeed their babies, no matter what (including when contraindicated, as in the case of Eliza Jane Scovill, and when not feasible). More from the Times:

In the other case, a Burbank couple charged that Fleiss had been too lax when their 3-year-old developed a fever. The doctor, they said, told them it was nothing to worry about. Then the child suffered a seizure resulting in irreversible brain damage. Lawyers for Fleiss–who admitted no guilt in either settlement–say that in the first case, factors other than the breast-feeding problems had led to the kidney loss. In the second case, according to Fleiss and his lawyer, the toddler’s seizure was caused by a virulent infection that would have caused brain damage even if it had been diagnosed earlier. Medical malpractice experts characterized his record as fairly typical for a veteran pediatrician. Less typical is the devotion of his patients, who use words like angelic and saint when they talk about him. “Finding Dr. Fleiss was like finding a treasure,” says Kelli Way, a 30-year-old mother of six. “He’s one of the sweetest men I have ever met.”

I don’t know who these experts were or what data led them to conclude Dr. Fleiss’s record was typical, but I have my doubts, especially considering the previously described substandard care of E.S. and Z.L. and after reading a new blog post by Harriet Hall, MD about data on malpractice suits. Compared to some physician specialists, pediatricians are not expected to be sued frequently for malpractice. But it would not surprise me to learn that there were other lawsuits filed against Dr. Fleiss that were settled out of court during the last nineteen years. (Sorry, I decided not to spend the $4.75 fee for looking up cases against Dr. Fleiss in Los Angeles, but I would be glad to receive the information from any reader.)

Raw Milk Promotion

A letter dated December 18, 2000 from Dr. Fleiss in the role of president of the now defunct American Association of Medical Milk Commission, Inc. to the Board of Supervisors of the County of Los Angeles on a website named RawMilk.org is included with various raw milk advocacy documents. The 1824 Hillhurst Ave. address given for Dr. Fleiss’s corporation is the same address of his pediatrics practice. The letter reads:

I hope that you, your family and associates are well and happy. I am Dr. Paul Fleiss, M.D., the incumbent President of the American Association of Medical Milk Commission.  I wish I were able to deliver this important message but my patient load restricts me. Arlene Binder, Attorney at Law, is reading my statement of deep concern to you. For many years I was your Medical Milk Commissioner, and Chairman. We had a record of clean and safe milk for all of those years when the regulations did not exceed those of the State. Mr. Antonovich’s reasonable, as well as important, Motion considers that we, intelligent and informed people, may choose to buy raw milk regulated by the State as safe and healthy under proved scientific standards. Also, it carries a warning label of possible bacteria. It is our right as intelligent people to have the right to choose. Please vote in a manner that reflects you respect us and our right to have State-approved Grade A and Guaranteed raw milk. Please vote yes on Item 7. Thank you for your consideration and understanding.

The biggest problem with framing the issue as one of intelligent people having the right to choose is that the choice isn’t free when it’s based on misinformation from a medical contrarian, especially one with a conflict of interest readily apparent. (Dr. Fleiss was president of the AAMMC, an organization that represented just one politically connected dairy.) And children aren’t free to choose parents who will make decisions based on trustworthy information. In 1996, I mentioned Dr. Fleiss’s opposition to pateurization in an article I wrote for Priorities in Health magazine. My source regarding Dr. Fleiss was Odom Fanning’s reporting about a 1994 Food and Drug Administration hearing about a proposal to ban the sale of raw (unpasteurized) dairy products. Fanning wrote:

Paul M. Fleiss, M.D…. admitted that he had been “repelled” to discover that in Hollywood there was a large group of consumers of raw milk. For a number of years, he said, he tried to dissuade mothers from feeding their infants and children a product with such a bad reputation. Finally, he investigated for himself, read the literature, visited dairies, “became a convert,” and now heads the Los Angeles County Milk Commission. “I have a very busy pediatrics practice, and many mothers tell me that their children do better on raw milk,” he said. “Some dairies are heating milk far beyond the heating required for pasteurization-they’re sterilizing it. This destroys some important nutrients. And you can taste the difference.” He also claimed that immunoglobulins and enzymes such as lactases and lipases are destroyed by sterilization. “Raw milk contains lipase, free fatty acids, which when absorbed help the body utilize fat better,” he explained. “This is why some allergies might be due to pasteurized milk.”

