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An open letter to Dr. J. Douglas Bremner

Peter Lipson wrote a post last week entitled Before You Trust That Blog…, which was a criticism of Dr. J. Douglas Bremner’s blog Before You Take That Pill. Dr. Bremner was not pleased, and posted a rebuttal entitled Response to Peter Lipson MD of “Science” Based Blogs, My Blog Does Not Suck, Yours Does. Given the kerfuffle and my role as managing editor of SBM, I felt the need to put my two cents in, which is why I’m posting this open letter to Dr. Bremner. This letter started as a much briefer response that I was going to e-mail to Dr. Bremner, but as I wrote it grew and grew to the point where I decided that, given the public nature of the disagreement between Dr. Lipson and Dr. Bremner, I might as well make my commentary public too. Consider it a bonus post from me. I still plan a post for my usual slot on Monday. In the meantime, here’s my open letter:

Dear Dr. Bremner:

I read your harsh rebuttal (Response to Peter Lipson MD of “Science” Based Blogs, My Blog Does Not Suck, Yours Does) to a post by one of our bloggers (Before You Trust That Blog…) that criticized some of your stands on flu vaccines, angioplasty, and mammographic screening for breast cancer. After rereading Peter’s post and reading yours, quite frankly I actually do see Peter’s point and find your rebuttal unconvincing, or, as you so charmingly put, it “lame-O.”

Let me describe to you the genesis of Dr. Lipson’s post. A reader sent in your flu vaccine post (Flu Shots Are [Still] For Idiots), asking me what I thought about it. I was appalled. So I circulated it among our bloggers to see if anyone wanted to comment on it, and Peter stepped up to the plate. As a blogger who regularly combats the lies of the anti-vaccine movement in general, especially the myth that vaccines cause autism, and the outrageous quackery that results from the lie that vaccines cause autism, I have in the past found your posts on vaccines (and now especially the one Peter took issue with) to be bordering on being anti-vaccine themselves and at the very least to reveal anti-vaccine sympathies in both content and tone. Really, saying that the flu vaccine is for idiots and telling people they shouldn’t get it, as you did? That I cannot countenance or leave unanswered, and, quite frankly, you richly deserved a blog beat down for it. Indeed, I had been contemplating doing a rebuttal or two to some of your more–shall we say?–hyperbolic posts myself, but Peter beat me to it. If he is too “blunt” for you, check out these posts by other SBM bloggers, which directly and indirectly demolish your points:

Try to dismiss them as not being “science-based,” if you can.

If that’s not enough, peruse the posts on the flu, the swine flu, and the flu vaccine by an acquaintance of mine “revere” at Effect Measure, a senior and well-respected epidemiologist:

For example:

Start by reading these posts, especially Influenza Deaths and How do we know how many people die from flu each year?, and you’ll see (I hope) that your complaint that the 30,000/year flu death figure is an exaggeration is, well, an exaggeration. You take a complex issue and simplify it beyond recognition, concluding:

Politicians that fell asleep in science class in high school are getting a lot of money from vaccine manufacturers. Through a combination of greasing the wheels and the fact that they are too stupid to know better, they actually think that they are helping us out by using government resources to try and ‘educate’ us that we need to get a flu shot that actually will do nothing for us.

And you object to Peter referring to you as “stupid”? Do you really think flu vaccines are “for idiots”?

Also, as a breast cancer surgeon, I find a couple of the posts I’ve seen on your blog about cancer (readers have actually forwarded them to me) and in particular on breast cancer so painfully simplistic and distorted that my teeth would grind reading them. I’ve even shown up at least once in your comments to take you to task for at least one grossly incorrect statement I’ve seen you make regarding cancer. (I did it under my other, pseudonymous persona, though; so don’t go looking for Gorski anywhere. Guess for yourself.)

