2020 UPDATE on the Tim Noakes Report

Summary: In a recent blog post, Tim Noakes continued to spread anti- misinformation and common anti-vaccine/vaccine hesitant tropes. Such misinformation included the flawed science done by anti-vaccine activist, Brian Hooker. This was used to defend Noakes’ 2014 social media post on Twitter that also included anti-vaccine misinformation (a video directed by with the false -vaccine connection and CDC “coverup” conspiracy). He calls on Nathan Geffen, PhD to remove a previous article about him due to concerns about potential falsehoods, but Noakes has failed to do this with the very factual errors he has expressed and spread, which indeed can have public health consequences. Noakes also doubles down by implying support to the discredited, flawed paper by Andrew Wakefield. Previously, Noakes’ social media had been assessed for not just what type of anti-vaccine misinformation was spread, but how much. This included observations of an increasing relationship between those who follow Noakes on Twitter, and those who also follow anti- vaccine accounts — this relationship has continued to increase dramatically in 2020. Noakes has continued to support several anti-vaccine leaders, such as Robert F. Kennedy Jr. and his organization Children’s Health Defense, and now recently and her documentary “”. When assessing the overall vaccine narrative that Noakes broadcasts to his audience, it seems that 93% of it has been anti-vaccine in . Furthermore, in the first four months of 2020, Tim Noakes generated a maximum of ~7 million exposures to anti-vaccine misinformation. Across all tweets from August 2014 to May 7th, 2020, this number adds up to a staggering 11 million possible exposures. The claim that Noakes “is not anti-vaccine” and has not shared anti-vaccine misinformation is terribly weak and not based on the evidence. Noakes has spread, expressed and supported unscientific, disproven claims and the majority of what he has shared about is dangerous to public health and can cause harm to the reputation of those in his profession. Continuing to do so, as he has done, is a complete contradiction to what Noakes stands for, what others in his profession stand for, and what his own country’s regulatory body, as well as international organizations, stand for.

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CONTENTS

Response to Vaccine Misinformation in Noakes’ May 4th, 2020 Blog Article ...... 3 Analysis of Tim Noakes’ Social Media: 2020 UPDATE ...... 6 Additional Twitter Concerns...... 13 Conclusion ...... 17 References ...... 18

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Response to Vaccine Misinformation in Noakes’ May 4th, 2020 Blog Article

On May 4th, 2020, an article was published by Tim Noakes on The Noakes Foundation’s website. In this article, Noakes addresses concerns and claims made by Nathan Geffen, PhD about vaccine related issues and COVID-19 information — here we will touch on the topic of vaccines. Noakes continues to defend his 2014 CDC Coverup Whistleblower tweet and claims that what he posted was “factually correct.” This could be farther from the truth as the video posted and concerns implied in the tweet are not scientifically correct and are explicit anti- vaccine tropes and rhetoric. The CDC whistleblower coverup story and risk of autism have shown to be false.1–13 Noakes claims that these allegations (about a risk of autism from MMR) are correct based on a reanalysis study by Brian Hooker. However, the study cited can no longer be found and has subsequently been removed from the journal’s site. Noakes includes that the reanalysis was published in the Journal of American Physicians and Surgeons and this might be an appeal to authority since it sounds academically legit. What Noakes might be unaware of, is that this journal is not a respectable journal; it has been criticized for promoting fringe views and for being a predatory journal.14–16 Put bluntly by Dr. , “The AAPS is, basically, a far right wing doctors’ organization masquerading as a medical professional society, with a world view that rejects nearly all restrictions on physicians’ practice of medicine, purportedly for the good of the patient.”3 It is disappointing that Tim Noakes did not look deeper before citing this study, journal and evidence. In the future, it would be quite concerning if this did not raise red flags with Noakes since he enjoys focusing on the issues of “Bad Science.” The 2018 reanalysis by Hooker was flawed.3 • “the numbers are so small that this is almost certainly a spurious result, particularly given that it wasn’t seen in any other subgroup and there is no biologically plausible mechanism why MMR would increase the risk of autism in only African-American males who received the MMR after 24 months.”3 Hooker’s attempted reanalysis in 2014 was also flawed and retracted.2–4,10,17,18 The publisher also issued “serious concerns about the validity of its conclusions because of possible undeclared competing interests of the author and peer reviewers.”19 Noakes’ believes that this makes the information conveyed in his original tweet “proven to be factually correct.” However, it does nothing of the sorts. The video Noakes tweeted is posted by an anti-vaccine account, which is directed by an anti-vaccine leader which claims there is a coverup in the CDC, which is an anti-vaccine claim, and the coverup is about a false autism association, which also happens to be an anti-vaccine claim. This checks all the boxes for being explicit anti-vaccine misinformation. Noakes also includes part of a quote that suggests these findings (now shown to be flawed) “could yield important clues regarding the current enormous increase in autism.” Thus, Noakes 3 continues to conflate autism and vaccines in order to explain the increase in autism — however, if Noakes referred to the current scientific evidence on the topic, he would find that vaccines do not explain this apparent increase.