Unfortunately, Dr. Fleiss’s investigation led him to embrace popular misconceptions. The federal Food and Drug Administration (FDA) has noted that raw milk presents unreasonable hazards and has refuted common misconceptions about raw milk and pasteurization. An FDA information page updated in 2011 makes these points supported by references:

Raw milk does not cure lactose intolerance. Raw milk does not cure or treat asthma and allergy. Raw milk is not more effective in preventing osteoporosis than pasteurized milk. There are no beneficial bacteria in raw milk for gastrointestinal health. Raw milk is not an immune system building food and is particularly unsafe for children. There are no immunoglobulins in raw milk that enhance the human immune system. There are no additional protease and lipases in raw milk that facilitate milk digestion. Raw milk is not nutritionally superior to pasteurized milk. Raw milk does not contain natural antimicrobial components that make milk safe. Raw milk does not contain nisin for pathogen inhibition. Folate binding protein (FBP) is not denatured during pateurization and folate utilization is not reduced in pasteurized milk. Pasteurized milk is safer than raw milk. Raw milk causes a greater rate of foodborne outbreaks than pasteurized milk. Raw milk produced under HAACP does not make it safe to drink.

In summary, FDA noted:

None of the claims made by the raw milk advocates that we have examined for you can withstand scientific scrutiny. Unfortunately, the false “health benefits” claims of raw milk advocates may cause parents to give raw milk to their children and prompt immuno-compromised people, such as pregnant women, the elderly, and hospitalized patients, who want better nutrition, to also start consuming raw milk.  It is these very same sub-groups of the population, however, that are most at risk for becoming ill or even dying from foodborne illness as a result of consuming adulterated raw milk.  

In 2013, the American Academy of Pediatrics issued a policy statement on “Consumption of Raw or Unpasteurized Milk and Milk Products by Pregnant Women and Children.” Some key points in the statement included:

  • Only 1% to 3% of dairy products consumed in the United States are unpasteurized.
  • 60% of dairy-associated food-borne illness outbreaks in the U.S. involved unpasteurized dairy products
  • In food-borne illness outbreaks involving unpasteurized dairy products, 13% of patients were hospitalized while only 1% of patients were hospitalized in outbreaks involving pasteurized dairy products.
  • In addition to older adults, populations at highest risk of illness and death from raw milk products are immunocompromised individuals, young infants, and children.

According to the California Department of Public Health:

1. Raw milk and raw dairy products are milk and dairy products (e.g., queso fresco, cheese, cream, etc.) made from milk that have not been pasteurized (heat treated) to kill off bacteria. Raw milk and raw dairy products are not as safe as pasteurized milk and dairy products made from pasteurized milk. 2. Raw milk and raw dairy products are inherently unsafe to consumers because they may contain one or more types of bacteria that can cause mild to severe illnesses. These bacteria include BrucellaCampylobacterShiga toxin-producing E. coli such as E. coli O157:H7Listeria, Mycobacterium bovisSalmonella species, and Yersinia. 3. Infection with one of these bacteria may occur from drinking raw milk or eating dairy products made from raw milk. The symptoms of these infections include diarrhea, stomach cramps, or fever. Rare, yet severe illness may also occur, including a neurological disease called Guillain-Barré syndrome with Campylobacter jejuni infection, acute renal failure in children or the elderly with E. coliO157:H7 infection, and miscarriage or fetal death in pregnant women with Listeria monocytogenes infection.

4. The risk of severe disease, hospitalization, or death from consuming raw milk or raw dairy products is greater for children, pregnant women and their unborn babies, the elderly, and persons with weakened immune systems.