Before you dismiss me as a pharma shill or a physician hopelessly in the thrall of the Dark Lords of Pharma, peruse my posts on SBM. Any fair reading of my output will show I am no such thing. Quite frankly, although Peter may have been a bit more–shall we say?–vociferous in how he expressed himself than I might have been (at least on SBM; on my other blog is a different story), I tend to agree with most, if not all, of what he wrote. From my reading, you appear to have lost all perspective. To you, if it’s pharma, it can’t be right; flu vaccines are useless; mammography is useless; chemotherapy is pointless and doesn’t save lives; and it’s all a plot by the medical-industrial-pharma-government complex to milk the sheeple of their hard-earned cash. Certainly that’s the impression I leave your blog with, as well as the question of what, if anything, from modern scientific medicine you actually do consider worthwhile and not a huge pharma-enriching scam.

That’s why I think Peter nailed it. You have devolved from reasonable skepticism to cynicism and beyond to conspiracy mongering. Worse, you overgeneralize and oversimplify complex medical and scientific issues to support that cynicism and conspiracy mongering. Moreover, you are hardly one to take affront at harsh language, when a recent perusal of your blog reveals posts entitled, Pimps, Whores, and the European Society of Cardiology Meeting, Should I Take Aspirin or Put a Gun To My Head?, Response to Peter Lipson MD of “Science” Based Blogs, My Blog Does Not Suck, Yours Does, and, of course, your post that started it all, ” “Flu Shots are [Still] For Idiots.” A lovely example comes to mind from a post to which you linked in trying to rebut Dr. Lipson, in which you criticized those who argue that PTSD may be overdiagnosed:

They write:

PTSD, as presently diagnosed, described, and treated, has failed to improve on what had been standard teaching. It has redefined and overextended the reach of a long-recognized natural human reaction of fear, anxiety, and conditioned emotional reactions to shocks and traumas.

In other words, nothing like the old days, when guys killed Japs and enjoyed it, and gals got raped and if they didn’t stop sniveling you could just give them a good wack to help them get over it.

Nice.

I suppose that your “flu shots are for idiots” post means you must think I’m an idiot, as I plan on getting my flu shots this year, be it one, two, or three. Be that as it may, it’s very easy to dismiss criticisms because they are harsh. It’s a lot harder to look a bit more closely and ask yourself if there’s anything to them.

Think about it for a moment. Try. Try real hard. Not every criticism of you is because the minions of big pharma are ganging up on you or because the person criticizing you or with whom you disagree is hopelessly deluded, biased, or stupid. You can be wrong, and in several cases that I’ve seen just from perusing your blog over the last couple of days, you are.

There is a fine line between severe criticism and conspiracy-mongering or taking complex issues and simplistically (and in a knee-jerk fashion) taking the side that most fits with your biases, the latter two of which are what you appear to do more often than I am comfortable with. I can’t speak for my co-bloggers, but I will be with you when you are correct and against you when I think you are wrong, as in here. You may have thought that doing a post saying that flu vaccines are still “for idiots,” complete with photos of of a pidgeon reading a book about pooping on people and a tasteless photo of “cretins” proclaiming, “Even these guys think your an idiot” was funny. I do not. I think it’s extremely irresponsible. The issue of flu vaccines and the the potential swine flu pandemic deserve better than your sophomoric attempt at humor.

But, hey, what do I know? I’m just one of those “stupid” people you dismiss who has concluded, on the basis of the scientific evidence, that flu vaccines are worthwhile, chemotherapy can save lives, and that mammography, when properly used as a screening tool, benefits women.

Sincerely

David Gorski, MD, PhD

P.S. Perhaps while you’re at it, you could answer me one question: Do you think that vaccines cause autism?

Posted in: Medical Academia, Pharmaceuticals, Public Health, Science and the Media, Vaccines

Leave a Comment (33) ↓

33 thoughts on “An open letter to Dr. J. Douglas Bremner

  1. nitpicking says:

    Apparently I’m an idiot. Got my flu vaccination yesterday.

    Nice post, Dr. Gorski.

  2. David Gorski says:

    I’ll be getting mine as soon as my cancer institute offers them, which will be soon.

  3. The Blind Watchmaker says:

    If idiot is the new codeword for someone who accepts the convergence of evidence from virology, immunology and epidemiology, then sign me up.

    We should all get the seasonal flu vaccine now, if possible. My family and I got ours this morning.

    The novel H1N1 vaccine should be available next month (for free) and will likely be a one dose vaccine. Hopefully not too late as the virus is already spreading quickly through schools.