Vaccines do not cause autism, they do not increase the risk of autism, and the epidemiologic and mechanistic evidence does not show any link whatsoever.20–41 A brand new 2020 Cochrane Systematic Review, which included 138 studies and totaled over 23 million participants, concluded once again, that there is no increased risk of autism.41 Noakes once again claims that his tweet was about “Bad Science” and not vaccine safety or the flawed autism connection. However, the content/video he tweeted was indeed about vaccine safety and the flawed autism connection. Furthermore, he is only partially correct since his tweet does in fact demonstrate “Bad Science”, that is, the bad science that tried to show vaccines increased the risk of autism and the lack of critical thinking that can follow when posting about such topics. This is about “Bad Science”, but not in the way that Noakes thinks — in this case, he has been the one that has posted bad science. On the topic of bad science, but off topic from vaccines, it is incredibly odd that Noakes seems to endorse the research findings of Professor Didier Raoult, when it appears as though Raoult has exemplified the act of bad science. Much of Raoult’s work on COVID-19 has been flawed.42–45 There is some additional irony within Noakes’ response, as he calls out the CDC’s conflict of interest and often brings up “Big Pharma”, but little does he know that Raoult seems to have pharmaceutical financial ties.46 He continues to defend this 2014 tweet by mentioning that the tweet “posed as a question and ended with a question mark.” In 2020, we could continue to ask questions about the topic, however, this then should be closely followed by the scientific evidence that shows no connection between . Asking questions for the sake of asking questions and ignoring the scientific answers is simply not science. It appears Noakes tries to lessen the impact of what he had posted by saying the tweet “just happened to involve the suppression of what proved to be legitimate findings relating to vaccine safety.” It is unclear why Noakes writes this the way he does. Not only were these findings flawed and the concerns about vaccine safety proven to be scientifically unsound, Noakes dodges the anti-vaccine nature of what he posted by claiming the tweet “just so happened” to also contain vaccine misinformation — as if it was sheer coincidence and as if he has no control, or responsibility, in what he posts. Ironically, Noakes’ claims that Geffen’s article is dishonest, when the content that Noakes has spread is also dishonest.