5. Outbreaks of infections due to consumption of raw milk or raw dairy products have been documented nationwide. From 1998 to 2008, the U.S. Centers for Disease Control and Prevention (CDC) documented 85 outbreaks of human infections that resulted from consumption of raw milk or cheese made from raw milk. A total of 1,614 reported illnesses, 187 hospitalizations and 2 deaths were reported from these outbreaks. The actual number of illnesses associated with raw milk or raw milk products is likely greater because not all cases of foodborne illness are recognized or reported

6. California outbreaks due to raw milk or raw dairy products included:

a. Cases of Salmonella Dublin infections in the 1970s into early 1980s that were associated with raw milk consumption. One published investigation in 1979 documented 113 patients with 89 hospitalizations and 22 deaths. Several patients had a serious underlying disease such as leukemia or lymphoma that might have predisposed them to a more severe outcome.

b. Two outbreaks of Campylobacter infection, one in 1984 where several children and adults were ill after drinking raw milk while on a tour of a dairy, and another in 1985 where several people became infected after drinking raw milk on a tour of a bottling plant.

c. Two outbreaks of multidrug-resistant Salmonella infection associated with eating unpasteurized Mexican-style cheese in 1997 resulting in over 10 culture-confirmed cases.

d. An outbreak of E. coli O157 infection in September 2006 that affected six children, three of whom were hospitalized including two with kidney failure.

e. A cluster of diarrheal illness and Campylobacter infections in May-June 2008 that affected some members of a cow-share program who consumed raw milk; one of those affected developed a form of Guillain-Barré syndrome that required prolonged hospitalization.

7. The California Department of Public Health recommends that:

a. persons at higher risk for severe foodborne disease (children, pregnant women, the elderly, and persons with weakened immune systems) and those who wish to reduce their risk of foodborne infections should not drink raw milk nor eat raw dairy products.

b. persons who experience illness after consuming raw milk or a raw dairy product should see their doctor.

Alarmist Intactivism

Dr. Fleiss was outspoken as an intactivist–an activist who opposes all forms of medically unnecessary surgical removal or modification of children’s normal genitalia. Intactivists deny that parents and/or guardians have the right to consent to surgical removal or modification of children’s normal genitalia and insist that it is irresponsible for healthcare providers to remove or mutilate normal parts of the body. I strongly support the intactivist message for protecting female children because there are no established or likely medical benefits for surgically altering normal female genitalia of children, while there are obvious harmful effects. However, I disagree with the many humanists and skeptics who object to the practice of elective circumcision of newborn males. That includes Dr. Dean Edell, who provided a blurb to promote Dr. Fleiss’s book Circumcision: Untold Facts on America’s Most Widely Performed-and Most Unnecessary-Surgery, which was part of the What Your Doctor May Not Tell You About(TM) series, and Penn & Teller, who included Dr. Fleiss in their program declaring that circumcision is bullshit. To the dismay of intactivists, in 2012, the American Academy of Pediatrics (AAP) issued, based on an in-depth technical review, this policy statement :

Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure. Benefits include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections.

The procedure is well tolerated when performed by trained professionals under sterile conditions with appropriate pain management. Complications are infrequent; most are minor, and severe complications are rare. Male circumcision performed during the newborn period has considerably lower complication rates than when performed later in life.

Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families.

Findings from the systematic evaluation are available in the accompanying technical report. The American College of Obstetricians and Gynecologists has endorsed this statement.

I don’t think Dr. Fleiss could have been convinced by any systematic evaluation of the literature. In 1999, he authored a book chapter title “An Analysis of Bias Regarding Circumcision in American Medical Literature.” I see it as an excellent example of the bias blind spot, the tendency to perceive bias in others, but not so much in oneself. The chapter begins with a critique of the peer review process of journals. While it’s fair to point out that the peer review process does not ensure that journals publish only high quality research, quality of research is closely scrutinized in evidence-based practice reviews such as the AAP technical report. But Dr. Fleiss insisted that circumcision is too well established in American medicine to be studied in an unbiased way. He argued:

Because the medical establishment in the United States is evidently committed to continuing its Cold War era programme of systematic circumcision of newborn males, and because American society has been conditioned to accept this programme unquestionably, there is little incentive for researchers to design prospective studies examining the potential flaws in either the circumcision programme or in pro-circumcision ideology.

