In a special episode of the Skeptics’ Guide to the Universe podcast, I host a discussion with David Gorski, Mark Crislip, and Joe Albietz about the flu, the H1N1 “swine” flu pandemic, and the controversies surrounding the flu vaccine.
You can download or stream the episode here. You can also subscribe to the podcast via iTunes or other popular aggregators.
For those who battle tirelessly against the never ending onslaught of anti-vaccine propaganda, misinformation, and fear, there was great news the other day from Merck. The pharmaceutical company, and maker of the MMR vaccine against measles, mumps, and rubella, has decided not to resume production of the individual, or “split”, components of the vaccine. A Merck representative made the announcement during a meeting of the CDC Advisory Committee on Immunization Practices (ACIP) on Tuesday. During previous ACIP meetings, science experts on that committee presented compelling arguments against continued, large scale production of the monovalent components of the MMR vaccine, which were echoed by scientists in Merck’s vaccine division. In a moment, I’ll discuss the arguments against the split vaccine, and why this is so important a decision. First, some background on the issue of splitting the MMR.
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.
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.
Gardasil (qHPV) was licensed in 2006 as a vaccine against four types of Human Papillomavirus (HPV) and marketed as, “The first vaccine targeted to prevent cancer.” From its inception it has been one of the more controversial vaccines. Some religious groups feared that the reduced threat of a sexually transmitted disease would lead to increased sexual promiscuity. Other groups were concerned about its safety. Some have questioned whether its high financial cost would make it a cost-effective intervention, while others have questioned the marketing tactics of its manufacturer Merck.
Most of these concerns bear consideration (though I have no time for those who advocate using the threat of disease and death to force conformation to their religious beliefs), and were in large part addressed by David Gorski in a SBM article last year. If you’ve not read his post, I strongly suggest you do so. Now that a large post-licensure study on qHPV has been published, it seems a good time to revisit the issue of greatest concern to me as a pediatrician and to most parents, namely qHPV’s safety and efficacy profile.
Fear is a curious thing. It often bears no relation to the actual risk of what we fear. When swine flu first broke out in Mexico, people were understandably afraid. Travel was restricted, schools were closed, and so many people stayed home that the streets of Mexico City were empty. As the disease spread around the world, Egypt developed a paranoid fear of pigs and committed national pigicide. They ordered the slaughter of all 300,000 of their country’s innocent little porkers, ignoring the fact that the flu is spread person-to-person, not pig-to-person. Now that the disease has officially been labeled a pandemic, fears have switched from the real threat of the disease to an imagined danger from the vaccine.
Some people just plain hate the idea of vaccines – to the point that they are willing to spread old falsehoods, make up new lies, distort the results of studies, misrepresent statistics, and endanger our public health. There are websites like “Operation Fax to Stop the Vax” and even anti-swine-flu-vaccine rap videos. Press releases, e-mail campaigns, talk shows, and blogs are being used to stir up irrational fears. These people are irresponsible fearmongers. They are wrong, and they are dangerous.
- © 2009 msnbc.com
Matt Lauer and NBC have continued the ignominious media tradition of feigning to bring “balance” to the issue of vaccine safety. In the Dateline episode A Dose of Controversy, which aired on Sunday night, Matt Lauer interviewed Andrew Wakefield, the originator of the MMR-causes-autism myth, and highlighted his work at Thoughtful House, the autism treatment center he created in Texas after he was exiled from the U.K. He also interviewed (as “balance”) Dr. Paul Offit, a renowned expert on vaccines and pediatric infectious disease, and Brian Deer, the British journalist whose investigative reporting on Wakefield revealed the true, dark underbelly of the story. Of course, no balance was required to cover this story, since there is no balance from a scientific perspective. There is the evidence – that there is no causal association between the MMR vaccine and autism, and there is the myth, belief, and dogma (and a smattering of fraud) backing the notion that there is. A good piece of journalism covering this topic would have discussed Wakefield only as reference in the narrative of the story. But then that wouldn’t be nearly as good for ratings. Tension, controversy, personalities, that’s what makes for a good story. And that’s just what Dateline provided it’s viewers. Unfortunately, what it probably didn’t do was ease the fears of parents who have been thrown off course by misleading media stories and the speed-of-light trajectory that has characterized this myth. Worse, by simply shining light on the debonair Dr. Wakefield, the show may have misled even more parents into believing this dangerous myth. (more…)