  4. nitpicking says:

    Last I heard, the H1N1 virus was expected to be in short supply and maybe not available for me, a 48-year-old non-healthcare worker who isn’t immunosuppressed.

  5. gill1109 says:

    This is a fascinating exchange.

    Let me start by revealing “where I am”. I am a statistician and a mathematician and a scientist; I was leftish when I was young (since I have a heart); now I am getting old and hence rightish (since I have a head); my political inclinations are libertarian/anarchist/socialist. In my experience there does exist an unholy alliance between the Dark Lords of Pharma and the Evidence-Based-Medicine Mafia. On the other hand, the new-age holistic back-to-basics people are not particular smarter, on average. As government retreats from its (historically speaking) brief role as sponsor of independent scientific research, business (and worse: mafia) steps in. But: this is a normal situation! After all, our heroes Archimedes and Leonardo da Vinci were in the pay of military dictators. So what. A great deal of medical research is funded by very big businesses and the (their) idea is to benefit those businesses. That research is done by medical researchers who have an ambition to be succesful in their chosen career of medical researcher, as well as in their vocation of helping sick people get better. Those businesses have an interest is having us sheeple consume their wares. Moreover, whatever you may say about sheeple and medical researchers, one thing you can be sure of is that, at the best, politicians are out for getting re-elected. And that power corrupts. And that we the voters have voted for politicians who have pretty well succeeded in destroying what briefly has been a period of good education for all.

    Nothing new under the sun. Civilizations (even thousand-year-civilizations) come and go.

    Let me get to my conclusion/contribution. IMHO the truth is somewhere in the middle. There is a strong case to be drawn that the H1N1 virus is just another, not particularly nicer or meaner than previous, influenzas. The real conclusion to be drawn from epidemiology/virology/immunology/… about flu vaccines, is that we don’t know! (I am talking about flu vaccines for ordinary people, not for people with weakened immune response, frail, old…). So you’re not an idiot if you get vaccinated. You are not an idiot if you don’t get vaccinated. Moreover: from the short term, egoistic point of view, there might be an advantage to getting vaccinated; but from the long term, “society”, Homo Sapiens, point of view, there are definitely advantages to not having lots of people vaccinated. From the very long term point of view, it doesn’t matter a shit.

    Why can’t people understand that nature is a whole lot more complex than our little ape brains can cope with, and that there is not one “right” answer to every question?

    BTW I do not believe that vaccination causes autism.

  6. qetzal says:

    [F]rom the long term, “society”, Homo Sapiens, point of view, there are definitely advantages to not having lots of people vaccinated.

    Please elaborate?

  7. gill1109 says:

    Advantages to not having lots of people vaccinated? Then this wave of influenza comes over us, some people die, some people live, the ones that live have got better genes for this influenza and probably better genes for the NEXT variety. Virusses are going to go on mutating and looking for new ways to get us to help them multiply. We had better keep moving too. We probably can’t hold them off forever.

    Anyway I think that the greatest threat facing homo sapiens at the moment is overpopulation by homo sapiens. In the long run (ie for the survivors) it is probably better to decrease our total population size by a series of small steps rather than in one huge step…

  8. Chris says:

    gill1109, you seem to have some very naive ideas. For one thing, you have no idea how influenza virus change, nor do you understand the detriment to mental health due to death of loved ones.

    First I suggest you do some reading, starting with William McNeill’s Plagues and Peoples… and them I suggest then I suggest you do some digging and go and find yourself some human decency and compassion. Perhaps you could start by going to your local children’s hospital and attempt by comforting a family who has just been handed their child for burial your words of “wisdom” on how that death helps world population.

    Good luck with that.

  9. wertys says:

    @gill1109

    I am interested to understand as a mathematician and scientist what your experience of the unholy alliance is, upon which you apparently can hold forth with some authority.

    As a run-of-the-mill doctor I am waiting for my call-up to participate in the scam. In the meantime, I must say that strangely enough most of the ‘treatments’ which have been ‘found to work’ actually seem to be very effective. I guess to explain everything I see at clinical meetings and conferences that some of the other doctors must be being paid to be agents provocateurs against the ‘shills’, as there are often heated and lengthy disagreements about the interpretation and worth of much of the research that is presented.