Unquestionably? I don’t know what he was referring to as the medical establishment, but I presume he included AAP as part of it. AAP published a statement on male newborn circumcision the same year Dr. Fleiss’s book chapter was published. That statement, like the revised, updated 2012 statement carefully examined risks of circumcision. Unlike Dr. Fleiss, AAP was willing to consider evidence for benefits of male newborn circumcision as well as risks. The 2012 AAP statement is more favorable toward circumcision largely because of new findings from prospective studies that were conducted in the interim even though Dr. Fleiss said researchers had no incentive to design such studies. While Dr. Fleiss insisted on prospective studies to support circumcision, it didn’t stop him from citing non-prospective studies and anecdotes to support his anti-circumcision ideology. For example, he claimed:

There, is in fact, a great deal of scientific evidence demonstrating long-term negative psychological and emotional effects of circumcision performed in childhood.

For this he cites three obscure references including one suggesting circumcised males suffer from “castration anxiety.” But wait, there’s more:

Although denied publication in medical journals, a convincing body of evidence has been collected and published documenting the long-term psychological harm of circumcision in some males.

His only citation to support this is to a book chapter with the subtitle “a preliminary poll of circumcised males.” If three males surveyed claimed psychological harm from circumcision, I guess that would constitute “some males.” Perhaps there is good reason rather the bias for denying publication in medical journals for what Dr. Fleiss considered convincing evidence. It doesn’t seem that Dr. Fleiss tried hard to present himself as unbiased. He wrote:

As an analogy, the Nazi scientific data “proving” that Jews were an inferior race was, to say the least, of dubious scientific worth, if for no other reason than that it served a contemporary agenda. Similarly, the American circumcisionist “scientific data” alleging the inferiority of the natural design of the human penis, is of dubious scientific merit, if for no other reason, because it serves a contemporary political and economic agenda.

I guess that implies that experts from AAP and the American College of Obstetricians were unable to recognize recent studies with favorable findings for circumcision as Nazi-like scientific data. But if either group had a political or economic agenda, it wound up being to respect choices of parents in the position statement they endorsed in 2012. According to Dr. Fleiss, but contrary to the life experiences of the vast majority of men who were circumcised as newborns: “The foreskin is necessary.” That was the title of an article he wrote in the April 1996 issue (p. 64-65) of the Townsend Letter for Doctors and Patients (subtitled The Examiner of Medical Alternatives), a magazine that continues to promote non-validated and invalidated health products, services, and regimens as the Townsend Letter: The Examiner of Alternative Medicine. He also used that article title as a section heading for his 1997 article “The Case Against Circumcision.”The article was published in Mothering: The Magazine of Natural Family Living, which Orac accurately described as “a bastion of woo targeting young mothers.” Dr. Fleiss’s articles did not manage to raise the publication standards of either magazine. There are several whoppers in the Mothering article, but most of them stem from this faulty premise:

Millions of years of evolution have fashioned the human body into a model of refinement, elegance, and efficiency, with every part having a function and purpose. Evolution has determined that mammals’ genitals should be sheathed in a protective, responsive, multipurpose foreskin. Every normal human being is born with a foreskin. In females, it protects the glans of the clitoris; in males, it protects the glans of the penis. Thus, the foreskin is an essential part of human sexual anatomy.

This is not only a fallacious appeal to nature, but also a misrepresentation of how evolution works. As noted by paleontologist and geologist Donald Prothero in his book Evolution: What the Fossils Say and Why It Matters (p. 39):

…the more one looks at nature, the more one finds examples of clumsy or jury-rigged design because, unlike a Divine Designer, evolution does not require perfection…. We humans are classic examples of an organism not optimally designed to our current lifestyles. Our backs and our feet are not well adapted to walking upright, as those of us who suffer with back and foot pain know. Our knees are poorly constructed and easily damaged, as those who have had knee surgery can attest. Our eyes are designed backward, with several layers of cells and tissues blocking and distorting the light hitting the retina in the back of our eye before the light finally reaches the photoreceptor cells on the very bottom layer. We have vestigial organs, such as our tiny tailbones, tonsils, and appendix, the latter two of which no longer perform an important function but can become infected and be deadly to us…. Our genome is full of nonfunctional DNA, including inactive pseudogenes that were active in our ancestors…. Finally, ask any ID [intelligent design] advocate: why did God give men nonfunctional nipples?

The Circumcision Resource Center, an anti-circumcision organization, quotes Dr. Fleiss on its webpages: “Doctors who circumcise are the most resistant to change. They will not admit that they made a critical mistake by amputating an important part of the penis.” But as Harriet Hall, MD revealed, unlike AAP, many ideologically-driven opponents of circumcision are resistant to changing their perspectives in response to new substantive evidence.