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I am unsure why Noakes brings up the fact that “The CDC is the largest single buyer and distributor of vaccines in the United States” — this conflict of interest is besides the point and can be considered a strawman fallacy or the “poisoning the well” fallacy. It might be helpful to include this additional detail from the same document Noakes cited: “CDC does not directly purchase vaccines; state and local grantees are each given a vaccine budget for the purchase of vaccines at the negotiated contract prices. With that budget, states can purchase, store, and redistribute these vaccines from their own depots or through contracts with pharmaceutical distribution companies.”47 What Noakes is expressing also happens to be a common “Big Pharma” trope and it could be concluded that the CDC profits are most likely less than what Noakes thinks.48,49 Noakes also doesn’t acknowledge the major conflicts of interest and profits from those within the anti- vaccine movement.50,51 It is unclear why Noakes wants Geffen to try and correct information when Noakes himself won’t correct his own falsehoods. Noakes’ “understanding is that a responsible journalist is ethically bound to correct any factual errors that he had reported, and which could have serious long-term health consequences for many.” Noakes has failed to do this with the very factual errors he has reported and spread, which indeed can have public health consequences. This also directly conflicts with the defenses and arguments he has made for himself, i.e. that he is “just asking questions.” Noakes seems to be talking about possible false balance created by Geffen. However, much of what Noakes has posted and expressed about vaccines has indeed created false balance — this hypocrisy has been a common theme over the years. He suggests that it would be better for Geffen to not only apologize, but to retract the article. Noakes has failed to retract his own misleading anti-vaccine related posts and tweets — starting with his 2014 tweet and continuing onto the long list of posts and retweets over the years. Noakes claims that Wakefield’s 1998 Lancet paper “nevertheless was the first to identify the findings that the Hooker paper has now confirmed.” The Hooker paper did not confirm those findings and was also flawed. In fact, Hooker ended up technically proving “Andrew Wakefield wrong, failing to find a relationship between MMR and autism for the vast majority of children.”3 Noakes erroneously believes that Geffen might want to apologize to Wakefield. In my opinion, being highly concerned about flawed, retracted, and manipulated findings to push an anti-vaccine agenda does not deserve an apology. Also, as Jacques Rousseau points out in his blog, Noakes mentions Geffen’s lack of formal training in medicine, virology, etc. However, “[Brian] Hooker has a bachelors degree and a doctorate in chemical engineering, but also none of the qualifications [that Noakes] listed.”52 It is unclear at this time why Noakes says that “journalism needs to be about truth” and not about “dissemination of malicious falsehoods”, when he himself has posted untruths and disseminated common falsehoods.

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Analysis of Tim Noakes’ Social Media: 2020 UPDATE

This section is meant to be a brief update to the original report on Tim Noakes, specifically the Social Media Analysis. The original report had planned to end by 2019. However, it was mentioned that the misinformation continued into 2020. This update will continue the social media analysis with regards to what has been posted in 2020. Of note, the original plan was to go into detail about each post and retweet just like the main report. However, given that there were 49 more posts to cover, each screenshot was not included.

Connections One observation was that those who follow Noakes and those who follow anti-vaccine accounts had continued to increase from December 22nd, 2019 to August 26th, 2020.

Table 1. Updated: Shared follower counts for Tim Noakes and popular anti-vaccine Twitter accounts. June 17th Dec 22nd May 4th May 8th Aug 26th 2019 2019 2020 2020 2020 Account CHD 305 429 699 736 1098 RFK, JR 844 1018 1552 1597 2283 Wakefield 291 324 343 343 369 Sharyl Attkission 2220 2633 3020 3028 3308 LaLaRueFrench75 252 307 347 349 362 Age Of Autism 303 317 336 336 344 vaxxedthemovie 346 391 440 443 509 vaccineresist 195 222 261 261 288 Physicians for Info 176 269 397 408 547 ProAntiVaxxer 97 154 - - - doctorsensation 590 680 734 735 - GenRescue 165 173 179 180 180 JeffereyJaxen 299 369 490 490 620 avoiceforchoice 161 214 276 280 317

It is worth mentioning that between May 4th and May 8th, some accounts had minimal or zero increases in followers. However, there was a noticeable increase in follower counts for both Children’s Health Defense and Robert F. Kennedy, Jr. This continued greatly into August.

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There seems to be a clear upward trend, specifically for Sharyl Attkission (purple), RFK, Jr. (red) and Children’s Health Defense (blue).

In the 14 months and 11 days tracked, follower counts increased from 2220 to 3308, 844 to 2283, and 305 to 1098 for Sharyl Attkission, RFK, Jr. and Children’s Health Defense, respectively.

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Concerningly, the trend also increased for those who follow both Noakes and Judy Mikovits.

