The following is a critique of the article, The Clinician’s Guide to the Anti-Vaccinationists’ Galaxy from the journal, Human Immunology. This article is still in press and has not yet been published though it is ready for publication once the journal has formatted and done their final copy-editing. We give full attribution to Human Immunology and post this article here for research and critiquing purposes only. The author of this critique is HPS and we will be seeing much more of this person on the REAL Australian Sceptics blog in the coming months.
Sceptical Rating for the article reviewed: Four Plungers –
Another day – another attempt by some doctors to justify the mandating of vaccines. They can’t win on arguments so instead, they resort to force. This paper is kind of weird in the sense that it wants to give doctors an easily-referenced guide to combating the concerns of parents. Apparently, the authors seem to feel they will blow all away with their brilliance and irrefutable logic while at the same time, claiming that ultimately, mandating vaccines is the way to go.
Now the first point to note is at the end of the article where we find out that the authors, Poland and Jacobson, are not exactly disinterested observers. They both work for Merck amongst other vaccine-related activities.
Of course, they are entitled to make their case irrespective of whether they have a vested interest or not. Nonetheless, given these interests, one would hope that they wouldn’t make the mistake of filling this piece with smears, insults or attempts to persuade people using themselves as some sort of authority.
First claim: Vaccines saved many millions of lives.
Now as far as I can tell, this cannot be backed up with any evidence. The site, Vaccines Did Not Save Us – 2 Centuries of Official Statistics, seems to debunk this notion as well as any other. If vaccines saved lives, it is hard to find evidence for this in the actual data. Most ‘data’ that demonstrates any life-saving ‘miracleness’ is in the form of projections that take assumptions about how many lives a doctor thinks that, for instance, the measles vaccine will save and multiplies that by the number of measles vaccines handed out. Now some might think that was a ridiculous thing to offer up as evidence given that the authors could come up with any number they like, but presumably that must be our ‘anti-vaccinationist’ brains not being able to understand science like these authors can.
Second notion – the eradication of smallpox.
I have to ask. How did the World Health Organisation (WHO) know that the smallpox virus was eradicated? How could they have known something that no mere mortal possibly could? Did they test every human on the planet to make sure that none of them were ‘asymptomatic carriers’? Did they test every rock, tree, piece of dirt, etc to ensure it wasn’t hiding there? How did they know it was gone? Since smallpox was declared to be eradicated, there have been sporadic outbreaks which local doctors have put down to smallpox. Then, when the WHO or similar organisations come in, they simply wave their hands and say “Well it couldn’t have been smallpox, could it? It doesn’t exist anymore.” So it seems to be just a self-fulfilling prophecy.
On a related note, did anybody worry about fatal chickenpox 250 years ago? Samuel Johnson’s dictionary suggests that no such condition had ever been reported. It would seem then that the concern for fatal/severe chickenpox is a more modern thing. In particular, and I suspect not coincidentally, after the introduction of the smallpox vaccine. Too many people who had been vaccinated still getting the pox and still dying from it. Some of the reputable medical textbooks at the time actually instructed doctors to use vaccination status when making their diagnosis. Still, that is probably just me not understanding enough about the scientific method and the peer-review process and thinking that there might be an investigator bias in these things. We all know that investigator bias doesn’t exist at all.
So the whole smallpox eradication looks pretty shaky. Of course, Poland and Jacobsen would counter by saying that they are caused by different viruses – but even if that’s true, how could doctors have known which disease was caused by which virus in 1800? I’m pretty sure that electron tunnelling microscopes weren’t in significant use back then. And how often do we test pox victims for the smallpox virus today? Or even in the mid 1970s?
Third point – the efficacy of vaccines
Their next point about the general efficacy of vaccines is similar to the smallpox one. And my retort is the same. In epidemiology the ‘double’ in randomised double blind placebo controlled trial is not there to help the phrase roll off the tongue better. Epidemiological evidence is always subject to bias if the doctors know you have received a particular treatment. This renders it nigh on worthless for trying to prove that the treatment works unless this bias is either quantified retrospectively or controlled for in the original trial (ie with a ‘double’ blinding).