Fleiss and Immunizations

In 2007, the Los Angeles Times reported:

“…although he recommends vaccinations for children, he does not insist upon them, according to some of the parents of his young patients.”

I’m not sure why he would not insist on immunizing children. In his chapter on supposed bias in the literature for circumcision, he rejected the the idea that circumcision could be compared to childhood immunizations for disease prevention. He expressed strong support “quasi-compulsory immunisation” as a public health measure. Several of the positive reviews I found of Dr. Fleiss on Yelp suggest that he recommended vaccines, but supported delayed schedules of vaccinating children. But these schedules are not evidence-based and don’t have biologically plausible rationales. Dr. Fleiss’s name appears on the list of [California] “DOCTORS WHO (MAY) SIGN VACCINE EXEMPTIONS” at the quackery-promoting, vaccination-opposing site thedoctorwithin, which presents itself as a repository for “alternative” views on health issues. Also on the list with Dr. Fleiss, is Dr. Jay Gordon, a vaccine critic in Santa Monica who is popular among celebrities and who began private practice in pediatrics in Dr. Fleiss’s office. Dr. Gordon was also one of Eliza Jane Scovill’s doctors. I searched the web for information about most of the doctors on the list (which includes medical doctors, osteopaths, and naturopaths) and found that most of the doctors on the list promote so-called “holistic” or “integrative” medicine. These labels for supposed types of medicine are usually used as euphemisms by those who promote non-validated and invalidated health care practices. I’m not sure what “DOCTORS WHO (MAY) SIGN VACCINE EXEMPTIONS” means. There are several references to roles of health care practitioners in the relevant Section 120325-120380 of California’s Health and Safety Code which concerns the legislature’s intent to totally immunize the population against vaccine-preventable diseases and exemptions from immunizations for medical reasons and personal beliefs. For example, one paragraph reads:

120370. If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances that contraindicate immunization, that person shall be exempt from the requirements of Chapter 1 (commencing with Section 120325, but excluding Section 120380) and Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician’s statement.

So perhaps this list includes doctors who are perceived as likely to state that an immunization is contraindicated when parents don’t want their children immunized. But it also could include doctors preferred by parents seeking belief-based exemptions to immunizations and who need a doctor to attest that they informed the parent about the benefits and risks of immunization and the communicable diseases prevented by vaccines.

Anti-Swaddling Absolutism

Dr. Fleiss was mentioned in an article in Mothering about swaddling:

Dr. Fleiss goes even farther, suggesting that when an infant with unmet needs is swaddled and separated from his mother, the message he receives is: Give up. No one cares, no one is going to help you; solve it yourself. [Emphasis in the original.] “You can say swaddling works; it stops the baby from crying. But because something works doesn’t mean it’s a good thing to do,” Fleiss argues. “I tell parents not to swaddle, ever. [Emphasis added.] When a baby is crying he’s saying where’s my mommy? He’s not saying wrap me up real tightly. He should be put to the breast, he should be talked to, sung to, held, loved.”

The problem with this is that crying infants aren’t always comforted by being put to the breast, talked to, sung to, or held. The loving thing to do is to comfort the baby and swaddling with safe technique is a tool for doing so that even Dr. Fleiss admits can be effective. Dr. Fleiss did a disservice to parents by suggesting that they must love their babies without ever swaddling.

