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“Methodolatry”: My new favorite term for one of the shortcomings of evidence-based medicine

I’d like to thank revere right now publicly. He’s taught me a new word:

Methodolatry: The profane worship of the randomized clinical trial as the only valid method of investigation.

Many of you have e-mailed me and other SBM bloggers about a recent article in The Atlantic by Shannon Brownlee and Jeanne Lenzer, two reporters whose particular bias is that we as a nation are “over treated.” That may be true, although not to the extent that Brownlee, at least, seems to think, and her article on swine flu was truly biased and painful to read. Moreover, “methodalatry” perfectly describes one of the complaints we at SBM have about the “evidence-based medicine” paradigm. So I’m really glad that revere took it on and demolished it.

The hero of The Atlantic article, Tom Jefferson clearly has an agenda about flu vaccines. Indeed, he has such an agenda that he was invited to the National Vaccine Information Center’s vaccine conference in early October. The NVIC is the oldest and biggest antivaccine organization there is. Either he didn’t know that, in which case he’s clueless, or he didn’t care. In any case, it was clear that he was invited there because of his stance on flu vaccination, and he was even going to be awarded the NVIC “Courage in Science” Award. To his credit, Jefferson backed out when he found out that he would be sharing the stage with Andrew Wakefield, who was to be given the NVIC “Humanitarian Award.” He was appropriately horrified. Still, he should never have accepted in the first place, given that the NVIC clearly wanted to coopt him and use his gadfly status to make its anti-vaccine stance seem reasonable and science-based.

That’s just one reason why I don’t take Tom Jefferson particularly seriously anymore. I tend to agree with revere that Jefferson is drifting perilously close to crank territory with respect to flu vaccines. Indeed, “methodolatry” is an awesome term to describe his approach. Actually, it’s a great term to describe some of the Cochrane scientists responsible for analyzing the efficacy of mammography screening, as well; their conclusions and methods rather remind me of Jefferson’s.

Finally, you might also want to reread (or read for the first time if you haven’t read it already) Mark Crislip’s article on flu vaccine efficacy, which, although not directly written in response to Brownlee’s article, does address many of the shortcomings in its analysis of H1N1 vaccine efficacy.

Posted in: Science and Medicine, Science and the Media, Vaccines

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The New Plague

I’m taking this opportunity to introduce a new blog to the SBM audience, and to draw yet more attention to the growing and dangerous trend of parental vaccine refusal. So, please take a momentary break from your perusal of this most esteemed font of knowledge, and point your browser to Gotham Skeptic.

Posted in: Public Health, Science and Medicine, Vaccines

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An epidemic of fear: The anti-vaccine movement’s war on science

We’ve often castigated the press and mainstream media for getting it so very, very wrong on the issue of vaccines and autism and its all-too-often credulous treatment of the anti-vaccine movement. That’s very important. However, it’s also equally important to recognize mainstream media outlets when they get it so very, very right. That’s why, with minimal fanfare, I’m simply going to refer you to an article in WIRED Magazine entitled An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All by Amy Wallace. I particularly like Wallace’s calling out some prominent anti-vaccine activists, such as Jenny McCarthy, Jim Carrey, Don Imus, and Robert F. Kennedy, Jr.

Bravo, Ms. Wallace. Bravo, WIRED.

Go. Read. While you’re at it, you might want to lend some tactical air support to the cause of science and reason in the comments section. As they always do, the anti-vaccine kooks have already descended.

Posted in: Vaccines

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“Oh, come on, Superman!” (Part II): Bill Maher meets Kryptonite over vaccines and “Western medicine”

It’s rather amazing how sometimes the best laid plans of mice and men (and bloggers) come to naught. I had planned on doing a followup post to my previous post about the cancer quackery known as the German New Medicine by discussing a particularly nasty French variant of it. Unfortunately (or fortunately, depending upon your point of view), events conspired to move my blogging ire towards another target, particularly since I had addressed this isse before. Specifically, I’m talking about 2009 Recipient of the Richard Dawkins Award, comedian and HBO talk show host Bill Maher.

As you may recall, about a month ago, I wrote a rather long post (par for the course for me, I know) detailing ad nauseam how Bill Maher not only embraces germ theory denialism, anti-vaccine nonsense, and alternative medicine, in particular his apparent belief that “aggregate toxicity” or the typical unnamed “toxins” that alternative medicine mavens are so fond of blaming most disease on or, as Maher likes to call it, the “poisons” that we are eating and otherwise exposed to every day, but has been preaching this pseudoscience since at least 2005. Maher then followed this up a mere week before receiving his award named after a famous scientist with a hideously irrational promotion of cancer quackery. At that point, I thought I was done with the topic, at least as far as this particular blog goes (others know that elsewhere I’ve not been so quiet). At least, I had intended not to deal with this again on SBM.