    If you want to see shonky bad science presented to sycophantic receptions without criticism, go to a conference of Integrative Medicine believers, not a science-based one

  10. Noadi says:

    I’m still trying to parse how “my political inclinations are libertarian/anarchist/socialist” possibly makes sense and it is the closest to sense of any of that.

  11. Michelle B says:

    gill sounds like a lazy bullshitter that does that deserve herd immunity (unless of course this particular lazy bullshitter does not want to be the one less human overcrowding this planet and does get vaccinated).

    Has this bullshitting dipshit not heard of birth control?

  12. Michelle B says:

    I will try again, I suspect the naughty language filter killed my comment.

    Gill sounds like a lazy bullcrapper, a bullcrapping lazoid that does not deserve herd immunity (unless of course this particular bullcrapper does not want to donate his life to the great cause of decimating the human population and does get vaccinated).

    Has this bullcrapper not heard of birth control?

  13. gill1109 says:

    @Chris: you said “For one thing, you have no idea how influenza virus change, nor do you understand the detriment to mental health due to death of loved ones.”. Actually I do have an idea that influenza virusses keep changing and that was the reason why I suspect massive innoculation against this particular one is not going to be particularly useful in the long run. As to the mental health problems due to death of loved ones I can assure you that I have had at least my fair share of that in my own life and life of close friends and family. I think you are missing the point I am making: that what might be good in the short term for you or your family or your friends, might not be good in the long term for the human race (say: other people’s grandchildrens children…)

    @Michelle B: you are good at using rude words but I do assure you that I know a lot about birth control. Indeed one might hope that birth control might in the long run solve a lot of problems of overpopulation. In the short run a lot of social unrest (war, terrorism, crime…) is caused by exponentially growing populations in poor countries with uneducated populations while in the rich countries next door there is exponentially decreasing population due to birth control and various other effects of industrialization, individualization, modernity etc. This leads to massive movements of population from places where there are lots of people but no future, no food, no water, to places where there are few people but relatively lots of food, water, etc.

    By the way several of my relatives in UK and NL already had Mexican flu and got over it. In NL the percentage of people with flu at the moment is growing rapidly and many of them are Mexican flu cases, but so far this is not causing any more trouble than any other typical flu outbreak. There is no mass vaccination program ready here, and by the time it is ready it would be too late. Presently the sound advice seems to be to treat this flu like any other. I am not planning to get vaccinated, and I am not going to get herd immunity either, since it is too late to have most of the herd immunized.

    @wertys: the unholy alliance. There is growing unease in the scientific community that more and more research is being paid for my commerical interests, and hence the wrong questions are being asked, critical thinking is being suppressed. I know people in the pharmaceutical industry who are deeply saddened that money is not put into researching how to cure something like shingles which actually causes a huge amount of suffering to elderly people, and is probably pretty easy to cure; instead money goes to research into what is likely to be a money spinner. Recently I was involved in the Utrecht probiotica trial in which commerical interests and the vague borderline between a food additive and a clinical treatment led to a phase 3 RCT being carried out before the animal experiments were ready, let alone phases 1 and 2. Because of some screwing up of the statistical safety measures some people died unnecessarily. I can assure you I do know what I am talking about. If you click on my name you will find my homepage and my “credentials”.

  14. gill1109 says:

    PS Just read an excellent item on science based medicine (which I am all in favour of!!)

    http://skepticstoolbox.org/hall/

    Tooth Fairy Science and Other Pitfalls: Applying Rigorous Science to Messy Medicine (by Harriet Hall, MD).

    I was pointed to it by David Colquhoun’s excellent blog

    http://www.dcscience.net/

    I am not against vaccination in general. I am deeply grateful that some terrible childhood diseases are now more or less eradicated. I am deeply greatful for antibiotics.

    But: vaccination, antibiotics and so on are like some kind of weapons race if used carelessly. Unfortunately, antibiotics have being used so on such a large scale and in such an unwise fashion in so many lesser developed countries, that their use has stimulated the evolution of extremely deadly antibiotic-resistant bacteria. It is now very dangerous to spend time in a hospital in Southern Europe. People who are admitted to a hospital in the Netherlands who were recently in hospital anywhere South of the Alps are nowadays necessarily placed in quarantine in order to prevent those bacteria becoming established in our hospitals. So far, they did not gain a foothold here. But who knows how long that will last?