I could list all the so-called vaccine success stories subject to this bias but I will just put polio out as an example. How many cases of crippling/paralysis that had no trauma-related cause in the Western world were under the banner of something other than polio before the vaccine? Virtually none it would seem. Later on, children with crippling/paralysis could have Guillian Barré, non-polio enteroviruses, coxsackie and a plethora of other conditions. Many of these labels didn’t even exist before the vaccine or were thought not to cause paralysis and yet today, they make up virtually all of the acute flaccid paralysis (AFP) cases. (AFP is a sort of ‘basket’ into which all diseases which are clinically indistinguishable from paralytic polio are gathered together.) This would be fine of course if AFP cases as a whole had fallen significantly. Alas, no such luck as the following paragraph will illustrate.
India is slated as soon to be ‘polio-free’. But what does this mean? Well if you look at the World Health Organisation’s website for India, you will see that even though AFP has risen in the past 16 years (since they have been counting), almost all of these cases have been dumped into the non-polio type. Apparently that makes it alright. You see, doctors couldn’t find a particular protein in the stools of these individuals so they declared them not to have polio (there were zero non-polio AFP cases in 1996 and 16 per 100,000 in 2011).
Now you might think that most parents wouldn’t really care too much about proteins in stools when they have a paralysed child to concern themselves with, but again, that is coming from an ‘anti-vaccinationist’ who doesn’t understand the glories of peer-review and the scientific method. If I did understand those things like our great doctors, I would understand that paralysis is no big deal. It’s the little protein in the stool that matters.
Next point – The Super-Bowl effect
The next point the authors make is some anecdotes (I thought ‘real scientists’ didn’t use them?) about some people getting rashes after a Super Bowl game. It seems reasonable that the entire country would be in a blind panic over such serious phenomena. I mean some of those people might have missed a couple of days work. Catastrophic. Not like those lucky souls in India who are paralysed but who have had the incredible stroke of good fortune to have been found not to have had the polio virus in their stools.
The authors acknowledge that there are real side effects to vaccines but of course, they are extremely rare. What do these scientists tell themselves at night? That hundreds of thousands of parents all around the world all got their children vaccinated and then subsequently decided to become part of a vast global conspiracy to bring down vaccinations for no apparent reason?
At least that is what I assume these ‘scientists’ must think. After all, vaccinations are the only product whereby people ignore the stories of those who actually had experiences of them when ascertaining their safety. Imagine if thousands of people walked into the Toyota headquarters and explained that when they pressed the brakes on their Camrys nothing happened and, in response, the Toyota executives came out with a bunch of graphs and ‘experts’ who told them that it was all in their imagination and that they had no intention of recalling and double-checking their cars.
We might also be people who are innumerate (which presumably includes people who think that the double in double blind trial actually means something), or have low cognitive skills. This is quite strange really given that in the Western world, those who question vaccinations are almost invariably among the more educated and better paid, but never mind.
Still we all reject the ‘scientific method’ and the peer-reviewed literature. But what about peer-review literature that calls into question vaccine safety or efficacy? Well all peer-review is equal but some peer-review is more equal than others I guess.
Is there a scientific method to their madness?
And just what is the ‘scientific method’. We hear about this a lot but no one ever really categorically defines what binds say medicine with astrophysics. The randomised double-blind placebo controlled trial (RDBPCT) is considered the gold standard of epidemiology but I can’t imagine how such a technique would be of any use in understanding how stars form. But what do I know? I think peer-review is nothing more than a euphemism for appealing to authority and its main purpose is to protect academic guilds from clandestine thoughts. Now that’s ‘otherworldly and alien’ for you.
And is statistical evidence the best we have in medicine anyway? For those who have studied some economics, you would know that the concept of ‘revealed preference’ has primacy in determining human beliefs. If I say I want to live an ascetic existence in order to win popularity but surround myself with precious jewels and iPods, then fair to say I don’t want an ascetic existence at all. My behaviour is the guide to my true beliefs – not my words. Nothing particularly revolutionary about this and most reasonable people would simply think that was a statement of the bleeding obvious (most sound economics is).
Put your money where your beliefs are
So how about this for true beliefs? Babies are smaller than adults, so their ability to withstand doses of various substances without harm would be significantly less.