Unfortunately, Bill Maher had other ideas. This is the perfect description for how I felt having to blog about this again:

Yes, it fits, particularly after Maher Tweeted to his fans:

If u get a swine flu shot ur an idiot.

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Posted in: Politics and Regulation, Science and the Media, Vaccines

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9 Reasons to Completely Ignore Joseph Mercola

Some of our more astute readers may have noticed that we are paying influenza slightly more attention than other topics of late.  That’s because this situation is new, rapidly changing, and covers more areas of science and medicine than one can easily count.  It’s also a subject about which the general public and media are keenly interested.  This is an outstanding learning and teaching opportunity for us as a professional community.  Unfortunately, it is also fertile ground for confusion, fear, and misinformation, and a playground for those who would exploit such things.

Mercola.com is a horrible chimera of tabloid journalism, late-night infomercials, and amateur pre-scientific medicine, and is the primary web presence of Joseph Mercola.  Unfortunately, it is also one of the more popular alternative medicine sites on the web and as such is uncommonly efficient at spreading misinformation.  I am not a fan, and have addressed his dross in the past.

Joseph Mercola has recently posted an excerpt from an individual he evidently holds in high regard, Bill Sardi.  Bill published “18 reasons why you should not vaccinate your children against the flu this season.”  Mercola chose his nine favorites (one would assume the nine best reasons), and re-posted it on Mercola.com.  There are so many mistakes, so much misinformation in so little space, it’s almost a work of art.  You know, like that crappy art that you might expect to find on the wall at an hourly motel.  Without further delay, let’s examine Mercola and Sardi’s nine best reasons for you not to vaccinate your children against influenza this season: (more…)

Posted in: Public Health, Science and Medicine, Vaccines

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More Nonsense from Dr. Jay Gordon

Dr. Jay Gordon is a pediatrician to a particular subculture of pseudoscientific celebrities, such as Jenny McCarthy. He lends his MD cred to this community. He also appears, in my opinion, to be a shameless self-promoter – one of those pop professionals (Dr. Oz, Dr. Phil) who has sold his soul for some easy celebrity.

Regardless of his motivations, he has been spouting arrogant nonsense about vaccines for years, essentially arguing that his clinical gut feeling and anecdotal experience trump the actual science. This is exactly the wrong approach to science-based medicine.

In a recent open letter on his website, he adds to the anti-vax chorus advising not to get the H1N1 (swine flu) vaccine. It’s almost as if this crowd wants to maximize the morbidity and suffering from this somewhat preventable disease. I know this is not literally true, but their ideologically motivated and confused actions will have the same effect.

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Posted in: Public Health, Vaccines

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H1N1 Update

I know we have been focusing on the vaccine issue extensively, but this is crunch time and the anti-vaccine forces are relentless. We are now facing a regular seasonal flu spiked with the H1N1 pandemic. Our best weapon against morbidity and mortality caused by the flu is information, and yet the public is being barraged with misinformation designed to encourage poor choices and thereby result in maximal morbidity and mortality.

I confess I was never impressed with FDR’s famous quip, “All we have to fear is fear itself,” – I think there is plenty else to fear. But his sentiment is very appropriate to the current situation – fear mongering around the seasonal flu and H1N1 vaccines is what we have most to fear.

And of course, as is almost always the case, accurate information is complex and requires a nuanced understanding. This creates uncertainty, which is easy to exploit to manufacture unreasonable fear.

The anti-vaccine fear mongers are playing every card in the deck. They are arguing (falsely) that H1N1 is not severe enough to warrant getting the vaccine, that the vaccine does not work anyway, and that there are unacceptable or unknown risks to the vaccine. In the most extreme cases, bizarre conspiracy theories are brought to bear, but I will not discuss these here as anyone compelled by such fantasies is likely beyond the reach of any information I could provide.

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Posted in: Public Health, Vaccines

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Flu Vaccine Efficacy

I guess I will be spending the rest the flu season writing about the nonsense that is promulgated about the flu vaccine and the disease. One of the more common laments about the flu vaccine is that it doesn’t work:  I got the flu vaccine and still got the flu. Well maybe. Maybe not.  It takes a few weeks to get protection, so the flu could have developed before the antibody response to the vaccine.  The vaccine does not protect to the numerous other viral infections that circulate each winter, so perhaps you had an adenovirus but thought it was the flu. Then there is the evidence.  Some readers of the blog are worried that the literature does not support the use of the vaccine.