  15. qetzal says:

    gill1109 wrote:

    Advantages to not having lots of people vaccinated? Then this wave of influenza comes over us, some people die, some people live, the ones that live have got better genes for this influenza and probably better genes for the NEXT variety.

    Given the way influenza works, that’s rather doubtful. So is the claim that not vaccinating would help with population. (Especially if you believe the survivors would be more resistant to future flu strains!)

    Even if I conceded that those are potential advantages (which I don’t), they are very far from “definite.”

    Also, I strongly doubt that shingles is “probably pretty easy to cure.” Last I knew, herpes virus latency and reactivation were relatively poorly understood. Of course, you may know more about it than I, but based on your “definite advantages” of not vaccinating, I’m skeptical.

  16. Calli Arcale says:

    I understand what Gill is saying, or at least I think so. Hopefully he will correct me if I’m wrong. ;-)

    * It is better in the short term if folks get vaccinated; that saves people here and now by reducing severity of epidemics.

    * It may be better in the long term if folks don’t get vaccinated; brutal as it is, that’s historically how our species has adapted to threats.

    * In the very long view, it doesn’t matter one way or the other, because odds are what does in our species in the end won’t be something we see coming.

    This is a reasonable view. I do find the long-term view to be somewhat naive; expecting H. sapiens to evolve resistence to influenza rests on some assumptions that may not be reasonable. First and foremost is the assumption that we *can* evolve resistance. We certainly cannot evolve as fast as influenza, so “keeping up with it” is not reasonable. We’d have to develop resistance on a fundamental level, and from what I’ve seen (note: total non-expert speaking), it seems that would require humans acquiring a mutation that we’ve never acquired before. There’s no basis for predicting the likelihood of that, since as far as we know, it’s never happened before. But I’d say the odds don’t look very good.

    Second, we’d have to evolve resistance before influenza kills us off. So as long as it keeps its current degree of virulence, we’re okay. (It doesn’t kill most of us. It could kill enough to throw humanity back into the dark ages, if it was a really bad pandemic, but not extinction.) So this might be a reasonable assumption. But there are of course no guarantees.

    Third, influenza would have to exert enough evolutionary pressure so that the new trait could be selected. Most influenzas, while nasty and potentially fatal, don’t kill enough of us to do that. Oh sure, you get the occasional Spanish Flu pandemic, but most of them aren’t like that. Not enough of us die; survival of the species is assured even without special powers against influenza.

    Fourth, the trait that protects against influenza would have to not compromise us in some other way. Consider malaria. People in certain parts of the world (especially Africa and parts of the Mediterranean) have indeed evolved in response to malaria; they have developed resistance. They’re not immune, but they’re much less likely to develop severe symptoms. There is, however, a price — they carry genes for sickle cell anemia, and thallassemia, both genetic blood disorders that can cause serious problems. Without malaria, these traits are not advantageous, and I have to wonder if anti-influenza traits might not suffer the same fate. If influenza doesn’t exert enough pressure, and the traits that protect are not real great to have otherwise, then we’re not likely to evolve resistance.

    Bottom line: vaccination *may* affect our evolution, or it may not. There is really no good way to predict that. Therefore, it’s not reasonable to make decisions about mass vaccinations campaigns based on evolutionary logic, so we might as well just decide based on the humanitarian argument of saving lives *now*.

  17. Scott says:

    Particularly relevant to the evolutionary angle is that the typical people who die from influenza are the elderly. In order to actually apply selective pressure, it would need to remove individuals from the gene pool before they can reproduce.

    So only a small fraction of the toll exacted by influenza actually produces any selective pressure, for the most part. Typical seasonal flu thus has minimal evolutionary effect, relative to the suffering it causes.

    And even the exceptions like Spanish flu (since killing the young in large numbers *does* apply selective pressure) are, by their nature, exceptional, so it’s quite hard to argue that evolutionary pressure from one round would be relevant to the next.

    So Gill’s argument doesn’t hold up at all.