Given this, any adult who claims the infant vaccine schedule is extremely safe should, assuming their words matched their true beliefs, have absolutely no qualms about taking a weight-adjusted dose of the infant schedule. And yet to this day, not one doctor, nurse, or any other vaccine-supporting individual has been prepared to put their money where their mouths are and actually do this. Now this simple fact tells us more than a million epidemiological studies. Indeed it simply isn’t possible for any statistical study to trump this fact. If vaccines were safe, its supporters wouldn’t think twice before doing this presumably simple challenge. But they never, ever do.
You see statistical studies are easy to rig. I can rig them to make vaccines look extremely dangerous. Vaccine supporters can rig them to make them look incredibly safe. That is the nature of statistics. An RDBPCT is hardest of all to rig, and yet, they still are. One of the more common methods is to use a non-inert substance instead of a placebo (so the new vaccine is being compared to something that most people wouldn’t assume was safe). Indeed, every single vaccine you have ever been given has been tested in this – what can only be described as fraudulent – manner.
Much harder to rig the results of taking the entire weight adjusted infant schedule.
So I won’t go too much into specifics of the safety aspect because, as I say, ‘scientists’ will come up with a bunch of cherry-picked data and I could do the same. But tellingly, they won’t put their money where their mouths are.
The authors try and make out that vaccines are incredibly safe because the number of antigens are much less than they used to be. Firstly, all that tells us is that in terms of the antigens, newer vaccines are presumably safer than previous vaccines but not necessarily safe. Secondly, last I checked, antigens weren’t the only component of a vaccine. The reason that there are less antigens is because it is cheaper to produce vaccines with less antigen but more aluminium (which increases the immune response). Now, replacing antigens with aluminium may in fact be safer but for the authors not to admit that this is the reason that there is less antigen now illustrates the deception at the heart of this paper.
They mention the pre-licensure studies as proving that everything is fine. Now remember what I said a couple of paragraphs ago about using a non-inert placebo? Well this is where this whole thing comes into play. They will give one cohort the new vaccine and another cohort another substance, be it the old vaccine, a completely different vaccine or, in some cases just aluminium (Merck’s study of Gardasil, for example). So, let us say the previous DTP vaccine resulted in the deaths of 10 out of every 10,000 recipients and the new one results in 9 out of every 10,000 recipients. Based on their definition of safety, the new vaccine will be declared safe! Indeed, the headlines will talk about it reducing mortality compared to a placebo!
Of course, what the newspapers or doctors will never volunteer is that the placebo wasn’t what you thought it was – ie a completely inert injection (such as saline). Instead, it was something that you would never consider to be inert. The information isn’t hidden – you can read the study – but of course only a fraction of people ever do that. They just trust that their doctors will have done so and more importantly to internalise that information in a manner that isn’t self-serving.
It’s there in black and white
What’s interesting though, is that the pharmaceutical company will write up in their package insert every single adverse event that happens in both cohorts. Because the health bureaucrats will approve the vaccine on the basis that it doesn’t do significantly more damage than the ‘placebo’, both they and the doctors will assure you that the chances of any of these adverse events are miniscule because they consider the relative chances to be the difference between the vaccine and the placebo. Since the placebo itself could have caused problems, this is nothing more than speculation – deception, actually. So the package inserts will often look scary for these vaccines but the doctors will assure you that the risks are tiny. They are wrong. The package leaflets written up by the pharmaceutical companies are in fact the only place to get any honest information on the possible side-effects of the vaccine.
Their spiel on Guillain-Barré syndrome (GBS) can be understood in that light now. If you look at package inserts for vaccines, GBS will crop up regularly. That’s because it happens in the pre-licensure studies. If it happens to both cohorts then it will be dismissed as ‘background’ levels (and won’t affect its approval) but will still be written up in the inserts as a possible contraindication or condition that should prevent you from taking the vaccine.
Now you should be starting to get an idea of the extraordinary deception that vaccine ‘science’ requires. When they say no link has been found, you can rest assured that no link was looked for. More than that, they had to cover their eyes in order not to see all the elephants in the room.
All they had to do was ask the parents for their stories and they would have had hundreds of thousands – perhaps millions of pieces of evidence. But they never do. Remember -many ‘scientists’ only use data that can be easily rigged. Imagine if there was a report written by a government body which detailed thousands of case studies of parents observing their children’s health falling apart after vaccines. If it were any other consumer item, this is exactly what would have been done.