“My research for  good studies on the efficasy (sic) of seasonal flu vaccines so far has left me wondering if I’ve somehow missed the good research. Tom Jefferson of the Cochrane Institute says that Most studies are of poor methodological quality and the impact of confounders is high. I agree.  Please would you refer me to some of the best studies on the efficasy (sic) of seasonal flu vaccines.  After a critical appraisal of the best studies you know of I’d like to submit the same for publication in the interest of science.”

Why some readers think I am a research librarian, I do not know. It is not an uncommon request. As an aside,   I have a full time job and a family to raise.  Don’t be asking me to do your grunt work. It’s called Pubmed. Use it.

But the topic for this post concerns the efficacy of the flu vaccine. I am limiting myself to the use of the vaccine in adults.
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Posted in: Science and Medicine, Vaccines

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Monkey business in autism research, part II

Over the last couple of months, I’ve noticed something about the anti-vaccine movement. Specifically, I’ve noticed that the mavens of pseudoscience that make up the movement seem to have turned their sights with a vengeance on the Hepatitis B vaccine. The reason for this new tactic, I believe, is fairly obvious. The fact that the Hep B vaccine is administered shortly after birth seems somehow to enrage the anti-vaccine movement more than just about any other vaccine. Moreover, given that, aside from maternal-child transmission when the mother is infected, hepatitis B is usually only contracted through either bloodborne contact (the sharing of needles, the administration of contaminated blood) or sexual activity, it’s very easy for anti-vaccinationists to make a superficially plausible-sounding argument that it’s not a necessary vaccine, even though there are reasonable rationales for giving it to infants. The image of sticking a needle into a newborn infant trumps that, though, at least for the anti-vaccine movement. Another possibility, suggested by Steve Novella just yesterday, is that, with the collapse under a overwhelmingly huge pile of evidence of the idea that the mercury-containing preservative thimerosal that used to be used in childhood vaccines until 2001, caused an “epidemic” of autism and the failure of the “too many too soon” slogan to convince anyone who is not already an anti-vaccinationist, the movement needed a new bogeyman to blame for autism. The hepatitis B vaccine, which was added to the pediatric vaccination schedule in the 1990s, around the right time to confuse correlation with causation when it comes to the increase in autism diagnoses (just like thimerosal) was a perfect next target, given that it’s administered shortly after birth.

Indeed, just the other day, the anti-vaccine crank groups the National Vaccine Information Center (NVIC), Talk About Curing Autism (TACA), and the anti-vaccine crank blog Age of Autism posted a call for the elimination of hepatitis B vaccination for newborns:

Washington, DC – National Vaccine Information Center and Talk About Curing Autism are calling on President Obama to order the immediate suspension of the Centers for Disease Control and Prevention recommendation of the birth dose of the Hepatitis B vaccine after two recent studies linking the Hepatitis B vaccine to functional brain damage in U.S. male newborns and infant primates.  In a related development today, the United States Department of Health and Human Services, including the Health Resources and Services Administration and Centers for Disease Control and Prevention,  announced that 1 in every 91 children are now diagnosed with an autism spectrum disorder as reported in the November 2009 issue of Pediatrics. Previous data released by the CDC indicated a prevalence of 1 in every 150 children affected by the disorder.

Note how AoA not-so-subtly interposed the latest information about autism prevalence with its call to eliminate the birth dose of the hepatitis B vaccine. Very clever. By doing so, it linked the two in readers’ minds, as if one had something to do with the other. There’s no good scientific evidence that the hepatitis B vaccine has anything to do with the “autism epidemic.” Meanwhile, David Kirby is up to his usual nonsense, and the resident anti-vaccine propagandist at CBS News, Sharyl Attkisson, who has been known to feed Age of Autism information on at least one occasion in the past, served up this credulous, noncritical interview with Andrew Wakefield:

The quantity of misinformation in that single six minute video is far beyond the scope of this article. Were I to start dissecting it, I would not have time to do what the purpose of this article was intended to do: To deal with the study Wakefield is hawking. That’s why I leave the dissection of this pièce de résistance of disingenuousness and misinformation as an exercise for SBM readers–after reading the rest of this post, of course. Trust me, it will help you.

At the heart of this latest propaganda onslaught by the anti-vaccine movement are two studies, one a restrospective study in humans and the other a study in monkeys, both of which the anti-vaccine movement is promoting as slam dunk evidence that the hepatitis B vaccine is causing all sorts of horrific problems. Taking both of them on in one post is too much, even for my logorrheic tendencies. So I’ll deal first with Wakefield’s monkey study and then, either later this week or sometime next week, hopefully discuss the human study.
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