  18. Calli Arcale says:

    I agree. I just feel that people who called him heartless were focusing far too much on his evolutionary argument against vaccination, ignoring that he’d previously said that in the short term, vaccination may be better because less people will die. (He put it as “egoistic”, in that vaccination is better for the individual because then the individual lives.) I felt that was a tad unfair. He may be wrong on the evolutionary angle, but that wasn’t the main point of his argument.

    Actually, it occurs to me that there *is* a good evolutionary argument to be made here, only it comes out in favor of vaccination.

    We can’t really hope to breed a better human through the evolutionary pressure of influenza. (Random note: might not vaccinations themselves be considered a survival strategy that a particularly intelligent species might employ against viruses? Are we evolving resistance to influenza by evolving the capacity to devise, manufacture, and inject vaccines against it?) But we *might* be able to breed a less dangerous form of influenza.

    There is some evidence (sorry, I don’t have a cite; it’s just something I remember reading) that influenza strains usually become less virulent over time. Not less contagious; just less virulent. It is actually not in influenza’s interests to kill the host, because a dead host doesn’t go around sneezing on other people. Virulence therefore exerts a certain evolutionary pressure. Of course, there’s a trade-off — a virus which is less virulent has more opportunties to spread due to the host being alive and well enough to socialize with other potential hosts, but may not reproduce fast enough or cause enough sneezing and mucus production to get transmitted efficiently enough.

    Vaccines against the most virulent strains could theoretically increase this evolutionary pressure, by making it even harder for very virulent strains to get around. Less virulent ones would therefore gain a competitive advantage.

    Of course, the idea of breeding a better flu virus is blown out of the water by an immensely cooler idea — the idea of making people actually immune to influenza on a fundamental level. Last I heard, it was still more theoretical than practical, but there are researchers who have isolated specific, stable gene sequences in influenza which are fundamental to its makeup. Devise an antigen to that, and you have a vaccine which is good for *any* flu. It wouldn’t be able to evolve around it.

  19. overshoot says:

    As for evolving resistance to influenza:

    That sucker’s been around a lot longer than our species. It infects birds, all sorts of mammals (pigs, ferrets, anyone?) and curiously enough none of them, in the course of millions of years, have evolved the kind of resistance Gill is suggesting we would acquire from not vaccinating.

    So remind me again what the upside would be from killing a few million people a year by not vaccinating against influenza?

  20. Prometheus says:

    Sort of on the topic – influenza virus is an avian (primarily waterfowl – ducks, geese, swans, etc.) virus in which a few strains have evolved an ability to infect other animals (pigs, horses, humans). Most influenza strains do not cause severe illness in waterfowl, although they can and do sicken and kill chickens and other birds.

    Influenza virus evolves during each “flu season”, mutating to evade our immune systems. It would do this whether we vaccinated or not. It mutates very rapidly because of its RNA genome (RNA polymerases are more error-prone than genomic DNA polymerases) It also has rarer recombination events when two different viruses infect a single host. When these events happen and the resulting recombinant virus gets into the population, we have pandemics.

    Gill1109 is not correct about the evolutionary pressures that influenza virus exerts on humans. We – as a species – have been co-evolving with the influenza strains that infect us for tens of thousands of years (if not longer). As a result, the influenza viruses that infect humans have adapted to be more easily spread and less lethal than their avian breathren are when they infect us.

    The H5N1 “Bird” influenza that was all over the news before the H1N1 “Swine” influenza emerged was not particularly well-adapted to humans – it was hard to catch, didn’t spread human-to-human well and was too rapidly lethal. It wasn’t adapted to us. A well-adapted virus – like most human influenzas – causes just enough illness to enhance spreading (sneezing, coughing, nose dripping) yet allow the host (us) to stay alive and active, riding on subways, going to the office to spread the virus to new hosts.

    The idea that “killing off” susceptible people will speed our adaptation to influenza is – sorry to be so blunt – silly. We’ve had hundreds of generations to adapt to influenza. Most human deaths from influenza are not the result of “bad genetics”, but are the result of extra-genetic factors, such as age, pre-existing medical problems, innoculum size and the like.