Shonky use of statistics
I note that the paper’s reference on flu deaths caused by A/H1N1 used just the upper range number of 2 million years of life even though the study had a lower range of one sixth that. You would think that lower figures deserve mentioning but I have a sneaking suspicion that the authors don’t put the references there in the hope that everybody will chase them all up. Now you might say that 300,000 person years is still significant, but you have to understand the inconsistent and convenient use of methodologies here.
The authors of the referred study (Viboud et al) did not use actual lab confirmed numbers of A/H1N1 influenza to get their mortality data but an assumption that a certain percentage of pneumonia/influenza mortality must have been due to A/H1N1 (so-called Swine Flu) in the US. The inconsistency arises when you understand what has happened with the polio vs AFP data. Today, you can’t have polio unless it is lab confirmed whereas in the past, the diagnosis was made on clinical grounds (in other words, by using symptoms). This change in criteria makes the vaccine look more effective.
Here, Viboud et al are saying that we should ignore lab confirmed results and just make estimates as to how many people had A/H1N1. Again, this is done to make the vaccine look good – or to show that its implementation was worthwhile. Poland and Jacbosen took this paper’s wild speculation and assumed that the top range must be the correct one and put it out there as though it was an established fact rather than some epidemiologist’s self-serving fantasy.
Again, it is this sort of thing that is pervasive in the pro-vaccination camp. They regularly come up with speculative projections and then try to pass them off as established numbers.
“Public health officials hail routine vaccination as one of the top ten public health achievements of the 20th century , but anti-vaccinationists have successfully campaigned to block legislation for school and day-care mandates and other public health interventions designed to increase vaccination uptake.”
This statement reflects that it is these authors who are on another planet. Firstly, why would ‘anti-vaccinationists’ care about the opinions of public health officials when it came to vaccines? Isn’t questioning public health officials kind of a corollary – desired or not – of questioning vaccines?
Secondly, there are many people who absolutely love vaccines yet who still oppose school and day-care mandates. Or at least they say they do.
It obviously comes as a total surprise to our illustrious authors that there are some people who think they should have the right to decide what gets injected into their bodies.
Anyway, what mandatory vaccine spiel would be complete without hurling abuse at Andrew Wakefield as though most people who question vaccines do so because of him? I can’t speak for others who question vaccines, but I have only a cursory knowledge of what Wakefield did and had never even heard of him before I made up my mind. Indeed, believe it or not, I had never even heard of the connection between vaccines and autism.
But what his story shows me is that when doctors tell me that they would happily admit to their mistakes if, indeed, it turned out that vaccines weren’t as great as they are made out to be, that is a complete lie.
The way Wakefield has been treated for doing no more than raising questions proves that doctors are far more concerned with protecting themselves than protecting patients. That is the moral to his story as far as I am concerned. I am not saying his science is flawed – it wouldn’t take much to be a million times better than an industry that compares its poisons to other poisons and then declares them to be safe – but it had nothing to do with my decisions. It does however demonstrate that vaccines are a sacred cow. A religion – not a scientific process.
“By being informed about the charges brought forward by anti-vaccine proponents, especially those of a quasi-immunological nature, clinicians can assist in providing data-driven information to health providers and the public, assist in research where data gaps are apparent, and provide data for the scientific basis for accepting or refuting claims of vaccine safety and function. The only rational way in which to proceed in devising individual and public health policy in regards to the use of vaccines requires high quality studies and resulting data, interpreted carefully and based on the scientific method.”
I personally would have thought this would require providing data that shows the real world efficacy of vaccines and wasn’t subject to the investigator bias.
It would also require the testing of these vaccines against actual placebos rather than non-inert substances.
But frankly, too much use of statistical mumbo-jumbo is how we got into this position of unyielding sides in the first place. So personally, I would prefer the time-honoured tradition of putting your money where your mouth is.
So some people (and I can think of no better candidates than the authors) need to take a weight adjusted dose of the infant schedule. Better yet, weight-adjust it and then multiply it by 5 times to show that absolutely no child – no matter how fragile – could possibly be harmed by these wonderful concoctions.