Narratives The common anti-vaccine tropes and rhetoric that had been expressed in Noakes’ tweets from January to May had once again been assessed. This was added to the ratio created in the original report. Once again, defining what is indeed “Anti-Vaccine” can be tricky, controversial and up for some debate; the criteria and examples, in this case, have been based on the tactics, tropes, techniques and rhetoric documented in the literature, particularly from Kata, A.53 and Davies et al.54 An important note is that a single tweet could have multiple tropes, consisting of only anti- vaccine, pro-vaccine or a mix of both. This time, Noakes’ response to Nathan Geffen, PhD was also included. The only content that could be found up until May 2020 about vaccines did indeed express several anti-vaccine tropes, fallacies and rhetoric. Notably, Noakes has tweeted or retweeted content supporting anti-vaccine advocate Judy Mikovits 34 times. In one post, Noakes had called her a “honorable medical hero.”

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As an example, two posts came from Robert F. Kennedy, Jr’s anti-vaccine group, Children’s Health Defense.

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One post was misinformation from “The Truth About Vaccines” and even included anti-vaccine activists/leaders Dr. Sherri Tenpenny, , RFK, Jr. and Andrew Wakefield.

With social media blowing up over the disinformation, Judy Mikovits almost doesn’t need an introduction. Things took a turn for Mikovits when she had her article retracted and was fired for alleged manipulation of data and . She’s now an anti-vaccine activist who spreads conspiracy theories and is taking advantage of the current COVID-19 pandemic.55–70 Noakes has shared her content, which includes 6 posts of her documentary as well as 7 posts of her book. This continued greatly into August. Any support of unscientific anti-vaccine content and conspiracy theories should not be tolerated.

In another post from January, he quotes anti-vaccine doctor Dr. Paul Thomas. Dr. Thomas has expressed many of the “not anti-vaccine, but pro safety” tropes that had already been covered.71 Here Noakes is quoting a tweet in this thread which claims that the autism rate is lower if an alternative vaccine schedule is given or even zero vaccines. This is false and this topic has already been covered in the original report.

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The validity of analyzing an individuals Twitter account for vaccine misinformation needs to be emphasized. Renee DiResta and Isabella García-Camargo from Stanford University’s Internet Observatory have recently published an in-depth social media analysis of Judy Mikovits Twitter account and the content and popularity that followed — “We analyzed 41,662 posts on , Instagram, YouTube, and Twitter starting April 15, when anti-vaccine and natural health Facebook pages began to promote Mikovits and her new book.”70 This not only adds to the discussion on Mikovits, but further validates conducting content and follower analyses on social media in the context of anti-vaccine related misinformation.

Back to determining Tim Noakes overall vaccine narrative on social media.

When going through each of the 49 tweets up until May 2020, assessing common anti-vaccine tropes within them, this amounted to an additional 62 anti-vaccine tropes. This means that from 2014 till now, Noakes’ content about vaccines has expressed 207 anti-vaccine related tropes.

Table 2. Counts and proportions of vaccine tropes/expressions from August 2014 to May 7th, 2020

Level Count Proportion

Anti-Vaccine 207 0.9283 Pro-Vaccine 16 0.0717

Since each post was not evaluated for smaller details (e.g. somebody wearing a “VAXXED II” movie hat, etc.), there is a possibility that there could be even more anti-vaccine related content. This gives us an updated version of the overall ratio of Pro-Vaccine VS Anti-Vaccine tropes and shared information online. The first four months of 2020 led to a 3% increase in Anti-Vaccine tropes and no change in Pro-Vaccine tropes. 93% (207/223) of Noakes’ shared expressions were Anti-Vaccine in nature, while still only 7% (16/223) were Pro-Vaccine. The claim that he “is NOT anti-vaxx!” is very difficult to reconcile with these findings. Thus, we can conclude that the overwhelming majority of Noakes’ rhetoric and information about vaccines is indeed anti-vaccine.