    Think about it for a moment: the influenza virus starts budding new viruses off of an infected cell 4 – 6 hours after infection. Its “generation time” is about 6 hours. Humans have a generation time of 15 to 20 years. Who’s going to evolve faster?

    This isn’t to say that a new influenza virus can’t “weed out” a large section of the population that is exceptionally susceptible to it, as the H1N1 “1919/Spanish” influenza probably did (it also killed a lot of people who weren’t particularly susceptible to it). However, there is no reason that this “weeding out” would reduce the death toll the next time a major recombination/mutation event occurs in influenza, since the virus can mutate much faster than we can.

    Perhaps there are people out there who have a different sialic acid on the membranes of their respiratory epithelium that will make them immune to influenza. Maybe, by using influenza vaccines, we are preventing that mutation from becoming more widespread (by decreasing the selective advantage). However, it only took a single DNA base change in the haemagglutinin gene of the influenza virus to allow them to switch from birds to humans.

    One of the features that humans have evolved is their overly complex brains. These brains allow us to do things that supercede our genetic programming.

    Such as making vaccines.

    Prometheus

  21. Whether he is blogging or commenting, I always enjoy reading what Prometheus has to say.

  22. Pathman says:

    Me gads. Dr. J. Douglas Bremner is pretty objective about scientific failings all round. With the loony antivaxers on the one side, and unquestioning pseudoscience on the other, this is just BORING. It’s a hard line to follow but Dr. J. Douglas Bremner has it about right.

    The reflex notions in the original posting above comes from the same pot of reeking crap that keeps the autism-MMR crowd amused. In politics, extreme left and extreme right are really the same thing – a sort of authoritarian fascism.

    “The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which.” (Orwell, 1984)

  23. Chris says:

    Hello, pec.

  24. David Gorski says:

    Me gads. Dr. J. Douglas Bremner is pretty objective about scientific failings all round. With the loony antivaxers on the one side, and unquestioning pseudoscience on the other, this is just BORING.

    But apparently not sufficiently boring to prevent you from bothering to post your little rant, I note. As for Dr. Bremner being “objective,” don’t make me laugh. Personally, after perusing his blog, I’m left wondering if he accepts that any science-based treatment or pharmaceutical is effective for anything or why he stays in medical academia if nothing we do helps patients.

    The reflex notions in the original posting above comes from the same pot of reeking crap that keeps the autism-MMR crowd amused. In politics, extreme left and extreme right are really the same thing – a sort of authoritarian fascism.

    You do realize that labeling someone with whom you disagree a fascist is a definite sign of someone who has no evidence, no logic, and no reason behind his arguments, don’t you?

  25. gill1109 says:

    This is an interesting discussion. I certainly admit to not being an expert on some things about which I do express opinions, so on some points raised here I am going to have to do some homework. The incredible thing is the strong passions on the both sides. Yes, when people start calling other people fascists it means their emotions are taking over from their arguments. And “from the middle” I observe that on both sides of the vaccination issue! Hence I get both sides like a ton of bricks on me.

    A state programme of mass vaccination is a political issue because it has potentially enormous costs and benefits, and those costs and benefits are a) different for different people, b) not entirely known, to be put it mildly, and c) different people have different information about it.

    I’m kind of amused that people who support “science-based medicine” start shouting rude words at scientists who try to explain (but clearly expressed themselves incompetently) that, IMHO, these issues are not so clear-cut. I am not going to get myself inocculated [famous last words? NOW that would be funny] against Mexican swine flu because I don’t see any point in it, for myself or for my nearest or dearest. I understand perfectly well why “high risk” people should want to get a flu vaccination every year. There is a political debate and our governments will decide what to do. Unfortunately all that has more to do with getting (re)-elected in the short term so it more or less independent of the scientific debate.

    My mother is happy that she is not going to get Mexican flu because it only gets young people – if you were born before whenever, you have the right antibodies from that last time, whenever. Vaccination means getting yourself immune by stimulating your own immune response to the bad guys in advance, cleverly doing it on material from the bad guys, or similar to theirs, which doesn’t (usually) do bad things to you. You can escape deadly infections by getting mild forms of the same, first.