Conclusion

The 1996 made-for-television movie dramatization The Good Doctor: The Paul Fleiss Story with Michael Gross in the title role portrayed Dr. Fleiss as “a good, caring, almost saintly family man, whose misguided liberal sympathies led him to excesses of self-indulgence when it came to raising his children.” The movie was mostly about his relationship with Heidi, but it also made clear that he was well-regarded as a devoted pediatrician. While I’m not impressed with what I have learned about Dr. Fleiss from his writings and public statements, I’m convinced that he was kind, compassionate, dedicated, warm, and gentle–just like most pediatricians. I don’t have to be convinced that the “Good Doctor” did a great deal of good as a doctor, including helping mothers overcome obstacles to breastfeeding. But I think it’s important to recognize how he was a false medical prophet, just as I think it’s important to recognize Dr. Mehmet Oz, who also has done a great deal of good when he’s not recommending nonsense, as a false medical prophet. It’s clear that Dr. Fleiss’s approach to medicine at his Los Feliz, California practice satisfied parents interested in “alternative” therapies. But satisfaction may not correlate well with important medical outcomes. I presume that Christine Maggiore was satisfied with his care of her daughter, but the care was irresponsible. Dr. Fleiss also did much that put off some parents rather than satisfy them. He was dogmatic in his opposition to formula feeding, pasteurization, circumcision, and swaddling. Yet it appears that he was willing to help parents avoid or delay having their children receive mandatory immunizations even though he wrote about their importance. Dr. Fleiss has been called a medical contrarian. I go one step further and suggest he was a medical renegade, a term I learned from the late John Renner, M.D. A similar term, cowboy doctors, was described in a recent article:

Cowboys go it alone. They have developed their own rules and they don’t necessarily adapt those rules to what the clinical evidence would suggest.

I conclude that for Dr. Fleiss, ideology emphasizing natural care could trump the best available clinical evidence. Wendy Hughes, my editor here at the Healthy Skepticism Channel, told me that she saw Dr. Fleiss many times at lectures held at the Center for Inquiry-Los Angeles, an organization I strongly support because it promotes secular humanism and skeptical inquiry. I’m not sure what Dr. Fleiss learned about best practices in skeptical inquiry. (I don’t think he attended my lecture at CFI-LA in 2003 when it was known as CFI-West.) It appears that Dr. Fleiss applied less skeptical scrutiny to what he perceived as natural than to what he perceived as part of the medical establishment. Dr. Fleiss probably would not have had a devoted following without having some well developed skills in the art of medical practice. But as pediatrician Clay Jones, MD recently wrote:

The art of medicine is often described as how we apply the science to the individual, but taken too far it can serve as a shield against criticism, a place for quacks of all kinds to take shelter against evidence. The art of medicine is all-too-often used as a conversation-ending justification for what is simply bad medical practice.

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Photo by Susan Gerbic

Photo by Susan Gerbic

William M. London is a specialist in the study of health-related superstition, pseudoscience, sensationalism, schemes, scams, frauds, deception, and misperception, who likes to use the politically incorrect word: quackery. He is a professor in the Department of Public Health at California State University, Los Angeles; a co-author of the college textbook Consumer Health: A Guide to Intelligent Decisions (ninth edition copyright 2013); the associate editor (since 2002) of Consumer Health Digest, the free weekly e-newsletter of Quackwatch; one of two North American editors of the journal Focus on Alternative and Complementary Therapies; co-host of the Quackwatch network’s Credential Watch website; a consultant to the Committee for Skeptical Inquiry. He earned his doctorate & master’s in health education, master’s in educational psychology, baccalaureate in biological science, and baccalaureate in geography at the University at Buffalo (SUNY), and his master of public health degree from Loma Linda University. He successfully completed all required coursework toward a Master of Science in Clinical Research from Charles R. Drew University of Medicine and Science, but he has taken way too much time writing up his thesis project: an investigation of therapeutic claims and modalities promoted by chiropractors in the City of Los Angeles.

  • http://www.skepticink.com/incredulous Edward Clint

    Thank you for this detailed account. Excellent article. I had no idea about most of this. It really goes to show how unable or unwilling the medical establishment is at responding deadly and otherwise harmful science denialists. Or maybe Fleiss just got away with it because he was a well-connected and beloved Hollywood doctor. Either way, pretty alarming.

    I am with Fleiss on one point, and that is newborn circumcision. Not because it is medically advantageous to be uncircumcised, but that I find it unethical and invasive. If a man wants the protective STI benefits, then that should be a choice he makes for himself. The other risks are rare and relatively minor.

  • Gary Harryman

    Professor London seems to have a curious blind spot in his many intellectualized analyses. In spite of the evidence, he still refuses to list infant genital mutilation of healthy babies by American doctors as child abuse for profit in Quackwatch. He merely clips and pastes the AAP party line. One has to wonder why. It makes me suspicious of everything he writes; not healthily skeptical – suspicious.

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