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Exposures To estimate the potential exposures to misinformation online, the same method was used as the original report. This was inspired by Shan et al.72, where the total number of followers for all tweets and retweets were summed. If Noakes had created a tweet of his own, then his follower count was added to the number of followers for each account that retweeted the post. If Noakes retweeted a post instead, then just his follower count was used. Once again, duplicate accounts were not a concern since what was being measured was each exposure to the content, not each user. 49 posts were evaluated between January 8th and May 7th. The number of followers for each account was recorded on May 7th, 2020. Some of the same limitations were the same as the original report. However, Noakes’ follower count had been tracked overtime in 2020, and thus this improves the accuracy of the calculation. In the first four months of 2020, Tim Noakes generated a maximum of approximately 7 million (7,213,804) exposures to vaccine misinformation and or anti-vaccine rhetoric and narratives. Across all tweets from 2014 to May 7th, 2020, this number adds up to a staggering 11 million (11,393,749) maximum exposures.

The conclusion remains the same Not only does this underscore the immense ability of misinformation and anti-vaccine rhetoric to spread and generate millions of views, which in turn can influence an individual’s decision, but this time we see that 63.3% of the misinformation has been spread in just four months.

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Additional Twitter Concerns

Briefly, additional concerns on social media mainly have to do with COVID-19 misinformation (“boosting” immunity, mass amount of hydroxychloroquine posts, alleged overreaction/panic, anti-government, multiple posts supporting the two Bakersfield doctors and claiming there was a coverup/censorship, anti-mask/anti-lockdown/anti-social distancing related retweets, more RFK, Jr retweets, etc.). As well as more misinformation, and even juvenile personal character attacks that took place in support of Noakes. However, the details and concerns are beyond the scope of this paper.

Some additional ironies and hypocrisies that could be added to the original report are presented below:

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This post above talks about holding core beliefs. Even when presented with evidence, core beliefs are protected through cognitive dissonance, and thus people will ignore or even deny the evidence. This is often the case within the anti-vaccine movement.

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It seems that Noakes understands the ethics of exposing people to a virus. However, he shared doubt on this principle when the topic was about measles.

If there is curiosity as to Noakes’ thinking, this (above) clears it up. It continues to be odd that he says stuff like this, but posts misinformation and content that is clearly wrong — and has been doing so for years.

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This becomes confusing since Noakes has barely shared any truthful facts about vaccines. Once again, as we have seen repeatedly, he says above he will change mind when the evidence changes — we have not seen this yet with the topic of vaccines.

There is tremendous concern over the fact that serious anti-vaccine misinformation and disinformation is still being spread and retweeted by Tim Noakes in 2020. This has continued into the summer of 2020:

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Conclusion

The conclusion is essentially the same as the original 2019 report. Noakes denies being an “anti- vaxxer” and denies sharing anti-vaccine opinions and information. However, almost all of what he posts and expresses says otherwise. Noakes has also supported leaders within the anti-vaccine movement and has amplified their voices on multiple occasions. Upon analysis of Tim Noakes’ social media, there is a substantial amount of evidence for concern. From December 2019 to August 2020 there continues to be an increase in the number of Twitter accounts that follow Noakes as well as anti-vaccine accounts. As for the content that Noakes himself has shared and expressed up until May, 93% were Anti-Vaccine in nature, while only 7% were Pro-Vaccine. The potential maximum number of exposures to this anti-vaccine misinformation and rhetoric are in the millions, with approximately 7 million exposures in the first four months of 2020 alone and 11 million in total from August 2014 to May 2020. The claim that Noakes “is not anti- vaccine” and has not shared anti-vaccine misinformation is terribly weak and not based on the evidence.

Despite much frustration, and perhaps at times outrange, from the public and professionals in the medical and science community, Noakes seems to think he has not done anything wrong, and thus the misinformation and untruthful claims persist. Noakes has spread, expressed and supported unscientific, disproven claims and the majority of what he has shared about vaccines is dangerous to public health and can cause harm to the reputation of those in his profession. Continuing to do so, as he has done, is a complete contradiction to what Noakes stands for, what others in his profession stand for, and what his own country’s regulatory body, as well as international organizations, stand for.

Conflicts of Interest: The author declares no financial or non-financial conflicts of interest whatsoever.

Edited on: August 30th, 2020

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