    I never said that we should kill off susceptible people to speed our evolution. Who got that strange idea? I don’t think I even mentioned evolution. I do have the idea that a sudden universal deadly pandemic would be much worse for the human race than “normal” waves of ordinary flu and medium pandemics. (BTW: The huge numbers of deaths from the Spanish flu had a lot to do also with the weakened state of enormous numbers of people after so-many years of world war… it wasn’t just the particulary nasty virus). Hence it seems to me a good idea that there are people around who have at least had a foretaste of a big bad one, and are able to help out the others. Because one thing I am sure of, you can’t wipe it out entirely, so it’s always going to be there, always mutating and discovering new ways to spread itself.

    The four horsemen of the apocalypse are war, plague, hunger and death. These tend to come together and have a lot to do with overpopulation. Personally I am much more worried about depletion of the world’s resources and creation of massive imbalance in wealth, than about the next flu epi- or even pan-demic.

  26. gill1109 says:

    @quetzal “Also, I strongly doubt that shingles is “probably pretty easy to cure.” Last I knew, herpes virus latency and reactivation were relatively poorly understood. Of course, you may know more about it than I, but based on your “definite advantages” of not vaccinating, I’m skeptical.”

    Why are these things relatively poorly understood? Because the pharmaceutical industry doesn’t put funds into it because they don’t see big profits there! I get this crazy idea from the Elected President of the International Association of whatever Pathologists, who is a well-known scientist and works in that very same industry (at the top of one of their big research labs). Moreover since I know this guy personally I know he means it and that he has no hidden agenda in saying this (privately).

  27. Jurjen S. says:

    If I can weigh in for a moment concerning the hypothetical long-term advantages of not vaccinating, I would refer to a point that Jared Diamond touched upon in Guns, Germs and Steel, which is that the natural selection you’re likely to end up with will favor the disease-resistant. There’s no guarantee the people who make it through the test of fire will be more intelligent, agile, perceptive etc. than those who didn’t. Hypothetically, you might end up with a bunch of complete cretins who survived because they had better immunity to pathogens. And where’s the benefit in that?

  28. Calli Arcale says:

    My mother is happy that she is not going to get Mexican flu because it only gets young people – if you were born before whenever, you have the right antibodies from that last time, whenever.

    Your mother is not correct. In fact, very few people of any age possess any antibodies that are the least bit effective against this novel strain of H1N1. Some people born in the first part of the century have antibodies with some cross-reactivity, but this is by no means enough to assume older people won’t get it. Indeed, elderly people *have* been catching this strain, and some have even died of it.

    That’s not to say your mother should wig out or anything. I think it is reasonable to not vaccinate against the new H1N1 if you do not have particular risk factors, or do not deal with a lot of people with those particular risk factors. (For instance, if you’re a respiratory specialist, you should probably get vaccinated, both to protect your patients and because you’re gonna get exposed to a lot of it.) The main reason it is reasonable to not vaccinate is because this vaccine has a very limited supply. If you don’t get it, that’s one more dose of vaccine available for those who need it.

    Just don’t trick yourself into thinking H1N1 is always harmless, or that you don’t need to worry about transmission. If you or your mother does come down with flu-like symptoms, stay home and get well.

    Why are these things relatively poorly understood? Because the pharmaceutical industry doesn’t put funds into it because they don’t see big profits there!

    Unfortunately, that is entirely true. The big money is *not* in vaccination. The pharmaceutical industry would rather you didn’t get vaccinated and instead got a prescription for antivirals and antibiotics and took lots of OTC pain relievers and decongestants and things. As it is, the government has to essentially pay pharmaceutical corporations to make vaccines, by subsidizing them. The swine flu vaccine is being paid for by the government. (Upshot: if you go get one, you’ll only have to pay for the time of the nurse administering it to you.) As it is, companies keep dropping out of the business due to minimal profits, and the result is periodic vaccine shortages — those left can only barely keep up with demand. This is likely why the manufacturer of Gardasil is trying to sell it for $150; trying to change the price model so it becomes a profit center instead of something barely better than charity (from the accountant’s perspective).

    I’m not entirely sure what the solution to this is. It’s certainly evidence of how damaging the free market is to health care; corporations only provide care that will maximize their profits. The only obvious thing I can see is to increase federal funding for medical research.

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